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What is Public Health?

Introduction

The many factors that contribute to disease and health, or determinants, are complex and often break down to genetic, environmental and lifestyle factors. In addition Public Health is a multi-disciplinary enterprise that requires expertise in biology, pathology, environmental science, sociology, psychology, government, medicine, statistics, communication, and more to truly understand.

Someone who is overwieght and smokes might require a expensive heart surgery to prolong their life. However, public health is about the intervensions that prevent disease from occuring in the first place, so the benefits tend to be less obvious. The prevention of disease not only prolongs life, but improves the qaulity of life. In a sense public health is the epidemic that didn't happen, or the heart disease that didn't developed. Successful public health is the sum of the adverse health outcomes that never occurred.

Chapter Objectives:

  1. List and describe the three core functions of public health
  2. Expand on the three core functions of public health and discuss how they relate to the 10 essential functions of public health
  3. Define and give examples of primary, secondary, and teriary prevention of disease
  4. Discuss modern concepts of population health
  5. Briefly explain how "Public Health 3.0" differs from earlier approaches.
  6. Explain the rationale and approach of Health Impact in 5 Years (HI-5)
  7. Outline the overall structure of global public health
  8. Outline the overall structure of US public health

Primary, Secondary, and Teriary Prevention

The goal of primary prevention is to prevent healthy people from becoming ill. While that sounds easy, it often creates ethical conflicts when healthy people are asked to take additional steps to prevent developing disease (i.e. vaccination, exercise, smoking).

Secondary prevention consists of screening for disease in order to fnd sub-clinical disease and treat it in the hope that earlier treatment will provide reduced harm or cure (e.i. cancer screening, blood pressure test for hypertension, routine urine and blood analysis).

Once an individual has been diagnosed and treated for a disease, subsequent efforts to reduce effects are regarded as tertiary prevention (i.e. cardiac rehabilliation after a heart attack, exersize and wieght loss for people who developed type 2 diabetes).

International Public Health Organizations

The World Health Organization (WHO) was created in 1948 by the UN as the global health authority that would coordinate and guide health policy, practice, research, and surviellence in participating countries. The headquarters is located in Geneva, Switzerland. The director general is appointed by the World Health assembly which consists of representatives from participating countries.

The core functions of the World Health Organization are:

  1. Providing leadership on matters critical to health and engaging in partnerships where joint action is needed.
  2. Shaping the research agenda and stimulating the generation, translation and dissemination of valueable knowledge.
  3. Setting norms and standards and promoting and monitoring their implementation.
  4. Articulating ethical and evidence-based policy options
  5. Providing technical support, catalyzing change, and building sustainable institutional capacity.
  6. Monitoring the health situation and assessing health needs.

The WHO oversees 6 region and each of these interacts with the national public health agencies of it's member nations.

Non-Governmental Organizations (NGOs)

NGOs are private organizations that are not part of a particular government, though they often partner with governmental or inter-governmental organizations. They can be supported by public or private funding, and thus may be supported by government but not governed by them. NGOs are important to countries to provide programs to countries that do not have them such as HIV prevention, clean water allocation, and disaster relief. Ex. Red Cross, CARE for Europe.

Public Health in the US

In some respect Windslow's definition of public health is still correct today but in the US the focus has shifted over the last several decades.

In 1988 The institute of Medicine issued a report entitled "The Future of Public Health" which concluded the US public health system needed refocusing because there was a lack of clarity regarding its roles and responsibilities. The report introduced the concept of three core functions:

  1. Assesment - Assessing needs of communities by collecting statistics and information related to the community's health needs. Assessment also means idenifying the sources of health problems and the determinatnts of health and disease.
  2. Policy Development - Prioritizing public health needs, advocating for public health, building constituencies and coalitions and pursuing the enactment of policies and laws that promote health.
  3. Assurance - Establishing and maintaining an infrastructure for public health and implementing programs to monitor the effectiveness of public health interventions. Assurance also rerquires effective communication of public health information to the general public.

In 1994 the CDC expanded the 3 core functions and identified 10 essential services which should be undertaken in all communities, regardless of size:

  1. Monitor health status to identify and solve community health problems
  2. Diagnose and investigate health problems and health hazards in the community
  3. Inform, educate, and empower people about health issues
  4. Mobilize community partnerships and action to identify and solve health problems
  5. Develop policies and plans that support individual and community health efforts
  6. Enforce laws and regulations that protect health and ensure safety
  7. Link people to needed personal health services and assure the provision of health care when otherwise unavailable
  8. Assure competent public and personal health care workers
  9. Evaluate effectiveness, accessibility and quality of personal and population-based health services
  10. Research for new insights and innovative solutions to health problems

In 2002 the Institute of Medicine titled "Who Will Keep the Public Healthy?", which concluded public health professionals must have a framework for action and an understanding of the forces that impact health.

Population Health

The final decades of the 20th century placed heavy emphasis on individual responsibility for health and behavior modification. The newer definition by the CDC refects a shift to population health. This shift was brought on by the recognition of the social determninates of health and acknowledgement of effective strategies to make communities safer and healthier. Other factors were threat of bioterrorism, disparties in healthcare. During the 20th century, Windslow's definition of public health focused mainly on physical health of a geographical region, but this has been redefined in the 21st century to concider mental health and envision populations not only geographically but by needs (the mentally ill, poor, those with HIV, etc).

Population health might include:

  1. Healthcare - Delivery of 1 on 1 screening, prevention, cure and rehabillitation
  2. Traditional public health - Survailance, control of infection of disease and enviornmental hazards, food and drug safety, education to public, and behavoir modification
  3. Social intervention - improvements to the envoirnment, better access to healthy food, community safety and reduction in disparities.

Public Health 3.0

The birth and evolution of public health during the enlightment is identified by the US Health and Human services seperates into 3 eras:

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