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Fundamentals of Public Health Chapter One
In this chapter we are going to learn about the definition and history of public health, how public health has become specialized and the five main pillars of public health, the five main principles that guide health promotion and health education efforts in public health, and the 10 essential functions that support the core services of public health. We are also going to learn why public health policy is often linked to legal and regulatory systems and the emerging physical activity specialization in public health.
Public Health and Medicine
What is Public Health?
Earliest roots of public health have been traced back to mid-14th century
The cholera epidemic of 1830s to 1850s created the basic foundation for the field of public health
Physician John Snow through his observation, data collection, and disease comparison founded the science of epidemiology.
Difference between Public Health and Medicine
The key difference between public health and medicine is:
Public health traditionally has focused less on individuals and treatment and more on populations and prevention
Perhaps public health is in scenario from the time diseases were affecting humanity. The earliest roots of public health have been traced back to mid-14th century. Though today this discipline has more organized infrastructure, the cholera epidemic of 1830s to 1850s created the basic foundation for the field of public health. In the London cholera epidemic of 1849 and 1853-54, physician John Snow through his observation, data collection, and disease comparison founded the science of epidemiology. Since then, the core principal of public health is to promote and protect health and to prevent disease and disability.
While medicine is integral to public health and vice versa , there is one fundamental difference between them. As your text describes (on page 4) “The key difference between public health and medicine is that public health traditionally has focused less on individuals and treatment and more on populations and prevention”. As such, the focus of public health has always been and will be on the diseases or conditions that affect significant portion of the population rather than rare conditions that affects a few.
Defining Moments in Public Health
Killed about 25% of the population
Vital statistics system
Developed by John Graunt
Systematic record of age, sex, who died, of what, where, and when. Record of how many persons per year died of what kind of event or disease
John Snow and Cholera outbreak
Proposed the radical idea at the time that government should take responsibilities to improve the situation by improving sanitation, housing conditions, worker safety and garbage disposal practices in poorer communities
Edwin Chadwick and policy and legislation in public health
Robert Koch and Louis Pasteur and germ theory of disease
Infectious diseases soon became better controlled with “Sanitary revolution”
Clean drinking water, sanitary disposals of human wastes, mosquito control, trash removal, pasteurization of milk, and regulation of food production.
In the mid -14th century bubonic plague, otherwise known as Black Death, devastated Europe by killing approximately 25% of the population. Though the cause of death was unknown at that time, the notion of epidemic became familiar. As time passed by, the field of public health advanced by the creation of health boards and system for counting and collecting dead, which was the first unknown attempt for a vital statistic system.
John Graunt was the first who developed vital statistics system and he systematically recorded age, sex, who died, of what, where, and when. He recorded how many persons per year died of what kind of event or disease. However, his work was discontinued after he died. Years later William Farr built on John Graunt’s idea and developed a modern vital statistics system.
John Snow’s cholera outbreak investigation had significant contribution in the field of epidemiology. Following his steps, Edwin Chadwick in Great Britain demonstrated the connection between disease and poor sanitary conditions in which poor were forced to work and live. Chadwick claimed in his report “The Sanitary Conditions of the Labouring Population” that anybody living in these conditions would get sick and die. He proposed the radical idea at the time that government should take responsibilities to improve the situation by improving sanitation, housing conditions, worker safety and garbage disposal practices in poorer communities. This had set the example of using policy and legislation in the field of health.
The early 20th century is one of the critical periods in the history of public health. Robert Koch and Louis Pasteur proposed the germ theory of the disease which facilitates new methods for treating and preventing diseases. Infectious diseases soon became better controlled with “Sanitary revolution” namely by the combination of clean drinking water, sanitary disposals of human wastes, mosquito control, trash removal, pasteurization of milk, and regulation of food production.
With the invention of microscope and isolation of Bacteria public health looks more like applied bacteriology. Vaccines and antibiotics were discovered and significant success was achieved in preventing (e.g.polio) and curing (e.g.tuberculosis) killer diseases. Death rates dropped from 1900 to 1960 and the focus of public health shifted from communicable (infectious) diseases to non –communicable (chronic) diseases. Maternal and child health played a critical role in public health puzzle. Interventions such as mandating training and licensure of midwives helped to lower infant mortality rates. As the battle of infectious diseases were won, chronic disease like heart disease, diabetes mellitus, cancers, mental health disorders and musculoskeletal disorders became the key causes of death and are the new focus of public health. According to a 2011 report by World Health organization (WHO) more than 60% of deaths worldwide in 2008 were due to chronic diseases. As once diseases were caused by poor hygienic condition of environment, today diseases again influenced by environment. However, this environment is mostly due to the lifestyle and behavior of individual and/or population. Let’s take a look into the chart of ten leading causes of death. ). Can you summarize what percentage of total death is attributed to sedentary lifestyle or physical inactivity?
1988–2008 No Leisure-Time Physical Activity Trend Chart
This chart is showing data from 36 participating states from 1988–2008. The proportion of the U.S. population that reported no leisure-time physical activity decreased from about 31% in 1989 to about 28% in 2000, and then decreased to about 25% in 2008. Can you think of some reasons for decreasing trend of physical inactivity over time?
Leisure-time inactivity — no reported leisure-time physical activities (i.e., any physical activities or exercises such as running, calisthenics, golf, gardening, or walking) in the previous month. Source: CDC http://www.cdc.gov/nccdphp/dnpa/physical/stats/leisure_time.htm
The World Health Organization estimate that 1.9 million deaths are attributable to physical inactivity (World Health Organization: Global Strategy on Diet, Physical Activity, and Health, 2006)
According to World Health Organization 1.9 million deaths are attributed to physical inactivity.
An important part of the evolution and history of public health has been the emergence of training programs and techniques to address public health challenges. The establishments of the London School of Tropical Medicine and Hygiene in the United Kingdom and the Johns Hopkins School of Public Health in the United States in the early 20th century were key steps to creating a workforce with the skills necessary for handling public health problems. Very rapidly following these early efforts, additional training and certification of academic programs took hold in the United States. In 2011, the United States and Mexico had 50 accredited schools of public health providing leadership and training opportunities for master’s and doctoral students. These training programs have evolved over the years, resulting in widely accepted standards for areas of training and specialization in public health. Today Epidemiology and disease control, environmental health, biostatistics, health administration, and health promotion and health education are known as five pillars of public health. Refer to your book page 7-9 for detail description on each of these five pillars.
THE 10 ESSENTIAL FUNCTIONS OF PUBLIC HEALTH
Competencies in the functions are developed through training in and across the five pillars.
Now comes the question how does public health discipline works? In 1999, U.S office of Diseases Prevention and Health Promotion outlined the fundamental services of public health. The 10 essential functions of public health are listed in the figure here. Competencies in the functions are developed through training in and across the five pillars. These 10 essential functions are meant to interact in a cycle to maximize public health.
Public Health System