Everything Totally Explained


Ask & we'll explain, totally!
Public health
Totally Explained

NEW: Download the Totally
Explained Alexa Toolbar!
The world's first toolbar is still the best, with safer & smarter surfing and the famous related links

    View this entry using RSS
   

Public health is concerned with threats to the overall health of a community based on population health analysis. Health is defined and promoted differently by many organizations. The World Health Organization, the United Nations body that sets standards and provides global surveillance of disease, defines health as: "A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." Public health experts agree that nutritional, spiritual, and intellectual aspects also affect an individual's health. The population in question can be as small as a handful of people or as large as all the inhabitants of several continents (for instance, in the case of a pandemic). Public health has many sub-fields, but is typically divided into the categories of epidemiology, biostatistics and health services. Environmental, social and behavioral health, and occupational health, are also important fields in public health.
   An alternative definition by Winslow from Modern Medicine in 1920 is: "the science and art of preventing disease, prolonging life and promoting health through the organised efforts and informed choices of society, organisations, public and private, communities and individuals."

Objectives

The focus of a public health intervention is to prevent rather than treat a disease through surveillance of cases and the promotion of healthy behaviors. In addition to these activities, in many cases treating a disease can be vital to preventing it in others, such as during an outbreak of an infectious disease. Vaccination programs and distribution of condoms are examples of public health measures.
   Most countries have their own government public health agencies, sometimes known as ministries of health, to respond to domestic health issues. In the United States, the frontline of public health initiatives are state and local health departments. The United States Public Health Service (PHS), led by the Surgeon General of the United States, and the Centers for Disease Control and Prevention, headquartered in Atlanta and a part of the PHS, are involved with several international health activities, in addition to their national duties.
   There is a vast discrepancy in access to healthcare and public health intiatives between developed nations and developing nations. In the developing world, public health infrastructures are still forming. There may not be enough trained health workers or monetary resources to provide even a basic level of medical care and disease prevention. As a result, a large majority of disease and mortality in the developing world results from and contributes to extreme poverty. For example, many African governments spend less than USD$10 per person per year on healthcare, while, in the United States, the federal government spent approximately USD$4,500 per capita in 2000.
   Many diseases are preventable through simple, non-medical methods. Public health plays a very important role in prevention efforts in both the developing world and in developed countries, either through local health systems or through international non-governmental organizations.
   The two major postgraduate professional degrees related to this field are the Master of Public Health (MPH) or the (much rarer) Doctor of Public Health (DrPH). Many public health researchers hold PhDs in their fields of speciality, while some public health programs confer the equivalent Doctor of Science degree instead. The United States medical residency specialty is General Preventive Medicine and Public Health.

History of public health

In some ways, public health is a modern concept, although it has roots in antiquity. From the beginnings of human civilization, it was recognized that polluted water and lack of proper waste disposal spread vector-borne diseases. Early religions attempted to regulate behavior that specifically related to health, from types of food eaten, to regulating certain indulgent behaviors, such as drinking alcohol or sexual relations. The establishment of governments placed responsibility on leaders to develop public health policies and programs in order to gain some understanding of the causes of disease and thus ensure social stability prosperity, and maintain order.

Early public health interventions

By Roman times, it was well understood that proper diversion of human waste was a necessary tenet of public health in urban areas. The Chinese developed the practice of variolation following a smallpox epidemic around 1000 BC. An individual without the disease could gain some measure of immunity against it by inhaling the dried crusts that formed around lesions of infected individuals. Also, children were protected by inoculating a scratch on their forearms with the pus from a lesion. This practice wasn't documented in the West until the early-1700s, and was used on a very limited basis. The practice of vaccination didn't become prevalent until the 1820s, following the work of Edward Jenner to treat smallpox.
   During the 14th century Black Death in Europe, it was believed that removing bodies of the dead would further prevent the spread of the bacterial infection. This did little to stem the plague, however, which was most likely spread by rodent-borne fleas. Burning parts of cities resulted in much greater benefit, since it destroyed the rodent infestations. The development of quarantine in the medieval period helped mitigate the effects of other infectious diseases. However, according to Michel Foucault, the plague model of governmentality was later controverted by the cholera model. A Cholera pandemic devastated Europe between 1829 and 1851, and was first fought by the use of what Foucault called "social medicine", which focused on flux, circulation of air, location of cemeteries, etc. All those concerns, born of the miasma theory of disease, were mixed with urbanistic concerns for the management of populations, which Foucault designated as the concept of "biopower". The German conceptualized this in the Polizeiwissenschaft ("Science of police").
   The science of epidemiology was founded by John Snow's identification of a polluted public water well as the source of an 1854 cholera outbreak in London. Dr. Snow believed in the germ theory of disease as opposed to the prevailing miasma theory. Although miasma theory correctly teaches that disease is a result of poor sanitation, it was based upon the prevailing theory of spontaneous generation. Germ theory developed slowly: despite Anton van Leeuwenhoek's observations of Microorganisms, (which are now known to cause many of the most common infectious diseases) in the year 1680, the modern era of public health didn't begin until the 1880s, with Robert Koch's germ theory and Louis Pasteur's production of artificial vaccines.

Modern public health

As the prevalence of infectious diseases in the developed world decreased through the 20th century, public health began to put more focus on chronic diseases such as cancer and heart disease.
   In America, public health worker Dr. Sara Josephine Baker lowered the infant mortality rate using preventative methods. She established many programs to help the poor in New York City keep their infants healthy. Dr. Baker led teams of nurses into the crowded neighborhoods of Hell's Kitchen and taught mothers how to dress, feed, and bathe their babies. After WWI many states and countries followed her example in order to lower infant mortality rates.
   During the 20th century, the dramatic increase in average life span is widely credited to public health achievements, such as vaccination programs and control of infectious diseases, effective safety policies such as motor-vehicle and occupational safety, improved family planning, fluoridation of drinking water, anti-smoking measures, and programs designed to decrease chronic disease.
   Meanwhile, the developing world remained plagued by largely preventable infectious diseases, exacerbated by malnutrition and poverty. Front-page headlines continue to present society with public health issues on a daily basis: emerging infectious diseases such as SARS, making its way from China to Canada and the United States; prescription drug benefits under public programs such as Medicare; the increase of HIV-AIDS among young heterosexual women and its spread in South Africa; the increase of childhood obesity and the concomitant increase in type II diabetes among children; the impact of adolescent pregnancy; and the ongoing social, economic and health disasters related to the 2005 Tsunami and Hurricane Katrina in 2006. These are all ongoing public health challenges.
   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, rather than advocating for individual behaviour change. There is a recognition that our health is affected by many factors including where we live, genetics, our income, our educational status and our social relationships - these are known as "social determinants of health." A social gradient in health runs through society, with those that are poorest generally suffering the worst health. However even those in the middle classes will generally have worse health outcomes than those of a higher social stratum (WHO, 2003). The new public health seeks to address these health inequalities by advocating for population-based policies that improve the health of the whole population in an equitable fashion.
   The burden of treating conditions caused by unemployment, poverty, unfit housing and environmental pollution have been calculated to account for between 16-22% of the clinical budget of the British National Health Service. (External Link) UK Public health functions include:
• Health surveillance, monitoring and analysis • Investigation of disease outbreaks, epidemics and risk to health • Establishing, designing and managing health promotion and disease prevention programmes • Enabling and empowering communities to promote health and reduce inequalities • Creating and sustaining cross-Government and intersectoral partnerships to improve health and reduce inequalities •Ensuring compliance with regulations and laws to protect and promote health • Developing and maintaining a well-educated and trained, multi-disciplinary public health workforce • Ensuring the effective performance of NHS services to meet goals in improving health, preventing disease and reducing inequalities • Research, development, evaluation and innovation • Quality assuring the public health function

Public health programs

Today, most governments recognize the importance of public health programs in reducing the incidence of disease, disability, and the effects of aging, although public health generally receives significantly less government funding compared with medicine. In recent years, public health programs providing vaccinations have made incredible strides in promoting health, including the eradication of smallpox, a disease that plagued humanity for thousands of years.
   One of the most important public health issues facing the world currently is HIV/AIDS. Tuberculosis, which claimed the lives of authors Franz Kafka and Charlotte Brontë, and composer Franz Schubert, among others, is also reemerging as a major concern due to the rise of HIV/AIDS-related infections and the development of tuberculin strains that are resistant to standard antibiotics.
   Another major public health concern is diabetes. In 2006, according to the World Health Organization, at least 171 million people worldwide suffered from diabetes. Its incidence is increasing rapidly, and it's estimated that by the year 2030, this number will double.
   A controversial aspect of public health is the control of smoking. Many nations have implemented major initiatives to cut smoking, such as increased taxation and bans on smoking in some or all public places. Proponents argue by presenting evidence that smoking is one of the major killers in all developed countries, and that therefore governments have a duty to reduce the death rate, both through limiting passive (second-hand) smoking and by providing fewer opportunities for smokers to smoke. Opponents say that this undermines individual freedom and personal responsibility (often using the phrase nanny state in the UK), and worry that the state may be emboldened to remove more and more choice in the name of better population health overall. However, proponents counter that inflicting disease on other people via passive smoking isn't a human right, and in fact smokers are still free to smoke in their own homes.

Economics of public health

The application of economics to the realm of public health has been rising in importance since the 1980s. Economic studies can show, for example, where limited public resources might best be spent to save lives or cause the greatest increase in quality of life.

Academic resources

   

External results

Click here for more details on Public Health

External Link Exchanges

Do you know how hard it is to get a link from a large encyclopaedia? Well we're different and will prove it. To get a link from us just add the following HTML to your site on a relevant page:

    <a href="http://public_health.totallyexplained.com">Public health Totally Explained</a>

Then simply click through this link from your web page. Our crawlers will verify your link, extract the title of your web page and instantly add a link back to it. If you like you can remove the words Totally Explained and embed the link in article text.
   As long as your link remains in place, we'll keep our link to you right here. Please play fair - our crawlers are watching. Your site must be closely related to this one's topic. Any kind of spamming, dubious practises or removing the link will result in your link from us being dropped and, potentially, your whole site being banned.



© 2007-8 totallyexplained.com | Licensed under the GFDL | Site Map | This article contains text from the Wikipedia article Public health (History) and is released under the GFDL | RSS Version