public health definition

public health definition

The Importance of Defining Public Health

1. The Significance of a Clear Public Health Definition

Complexity has been recognized as a prominent characteristic of health issues, particularly since the turn of the millennium. It is often cited as a reason for the slow progress in acknowledging the multidisciplinary nature of the determinants of health and the effective solutions to public health problems. This is where an understanding of public health has often fallen short. Because public health is not well understood, it is often applied as an approach to health issues rather than a clear identifiable sector of the health system. This has created, at times, an ad hoc approach to assigning health resources to problems with the hopes of achieving a cost-effective solution. An increased clarity in what constitutes public health will direct more resources to the problems it aims to address and will give public health professionals a stronger identity.

It is essential to begin by addressing the rapidly growing importance of distinguishing public health from clinical and other health sciences. The need is driven by the increasing global interconnectedness of health issues, and a recognition that effective health interventions are key to escaping from the cycle of poverty. Globalization has blurred the line between what is foreign and domestic, compounding the problems and opportunities that health presents. Developments in health today are rarely limited to one country; thus it is often more effective to address health concerns on a regional or global level. This and other aspects of the global society have led to a recharacterization of health problems from being perceived as local or regional acute diseases to complex global issues with long-term implications. An example of this is the shift in priority that HIV/AIDS has received over the past two decades. It is now considered the global pandemic, and international efforts to combat it have grown substantially.

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2. Understanding the Scope of Public Health

Putting these varying definitions and practical application of public health into plain English to best catch what it actually involves doing is quite complex. The best attempt at defining this comes from Dr. Bernard Turnock in public health; what it is and how it works, who says that public health is “The what we all as a society do collectively to assure the conditions in which people can be healthy.” What is meant by “the what” is purposeful actions taken in the interests of the health of a population, i.e. clean water or immunization, and assuring the conditions means making certain.

The practice of public health requires an organized, systematic, and comprehensive approach to addressing these threats to the health of the general population. This approach is commonly illustrated by the Public Health Action Cycle, which includes assessment, identifying and prioritizing issues, planning, implementation, and evaluation, any of which can be applied to any specific issue.

Following this further, The Public Health Practice Programme Office in the US has come up with the following definition: “Public health is concerned with threats to the health of the general population, whether local, national, or global. It is a science in the sense that it uses organized methods and knowledge drawn from many disciplines to improve the health of the population.”

The scope of public health is indeed vast. It has been defined as “The organized response by society to protect and promote the health of the public.” This definition, from a well-known textbook, Public Health in Australia, is a useful starting point. It helps us to focus on the collective good or what is in the best interests for everyone.

3. Key Components of Public Health

Determinants of health can be broadly categorized into 4 groups. These are: genetic, biological factors; behavior; environmental factors, and the organization of, and access to, healthcare. These all influence the health status of an individual or population. This should then be linked in with the definition of health that often varies in western to eastern cultures. In the west, health is seen as a biological state, which is free from disease or symptoms of illness. In eastern cultures, health is defined as complete physical, mental, and social well-being, and not merely the absence of disease or infirmity. These factors and definitions are taken on board in the context of health promotion and public health action. An example could be promoting mental well-being in children from ethnic minorities by creating the right learning environment for them and ensuring they have access to preventative mental health services.

In order to understand the actions that have a beneficial effect on the public’s health, we must first understand the causal factors and the definition of health. Greenwood and Gordon have proposed a model that outlines the determinants of health and the health and wellbeing equation. This model states that the health status of a population or person is a function of the actual health potential, minus the potential risks and vulnerabilities that predispose the failure of or loss of health.

From these two definitions, we can take public health to be the structured actions of society to promote health, prevent disease, and systematically eliminate health disparities among populations. This should be achieved by creating the right conditions and environments, giving people the tools and information to be healthier, and empowering them to make long-lasting behavioral change. Step 1 of the Ottawa Charter. Acheson’s definition also recognizes the different sectors and levels of society involved in taking action, and ensuring conditions occur suggests that it is a multidimensional nature. Public health isn’t just healthcare, but all actions that promote health and prevent disease. This is the distinction of health promotion. Public health spans many sectors, from public to private, and third sector in a whole range of policy areas such as education, transport, and urban planning.

Public health has been defined as “the science and art of preventing disease, prolonging life and promoting health through the organized efforts of society”. This definition is broad and generic, and it fails to reflect the complexity and the multi-sectoral nature of the activities that contribute to improving the public’s health. Acheson realized this, and in his independent inquiry into health inequalities in the UK, he offered a more detailed definition: “Public health are the actions society takes collectively to ensure that the conditions in which people can be healthy can occur”. Koplan et al offered an even more complex but usable definition: “Public health is what we as a society do to collectively assure the conditions in which people can be healthy”.

4. The Impact of a Well-Defined Public Health Framework

Moving onwards, the most highlighted topic is that of the mission to improve the health of individuals. Prior to any framework, the goal has always been to improve the health of the general public, although ways to do it have often been disorganized and diverse. With a defined mission, there is great potential to reach our goal. This is evidenced today through the presence and expansions of public health organizations, the work of which is shown in the article “Political Will for Global Health Inequity,” by the removal of vast health differentials between the poor and rich.

Most important, albeit predictable, is that a well-defined framework has led to overall improvements in health over the years. One issue the body identified was that of communicable diseases. Communicable diseases have been a target for improvement from the 19th to the 20th century. In the late 19th century, the understanding and prevention of such diseases was the target. The accepted germ theory allowed progress toward identifying the cause and finding ways to prevent it. This led to the US in the 1920s creating a Division of Venereal Diseases which was aimed initially at the prevention of prostitution. This was a push from society to improve communication and prevention of, at the time, very widespread diseases. Around the same time, progress was made in understanding controlling diseases through quarantine and isolation, which, while controversial now, was an effective measure then. Step by step, events in history such as the Great Depression, World Wars, and Civil Rights Movements led to a learning curve of improved understanding, communication, and prevention of various diseases around the world.

5. Ensuring Effective Public Health Policies and Interventions

Closely linked to the above, a critical task for public health is implementing policy and interventions which are founded upon evidence and which are thus effective in improving the health of the population. This involves defining the problem and what a successful outcome would look like, and the complex assessment of the comparative effectiveness of alternative activities. Although finance ministries have traditionally been reluctant to release funds for preventive activities, the adoption of the Health in All Policies resolution at the World Health Assembly in 2007 is an interesting development which may lead to increased consideration of health outcomes in the formation of policy in other sectors, although little progress has been observed. In recent years, evidence-based practice has begun to spill over from clinical practice into public health and is now at the heart of decision making in the NHS. This is in part due to the establishment of the National Institute for Health and Clinical Excellence as well as political initiatives such as the target to ‘close the health gap’ by 2015, and there are high hopes that a similar approach will be undertaken in other countries, though the nature of public health makes this far more complex. Steps to develop the capacity and infrastructure to generate and appraise evidence should be taken, and alternative research methods and ‘testing’ of possible policies using outcome data (for example by comparing different European countries’ health policies and looking at the relative effects on the population’s health) should be encouraged. This is an area in which much work is still to be done.