The resetting of a local health system: an opportunity for health promotion

ABSTRACT

Background The COVID-19 pandemics brings a window of opportunity for the 2021-2025 Health Plan of Catalonia to better address the social determinants of health. Different public organisms are leading the Health Promotion (HP) agenda without a real integration of the approach. An interdisciplinary group of health professionals working on HP carried out a qualitative study to assess barriers, facilitators and recommendations of health professionals and public policy managers for applying HP. Methods Six focus groups with 52 purposively selected professionals of different health disciplines and three in-depth interviews with public policy managers were conducted between March 2017-February 2020 until saturation was reached. An external expert on Sociology conducted all interviews and codification was done by three researchers from the group. Literature review helped to complete triangulation. Results The salutogenic approach was mostly unknown. The health system was not set with a people-centred perspective and HP not integrated within health services. Different public organisms competed for leadership and resources in HP. There was limited expenditure for the primary health care services working on HP. Coordination across healthcare services levels and sectors was scarce. Roles and responsibilities related to HP were not defined. Health professionals were not aware of evidence-based approaches. Some interdepartmental public health plans were already designed but not fully deployed, mainly due to lack of funding and disaggregated mechanisms of governance and financing. Initiatives such as the Municipal Health Committees or social prescription were positively perceived. Conclusions The Catalan Public Health Agency and health providers should work aligned. Financing and reallocation of resources for Public Health and HP should be enhanced. Health should be a core value in educational plans. Local and regional stakeholders should have a higher role in resetting health services. Key messages Governance for Health in All Policies needs intersectoral partnerships. The health system should be rebuilt to properly address the social determinants of health in the post-COVID era.