Chapter 1

Public Health:
Science, Politics,
and Prevention
 What Is Public Health?
• C.E.A. Winslow provided the definition of public
health in 1920 that is still valid today.
• IOM’s The Future of Public Health refocused
attention on public health and revitalized the
field.
– Mission is “fulfillment of society’s interest in assuring
the conditions in which people can be healthy.”
– Substance is “organized community efforts aimed at
the prevention of disease and the promotion of
health.”
 Core Functions of Public Health
• Core functions of public health:
– Assessment
– Policy development
– Assurance
 Public Health Versus Medical Care
• In medicine, the patient is the individual; in public health,
the patient is the community.
• Public health diagnoses the health of the community using
public health sciences.
• Treatment of a community involves new policies and
interventions.
• Goal of medicine is to cure; goal of public health is to
prevent disease and disability.
• Only 3% of the nation’s total health spending is spent on
public health.
• Life expectancy of Americans has increased by 30 years
over the 20th century, and only 5 of the 30 years are
attributed to modern medicine.
 Public Health: Science and Politics
• Science is how we understand threats to health,
determine what interventions might work, and
evaluate whether the interventions worked.
• Politics is how we as a society make decisions
about what policies to implement.
• Politics is part of both the policy development
and assurance functions of public health.
• Community pays for public health initiatives
through taxes.
 Public Health Disciplines
• Epidemiology
• Statistics
• Biomedical Sciences
• Environmental Health Science
• Social and Behavioral Sciences
• Health Policy and Management
 Epidemiology
• Epidemiology is the basic science of public health.
• The study of epidemics
– Focuses on human populations, usually starting with
an outbreak of disease in a community.
– Aims to control the spread of infectious diseases.
– Seeks causes of chronic disease and ways to limit
harmful exposures.
• Epidemiologists are mainstays of local public
health departments.
– “Shoe-leather epidemiology”
 Statistics
• Government collects health data on the population.
• These numbers are diagnostic tools for the health of
the community.
• The science of statistics is used to calculate risks and
benefits.
• Statistical analysis is an integral part of any
epidemiological study seeking the cause of a disease.
• Statistical analysis is an integral part of any clinical
study testing the effectiveness of a new drug.
 Biomedical Sciences
• Infectious diseases are pathogens.
• Control of infectious diseases was a major
public health focus in the 19th and early 20th
centuries.
• Biomedical research is important to
understanding control of new diseases and
noninfectious diseases.
– Chronic diseases
– Genetics
 Environmental Health Science
• A classic component of public health:
– Much of the public health improvement in the U.S. in the 20th
century was due to improved environmental health.
• Health is affected by exposure to environmental factors:
– Air quality
– Water quality
– Solid and hazardous wastes
– Safe food and drugs
– Global environmental change
• Thousands of new chemicals enter the environment
every year.
 Social and Behavioral Sciences
• Behavior is now the leading concern of factors
that affect people’s health.
• A theory of health behavior is that social
environment affects people’s behavior.
– Major health threats are tobacco, poor diet, and
physical inactivity and injuries.
– Blacks have a lower overall life expectancy than
whites, even when incomes are similar.
– Other ethnic minority groups are also at increased risk
for a variety of health problems.
 Health Policy and Management
or Health Administration
• This area of study examines the role of medical care in
public health.
• Cost of medical care in the U.S. is out of control.
• U.S. has a high percentage of population without
health insurance.
– These people often lack access to medical care.
• Quality of medical care can be measured and is often
questionable.
• Medical care has eaten up profits that could be used
more beneficially for education, housing, and the
environment.
 Public Health:
Prevention and Intervention
• Primary prevention prevents an illness or
injury from occurring at all.
• Secondary prevention minimizes the severity
of the disease or injury once it has occurred.
• Tertiary prevention minimizes disability by
providing medical care and rehabilitation
services.
 Public Health Approach
• Define the health problem.
• Identify risk factors associated with the
problem.
• Develop and test community-level
interventions to control or prevent the cause
of the problem.
• Implement interventions to improve the
health of the population.
• Monitor interventions to assess their
effectiveness.
 Chain of Causation
• Chain of Causation involves:
– Agent
– Host
– Environment
• This is a traditional approach to dealing with
infectious diseases.
• Interventions can focus on any of these targets.
• This model can also be used for other kinds of
illnesses or injuries.
 Public Health and Terrorism
• Events of 9/11 and the anthrax letters highlighted the
importance of public health.
• Public health response to disasters, natural and man-made,
helps to control the damage and to prevent further harm to
survivors and rescuers.
• Public health response to 9/11 was essentially the same as
needed for other disasters, such as factory explosions and
plane crashes.
• Bioterrorism is recognized primarily through classic public
health measures similar to those used for natural epidemics.
• The threat of bioterrorism did more to teach the public about
public health than any educational program.
 Discussion Question 1
• Describe actions that governments have taken
to ensure that people are safer and healthier
today than people were 100 years ago.
 Discussion Questions 2
• What are the three core functions of public
health?
• How do these functions compare with the
functions of medical care?
• How are the six disciplines of public health
used to accomplish the core functions?
 Discussion Question 3
• Identify a health problem in your community.
• What are some risk factors associated with the
problem?
• Suggest a possible intervention that the
community could take to ameliorate the
problem.
 Discussion Question 4
• Visit the website for American Public Health
Association (APHA), www.apha.org.
– Read the highlights from the current issue of the American
Journal of Public Health.
– Which of the public health sciences does each of these
articles belong to?
• Visit the website for The Nation’s Health, the official
newspaper of APHA,
thenationshealth.aphapublications.org.
– Read the headlines of the current issue to get an idea of
the range of topics encompassed by the field of public
health.