Meng-Kin Lim

The year 2008 marks the 55th anniversary of the graduate public health programme in Singapore. This article traces the evolution of the programme-from the Diploma in Public Health in 1953 to the Master of Public Health in 2007--in response to changing challenges and needs. It also discusses the role Singapore can continue to play in addressing global inequities in access to public health education and in strengthening public health capacity in the region and beyond.

Despite the intense debates over state or private sector dominance in healthcare finance and provision, there are no clear winners. Failed models exist on either end of the ideological spectrum and no country in the world has one that is purely public or purely private. Neither does a perfect public-private mix exist; all solutions are, at best, partial. The important questions are whether or not the political choices made are affordable, sustainable and equitable. When ideology meets reality, it boils down to what trade-offs different societies at different stages of economic development are willing to make.

We present the findings of a United Nations Development Programme–World Health Organization study commissioned by China’s Ministry of Health on use of public and private ambulatory care services in three Chinese provinces. We found much unmet medical need (16 percent), attributed mainly to the perceived high cost of care. Seventy-one percent had no health insurance (90 percent in rural and 51 percent in urban areas). For 33 percent, the last consultation was with a private practitioner. Widespread dissatisfaction with public providers (mainly high user fees and poor staff attitudes) is driving patients to seek cheaper but lower-quality care from poorly regulated private providers.

Throughout the war‐ and disease‐ridden history of our world, more have died from pathogens than have perished by the sword. Both kinds of war – one seen and one unseen – threaten our very existence. Yet we seem to have learned nothing from our experience on both fronts. What chance is there that our species will survive into the next millennium, as microbes almost certainly will?