Public health
Public health is "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". Analyzing the determinants of health of a population and the threats it faces is the basis for public health. The public can be as small as a handful of people or as large as a village or an entire city; in the case of a pandemic it may encompass several continents. The concept of health takes into account physical, psychological, and social well-being, among other factors.
Public health is an interdisciplinary field. For example, epidemiology, biostatistics, social sciences and management of health services are all relevant. Other important sub-fields include environmental health, community health, behavioral health, health economics, public policy, mental health, health education, health politics, occupational safety, disability, oral health, gender issues in health, and sexual and reproductive health. Public health, together with primary care, secondary care, and tertiary care, is part of a country's overall healthcare system. Public health is implemented through the surveillance of cases and health indicators, and through the promotion of healthy behaviors. Common public health initiatives include promotion of hand-washing and breastfeeding, delivery of vaccinations, promoting ventilation and improved air quality both indoors and outdoors, suicide prevention, smoking cessation, obesity education, increasing healthcare accessibility and distribution of condoms to control the spread of sexually transmitted diseases.
There is a significant disparity in access to health care and public health initiatives between developed countries and developing countries, as well as within developing countries. In developing countries, public health infrastructures are still forming. There may not be enough trained healthcare workers, monetary resources, or, in some cases, sufficient knowledge to provide even a basic level of medical care and disease prevention. A major public health concern in developing countries is poor maternal and child health, exacerbated by malnutrition and poverty and limited implementation of comprehensive public health policies. Developed nations are at greater risk of certain public health crises, including childhood obesity, although overweight populations in low- and middle-income countries are catching up.
From the beginnings of human civilization, communities promoted health and fought disease at the population level. In complex, pre-industrialized societies, interventions designed to reduce health risks could be the initiative of different stakeholders, such as army generals, the clergy or rulers. Great Britain became a leader in the development of public health initiatives, beginning in the 19th century, due to the fact that it was the first modern urban nation worldwide. The public health initiatives that began to emerge initially focused on sanitation, control of infectious diseases and an evolving infrastructure of various sciences, e.g. statistics, microbiology, epidemiology, sciences of engineering.
Definition
Public health has been defined as "the science and art of preventing disease", prolonging life and improving quality of life through organized efforts and informed choices of society, organizations, communities and individuals. The public can be as small as a handful of people or as large as a village or an entire city. The concept of health takes into account physical, psychological, and social well-being. As such, according to the World Health Organization, "health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity".Related terms
Public health is related to global health which is the health of populations in the worldwide context. It has been defined as "the area of study, research and practice that places a priority on improving health and achieving equity in "Health for all" people worldwide". International health is a field of health care, usually with a public health emphasis, dealing with health across regional or national boundaries. Public health is not the same as public healthcare.The term preventive medicine is related to public health. The American Board of Preventive Medicine separates three categories of preventive medicine: aerospace health, occupational health, and public health and general preventative medicine. Jung, Boris and Lushniak argue that preventive medicine should be considered the medical specialty for public health but note that the American College of Preventive Medicine and American Board of Preventive Medicine do not prominently use the term "public health". Preventive medicine specialists are trained as clinicians and address complex health needs of a population such as by assessing the need for disease prevention programs, using the best methods to implement them, and assessing their effectiveness.
Since the 1990s many scholars in public health have been using the term population health. There are no medical specialties directly related to population health. Valles argues that consideration of health equity is a fundamental part of population health. Scholars such as Coggon and Pielke express concerns about bringing general issues of wealth distribution into population health. Pielke worries about "stealth issue advocacy" in population health. Jung, Boris and Lushniak consider population health to be a concept that is the goal of an activity called public health practiced through the specialty preventive medicine.
Lifestyle medicine uses individual lifestyle modification to prevent or revert disease and can be considered a component of preventive medicine and public health. It is implemented as part of primary care rather than a specialty in its own right. Valles argues that the term social medicine has a narrower and more biomedical focus than the term population health.
Purpose
The purpose of a public health intervention is to prevent and mitigate diseases, injuries, and other health conditions. The overall goal is to improve the health of individuals and populations, and to increase life expectancy.Components
Public health is a complex term, composed of many elements and different practices. It is a multi-faceted, interdisciplinary field. For example, epidemiology, biostatistics, social sciences and management of health services are all relevant. Other important sub-fields include environmental health, community health, behavioral health, health economics, public policy, mental health, health education, health politics, occupational safety, disability, gender issues in health, and sexual and reproductive health.Modern public health practice requires multidisciplinary teams of public health workers and professionals. Teams might include epidemiologists, biostatisticians, physician assistants, public health nurses, midwives, medical microbiologists, pharmacists, economists, sociologists, geneticists, data managers, environmental health officers, bioethicists, gender experts, sexual and reproductive health specialists, physicians, and veterinarians.
The elements and priorities of public health have evolved over time, and are continuing to evolve. Common public health initiatives include promotion of hand-washing and breastfeeding, delivery of vaccinations, suicide prevention, smoking cessation, obesity education, increasing healthcare accessibility and distribution of condoms to control the spread of sexually transmitted diseases.
Methods
Public health aims are achieved through surveillance of cases and the promotion of healthy behaviors, communities and environments. Analyzing the determinants of health of a population and the threats it faces is the basis for public health.Many diseases are preventable through simple, nonmedical methods. For example, research has shown that the simple act of handwashing with soap can prevent the spread of many contagious diseases. In other cases, treating a disease or controlling a pathogen can be vital to preventing its spread to others, either during an outbreak of infectious disease or through contamination of food or water supplies.
Public health, together with primary care, secondary care, and tertiary care, is part of a country's overall health care system. Many interventions of public health interest are delivered outside of health facilities, such as food safety surveillance, distribution of condoms and needle-exchange programs for the prevention of transmissible diseases.
Public health requires Geographic Information Systems because risk, vulnerability and exposure involve geographic aspects.
Ethics
A dilemma in public health ethics is dealing with the conflict between individual rights and maximizing right to health. Public health is justified by consequentialist utilitarian ideas, but is constrained and critiqued by liberal, deontological, principlist and libertarian philosophies Stephen Holland argues that it can be easy to find a particular framework to justify any viewpoint on public health issues, but that the correct approach is to find a framework that best describes a situation and see what it implies about public health policy.The definition of health is vague and there are many conceptualizations. Public health practitioners definition of health can different markedly from members of the public or clinicians. This can mean that members of the public view the values behind public health interventions as alien which can cause resentment amongst the public towards certain interventions. Such vagueness can be a problem for health promotion. Critics have argued that public health tends to place more focus on individual factors associated with health at the expense of factors operating at the population level.
Historically, public health campaigns have been criticized as a form of "healthism", as moralistic in nature rather than being focused on health. Medical doctors, Petr Shkrabanek and James McCormick wrote a series of publications on this topic in the late 1980s and early 1990s criticizing the UK's the Health of The Nation campaign. These publications exposed abuse of epidemiology and statistics by the public health movement to support lifestyle interventions and screening programs. A combination of inculcating a fear of ill-health and a strong notion of individual responsibility has been criticized as a form of "health fascism" by a number of scholars, objectifying the individual with no considerations of emotional or social factors.