THURSDAY NIGHT IS HEALTH CARE CHANGE NIGHT, a weekly Daily Kos Health Care Series.
Tonight it is back to first principles with: "What is Public Health?"
As you will see if you read on through, it has a lot to do with SHIT.
Public health is science art and practice of preventing disease, prolonging life and promoting health through the organized efforts of society.
While public health is comprised of many of familiar health disciplines -- such as medicine, dentistry, nursing, nutrition, social work, environmental science, education, administration, and behavioral science -- its activities focus on communities and populations rather than individual patients.
Doctors usually treat individual patients one-on-one for a specific disease or injury. Public health professionals monitor and diagnose the health concerns of entire communities and promote healthy practices and behaviors to assure our populations stay healthy.
"Health care is vital to all of us some of the time, but public health is vital to all of us all of the time." (attributed to former Surgeon General, C. Everett Koop)
The Public Health Paradox:
"When public health succeeds, nothing happens."
This "Public Health Paradox" can make it hard for the public and for politicians to remember its importance, the need to maintain it and yes, even to pay for it.
Nobody wakes up in the morning and says, "Boy, it’s great that I don’t have cholera," or "Isn’t it wonderful that my children aren’t crippled by polio?" Only when it fails or breaks down do we notice: the drinking water was contaminated, the food is safe, the medicine is not effective, the disease is spreading, the community is designed so we all get diabetes and heart disease.
Ever since people banded together in groups there has been both clinical medicine and public health. Our earliest hunter gatherer ancestors had healers to lay on the hands and give comfort to sick and injured. It is also likely that they some sort of rules about where to shit, and to keep their shit separate from their food and water. That was public health.
Public health became increasingly necessary with the development of cities. Whenever people, and their associated animals, gather together in groups there is more chance for disease to evolve and spread. Where there is the predictable increase in disease, than there are predictable organized ways to prevent it.
Hence the philosophy, politics and law of public health stem from the same implied social contract as provides for the underlying organizing of complex society. Individuals do give up certain individual rights, not only for the collective good but also for their own rights and good as a member of that society. Just as your right to make a fist ends where my nose begins, so to does your right as individual to shit anywhere, is limited by our right (including yours) to all have clean drinkable water.
Specificially, much of public health law derives from the general legal concept of the "Police Power" of the State: The inherent authority of a government to impose restrictions on private rights for the sake of public welfare, order, and security. It is from this that we get laws requiring childhood immunization, and even forced treatment in the case of a recalcitrant person with active tuberculosis.
It will not surprise you that public health professionals tend not to be hardcore libertarians.
As noted, all ancient civilizations had some system for waste disposal.But modern western public health organization is often dated first to the gradual implementation of government promoted smallpox vaccination between the 1770s-1820s, and to development of permanent and empowered "Boards of Health" during the cholera epidemics of the 1830s.
Public health can come into conflict with the political (and public) powers that be: in fiction this was notably the story of Henrik Ibsen’s play "Enemy of the People" wherein the doctor discovers that the town’s industrial plant is poisoning the burgeoning tourist attraction Hot Springs. Due to the economic implications, he is denounced as a lunatic and run out of town, not only by the mayor but by the townspeople (they stole the story for the movie Jaws). The parallels to current events are obvious. Our friends at the Big Con refer to this as E. Coli Conservatism.
Since pointing out why Republicans and Bushies are wrong is an important function of this site, let me cite another public health example of the difference between individual and community thinking: Bush and the Bushies have emphasized the important of personal physical fitness for health and well being. This is true so far as it goes. But a public health perspective would not focus solely on exhorting individuals to exercise more. We would recognize and promote the need for a community, environment, country and public policy that inherently promotes fitness. This would include policies that would stop promoting sprawl and high fructose corn syrup, start promoting more neo-urbanism, sidewalks and real food. It is not just individual choice, but also public and policy choices.
Public Health Organization in America Today:
The U.S. Dept. of Health & Human Services and its constituent agencies, notably the Centers for Disease Control & Prevention, the Food & Drug Administration, other agencies such as the Occupational Safety & Health Administration, the
Environmental Protection Agency and others make up the infrastructure at the federal level. As an additional side note: Within HHS is the Public Health Service (PHS). About 5% of employees (though a higher percent of among clinicians and health professionals as opposed to adminstration) are not regular civil service but are a PHS Commissioned Officer Corps which is a Uniformed Service. The Surgeon General is the titular leader of PHS. Mostly PHS officers do the same work across the HHS agencies in which they work as their civil service counterparts. But they are specially deployable 365/24/7 for emergencies such as Katrina.
Of course in the U.S., much is left to the States, in this case the Departments of Health in each State and at the more local County & City level as well.
Separate from government, the American Public Health Association is the major organization representing public health professionals from all disciplines. There is also the Public Health Foundation whose links page has an especially nice list of the many other public health related organizations in the U.S.
Internationally there is World Health Organization, UNICEF and other United Nations related organizations.
Back in 2000, the Center Centers for Disease Control decided to come up with their list of the "Ten Great Public Health Achievements in the United States from 1900-1999." Here is what they came up with:
• Vaccination
• Motor-vehicle safety
• Safer workplaces
• Control of infectious diseases
• Decline in deaths from coronary heart disease and stroke
• Safer and healthier foods
• Healthier mothers and babies
• Family planning
• Fluoridation of drinking water
• Recognition of tobacco use as a health hazard
Now I am not usually a cheerleader, and lord knows we have a ton of problems especially with health disparities related to race, class and poverty in America. But just for once I would like to show some happy public health success stories. Here are some graphs that tell some good stories:
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Having patted ourselves on the back for the above successes, we are now deeply into Healthy People 2010 which laid out 467 objectives designed to serve as a framework for improving the health of all people in the United States during the first decade of the 21st century. One important change from the preceding Healthy People 2000 is that we are not accepting any disparities by race.
For those interested in a career in public health, there is the Association of Schools of Public which has more on what is public health and public health practice. They also host this fun informational site site (though be warned; it is sponsored by Pfizer).
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For those interested in specific topics see:
CDC's A to Z
HHS's Healthfinder
APHA's A to Z
NIH's MedlinePlus
And the wonderful and free SuperCourse which is a global repository of lectures on public health and prevention targeting educators across the world.
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What Public Health Does:
• Prevents epidemics and the spread of disease.
• Protects against environmental hazards.
• Prevents injuries.
• Promotes and encourages healthy behaviors.
• Responds to disasters and assists communities in recovery.
• Assures the quality and accessibility of health services.
Essential Public Health Services:
• Monitor health status to identify community health problems.
• Diagnose & investigate health problems & hazards in the community.
• Inform, educate, and empower people about health issues.
• Mobilize community partnerships to identify & solve health problems.
• Develop policies & plans that support individual & community health efforts.
• Enforce laws and regulations that protect health and ensure safety.
• Link people to needed personal health services & assure the provision of health care when otherwise unavailable.
• Assure a competent public health and personal health care workforce
• Evaluate effectiveness, accessibility & quality of personal & population-based health services.
• Research for new insights and innovative solutions to health problems.