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Synopsis of a lecture given on 27th October 2006 to MPH (Epidemiology) students at the Department of Social and Preventive Medicine, Universiti Malaya by Professor Omar Hasan Kasule, Sr. MB ChB (MUK), MPH (Harvard), DrPH (Harvard)
DEFINITION OF PUBLIC HEALTH
Public health is the sum of all official (government) efforts to promote, protect, and maintain health. It is investigation, promotion, and evaluation of optimal health services for communities. Public health has 2 main paradigms: disease prevention & health promotion. Public health had developed as a reaction to bad health and social conditions and can therefore be looked as a reform movement. The scope of public health covers health problems and disease determinants. It faces many challenges because of its wide scope: demographic, globalization, human will and behavior, scarcity of resources, distributive justice & equity, and ethico-legal issues. The essential public health functions are: prevention of disease and injuries; protection against environmental hazards; promotion of healthy behavior; assurance of quality and accessibility of health services; and provision of personal and community health services. Public health uses the scientific approach to solve problems. However its interventions are often tentative and do not wait for acquisition of perfect information.
DISCIPLINES THAT ASSIST PUBLIC HEALTH
Quantitative disciplines that contribute to public health are epidemiology, biostatistics, and operations research. Economic disciplines deal with resources. Other disciplines that make contributions are sociology, social policy, communication, and management sciences.
PUBLIC HEALTH PROGRAMS and STRATEGIES
The main programs of public health are health policy formulation, disease prevention and health promotion, medical and social services, and environmental protection. The main strategies are surveillance, intervention, and evaluation. Economic interventions have a public health impact.
HISTORY OF PUBLIC HEALTH
In the UK government interest in public health was complacent and adhoc. The cholera epidemics of 1831-2 and 1865-66 as well as the 1842 Chadwick report on sanitary conditions and disease led to an awakening. The Public Health Act was passed in 1848. Legislation 1872 and 1875 established a sanitary authority in every district. Housing laws were passed in the 1870s. In 1872 local authorities were required to appoint a medical officer of health (MOH) for sanitation and disease control. In 1939 local authorities were permitted to provide a wider range of services including MCH. The National Health Service (NHS), established in 1948, became the main provider of services and in 1968 started providing primary health care through community physicians. In the US public health started with port health and quarantines. Higher disease than combat mortality in the American civil war led to an awakening. State and national health boards were set up by 1879. In 1912 the role of the United States Public Health Service (USPHS) was expanded to include investigation of disease and sanitation. In 1912 USPHS started helping states develop public health departments. The 1935 Social Security Act provided funds to states through USPHS for public health. After World War II funding of public health programs was seen as part of the defense policy. The political atmosphere of the 1950s did not support public health but during the Great Society (1960-1980) funding for public health increased and medicaid and medicare bills were passed in 1965. In the health promotion period (1980-1990) health promotion and disease prevention were recognized as priorities and the role of life-style change was emphasized. The major community health problems of the 1990s were: rising health care costs and barriers to access, environmental concerns, life style diseases (cancer, stroke, and injuries), communicable diseases (HIV, Lyme’s disease), abuse of alcohol and drugs
Community Health involves both private and public efforts of individuals, groups, and organizations to promote, protect, and preserve the health of those in the community. It involves community development, community organization, community participation, and community diagnosis. Community health is affected by physical factors (geography, the environment, community size, industrial development, socio-cultural factors (beliefs, traditions, prejudices, economic status, politics, religion, and social norms, individual behavior, and community organization. Whereas public health is government-driven, community health is community-driven. Communities both in pre-history and the historical era undertook measures to protect health. Before the 1980s emphasis was on public health. After that the importance of community health and community participation were recognized.