Public health 463734 225580377 2008-07-14T12:08:09Z KC Panchal 3449833 /* Modern public health */ expanded and wikilinked World war I '''Public health''' is the study and practice of managing threats to the [[health]] of a community. The field pays special attention to the ''social context'' of disease and health, and focuses on improving health through society-wide measures like [[vaccinations]], the [[fluoridation]] of drinking water, or through policies like [[seatbelt]] and [[non-smoking]] laws. The goal of public health is to improve lives through the prevention and treatment of disease. The United Nations' [[World Health Organization]] defines health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." In 1920, C.E.A. Winslow defined public health as "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." The public-health approach can be applied to a population of just a handful of people or to the whole human population. Public health is typically divided into [[epidemiology]], [[biostatistics]] and [[health services]]. [[Environmental Health|Environmental]], social, [[behavioral health|behavioral]], and [[occupational health]] are also important subfields. ==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 its spread to others, such as during an outbreak of [[infectious disease]] or contamination of food or water supplies. [[Vaccination]] programs and distribution of [[condom]]s 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 department]]s. 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, Georgia|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 [[United States dollar|USD$]]10 per person per year on healthcare, while, in the United States, the [[federal government of the United States|federal government]] spent approximately USD$4,500 per capita in 2000. Many diseases are preventable through simple, non-medical methods. For example, research has shown that the simple act of [[hand washing]] can prevent many contagious diseases.[http://www.globalhandwashing.org/Publications/Lit_review.htm] Public health plays an important role in disease prevention efforts in both the developing world and in developed countries, through local health systems and through international [[non-governmental organization]]s, like the [http://www.iphfonline.org International Public Health Forum (IPHF)] 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 [[PhD]]s 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 communicable diseases (theory of [[miasma]]). Early [[religion]]s attempted to regulate behavior that specifically related to health, from types of [[food]] eaten, to regulating certain indulgent behaviors, such as drinking [[alcohol]] or [[human sexual behaviour|sexual relations]]. The establishment of [[government]]s placed responsibility on [[leadership|leader]]s to develop public health policies and programs in order to gain some understanding of the causes of [[disease]] and thus ensure social stability [[wealth|prosperity]], and maintain order. ===Early public health interventions=== By [[Ancient Rome|Roman]] times, it was well understood that proper [[waste management|diversion of human waste]] was a necessary tenet of public health in urban areas. The [[history of China|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 [[inoculation|inoculating]] a scratch on their forearms with the pus from a lesion. This practice was not documented in the West until the early-1700s, and was used on a very limited basis. The practice of [[vaccination]] did not 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 [[flea]]s. 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 [[urbanism|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 (physician)|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 of disease|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 did not begin until the 1880s, with [[Robert Koch]]'s germ theory and [[Louis Pasteur]]'s production of artificial [[vaccine]]s. Other public health interventions include latrinization, the building of [[sewer]]s, the regular collection of garbage followed by incineration or disposal in a [[landfill]], providing clean water and draining standing water to prevent the breeding of mosquitos. ===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. An emphasis on physical exercise was reintroduced. 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 [[World War I]] 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 factor]]s 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. [http://www.greenhealth.org.uk/BoHmain.html] 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== [[Image:Polio vaccine poster.jpg|thumb|This 1963 poster featured CDC’s national symbol of public health, the "Wellbee", encouraging the public to receive an oral [[polio vaccine]].]] 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 is estimated that by the year 2030, this number will double. A controversial aspect of public health is the control of [[Tobacco smoking|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]] is not a human right, and in fact smokers are still free to smoke in their own homes. == Public Hygiene == Public hygiene includes public behaviors individuals can take to improve their personal health and wellness. Topics include public transportation, food preparation and public washroom use. These are steps individuals can take themselves. Examples would include avoiding crowded subways during the flu season, using gloves when touching the handrails and opening doors in public malls as well as going to clean restaurants. ==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. ==Research== Public health investigates sources of disease and descriptors of health through scientific methodology. This can lead to a public health solution to an epidemic, or a community based intervention for chronic diseases. Either way, research can provide the link between cause and effect for public health issues. ===Community based participatory research=== {{main | Community-based participatory research}} In contrast to clinical, patient oriented, or literature review research, community based participatory research (CBPR) investigates community-based [[etiology]], involves community leaders, and overall respects the forces under which the community and its participants preside toward promoting and sustaining public health matters. As described by the WK Kellogg Foundation Community Health Scholars Program, CBPR is a <blockquote> ''"collaborative approach to research that equitably involves all partners in the research process and recognizes the unique strengths that each brings. CBPR begins with a research topic of importance to the community, has the aim of combining knowledge with action and achieving social change to improve health outcomes and eliminate health disparities."<ref>[http://depts.washington.edu/ccph/commbas.html Community-Campus Partnerships for Health], in Seattle, Washington.</ref>''</blockquote> CBPR methods have been necessary for implementation of certain public health actions. This have been difficult to accomplish because communities in poorer, less well developed areas often distrust researchers and scientists from "outside."<ref>SYED M. AHMED, BARBRA BECK, CHERYL A. MAURANA & GAIL NEWTON [http://depts.washington.edu/ccph/pdf_files/EducforHealthAhmed.pdf Overcoming Barriers to Effective Community-Based Participatory Research in US Medical Schools]. Education for Health, Vol. 17, No. 2, July 2004, 141 – 151.</ref> ==Education and training== Schools of public health offer a variety of degrees which generally fall into two categories: professional or academic. Professional degrees are oriented towards practice in public health settings. The [[Master of Public Health]] (MPH), [[Doctor of Public Health]] (DrPH), and Master of Healthcare Administration (MHA) are examples of degrees which are geared towards people who want careers as practitioners of public health in health departments, managed care organizations, community-based organizations, hospitals, consulting firms, international agencies, state and federal agencies, among others. Academic degrees are more oriented toward students wishing to seek a career in teaching at a college or university or conducting research at a university or other settings. Examples of academic degrees are the Master of Science (MS), Doctor of Philosophy (PhD), and Doctor of Science (ScD). The Association of Schools of Public Health ([http://www.asph.org/ ASPH]) represents CEPH-accredited schools of public health in the United States, Puerto Rico, and Mexico. ASPH-member schools prepare people to become public health professionals. In addition to representing its member schools, ASPH provides: education and training for students and graduates of its member schools, a job search website [http://www.publichealthjobs.net/ PublicHealthJobs.net], funding opportunities, awards, [http://www.deltaomega.org/ Delta Omega] (honorary society for graduate studies in public health), and publications such as [http://www.publichealthreports.org/ Public Health Reports] and the [http://fridayletter.asph.org/ Friday Letter]. Distance learning has increasingly become an attractive option for working professionals or people whose other life commitments prevent them from traveling to a physical location for classes. [http://www.asph.org/ ASPH] lists distance learning programs from its member schools. == Academic Journals == * [[American Journal of Public Health]] * [http://arjournals.annualreviews.org/loi/publhealth Annual Review of Public Health,] ISSN: 15452093 (electronic) 0163-7525 (paper), Annual Reviews * [http://www.liebertpub.com/publication.aspx?pub_id=111 Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science], ISSN 1538–7135, Mary Ann Lieber * [http://www.cahr.info Central Asia Health Review], New York based independent magazine * [http://www.informaworld.com/smpp/title~content=t716100756~db=all International Journal of Prisoner Health,] ISSN: 1744-9219 (electronic) 1744-9200 (paper), Taylor & Francis * [http://www.icddrb.org/jhpn Journal of Health, Population and Nutrition]ISSN: 1606 0997 * [http://www.jphmp.com/pt/re/jphmp/home.htm;jsessionid=G5fGRLrNf6rLb9ygThhnb4Shwq2m0H0f2PsBJbdgW2TbYQHDVYB7!2112021004!181195629!8091!-1 Journal of Public Health Management and Practice], ISSN: 1078-4659, Lippincott William & Wilkins *[http://www.springerlink.com/content/119977/ Journal of Urban Health,] ISSN: 1468-2869 (electronic) 1099-3460 (paper) , Springer *[http://journals.cambridge.org/action/displayJournal?jid=PHN Public Health Nutrition,] ISSN: 1475-2727 (electronic) 1368-9800 (paper), Cambridge *[http://www.publichealthreports.org Public Health Reports ], ISSN: 0033-3549 * [http://www.informaworld.com/smpp/title~content=t713684341 Scandinavian Journal of Public Health,] ISSN: 1651-1905 (electronic) 1403-4948 (paper), Informa Healthcare * [http://eurpub.oxfordjournals.org/ The European Journal of Public Health,] ISSN: 1464-360X (electronic) 1101-1262 (paper), Oxford University Press * [http://www.journals.uchicago.edu/JID/home.html The Journal of Infectious Diseases], ISSN: 0022-1899, The University of Chicago Press ==See also== {{col-begin}} {{col-2}} * [[Auxology]] * [[Biological hazard]] * [[Carl Rogers Darnall]] * [[Central Asia Health Review]] * [[Chief Medical Officer, United Kingdom|Chief Medical Officer]] * [[Committee on the Environment, Public Health and Food Safety]] * [[Community-led total sanitation]] * [[Epidemiology]] * [[Environmental health]] * [[Environmental, Safety and Health Communication]] * [[Food safety]] * [[Globalization and disease]] * [[Globalization and Health]] * [[Health disparities]] * [[Health economics]] * [[Health Impact Assessment]] * [[Health literacy]] * [[Health reform]] * [[Health policy analysis]] * [[Health promotion]] * [[Healthy diet]] * [[Hygiene]] * [[Infection control]] * [[Mary Mallon|"Typhoid Mary"]] &ndash; an important case of the clash of individual rights and public health * [[Maternal health]] * [[Medical specialty]] * [[Mental health]] * [[National Health Federation]] * [[Nutrition]] * [[Occupational safety and health]] * [[Patient safety]] * [[Patient safety organization]] * [[Pharmaceutical policy]] * [[Pharmacovigilance]] * [[Population health]] * [[Preventive care]] {{col-2}} * Public health agencies ** [[European Centre for Disease Prevention and Control]] ** [[Indian health ministry]] ** [[Public health laboratories]] ** [[Public Health - Seattle & King County]] ** [[Centers for Disease Control and Prevention]] ** [[Center for Public Health Practice| Public Health - Center for Public Health Practice]] ** [[Center for Minority Health]] ** Public health by country ** [[Public health in the People's Republic of China]] * Public health education ** [[Health education]] ** [[Bachelor of Science in Public Health]] ** [[Master of Public Health]] ** [[Doctor of Public Health]] ** [[EPIET|European Programme for Intervention Epidemiology Training]] (EPIET) * [[Public health laboratory]] * [[Public Health Genomics]] * [[Public health informatics]] * [[Public health law]] * Public Health Software ** [[Epi Info]] ** [[OpenEpi]] * [[Risk management]] * [[Reproductive health]] * [[Samuel Crumbine]] * [[Sara Josephine Baker]] * [[Sewer]] * [[Social hygiene movement]] * [[Social medicine]] * [[Tropical disease]] * [[Waterborne diseases]] * [[Water management]] * [[World Toilet Organization]] {{col-end}} ==References== <div style="font-size:90%;"> <references /> </div> *[http://www.who.int/about/definition/en/ WHO Definition of Health] Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, 1946 *[[Control of Communicable Diseases Manual]] edited by James B. Chin, APHA, 2000 *[[Encyclopedia of public health]] edited by Lester Breslow, Macmillan Reference 2002 *[[The Solid Facts: Social Determinants of Health]] edited by Richard Wilkinson and Michael Marmot, WHO, 2003 *CCC. (2006), Public Health Emergency Response Guide for State, Local, and Tribal Public Health Directors. Retrieved April10, 2006, from: http://www.bt.cdc.gov/planning/responseguide.asp *Department of Homeland Security (2004) National Response Plan. Retrieved April 11, 2006, from http://www.dhs.gov/interweb/assetlibrary/NRPbaseplan.pdf ==External links== {{external links|August 2007}} * {{dmoz|Health/Public_Health_and_Safety/|Public Health and Safety}} * {{Yahoo directory|/Health/Public_Health_and_Safety/|Public Health and Safety}} * [http://www.healthaffairs.org/indexhw.php Health Affairs] * [http://www.who.int World Health Organization] * [http://www.cdc.gov Centers for Disease Control]: [http://www.cdc.gov/phin/ Public Health Information Network] * [http://www.cahr.info Central Asia Health Review] * [http://www.astho.org Association of State and Territorial Health Officials] Organization representing heads of state public health agencies. * [http://www.naccho.org National Association of County and City Health Officials] The national organization representing local public health officials; based in Washington, DC. * [http://www.chnri.org Child Health and Nutrition Research Initiative] * [http://www.asph.org/ Association of Schools of Public Health] The organization representing CEPH accredited schools of public health * [http://www.whatispublichealth.org/ What Is Public Health] * [http://www.phac-aspc.gc.ca Public Health Agency of Canada] * [http://www.apho.org.uk/ UK Association of Public Health Observatories] *[http://www.apha.org American Public Health Association] APHA is the oldest, largest and most diverse organization of public health professionals in the world. *[http://www.iphfonline.org International Public Health Forum (IPHF)] International, nongovernmental organization bringing public health domain and development sector workers towards creating strong global synergy and shared best-practices. *[http://www.wfpha.org World Federation of Public Health Associations] International, nongovernmental organization bringing health workers throughout the world together for professional exchange, collaboration, and action. * [http://www.public-health-deutschland.de Public Health Postgraduates Germany e.V.] * [http://www.bdsp.tm.fr Public health database]: free access ; documentation base ; documents in full text ; collections ; public health thesaurus ; Web sites directory ; diary of conferences ; multilingual glossary ; employment offers {{Medicine}} [[Category:Public health|*]] [[Category:Health economics]] [[Category:Sociology]] [[Category:Medical specialties]] [[bs:Javno zdravstvo]] [[ca:Salut pública]] [[da:Folkesundhedsvidenskab]] [[de:Gesundheitswissenschaften]] [[es:Salud pública]] [[fr:Santé publique]] [[hr:Zdravstvo]] [[id:Ilmu kesehatan masyarakat]] [[nl:Volksgezondheid]] [[ja:公衆衛生]] [[no:Folkehelse]] [[pl:Zdrowie publiczne]] [[pt:Saúde pública]] [[sh:Zdravstvo]] [[fi:Kansanterveys]] [[th:สาธารณสุข]] [[vi:Y tế công cộng]] [[zh:公共卫生]]