Public health
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Public health |
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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".
Public health is an
There is a significant disparity in access to health care and public health initiatives between
From the beginnings of
Definitions and purposes
Definition
Public health has been defined as "the science and art of
Related terms
Public health is related to
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".[13]: 1 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.[13]: 1, 3
Since the 1990s many scholars in public health have been using the term population health.[14]: 3 There are no medical specialties directly related to population health.[13]: 4 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.[14]: 163 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.[13]: 4
Purposes
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 populations and increase life expectancy.[citation needed]
Characteristics and components
Public health is a complex term, composed of many elements and different practices. It is a multi-faceted,
Modern public health practice requires
The elements and priorities of public health have evolved over time, and are continuing to evolve.[10] Different regions in the world can have different public health concerns at a given time.[citation needed]
Common public health initiatives include promotion of
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.[3]
Many diseases are
Public health, together with
Public health requires Geographic Information Systems (GIS) because risk, vulnerability and exposure involve geographic aspects.[17]
Ethics
A dilemma in public health ethics is dealing with the conflict between individual rights and maximizing right to health.[18]: 28 Public health is justified by consequentialist utilitarian ideas,[18]: 153 but is constrained and critiqued by liberal,[18] deontological, principlist and libertarian philosophies[18]: 99, 95, 74, 123 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.[18]: 154
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.[18]: 230 Such vagueness can be a problem for health promotion.[18]: 241 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.[14]: 9
Historically, public health campaigns have been criticized as a form of "
Priority areas
Original focal areas
When public health initiatives began to emerge in England in modern times (18th century onwards) there were three core strands of public health which were all related to statecraft: Supply of clean water and
Changing focal areas and expanding scope
With the onset of the
A major public health concern in
Public health surveillance has led to the identification and prioritization of many public health issues facing the world today, including
For example, the WHO reports that at least 220 million people worldwide have diabetes. Its incidence is increasing rapidly, and it is projected that the number of diabetes deaths will double by 2030.[25] In a June 2010 editorial in the medical journal The Lancet, the authors opined that "The fact that type 2 diabetes, a largely preventable disorder, has reached epidemic proportion is a public health humiliation."[26] The risk of type 2 diabetes is closely linked with the growing problem of obesity. The WHO's latest estimates as of June 2016[update] highlighted that globally approximately 1.9 billion adults were overweight in 2014, and 41 million children under the age of five were overweight in 2014.[27] Once considered a problem in high-income countries, it is now on the rise in low-income countries, especially in urban settings.[citation needed]
Many public health programs are increasingly dedicating attention and resources to the issue of obesity, with objectives to address the underlying causes including
Health inequalities, driven by the social determinants of health, are also a growing area of concern in public health. A central challenge to securing health equity is that the same social structures that contribute to health inequities also operate and are reproduced by public health organizations.[29] In other words, public health organizations have evolved to better meet the needs of some groups more than others. The result is often that those most in need of preventative interventions are least likely to receive them[30] and interventions can actually aggravate inequities[31] as they are often inadvertently tailored to the needs of the normative group.[32] Identifying bias within public health research and practice is essential to ensuring public health efforts mitigate and don't aggravate health inequities.
Organizations
World Health Organization (WHO)
The
Others
Most countries have their own governmental public health agency, often called the ministry of health, with responsibility for domestic health issues.
For example, in the
Public health programs
Most governments recognize the importance of public health programs in reducing the incidence of disease, disability, and the effects of
The World Health Organization (WHO) identifies core functions of public health programs including:[40]
- providing leadership on matters critical to health and engaging in partnerships where joint action is needed;
- shaping a research agenda and stimulating the generation, translation and dissemination of valuable knowledge;
- setting norms and standards and promoting and monitoring their implementation;
- articulating ethical and evidence-based policy options;
- monitoring the health situation and assessing health trends.
In particular, public health surveillance programs can:[41]
- serve as an early warning system for impending public health emergencies;
- document the impact of an intervention, or track progress towards specified goals; and
- monitor and clarify the epidemiology of health problems, allow priorities to be set, and inform health policyand strategies.
- diagnose, investigate, and monitor health problems and health hazards of the community
Behavior change
Many health problems are due to maladaptive personal behaviors. From an
Applications in health care
As well as seeking to improve population health through the implementation of specific population-level interventions, public health contributes to medical care by identifying and assessing population needs for health care services, including:[44][45][46][47]
- Assessing current services and evaluating whether they are meeting the objectives of the health care system
- Ascertaining requirements as expressed by health professionals, the public and other stakeholders
- Identifying the most appropriate interventions
- Considering the effect on resources for proposed interventions and assessing their cost-effectiveness
- Supporting decision making in health care and planning health services including any necessary changes.
- Informing, educating, and empowering people about health issues
Conflicting aims
Some programs and policies associated with public
Psychological research confirms this tension between concerns about public health and concerns about personal liberty: (i) the best predictor of complying with public health recommendations such as hand-washing, mask-wearing, and staying at home (except for essential activity) during the COVID-19 pandemic was people's perceived duties to prevent harm but (ii) the best predictor of flouting such public health recommendations was valuing liberty more than equality.[48]
Simultaneously, while communicable diseases have historically ranged uppermost as a global health priority, non-communicable diseases and the underlying behavior-related risk factors have been at the bottom. This is changing, however, as illustrated by the United Nations hosting its first General Assembly Special Summit on the issue of non-communicable diseases in September 2011.[49]
Global perspectives
Disparities in service and access
This section needs additional citations for verification. (September 2020) |
There is a significant disparity in access to health care and public health initiatives between
Large parts of the world remained plagued by largely preventable or treatable infectious diseases. In addition to this however, many developing countries are also experiencing an
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. There is a recognition that health is affected by many factors including class, race, income, educational status, region of residence, and social relationships; these are known as "social determinants of health". The upstream drivers such as environment, education, employment, income, food security, housing, social inclusion and many others effect the distribution of health between and within populations and are often shaped by policy.[52] A social gradient in health runs through society. The poorest generally have the worst health, but even the middle classes will generally have worse health outcomes than those of a higher social level.[53] The new public health advocates for population-based policies that improve health in an equitable manner.
The health sector is one of Europe's most labor-intensive industries. In late 2020, it accounted for more than 21 million employment in the European Union when combined with social work. According to the WHO, several countries began the COVID-19 pandemic with insufficient health and care professionals, inappropriate skill mixtures, and unequal geographical distributions. These issues were worsened by the pandemic, reiterating the importance of public health.[54] In the United States, a history of underinvestment in public health undermined the public health workforce and support for population health, long before the pandemic added to stress, mental distress, job dissatisfaction, and accelerated departures among public health workers.[55]
Health aid in developing countries
Health aid to developing countries is an important source of public health funding for many developing countries.[57] Health aid to developing countries has shown a significant increase after World War II as concerns over the spread of disease as a result of globalization increased and the HIV/AIDS epidemic in sub-Saharan Africa surfaced.[58][59] From 1990 to 2010, total health aid from developed countries increased from 5.5 billion to 26.87 billion with wealthy countries continuously donating billions of dollars every year with the goal of improving population health.[59] Some efforts, however, receive a significantly larger proportion of funds such as HIV which received an increase in funds of over $6 billion between 2000 and 2010 which was more than twice the increase seen in any other sector during those years.[57] Health aid has seen an expansion through multiple channels including private philanthropy, non-governmental organizations, private foundations such as the Rockefeller Foundation or the Bill & Melinda Gates Foundation, bilateral donors, and multilateral donors such as the World Bank or UNICEF.[59] The result has been a sharp rise in uncoordinated and fragmented funding of an ever-increasing number of initiatives and projects. To promote better strategic cooperation and coordination between partners, particularly among bilateral development agencies and funding organizations, the Swedish International Development Cooperation Agency (Sida) spearheaded the establishment of ESSENCE,[60] an initiative to facilitate dialogue between donors/funders, allowing them to identify synergies. ESSENCE brings together a wide range of funding agencies to coordinate funding efforts.
In 2009 health aid from the OECD amounted to $12.47 billion which amounted to 11.4% of its total bilateral aid.[61] In 2009, Multilateral donors were found to spend 15.3% of their total aid on bettering public healthcare.[61]
International health aid debates
Debates exist questioning the efficacy of international health aid. Supporters of aid claim that health aid from wealthy countries is necessary in order for developing countries to escape the
Economic modeling based on the Institute for Health Metrics and Evaluation and the World Health Organization has shown a link between international health aid in developing countries and a reduction in adult mortality rates.[59] However, a 2014–2016 study suggests that a potential confounding variable for this outcome is the possibility that aid was directed at countries once they were already on track for improvement.[57] That same study, however, also suggests that 1 billion dollars in health aid was associated with 364,000 fewer deaths occurring between ages 0 and 5 in 2011.[57]
Sustainable development goals for 2030
To address current and future challenges in addressing health issues in the world, the
History
Until the 18th century
From the beginnings of
Public health was born neither in
Western European,
In complex, pre-industrialized societies, interventions designed to reduce health risks could be the initiative of different stakeholders. For instance, in Greek and Roman antiquity, army generals learned to provide for soldiers' wellbeing, including off the battlefield, where most combatants died prior to the twentieth century.[84][85] In Christian monasteries across the Eastern Mediterranean and western Europe since at least the fifth century CE, monks and nuns pursued strict but balanced regimens, including nutritious diets, developed explicitly to extend their lives.[86] And royal, princely and papal courts, which were often mobile as well, likewise adapted their behavior to suit environmental conditions in the sites they occupied. They could also choose sites they considered salubrious for their members and sometimes had them modified.[87]
In cities, residents and rulers developed measures to benefit the general population, which faced a broad array of recognized health risks. These provide some of the most sustained evidence for preventive measures in earlier civilizations. In numerous sites the upkeep of infrastructures, including roads, canals and marketplaces, as well as zoning policies, were introduced explicitly to preserve residents' health.[88] Officials such as the muhtasib in the Middle East and the Road master in Italy, fought the combined threats of pollution through sin, ocular intromission and miasma.[89][90][91][92] Craft guilds were important agents of waste disposal and promoted harm reduction through honesty and labor safety among their members. Medical practitioners, including public physicians,[93] collaborated with urban governments in predicting and preparing for calamities and identifying and isolating people perceived as lepers, a disease with strong moral connotations.[94][95] Neighborhoods were also active in safeguarding local people's health, by monitoring at-risk sites near them and taking appropriate social and legal action against artisanal polluters and neglectful owners of animals. Religious institutions, individuals and charitable organizations in both Islam and Christianity likewise promoted moral and physical wellbeing by endowing urban amenities such as wells, fountains, schools and bridges, also in the service of pilgrims.[96][97] In western Europe and Byzantium, religious processions commonly took place, which purported to act as both preventive and curative measures for the entire community.[98]
Urban residents and other groups also developed preventive measures in response to calamities such as war, famine, floods and widespread disease.[99][100][101][102] During and after the Black Death (1346–53), for instance, inhabitants of the Eastern Mediterranean and Western Europe reacted to massive population decline in part on the basis of existing medical theories and protocols, for instance concerning meat consumption and burial, and in part by developing new ones.[103][104][105] The latter included the establishment of quarantine facilities and health boards, some of which eventually became regular urban (and later national) offices.[106][107] Subsequent measures for protecting cities and their regions included issuing health passports for travelers, deploying guards to create sanitary cordons for protecting local inhabitants, and gathering morbidity and mortality statistics.[108][109][110] Such measures relied in turn on better transportation and communication networks, through which news on human and animal disease was efficiently spread.
After the 18th century
With the onset of the
The practice of
Public health legislation in England
The first attempts at sanitary reform and the establishment of public health institutions were made in the 1840s.
The Poor Law Commission reported in 1838 that "the expenditures necessary to the adoption and maintenance of measures of prevention would ultimately amount to less than the cost of the disease now constantly engendered". It recommended the implementation of large scale government engineering projects to alleviate the conditions that allowed for the propagation of disease.[111] The Health of Towns Association was formed at Exeter Hall London on 11 December 1844, and vigorously campaigned for the development of public health in the United Kingdom.[118] Its formation followed the 1843 establishment of the Health of Towns Commission, chaired by Sir Edwin Chadwick, which produced a series of reports on poor and insanitary conditions in British cities.[118]
These national and local movements led to the
The Vaccination Act 1853 introduced compulsory smallpox vaccination in England and Wales.[121] By 1871 legislation required a comprehensive system of registration run by appointed vaccination officers.[122]
Further interventions were made by a series of subsequent
The
Public health legislation in other countries
In the United States, the first public health organization based on a state health department and local boards of health was founded in New York City in 1866.[124]
In Germany during
Epidemiology
The science of
Snow later used a
Control of infectious diseases
With the pioneering work in
Society and culture
Education and training
Education and training of public health professionals is available throughout the world in Schools of Public Health, Medical Schools, Veterinary Schools, Schools of Nursing, and Schools of Public Affairs. The training typically requires a
In the global context, the field of public health education has evolved enormously in recent decades, supported by institutions such as the World Health Organization and the World Bank, among others. Operational structures are formulated by strategic principles, with educational and career pathways guided by competency frameworks, all requiring modulation according to local, national and global realities. Moreover, integrating technology or digital platforms to connect to low health literacy LHL groups could be a way to increase health literacy. [136]It is critically important for the health of populations that nations assess their public health human resource needs and develop their ability to deliver this capacity, and not depend on other countries to supply it.[137]
Schools of public health: a US perspective
In the United States, the Welch-Rose Report of 1915[138] has been viewed as the basis for the critical movement in the history of the institutional schism between public health and medicine because it led to the establishment of schools of public health supported by the Rockefeller Foundation.[139] The report was authored by William Welch, founding dean of the Johns Hopkins Bloomberg School of Public Health, and Wickliffe Rose of the Rockefeller Foundation. The report focused more on research than practical education.[139][140] Some have blamed the Rockefeller Foundation's 1916 decision to support the establishment of schools of public health for creating the schism between public health and medicine and legitimizing the rift between medicine's laboratory investigation of the mechanisms of disease and public health's nonclinical concern with environmental and social influences on health and wellness.[139][141]
Even though schools of public health had already been established in
Over the years, the types of students and training provided have also changed. In the beginning, students who enrolled in public health schools typically had already obtained a medical degree; public health school training was largely a second degree for medical professionals. However, in 1978, 69% of American students enrolled in public health schools had only a bachelor's degree.[134]
Degrees in public health
Schools of public health offer a variety of degrees generally fall into two categories: professional or academic.
Professional degrees are oriented towards practice in public health settings. The
Academic degrees are more oriented towards those with interests in the scientific basis of public health and
Notable people
- John Graunt (1620–1674) was a British citizen scientist who laid the foundations for epidemiology.[150]
- Edward Jenner (1749–1823) created the smallpox vaccine, the first vaccine in the world. He is often known as "the father of immunology".
- Benjamin Waterhouse (1753–1846) introduced the smallpox vaccine in the United States.
- Lemuel Shattuck (1793–1859) has been described as an "architect" and "prophet" of American public health[151]
- John Snow (1813-1858) was 'the father of modern epidemiology'.[152]
- sewer network for central London in response to the Great Stink of 1858. This proved instrumental in relieving the city from cholera epidemics.[153]
- Louis Pasteur (1822–1895) conducted research that laid the foundation for our understanding of the causes and preventions of diseases.
- Charles V. Chapin (1856–1941) public health advocate and researcher credited with planting "the roots of quality in public health" in the United States[157]
- Sara Josephine Baker (1873–1945) was an "instrumental force in child and maternal health"[158]
- Nora Wattie (1900–1994) led the development of public health services and sanitation, and education in improving women and child health in the poorest slums of Glasgow, for which she received the OBE.[159]
- Jonas Salk (1914–1995) developed one of the first polio vaccines and campaigned vigorously for mandatory vaccinations.
- Ruth Huenemann (1910–2005) She became a pioneer in the study of childhood obesity in the 1960s studying the diet and exercise habits of Berkeley teenagers.[160]
- Edmond Fernandes ( 1990-) Demonstrated proof of concept to end the burden of Malnutrition in India and around the world.[161]
- Dilip Mahalanabis - Credited to have evolved and utilized ORS to save thousands of lives during the liberation war.
Country examples
Canada
In Canada, the
Cuba
Since the 1959
Colombia and Bolivia
Public health was important elsewhere in Latin America in consolidating state power and integrating marginalized populations into the nation-state. In Colombia, public health was a means for creating and implementing ideas of citizenship.[164] In Bolivia, a similar push came after their 1952 revolution.[165]
Ghana
Though curable and preventive, malaria remains a major public health issue and is the third leading cause of death in Ghana.[166] In the absence of a vaccine, mosquito control, or access to anti-malaria medication, public health methods become the main strategy for reducing the prevalence and severity of malaria.[167] These methods include reducing breeding sites, screening doors and windows, insecticide sprays, prompt treatment following infection, and usage of insecticide treated mosquito nets.[167] Distribution and sale of insecticide-treated mosquito nets is a common, cost-effective anti-malaria public health intervention; however, barriers to use exist including cost, household and family organization, access to resources, and social and behavioral determinants which have not only been shown to affect malaria prevalence rates but also mosquito net use.[168][167]
France
Mexico
Public health issues were important for the Spanish Empire during the colonial era. Epidemic disease was the main factor in the decline of indigenous populations in the era immediately following the sixteenth-century conquest era and was a problem during the colonial era. The Spanish crown took steps in eighteenth-century Mexico to bring in regulations to make populations healthier.[173] In the late nineteenth century, Mexico was in the process of modernization, and public health issues were again tackled from a scientific point of view.[174][175][176] As in the U.S., food safety became a public health issue, particularly focusing on meat slaughterhouses and meatpacking.[177]
Even during theUnited States
The
The United States lacks a coherent system for the governmental funding of public health, relying on a variety of agencies and programs at the federal, state and local levels.[183] Between 1960 and 2001, public health spending in the United States tended to grow, based on increasing expenditures by state and local government, which made up 80–90% of total public health spending. Spending in support of public health in the United States peaked in 2002 and declined in the following decade.[184] State cuts to public health funding during the Great Recession of 2007–2008 were not restored in subsequent years.[185] As of 2012, a panel for the
See also
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