Structural Foundations of Public Health: A Comparative Study of Health System Architectures and Their Impact on Population Well-being

Abstract

This study investigates the role of differences in the structure and management of public health systems in the 5.7-year difference in life expectancy and healthy lifespan between Canada and Hungary. Using qualitative document analysis across four dimensions: national strategy, professional competency, leadership requirements and auditing. It explores enduring structural differences between the two countries. Canada's model is decentralised with high professional standards, strategic competencies and a multi-layered auditing framework. Unlike Hungary, which is a centralised system where skilled professionals are produced but there are no formal leadership qualification mandates and consistent regulatory auditing. Although it is impossible to establish a causal link between system design and population longevity in a direct manner due to the observational nature of the data, the evidence points to the relevance of institutional arrangements for real world health outcomes. Hence, tailored reform initiatives in governance, leadership norms and surveillance are recommended to boost system effectiveness and health outcomes.