Global health. The current scenario and future perspectives

191 by the WHO in 2021 at regional or country level as mentioned earlier. Essential Functions of Public Health (EFPH) From a retrospective perspective, the functions assigned to public health in the early 20 th century consisted mainly of developing environmental sanitation actions, controlling communicable diseases and promoting hygiene. Over the years, these expanded to include health promotion, control of non-communicable diseases and access to primary care. The complexity of healthcare action and its conceptual challenges led the World Health Organization in 1998 to present a list of essential public health functions. This list was created with input from various global actors who helped define competencies in public health and a framework for healthcare system reforms (WHO, 2018). The Pan American Health Organization defines Essential Public Health Functions (EPHF) as “the capacities of health authorities at all institutional levels, together with civil society, to strengthen health systems and ensure full exercise of public health by acting on factors and social determinants that affect population health” (PAHO, 2020). In the Americas region, EPHF was put on the agenda to strengthen the healthcare sector in the 1980s within a framework of reforms seeking to reduce the role of states and their stewardship in healthcare. In this context, member states of the Pan American Health Organization developed a conceptual and methodological framework for public health and its essential functions. This led to a regional initiative called Public Health in the Americas that was launched in 2000. During this initiative, EPHF were extensively debated and agreed upon by diverse actors from the region. The initiative was further deepened through the document “New concepts: performance analysis and bases for action” published in 2002. It became an important milestone for developing institutional capacities and implementing healthcare improvement plans across numerous countries in the region (PAHO, 2002). However, fifteen years later a review process began to update this horizon from year 2000 due to changes within different countries alongside challenges anticipated for the twenty-first century. This required adopting a more comprehensive approach to public health. In 2020, the Pan American Health Organization acknowledged this era of change in its document “Essential Public Health Functions”: “The socioeconomic and political changes that have occurred since the