From Wikipedia, the free encyclopedia
Public health is the study and practice of managing threats to the health of a community. The field pays special attention to the social context of disease and health, and focuses on improving health through society-wide measures like vaccinations, the fluoridation of drinking water, or through policies like seatbelt and non-smoking laws.
The goal of public health is to improve lives through the prevention and treatment of disease. The United Nations' World Health Organization
defines health as "a state of complete physical, mental and social
well-being and not merely the absence of disease or infirmity." In
1920, C.E.A. Winslow defined public health as "the science and art of
preventing disease, prolonging life and promoting health through the
organized efforts and informed choices of society, organizations,
public and private, communities and individuals."
The public-health approach can be applied to a population of just a
handful of people or to the whole human population. Public health is
typically divided into epidemiology, biostatistics and health services. Environmental, social, behavioral, and occupational health are also important subfields.
Objectives
The focus of a public health intervention is to prevent rather than
treat a disease through surveillance of cases and the promotion of
healthy behaviors. In addition to these activities, in many cases
treating a disease can be vital to preventing its spread to others,
such as during an outbreak of infectious disease or contamination of food or water supplies. Vaccination programs and distribution of condoms are examples of public health measures.
Most countries have their own government public health agencies,
sometimes known as ministries of health, to respond to domestic health
issues. In the United States, the frontline of public health initiatives are state and local health departments. The United States Public Health Service (PHS), led by the Surgeon General of the United States, and the Centers for Disease Control and Prevention, headquartered in Atlanta and a part of the PHS, are involved with several international health activities, in addition to their national duties.
There is a vast discrepancy in access to healthcare and public health intiatives between developed nations and developing nations.
In the developing world, public health infrastructures are still
forming. There may not be enough trained health workers or monetary
resources to provide even a basic level of medical care and disease
prevention. As a result, a large majority of disease and mortality in
the developing world results from and contributes to extreme poverty.
For example, many African governments spend less than USD$10 per person per year on healthcare, while, in the United States, the federal government spent approximately USD$4,500 per capita in 2000.
Many diseases are preventable through simple, non-medical methods. For example, research has shown that the simple act of hand washing can prevent many contagious diseases.[1]
Public health plays an important role in disease prevention efforts
in both the developing world and in developed countries, through local
health systems and through international non-governmental organizations, like the International Public Health Forum (IPHF)
The two major postgraduate professional degrees related to this field are the Master of Public Health (MPH) or the (much rarer) Doctor of Public Health (DrPH). Many public health researchers hold PhDs in their fields of speciality, while some public health programs confer the equivalent Doctor of Science degree instead. The United States medical residency specialty is General Preventive Medicine and Public Health.
History of public health
In some ways, public health is a modern concept, although it has
roots in antiquity. From the beginnings of human civilization, it was
recognized that polluted water and lack of proper waste disposal spread communicable diseases (theory of miasma). Early religions attempted to regulate behavior that specifically related to health, from types of food eaten, to regulating certain indulgent behaviors, such as drinking alcohol or sexual relations. The establishment of governments placed responsibility on leaders to develop public health policies and programs in order to gain some understanding of the causes of disease and thus ensure social stability prosperity, and maintain order.
Early public health interventions
By Roman times, it was well understood that proper diversion of human waste was a necessary tenet of public health in urban areas. The Chinese developed the practice of variolation following a smallpox
epidemic around 1000 BC. An individual without the disease could gain
some measure of immunity against it by inhaling the dried crusts that
formed around lesions of infected individuals. Also, children were
protected by inoculating
a scratch on their forearms with the pus from a lesion. This practice
was not documented in the West until the early-1700s, and was used on a
very limited basis. The practice of vaccination did not become prevalent until the 1820s, following the work of Edward Jenner to treat smallpox.
During the 14th century Black Death in Europe,
it was believed that removing bodies of the dead would further prevent
the spread of the bacterial infection. This did little to stem the
plague, however, which was most likely spread by rodent-borne fleas. Burning parts of cities resulted in much greater benefit, since it destroyed the rodent infestations. The development of quarantine in the medieval period helped mitigate the effects of other infectious diseases. However, according to Michel Foucault, the plague model of governmentality was later controverted by the cholera
model. A Cholera pandemic devastated Europe between 1829 and 1851, and
was first fought by the use of what Foucault called "social medicine",
which focused on flux, circulation of air, location of cemeteries, etc. All those concerns, born of the miasma theory of disease, were mixed with urbanistic concerns for the management of populations, which Foucault designated as the concept of "biopower". The German conceptualized this in the Polizeiwissenschaft ("Science of police").
The science of epidemiology was founded by John Snow's identification of a polluted public water well as the source of an 1854 cholera outbreak in London. Dr. Snow believed in the germ theory of disease as opposed to the prevailing miasma theory.
Although miasma theory correctly teaches that disease is a result of
poor sanitation, it was based upon the prevailing theory of spontaneous generation. Germ theory developed slowly: despite Anton van Leeuwenhoek's observations of Microorganisms,
(which are now known to cause many of the most common infectious
diseases) in the year 1680, the modern era of public health did not
begin until the 1880s, with Robert Koch's germ theory and Louis Pasteur's production of artificial vaccines.
Other public health interventions include latrinization, the building of sewers, the regular collection of garbage followed by incineration or disposal in a landfill, providing clean water and draining standing water to prevent the breeding of mosquitos.
Modern public health
As the prevalence of infectious diseases in the developed world
decreased through the 20th century, public health began to put more
focus on chronic diseases such as cancer and heart disease. An emphasis
on physical exercise was reintroduced.
In America, public health worker Dr. Sara Josephine Baker
lowered the infant mortality rate using preventative methods. She
established many programs to help the poor in New York City keep their
infants healthy. Dr. Baker led teams of nurses into the crowded
neighborhoods of Hell's Kitchen and taught mothers how to dress, feed, and bathe their babies. After World War I many states and countries followed her example in order to lower infant mortality rates.
During the 20th century, the dramatic increase in average life span
is widely credited to public health achievements, such as vaccination
programs and control of infectious diseases, effective safety policies
such as motor-vehicle and occupational safety, improved family planning, fluoridation of drinking water, anti-smoking measures, and programs designed to decrease chronic disease.
Meanwhile, the developing world remained plagued by largely preventable infectious diseases, exacerbated by malnutrition
and poverty. Front-page headlines continue to present society with
public health issues on a daily basis: emerging infectious diseases
such as SARS, making its way from China to Canada and the United
States; prescription drug benefits under public programs such as
Medicare; the increase of HIV-AIDS among young heterosexual women and
its spread in South Africa; the increase of childhood obesity
and the concomitant increase in type II diabetes among children; the
impact of adolescent pregnancy; and the ongoing social, economic and
health disasters related to the 2005 Tsunami and Hurricane Katrina in
2006. These are all ongoing public health challenges.
Since the 1980s, the growing field of population health has broadened the focus of public health from individual behaviors and risk factors
to population-level issues such as inequality, poverty, and education.
Modern public health is often concerned with addressing determinants of
health across a population, rather than advocating for individual
behaviour change. There is a recognition that our health is affected by
many factors including where we live, genetics, our income, our
educational status and our social relationships - these are known as
"social determinants of health." A social gradient in health runs
through society, with those that are poorest generally suffering the
worst health. However even those in the middle classes will generally have worse health outcomes than those of a higher social stratum (WHO, 2003). The new
public health seeks to address these health inequalities by advocating
for population-based policies that improve the health of the whole
population in an equitable fashion.
The burden of treating conditions caused by unemployment, poverty,
unfit housing and environmental pollution have been calculated to
account for between 16-22% of the clinical budget of the British
National Health Service. [2]
UK Public health functions include:
- Health surveillance, monitoring and analysis
- Investigation of disease outbreaks, epidemics and risk to health
- Establishing, designing and managing health promotion and disease prevention programmes
- Enabling and empowering communities to promote health and reduce inequalities
- Creating and sustaining cross-Government and intersectoral partnerships to improve health and reduce inequalities
- Ensuring compliance with regulations and laws to protect and promote health
- Developing and maintaining a well-educated and trained, multi-disciplinary public health workforce
- Ensuring the effective performance of NHS services to meet goals in
improving health, preventing disease and reducing inequalities
- Research, development, evaluation and innovation
- Quality assuring the public health function
Public health programs
This 1963 poster featured CDC’s national symbol of public health, the "Wellbee", encouraging the public to receive an oral
polio vaccine.
Today, most governments recognize the importance of public health
programs in reducing the incidence of disease, disability, and the
effects of aging, although public health generally receives
significantly less government funding compared with medicine. In recent
years, public health programs providing vaccinations have made
incredible strides in promoting health, including the eradication of
smallpox, a disease that plagued humanity for thousands of years.
One of the most important public health issues facing the world currently is HIV/AIDS. Tuberculosis, which claimed the lives of authors Franz Kafka and Charlotte Brontë, and composer Franz Schubert,
among others, is also reemerging as a major concern due to the rise of
HIV/AIDS-related infections and the development of tuberculin strains
that are resistant to standard antibiotics.
Another major public health concern is diabetes.
In 2006, according to the World Health Organization, at least 171
million people worldwide suffered from diabetes. Its incidence is
increasing rapidly, and it is estimated that by the year 2030, this
number will double.
A controversial aspect of public health is the control of smoking.
Many nations have implemented major initiatives to cut smoking, such as
increased taxation and bans on smoking in some or all public places.
Proponents argue by presenting evidence that smoking is one of the
major killers in all developed countries, and that therefore
governments have a duty to reduce the death rate, both through limiting
passive (second-hand) smoking and by providing fewer opportunities for
smokers to smoke. Opponents say that this undermines individual freedom
and personal responsibility (often using the phrase nanny state
in the UK), and worry that the state may be emboldened to remove more
and more choice in the name of better population health overall.
However, proponents counter that inflicting disease on other people via
passive smoking is not a human right, and in fact smokers are still free to smoke in their own homes.
Public Hygiene
Public hygiene includes public behaviors individuals can take to
improve their personal health and wellness. Topics include public
transportation, food preparation and public washroom use. These are
steps individuals can take themselves. Examples would include avoiding
crowded subways during the flu season, using gloves when touching the
handrails and opening doors in public malls as well as going to clean
restaurants.
Economics of public health
The application of economics
to the realm of public health has been rising in importance since the
1980s. Economic studies can show, for example, where limited public
resources might best be spent to save lives or cause the greatest
increase in quality of life.
Research
Public health investigates sources of disease and descriptors of
health through scientific methodology. This can lead to a public health
solution to an epidemic, or a community based intervention for chronic
diseases. Either way, research can provide the link between cause and
effect for public health issues.
Community based participatory research
-
In contrast to clinical, patient oriented, or literature review
research, community based participatory research (CBPR) investigates
community-based etiology,
involves community leaders, and overall respects the forces under which
the community and its participants preside toward promoting and
sustaining public health matters. As described by the WK Kellogg
Foundation Community Health Scholars Program, CBPR is a
"collaborative approach to research that equitably involves all
partners in the research process and recognizes the unique strengths
that each brings. CBPR begins with a research topic of importance to
the community, has the aim of combining knowledge with action and
achieving social change to improve health outcomes and eliminate health
disparities."[1]
CBPR methods have been necessary for implementation of certain
public health actions. This have been difficult to accomplish because
communities in poorer, less well developed areas often distrust
researchers and scientists from "outside."[2]
Education and training
Schools of public health offer a variety of degrees which generally fall into two categories: professional or academic.
Professional degrees are oriented towards practice in public health settings. The Master of Public Health (MPH), Doctor of Public Health
(DrPH), and Master of Healthcare Administration (MHA) are examples of
degrees which are geared towards people who want careers as
practitioners of public health in health departments, managed care
organizations, community-based organizations, hospitals, consulting
firms, international agencies, state and federal agencies, among others.
Academic degrees are more oriented toward students wishing to seek a
career in teaching at a college or university or conducting research at
a university or other settings. Examples of academic degrees are the
Master of Science (MS), Doctor of Philosophy (PhD), and Doctor of
Science (ScD).
The Association of Schools of Public Health (ASPH)
represents CEPH-accredited schools of public health in the United
States, Puerto Rico, and Mexico. ASPH-member schools prepare people to
become public health professionals. In addition to representing its
member schools, ASPH provides: education and training for students and
graduates of its member schools, a job search website PublicHealthJobs.net, funding opportunities, awards, Delta Omega (honorary society for graduate studies in public health), and publications such as Public Health Reports and the Friday Letter.
Distance learning has increasingly become an attractive option for
working professionals or people whose other life commitments prevent
them from traveling to a physical location for classes. ASPH lists distance learning programs from its member schools.
Academic Journals
- American Journal of Public Health
- Annual Review of Public Health, ISSN: 15452093 (electronic) 0163-7525 (paper), Annual Reviews
- Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science, ISSN 1538–7135, Mary Ann Lieber
- Central Asia Health Review, New York based independent magazine
- International Journal of Prisoner Health, ISSN: 1744-9219 (electronic) 1744-9200 (paper), Taylor & Francis
- Journal of Health, Population and NutritionISSN: 1606 0997
- Journal of Public Health Management and Practice, ISSN: 1078-4659, Lippincott William & Wilkins
- Journal of Urban Health, ISSN: 1468-2869 (electronic) 1099-3460 (paper) , Springer
- Public Health Nutrition, ISSN: 1475-2727 (electronic) 1368-9800 (paper), Cambridge
- Public Health Reports , ISSN: 0033-3549
- Scandinavian Journal of Public Health, ISSN: 1651-1905 (electronic) 1403-4948 (paper), Informa Healthcare
- The European Journal of Public Health, ISSN: 1464-360X (electronic) 1101-1262 (paper), Oxford University Press
- The Journal of Infectious Diseases, ISSN: 0022-1899, The University of Chicago Press
See also
References
- WHO Definition of Health Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, 1946
- Control of Communicable Diseases Manual edited by James B. Chin, APHA, 2000
- Encyclopedia of public health edited by Lester Breslow, Macmillan Reference 2002
- The Solid Facts: Social Determinants of Health edited by Richard Wilkinson and Michael Marmot, WHO, 2003
- CCC. (2006), Public Health Emergency Response Guide for State,
Local, and Tribal Public Health Directors. Retrieved April10, 2006,
from: http://www.bt.cdc.gov/planning/responseguide.asp
- Department of Homeland Security (2004) National Response Plan. Retrieved April 11, 2006, from http://www.dhs.gov/interweb/assetlibrary/NRPbaseplan.pdf
External links
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