Healthcare is vital to all of us some of the time, but public health is vital to all of us all of the time.
– Former Surgeon General C. Everett Koop
Public health works to protect and improve the health and lives of individuals, families, communities, and populations. It is practiced at the local level, the state level, the national level, and certainly at the global level.
According to Pulitzer prize-winning science journalist and best-selling author, Laurie Garrett: In an ideal world, public health would mean no epidemics, safe food and water, well-informed citizens regarding personal health habits, immunized children, clean air and water, and little class-disparity when it comes to disease and life expectancy.
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Thanks to public health initiatives, in the past century alone we have increased the life expectancy of U.S. citizens by nearly 30 years. Still, AIDS alone has taken the lives of some 35 million people throughout the world, and the World Health Organization (WHO) estimates that 1.3 million people die every year from the negative effects of air pollution.
Despite the significant strides in public health, health disparities still exist, leading to populations that are disproportionately affected by disease. These populations may have limited access to affordable healthcare, putting them at greater risk of developing chronic diseases, such as obesity and heart disease.
In other words, there is still much work to be done in the field of public health. Professionals in public health, whether they are working at the local or global level, are committed to ensuring that healthcare is accessible to all segments of society.
The Goals and Objectives of Public Health Initiatives
Public health is a science that is aimed at protecting and improving the health of individuals, communities and greater populations, which may be as small as a neighborhood or as big as a region of the world.
Regardless of the size of the populations they serve, public health professionals, work to prevent health problems from occurring or reoccurring, and mitigate the effects when problems do occur. They accomplish this task through educational programs, the creation and implementation of policies, the administration of services, and through research. Therefore, a major objective of public health is to promote healthcare equity, quality, and accessibility.
The objectives of public health may be carried out through public or private endeavors, and many times efforts are coordinated among a number of private and public entities. According to the World Health Organization (WHO), the goal of public health is to prevent disease, promote health, and prolong life among the population as a whole. Therefore, public health initiatives are aimed at fostering conditions in which people can be healthy within specific populations.
The World Health Organization recognizes the main objectives of public health initiatives to be:
- To assess and monitor the health of communities and populations at risk so as to identify health problems and priorities
- To formulate public policies designed to solve local and national health problems and priorities
- To assure that all populations have access to cost-effective and appropriate care, which includes health promotion and disease prevention services
In short, the goals of public health are to save money, improve the quality of life, help children thrive, and reduce human suffering by:
- Assuring the quality and accessibility of health services
- Preventing epidemics and the spread of disease
- Preventing injuries
- Promoting and encouraging healthy behaviors
- Protecting against environmental hazards
- Responding to disasters and assisting communities in recovery
Examining the Components of Public Health
Public health can be distinguished from healthcare in that instead of treating diseases and injuries, one patient at a time, public health is focused on preventing disease and injury in communities and populations. In other words, public health professionals are motivated to identify the cause of disease and disability and implement solutions to address these causes.
A good example of healthcare versus public health is that a medical practitioner would treat a gunshot wound, while a public health professional would work to identify the systemic causes of gun violence and look for solutions. Similarly, while a medical professional would prescribe medication to treat high cholesterol, a public health professional would examine causes of obesity and high cholesterol and work to implement programs to encourage healthy lifestyle changes among populations.
Public health encompasses a wide array of topics and issues, such as chronic disease, the science of aging, mental health, injury prevention, disaster response, and tobacco control. Just a few of the contemporary topics in public health include:
- Developing emergency preparedness plans
- Examining the dangers of secondhand tobacco smoke exposure
- Identifying ways to stop bullying in schools
- Improving technologies that make clean drinking water available
- Investigating the consequences of antibiotic use in industrial agriculture
- Promoting family planning and reproductive health programs and policies
- Promoting policies that protect the global environment
The U.S. Department of Health and Human Services identifies 10 essential public health services:
- Monitor health status so as to identify and solve community health problems
- Diagnose and investigate health hazards and health problems in a community
- Educate and empower people about contemporary health issues
- Inspire and support community partnerships to identify and solve health problems
- Set policies and plans in motion so as to support individual and community health efforts
- Enforce laws and regulations that are designed to protect the safety and health of communities
- Pair people to beneficial personal health services
- Provide a competent public and personal healthcare workforce
- Evaluate the effectiveness and the quality of personal and population-based health services
- Engage in ongoing research to discover innovative solutions and new insights to health problems
The public health system consists of official government public health agencies, private-sector business, and nonprofit organizations. The entities of the public health infrastructure in the U.S. include:
- More than 3,000 county and city health departments and local boards of health
- About 59 state, territorial, and island nation health departments
- A number of U.S. public health services agencies (HHS, CDC, EPA, FDA, OSHA, etc.)
- Tribal health agencies (coordinated by the Indian Health Service)
- More than 160,000 public and private laboratories
- Hospitals and private-sector healthcare providers
- National volunteer organizations (American Red Cross, American Cancer Society, American Diabetes Association, etc.)
- State and local volunteer organizations
The History of Public Health in America
Although public health efforts in the U.S. have been around for centuries, the organized mission of public health has its roots in the mid-nineteenth century when physicians, reformers, advocates, and scientists came together to address issues that grew out of urbanization, industrialization, and large-scale immigration.
Public health issues at the time, which were often referred to as “conditions of the poor,” were focused on the social and environmental causes and consequences of disease. For example, civic leaders in Chicago focused on the relationship between living conditions and the declining health and wellbeing of workers, women, and children.
Public health solutions included indoor plumbing in housing, tenement laws, housing density laws, and nuisance laws, all of which had a dramatic impact on lowering the rates of tuberculosis and other diseases. Other laws that governed foodstuffs, meat, and milk soon followed, while in rural areas, yellow fever, pellagra, and malaria were addressed through a number of engineering and social reforms.
Fast-forward to the twentieth century, when disease epidemics were soon replaced with cancers and chronic illnesses. Land use and transportation improved accessiblity to healthcare, although it also created new hazards and diseases due to the exposure to chemicals; air, water, and soil pollution; and toxic materials like lead paint and tobacco.
The National Health Act of 1939 supported public health through the construction of new hospitals and clinics, particularly in economically distressed areas. Around the same time, the American Public Health Association passed a resolution that all public health agencies should provide the following (referred to as the Basic 6):
- Collecting data on vital statistics
- Controlling communicable diseases
- Ensuring environmental sanitation
- Offering maternal, infant, and child health services
- Providing education to promote healthy behaviors
- Providing laboratory services for the diagnoses of illnesses
As years progressed, science and medicine became the focus, thus allowing public health officials to ignore a number of social factors. New medical technologies, such as antibiotics, vaccines, and psychotropic medication allowed officials to attack disease without disrupting the social order. In 1970, however, this all changed when Paul Cornely, the first African American president of the American Public Health Association, made an attack on what he perceived as complacency in his profession. His address called for more aggressive action against a host of health problems that were part of the modern, industrial society.
Since then public health has shifted dramatically, addressing a vast array of public health problems. In 1988, the Institute of Medicine published its renowned report, The Future of Public Health, which resulted in population-based strategies for improving community health efforts to control epidemics, reduce vaccine-preventable diseases, ensure safe food and water, improve maternal and child health, and conduct studies of health problems.
New risks, such as obesity, adolescent pregnancy, HIV, natural disasters, and bioterrorism were soon part of the nation’s public health efforts.
The CDC recognizes the following as the ten greatest public health achievements of the 20th century:
- Control of Infectious Diseases
- Declines in Deaths from Heart Disease and Stroke
- Family Planning
- Fluoridation of Drinking Water
- Healthier Mothers and Babies
- Motor Vehicle Safety
- Safer and Healthier Foods
- Tobacco as a Health Hazard
- Workplace Safety
Despite the expansion of services and the mobilization of resources, the incidence of preventable diseases remains high worldwide. One of the major goals of today’s public health community is to reduce the impact and prevalence of these diseases.
Other major global health issues now at the forefront include:
- Infant mortality
- Water scarcity
- Environmental risk factors (factory emissions, car exhaust, tobacco smoke, etc.)
- Tobacco use