WHAT IS PUBLIC HEALTH?
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. 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. 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.
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 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. The development of quarantine in the medieval period helped mitigate the effects of other infectious diseases. Other public health interventions include latrinization, the building of sewers, 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 mosquitoes. 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.
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.
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 behavior 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.
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.
The Committee for the Study of the Future of Public Health Division of Health Care Services, Institute of Medicine ( The Future of Public Health, 1988) states that no citizen from any community, no matter how small or remote, should be without identifiable and realistic access to the benefits of public health protection, which is possible only through a local component of the public health delivery system. Local public health units must be responsible for assessment, monitoring, and surveillance of local health problems and needs, as well as obtaining resources for dealing with them. Local public health units are also responsible for policy development that fosters local involvement, a sense of ownership that emphasizes local needs, and advocate equitable distribution of public resources and community needs. Finally, public health units must assure high-quality services, including personal health services needed for the protection of public health in the community, are available and accessible to all persons.
Public health is a vital function that requires broad public concern and support in order to fulfill society’s interest in assuring the conditions in which people can be healthy. History teaches us that organized community effort to prevent disease and promote health is both valuable and effective. It is this philosophy of assuring a healthy environment, promoting healthy behaviors, and preventing disease that the staff of the Stone County Health Department is committed to practicing now and in the future.
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