Public health is "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".
Analyzing the determinants of
health
Health, according to the World Health Organization, is "a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity".World Health Organization. (2006)''Constitution of the World Health Organ ...
of a
population
Population typically refers to the number of people in a single area, whether it be a city or town, region, country, continent, or the world. Governments typically quantify the size of the resident population within their jurisdiction usi ...
and the threats it faces is the basis for public health.
The ''public'' can be as small as a handful of people or as large as a village or an entire city; in the case of a
pandemic it may encompass several continents. The concept of ''health'' takes into account physical,
psychological, and
social well-being.
[What is the WHO definition of health?](_blank)
from the Preamble to the Constitution of WHO as adopted by the International Health Conference, New York, 19 June - 22 July 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of WHO, no. 2, p. 100) and entered into force on 7 April 1948. The definition has not been amended since 1948.
Public health is an
interdisciplinary field. For example,
epidemiology
Epidemiology is the study and analysis of the distribution (who, when, and where), patterns and determinants of health and disease conditions in a defined population.
It is a cornerstone of public health, and shapes policy decisions and evi ...
,
biostatistics,
social sciences and
management
Management (or managing) is the administration of an organization, whether it is a business, a nonprofit organization, or a government body. It is the art and science of managing resources of the business.
Management includes the activitie ...
of
health services are all relevant. Other important sub-fields include
environmental health,
community health,
behavioral health,
health economics,
public policy
Public policy is an institutionalized proposal or a decided set of elements like laws, regulations, guidelines, and actions to solve or address relevant and real-world problems, guided by a conception and often implemented by programs. Public ...
,
mental health
Mental health encompasses emotional, psychological, and social well-being, influencing cognition, perception, and behavior. It likewise determines how an individual handles Stress (biology), stress, interpersonal relationships, and decision-maki ...
,
health education,
health politics
Health politics or politics of health is an interdisciplinary field of study concerned with the analysis of social and political power over the health status of individuals.
Health politics, incorporating broad perspectives from medical socio ...
,
occupational safety,
disability
Disability is the experience of any condition that makes it more difficult for a person to do certain activities or have equitable access within a given society. Disabilities may be cognitive, developmental, intellectual, mental, physical, ...
,
oral health,
gender issues in health, and
sexual and reproductive health.
Public health, together with
primary care, secondary care, and
tertiary care, is part of a country's overall
health care system. Public health is implemented through the
surveillance of cases and
health indicators, and through the
promotion of healthy behaviors. Common public health initiatives include promotion of
hand-washing and
breastfeeding, delivery of
vaccination
Vaccination is the administration of a vaccine to help the immune system develop immunity from a disease. Vaccines contain a microorganism or virus in a weakened, live or killed state, or proteins or toxins from the organism. In stimulat ...
s, promoting ventilation and improved air quality both
indoors and
outdoors,
suicide prevention,
smoking cessation,
obesity education, increasing
healthcare accessibility and distribution of
condoms to control the spread of
sexually transmitted disease
Sexually transmitted infections (STIs), also referred to as sexually transmitted diseases (STDs) and the older term venereal diseases, are infections that are spread by sexual activity, especially vaginal intercourse, anal sex, and or ...
s.
There is a significant disparity in access to health care and public health initiatives between
developed countries and
developing countries, as well as within developing countries. In developing countries, public health infrastructures are still forming. There may not be enough trained
healthcare workers, monetary resources, or, in some cases, sufficient knowledge to provide even a basic level of medical care and disease prevention.
A major public health concern in developing countries is poor
maternal and child health, exacerbated by
malnutrition and poverty coupled with governments' reluctance in implementing public health policies.
From the beginnings of
human civilization, communities promoted
health
Health, according to the World Health Organization, is "a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity".World Health Organization. (2006)''Constitution of the World Health Organ ...
and fought
disease at the population level.
In
complex,
pre-industrialized societies, interventions designed to reduce health risks could be the initiative of different stakeholders, such as army generals, the clergy or rulers. Great Britain became a leader in the development of public health initiatives, beginning in the 19th century, due to the fact that it was the first modern
urban nation worldwide.
The public health initiatives that began to emerge initially focused on
sanitation (for example, the Liverpool and
London sewerage systems), control of
infectious diseases (including vaccination and
quarantine) and an evolving infrastructure of various sciences, e.g. statistics, microbiology, epidemiology, sciences of engineering.
Definitions and purposes
Definition
Public health has been defined as "the science and art of
preventing disease", prolonging life and improving
quality of life through organized efforts and informed choices of
society,
organizations (public and private),
communities and
individuals.
The ''public'' can be as small as a handful of people or as large as a village or an entire city. The concept of ''health'' takes into account physical,
psychological, and
social well-being. As such, according to the
World Health Organization
The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level o ...
, "health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity".
Related terms
Public health is related to
global health which is the health of populations in the worldwide context. It has been defined as "the area of study,
research and practice that places a priority on improving health and achieving equity in "
Health for all" people worldwide".
International health is a field of
health
Health, according to the World Health Organization, is "a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity".World Health Organization. (2006)''Constitution of the World Health Organ ...
care, usually with a public health emphasis, dealing with health across regional or national boundaries. Public health is not the same as public healthcare (
publicly funded health care).
The term preventive medicine is related to public health. The American Board of Preventive Medicine separates three categories of preventive medicine: aerospace health,
occupational health, and public health and general preventative medicine. Jung, Boris and Lushniak argue that preventive medicine should be considered the medical specialty for public health but note that the American College of Preventive Medicine and American Board of Preventive Medicine do not prominently use the term "public health".
Preventive medicine specialists are trained as
clinicians and address complex health needs of a population such as by assessing the need for
disease prevention programs, using the best methods to implement them, and assessing their effectiveness.
Since the 1990s many scholars in public health have been using the term population health.
There are no medical specialties directly related to population health.
Valles argues that consideration of
health equity
Health equity arises from access to the social determinants of health, specifically from wealth, power and prestige. Individuals who have consistently been deprived of these three determinants are significantly disadvantaged from health inequiti ...
is a fundamental part of population health. Scholars such as Coggon and Pielke express concerns about bringing general issues of wealth distribution into population health. Pielke worries about "stealth issue advocacy" in population health.
Jung, Boris and Lushniak consider population health to be a concept that is the goal of an activity called public health practiced through the specialty preventive medicine.
Lifestyle medicine uses individual lifestyle modification to prevent or revert disease and can be considered a component of preventive medicine and public health. It is implemented as part of
primary care rather than a specialty in its own right.
Valles argues that the term
social medicine has a narrower and more
biomedical focus than the term population health.
Purposes
The purpose of a
public health intervention
A public health intervention is any effort or policy that attempts to improve mental and physical health on a population level. Public health interventions may be run by a variety of organizations, including governmental health departments and ...
is to prevent and
mitigate diseases,
injuries and other health conditions. The overall goal is to improve the health of populations and increase
life expectancy
Life expectancy is a statistical measure of the average time an organism is expected to live, based on the year of its birth, current age, and other demographic factors like sex. The most commonly used measure is life expectancy at birth ...
.
Characteristics and components
Public health is a complex term, composed of many elements and different practices. It is a multi-faceted,
interdisciplinary field.
For example,
epidemiology
Epidemiology is the study and analysis of the distribution (who, when, and where), patterns and determinants of health and disease conditions in a defined population.
It is a cornerstone of public health, and shapes policy decisions and evi ...
,
biostatistics,
social sciences and
management
Management (or managing) is the administration of an organization, whether it is a business, a nonprofit organization, or a government body. It is the art and science of managing resources of the business.
Management includes the activitie ...
of health services are all relevant. Other important sub-fields include
environmental health,
community health,
behavioral health,
health economics,
public policy
Public policy is an institutionalized proposal or a decided set of elements like laws, regulations, guidelines, and actions to solve or address relevant and real-world problems, guided by a conception and often implemented by programs. Public ...
,
mental health
Mental health encompasses emotional, psychological, and social well-being, influencing cognition, perception, and behavior. It likewise determines how an individual handles Stress (biology), stress, interpersonal relationships, and decision-maki ...
,
health education,
health politics
Health politics or politics of health is an interdisciplinary field of study concerned with the analysis of social and political power over the health status of individuals.
Health politics, incorporating broad perspectives from medical socio ...
,
occupational safety,
disability
Disability is the experience of any condition that makes it more difficult for a person to do certain activities or have equitable access within a given society. Disabilities may be cognitive, developmental, intellectual, mental, physical, ...
,
gender issues in health, and
sexual and reproductive health.
Modern public health practice requires
multidisciplinary teams of public health workers and professionals. Teams might include
epidemiologists
Epidemiology is the study and analysis of the distribution (who, when, and where), patterns and determinants of health and disease conditions in a defined population.
It is a cornerstone of public health, and shapes policy decisions and evidenc ...
,
biostatisticians
Biostatistics (also known as biometry) are the development and application of statistical methods to a wide range of topics in biology. It encompasses the design of biological experiments, the collection and analysis of data from those experimen ...
,
physician assistants,
public health nurses,
midwives
A midwife is a health professional who cares for mothers and newborns around childbirth, a specialization known as midwifery.
The education and training for a midwife concentrates extensively on the care of women throughout their lifespan; c ...
,
medical microbiologists,
pharmacists,
economists,
sociologists
This is a list of sociologists. It is intended to cover those who have made substantive contributions to social theory and research, including any sociological subfield. Scientists in other fields and philosophers are not included, unless at lea ...
,
geneticists,
data managers,
environmental health officers (
public health inspector
Environmental Health Officers (also known as Public Health Inspectors or Environmental Health Practitioners) are responsible for carrying out measures for protecting public health, including administering and enforcing legislation related to enviro ...
s),
bioethicists
Bioethics is both a field of study and professional practice, interested in ethical issues related to health (primarily focused on the human, but also increasingly includes animal ethics), including those emerging from advances in biology, med ...
, gender experts, sexual and reproductive health specialists,
physicians, and
veterinarians.
The elements and priorities of public health have evolved over time, and are continuing to evolve.
Different regions in the world can have different public health concerns at a given time.
Common public health initiatives include promotion of
hand-washing and
breastfeeding, delivery of
vaccination
Vaccination is the administration of a vaccine to help the immune system develop immunity from a disease. Vaccines contain a microorganism or virus in a weakened, live or killed state, or proteins or toxins from the organism. In stimulat ...
s,
suicide prevention,
smoking cessation,
obesity education, increasing
healthcare accessibility and distribution of
condoms to control the spread of
sexually transmitted disease
Sexually transmitted infections (STIs), also referred to as sexually transmitted diseases (STDs) and the older term venereal diseases, are infections that are spread by sexual activity, especially vaginal intercourse, anal sex, and or ...
s.
Methods
Public health aims are achieved through surveillance of cases and the
promotion of healthy behaviors,
communities and
environments
Environment most often refers to:
__NOTOC__
* Natural environment, all living and non-living things occurring naturally
* Biophysical environment, the physical and biological factors along with their chemical interactions that affect an organism or ...
. Analyzing the determinants of
health
Health, according to the World Health Organization, is "a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity".World Health Organization. (2006)''Constitution of the World Health Organ ...
of a
population
Population typically refers to the number of people in a single area, whether it be a city or town, region, country, continent, or the world. Governments typically quantify the size of the resident population within their jurisdiction usi ...
and the threats it faces is the basis for public health.
Many diseases are
preventable through simple, nonmedical methods. For example, research has shown that the simple act of
handwashing
Hand washing (or handwashing), also known as hand hygiene, is the act of cleaning one's hands with soap or handwash and water to remove viruses/ bacteria/microorganisms, dirt, grease, or other harmful and unwanted substances stuck to the hand ...
with soap can prevent the spread of many
contagious diseases. In other cases, treating a disease or controlling a
pathogen
In biology, a pathogen ( el, πάθος, "suffering", "passion" and , "producer of") in the oldest and broadest sense, is any organism or agent that can produce disease. A pathogen may also be referred to as an infectious agent, or simply a g ...
can be vital to preventing its spread to others, either during an outbreak of
infectious disease
An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable di ...
or through
contamination of food or
water
Water (chemical formula ) is an inorganic, transparent, tasteless, odorless, and nearly colorless chemical substance, which is the main constituent of Earth's hydrosphere and the fluids of all known living organisms (in which it acts as ...
supplies.
Public health communications programs,
vaccination
Vaccination is the administration of a vaccine to help the immune system develop immunity from a disease. Vaccines contain a microorganism or virus in a weakened, live or killed state, or proteins or toxins from the organism. In stimulat ...
programs and distribution of
condoms are examples of common preventive public health measures.
Public health, together with
primary care, secondary care, and
tertiary care, is part of a country's overall
health care system. Many interventions of public health interest are delivered outside of
health facilities, such as
food safety surveillance, distribution of
condoms and
needle-exchange programs for the prevention of transmissible diseases.
Public health plays an important role in disease prevention efforts in both the developing world and in developed countries through local health systems and
non-governmental organization
A non-governmental organization (NGO) or non-governmental organisation (see spelling differences) is an organization that generally is formed independent from government. They are typically nonprofit entities, and many of them are active in ...
s.
Public health requires
Geographic Information Systems (GIS) because risk, vulnerability and exposure involve geographic aspects.
Ethics
A dilemma in public health ethics is dealing with the conflict between
individual rights and maximizing
right to health.
Public health is justified by
consequentialist
In ethical philosophy, consequentialism is a class of normative, teleological ethical theories that holds that the consequences of one's conduct are the ultimate basis for judgment about the rightness or wrongness of that conduct. Thus, from ...
utilitarian ideas,
but is constrained and critiqued by
liberal,
deontological
In moral philosophy, deontological ethics or deontology (from Greek: + ) is the normative ethical theory that the morality of an action should be based on whether that action itself is right or wrong under a series of rules and principles, ...
,
principlist and
libertarian philosophies
Stephen Holland argues that it can be easy to find a particular framework to justify any viewpoint on public health issues, but that the correct approach is to find a framework that best describes a situation and see what it implies about public health policy.
The definition of
health
Health, according to the World Health Organization, is "a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity".World Health Organization. (2006)''Constitution of the World Health Organ ...
is vague and there are many conceptualizations. Public health practitioners definition of health can different markedly from members of the public or
clinicians. This can mean that members of the public view the values behind public health interventions as alien which can cause resentment amongst the public towards certain interventions.
Such vagueness can be a problem for
health promotion.
Critics have argued that public health tends to place more focus on individual factors associated with health at the expense of factors operating at the population level.
Historically, public health campaigns have been criticized as a form of "
healthism
Medicalization is the process by which human conditions and problems come to be defined and treated as medical conditions, and thus become the subject of medical study, diagnosis, prevention, or treatment. Medicalization can be driven by new evid ...
", as moralistic in nature rather than being focused on health. Medical doctors, Petr Shkrabanek and James McCormick wrote a series of publications on this topic in the late 1980s and early 1990s criticizing the UK's ''the Health of The Nation'' campaign. These publications exposed abuse of epidemiology and statistics by the public health movement to support lifestyle interventions and screening programs.
A combination of inculcating a fear of ill-health and a strong notion of individual responsibility has been criticized as a form of "health fascism" by a number of scholars, objectifying the individual with no considerations of emotional or social factors.
Priority areas
Original focal areas
When public health initiatives began to emerge in England in modern times (18th century onwards) there were three core strands of public health which were all related to statecraft: Supply of clean water and
sanitation (for example
London sewerage system); control of
infectious diseases (including
vaccination
Vaccination is the administration of a vaccine to help the immune system develop immunity from a disease. Vaccines contain a microorganism or virus in a weakened, live or killed state, or proteins or toxins from the organism. In stimulat ...
and
quarantine); an evolving infrastructure of various sciences, e.g. statistics, microbiology, epidemiology, sciences of engineering.
Great Britain was a leader in the development of public health during that time period out of necessity: Great Britain was the first modern
urban nation (by 1851 more than half of the population lived in settlements of more than 2000 people).
This led to a certain type of distress which then led to public health initiatives.
Later that particular concern faded away.
Changing and differing focal areas
With the onset of the
epidemiological transition
In demography and medical geography, epidemiological transition is a theory which "describes changing population patterns in terms of fertility, life expectancy, mortality, and leading causes of death." For example, a phase of development marke ...
and as the prevalence of
infectious diseases decreased through the 20th century, public health began to put more focus on
chronic diseases such as
cancer
Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal b ...
and
heart disease. Previous efforts in many developed countries had already led to dramatic reductions in the
infant mortality rate
Infant mortality is the death of young children under the age of 1. This death toll is measured by the infant mortality rate (IMR), which is the probability of deaths of children under one year of age per 1000 live births. The under-five morta ...
using preventive methods. In Britain, the infant mortality rate fell from over 15% in 1870 to 7% by 1930.
A major public health concern in
developing countries is poor
maternal and child health, exacerbated by
malnutrition and poverty. The
WHO reports that a lack of
exclusive breastfeeding during the first six months of life contributes to over a million avoidable child deaths each year.
Public health surveillance has led to the identification and prioritization of many public health issues facing the world today, including
HIV/AIDS
Human immunodeficiency virus infection and acquired immunodeficiency syndrome (HIV/AIDS) is a spectrum of conditions caused by infection with the human immunodeficiency virus (HIV), a retrovirus. Following initial infection an individual ...
,
diabetes
Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level ( hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased ...
,
waterborne diseases,
zoonotic diseases
A zoonosis (; plural zoonoses) or zoonotic disease is an infectious disease of humans caused by a pathogen (an infectious agent, such as a bacterium, virus, parasite or prion) that has jumped from a non-human (usually a vertebrate) to a ...
, and
antibiotic resistance leading to the reemergence of infectious diseases such as
tuberculosis
Tuberculosis (TB) is an infectious disease usually caused by '' Mycobacterium tuberculosis'' (MTB) bacteria. Tuberculosis generally affects the lungs, but it can also affect other parts of the body. Most infections show no symptoms, ...
.
Antibiotic resistance, also known as drug resistance, was the theme of
World Health Day 2011.
For example, the WHO reports that at least 220 million people worldwide have diabetes. Its incidence is increasing rapidly, and it is projected that the number of diabetes deaths will double by 2030. In a June 2010 editorial in the medical journal ''
The Lancet
''The Lancet'' is a weekly peer-reviewed general medical journal and one of the oldest of its kind. It is also the world's highest-impact academic journal. It was founded in England in 1823.
The journal publishes original research articles ...
'', the authors opined that "The fact that type 2 diabetes, a largely preventable disorder, has reached epidemic proportion is a public health humiliation." The risk of
type 2 diabetes is closely linked with the growing problem of
obesity
Obesity is a medical condition, sometimes considered a disease, in which excess body fat has accumulated to such an extent that it may negatively affect health. People are classified as obese when their body mass index (BMI)—a person's ...
. The WHO's latest estimates highlighted that globally approximately 1.9 billion adults were
overweight in 2014, and 41 million children under the age of five were overweight in 2014. Once considered a problem in high-income countries, it is now on the rise in low-income countries, especially in urban settings.
Many public health programs are increasingly dedicating attention and resources to the issue of obesity, with objectives to address the underlying causes including
healthy diet and
physical exercise. The
National Institute for Health and Care Research (NIHR) has published a review of research on what
local authorities
Local government is a generic term for the lowest tiers of public administration within a particular sovereign state. This particular usage of the word government refers specifically to a level of administration that is both geographically-loca ...
can do to tackle obesity. The review covers interventions in the food environment (what people buy and eat), the
built and
natural environment
The natural environment or natural world encompasses all living and non-living things occurring naturally, meaning in this case not artificial. The term is most often applied to the Earth or some parts of Earth. This environment encompasses t ...
s, schools, and the community, as well as those focussing on
active travel
Active mobility, soft mobility, active travel, active transport or active transportation is the transport of people or goods, through non-motorized means, based around human physical activity. The best-known forms of active mobility are walking a ...
,
leisure services and public sports,
weight management programmes, and
system-wide approaches.
Current practice
Organizations
World Health Organization (WHO)
The
World Health Organization
The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level o ...
(WHO) is a
specialized agency of the United Nations responsible for international public health.
The WHO Constitution, which establishes the agency's governing structure and principles, states its main objective as "the attainment by all peoples of the highest possible level of health". The WHO's broad mandate includes advocating for universal healthcare, monitoring public health risks, coordinating responses to health emergencies, and promoting human health and well-being. The WHO has played a leading role in several public health achievements, most notably the
eradication of
smallpox
Smallpox was an infectious disease caused by variola virus (often called smallpox virus) which belongs to the genus Orthopoxvirus. The last naturally occurring case was diagnosed in October 1977, and the World Health Organization (WHO) c ...
, the near-
eradication of polio
The word "Eradication" is derived from Latin word "radix" which means "root". It may refer to:
*Eradication of infectious diseases (human), the reduction of the global incidence of an infectious disease in humans to zero
*Eradication of infectiou ...
, and the development of an
Ebola vaccine
Ebola vaccines are vaccines either approved or in development to prevent Ebola. As of 2022, there are only vaccines against the Zaire ebolavirus. The first vaccine to be approved in the United States was rVSV-ZEBOV in December 2019. It had be ...
. Its current priorities include
communicable diseases, particularly
HIV/AIDS
Human immunodeficiency virus infection and acquired immunodeficiency syndrome (HIV/AIDS) is a spectrum of conditions caused by infection with the human immunodeficiency virus (HIV), a retrovirus. Following initial infection an individual ...
,
Ebola
Ebola, also known as Ebola virus disease (EVD) and Ebola hemorrhagic fever (EHF), is a viral hemorrhagic fever in humans and other primates, caused by ebolaviruses. Symptoms typically start anywhere between two days and three weeks after becom ...
,
COVID-19
Coronavirus disease 2019 (COVID-19) is a contagious disease caused by a virus, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first known case was identified in Wuhan, China, in December 2019. The disease quick ...
,
malaria
Malaria is a mosquito-borne infectious disease that affects humans and other animals. Malaria causes symptoms that typically include fever, tiredness, vomiting, and headaches. In severe cases, it can cause jaundice, seizures, coma, or death. ...
and
tuberculosis
Tuberculosis (TB) is an infectious disease usually caused by '' Mycobacterium tuberculosis'' (MTB) bacteria. Tuberculosis generally affects the lungs, but it can also affect other parts of the body. Most infections show no symptoms, ...
;
non-communicable diseases such as heart disease and cancer;
healthy diet, nutrition, and
food security
Food security speaks to the availability of food in a country (or geography) and the ability of individuals within that country (geography) to access, afford, and source adequate foodstuffs. According to the United Nations' Committee on World ...
;
occupational health; and
substance abuse.
Others
Most countries have their own governmental public health agency, often called the ministry of health, with responsibility for domestic health issues.
For example, in the
United States
The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country Continental United States, primarily located in North America. It consists of 50 U.S. state, states, a Washington, D.C., ...
, state and local
health departments are on the front line of public health initiatives. In addition to their national duties, the
United States Public Health Service (PHS), led by the
Surgeon General of the United States Public Health Service, and the
Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention (CDC) is the national public health agency of the United States. It is a United States federal agency, under the Department of Health and Human Services, and is headquartered in Atlanta, Georg ...
, headquartered in
Atlanta
Atlanta ( ) is the capital and most populous city of the U.S. state of Georgia. It is the seat of Fulton County, the most populous county in Georgia, but its territory falls in both Fulton and DeKalb counties. With a population of 498,7 ...
, are also involved with international health activities.
Public health programs
Most governments recognize the importance of public health programs in reducing the incidence of disease, disability, and the effects of
aging
Ageing ( BE) or aging ( AE) is the process of becoming older. The term refers mainly to humans, many other animals, and fungi, whereas for example, bacteria, perennial plants and some simple animals are potentially biologically immortal. In ...
and other physical and mental health conditions. However, public health generally receives significantly less government funding compared with medicine. Although the collaboration of local health and government agencies is considered best practice to improve public health, the pieces of evidence available to support this is limited. Public health programs providing
vaccination
Vaccination is the administration of a vaccine to help the immune system develop immunity from a disease. Vaccines contain a microorganism or virus in a weakened, live or killed state, or proteins or toxins from the organism. In stimulat ...
s have made major progress in promoting health, including substantially reducing the occurrence of
cholera and
polio
Poliomyelitis, commonly shortened to polio, is an infectious disease caused by the poliovirus. Approximately 70% of cases are asymptomatic; mild symptoms which can occur include sore throat and fever; in a proportion of cases more severe sy ...
and eradicating
smallpox
Smallpox was an infectious disease caused by variola virus (often called smallpox virus) which belongs to the genus Orthopoxvirus. The last naturally occurring case was diagnosed in October 1977, and the World Health Organization (WHO) c ...
, diseases that have plagued humanity for thousands of years.
The World Health Organization (WHO) identifies core functions of public health programs including:
* providing leadership on matters critical to health and engaging in partnerships where joint action is needed;
* shaping a
research agenda and stimulating the generation, translation and
dissemination of valuable knowledge;
* setting norms and standards and promoting and monitoring their implementation;
* articulating ethical and
evidence-based policy
Evidence-based policy is an idea in public policy proposing that policy decisions should be based on, or informed by, rigorously established objective evidence. The implied contrast is with policymaking based on ideology, 'common sense,' anecd ...
options;
* monitoring the health situation and assessing health trends.
In particular, public health surveillance programs can:
* serve as an
early warning system for impending public health emergencies;
* document the impact of an intervention, or track progress towards specified goals; and
* monitor and clarify the epidemiology of health problems, allow priorities to be set, and inform
health policy and strategies.
* diagnose, investigate, and monitor health problems and health hazards of the community
Behavior change
Many health problems are due to maladaptive personal behaviors. From an
evolutionary psychology
Evolutionary psychology is a theoretical approach in psychology that examines cognition and behavior from a modern evolutionary perspective. It seeks to identify human psychological adaptations with regards to the ancestral problems they evo ...
perspective, over consumption of novel substances that are harmful is due to the activation of an evolved
reward system for substances such as drugs, tobacco,
alcohol,
refined salt,
fat, and
carbohydrate
In organic chemistry, a carbohydrate () is a biomolecule consisting of carbon (C), hydrogen (H) and oxygen (O) atoms, usually with a hydrogen–oxygen atom ratio of 2:1 (as in water) and thus with the empirical formula (where ''m'' may o ...
s. New technologies such as modern transportation also cause reduced
physical activity
Physical activity is defined as any voluntary bodily movement produced by skeletal muscles that requires energy expenditure.Global Recommendations on Physical Activity for Health, 2009. World Health Organization. Geneva, Switzerland. Accessed 13/ ...
. Research has found that
behavior is more effectively changed by taking evolutionary motivations into consideration instead of only presenting information about health effects. The marketing industry has long known the importance of associating products with high status and attractiveness to others. Films are increasingly being recognized as a public health tool. In fact,
film festivals and
competitions have been established to specifically promote films about health. Conversely, it has been argued that emphasizing the harmful and undesirable effects of tobacco smoking on other persons and imposing smoking bans in public places have been particularly effective in reducing tobacco smoking.
Applications in health care
As well as seeking to improve population health through the implementation of specific population-level interventions, public health contributes to medical care by identifying and assessing population needs for health care services, including:
* Assessing current services and evaluating whether they are meeting the objectives of the
health care system
* Ascertaining requirements as expressed by
health professionals, the public and other stakeholders
* Identifying the most appropriate interventions
* Considering the effect on resources for proposed interventions and assessing their cost-effectiveness
* Supporting decision making in health care and planning health services including any necessary changes.
* Informing, educating, and empowering people about health issues
Conflicting aims
Some programs and policies associated with public
health promotion and prevention can be controversial. One such example is programs focusing on the prevention of
HIV transmission through
safe sex campaigns and
needle-exchange program
A needle and syringe programme (NSP), also known as needle exchange program (NEP), is a social service that allows injecting drug users (IDUs) to obtain clean and unused hypodermic needles and associated paraphernalia at little or no cost. It ...
s. Another is the control of
tobacco smoking
Tobacco smoking is the practice of burning tobacco and ingesting the resulting smoke. The smoke may be inhaled, as is done with cigarettes, or simply released from the mouth, as is generally done with pipes and cigars. The practice is beli ...
. Changing smoking behavior requires long-term strategies, unlike the fight against
communicable diseases
An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dis ...
, which usually takes a shorter period for effects to be observed. Many nations have implemented
major initiatives to cut smoking, such as increased taxation and bans on smoking in some or all public places. Supporters argue by presenting evidence that smoking is one of the major killers, 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 people to smoke. Opponents say that this undermines individual freedom and personal responsibility, and worry that the state may be encouraged to remove more and more choice in the name of better population health overall.
Psychological research confirms this tension between concerns about public health and concerns about personal liberty: (i) the best predictor of complying with public health recommendations such as hand-washing, mask-wearing, and staying at home (except for essential activity) during the
COVID-19 pandemic
The COVID-19 pandemic, also known as the coronavirus pandemic, is an ongoing global pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The novel virus was first identi ...
was people's perceived duties to prevent harm but (ii) the best predictor of flouting such public health recommendations was valuing liberty more than equality.
Simultaneously, while communicable diseases have historically ranged uppermost as a
global health priority,
non-communicable diseases and the underlying behavior-related risk factors have been at the bottom. This is changing, however, as illustrated by the
United Nations
The United Nations (UN) is an intergovernmental organization whose stated purposes are to maintain international peace and security, develop friendly relations among nations, achieve international cooperation, and be a centre for harmoni ...
hosting its first General Assembly Special Summit on the issue of non-communicable diseases in September 2011.
Global perspectives
Disparities in service and access
There is a significant disparity in access to health care and public health initiatives between
developed countries and
developing countries, as well as within developing countries. In developing countries, public health infrastructures are still forming. There may not be enough trained
health workers
A health professional, healthcare professional, or healthcare worker (sometimes abbreviated HCW) is a provider of health care treatment and advice based on formal training and experience. The field includes those who work as a nurse, physician ( ...
, monetary resources or, in some cases, sufficient knowledge to provide even a basic level of medical care and disease prevention.
As a result, a large majority of disease and mortality in developing countries results from and contributes to extreme
poverty. For example, many African governments spend less than
US$10 per person per year on health care, while, in the United States, the
federal government spent approximately US$4,500 per capita in 2000. However, expenditures on health care should not be confused with spending on public health. Public health measures may not generally be considered "health care" in the strictest sense. For example, mandating the use of seat belts in cars can save countless lives and contribute to the health of a population, but typically money spent enforcing this rule would not count as money spent on health care.
Large parts of the world remained plagued by largely preventable or treatable infectious diseases. In addition to this however, many developing countries are also experiencing an
epidemiological shift and
polarization in which populations are now experiencing more of the effects of chronic diseases as life expectancy increases, the poorer communities being heavily affected by both chronic and infectious diseases.
Another major public health concern in the developing world is poor
maternal and child health, exacerbated by
malnutrition and poverty. The
WHO reports that a lack of
exclusive breastfeeding during the first six months of life contributes to over a million avoidable child deaths each year.
Intermittent preventive therapy aimed at treating and preventing
malaria
Malaria is a mosquito-borne infectious disease that affects humans and other animals. Malaria causes symptoms that typically include fever, tiredness, vomiting, and headaches. In severe cases, it can cause jaundice, seizures, coma, or death. ...
episodes among pregnant women and young children is one public health measure in
endemic
Endemism is the state of a species being found in a single defined geographic location, such as an island, state, nation, country or other defined zone; organisms that are indigenous to a place are not endemic to it if they are also found else ...
countries.
Since the 1980s, the growing field of
population health has broadened the focus of public health from individual behaviors and
risk factor
In epidemiology, a risk factor or determinant is a variable associated with an increased risk of disease or infection.
Due to a lack of harmonization across disciplines, determinant, in its more widely accepted scientific meaning, is often u ...
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. There is a recognition that health is affected by many factors including class, race, income, educational status, region of residence, and
social relation
A social relation or also described as a social interaction or social experience is the fundamental unit of analysis within the social sciences, and describes any voluntary or involuntary interpersonal relationship between two or more individuals ...
ships; these are known as "
social determinants of health". The upstream drivers such as environment, education, employment, income, food security, housing,
social inclusion and many others effect the distribution of health between and within populations and are often shaped by policy. A social gradient in health runs through society. The poorest generally have the worst health, but even the middle classes will generally have worse health outcomes than those of a higher social level. The new public health advocates for population-based policies that improve health in an equitable manner.
Health aid in developing countries
Health aid to developing countries is an important source of public health funding for many developing countries.
Health aid to developing countries has shown a significant increase after World War II as concerns over the spread of disease as a result of
globalization
Globalization, or globalisation (Commonwealth English; see spelling differences), is the process of interaction and integration among people, companies, and governments worldwide. The term ''globalization'' first appeared in the early 20t ...
increased and the HIV/AIDS epidemic in sub-Saharan Africa surfaced.
From 1990 to 2010, total health aid from developed countries increased from 5.5 billion to 26.87 billion with wealthy countries continuously donating billions of dollars every year with the goal of improving population health.
Some efforts, however, receive a significantly larger proportion of funds such as HIV which received an increase in funds of over $6 billion between 2000 and 2010 which was more than twice the increase seen in any other sector during those years.
Health aid has seen an expansion through multiple channels including private philanthropy,
non-governmental organization
A non-governmental organization (NGO) or non-governmental organisation (see spelling differences) is an organization that generally is formed independent from government. They are typically nonprofit entities, and many of them are active in ...
s, private foundations such as the
Rockefeller Foundation or the
Bill & Melinda Gates Foundation, bilateral donors, and multilateral donors such as the
World Bank
The World Bank is an international financial institution that provides loans and grants to the governments of low- and middle-income countries for the purpose of pursuing capital projects. The World Bank is the collective name for the Inte ...
or
UNICEF.
The result has been a sharp rise in uncoordinated and fragmented funding of an ever-increasing number of initiatives and projects. To promote better strategic cooperation and coordination between partners, particularly among bilateral development agencies and funding organizations, the
Swedish International Development Cooperation Agency
The Swedish International Development Cooperation Agency ( sv, Styrelsen för internationellt utvecklingssamarbete, ) is a government agency of the Swedish Ministry for Foreign Affairs. Sida is responsible for organization of the bulk of Swed ...
(Sida) spearheaded the establishment of ESSENCE, an initiative to facilitate dialogue between donors/funders, allowing them to identify synergies. ESSENCE brings together a wide range of funding agencies to coordinate funding efforts.
In 2009 health aid from the
OECD
The Organisation for Economic Co-operation and Development (OECD; french: Organisation de coopération et de développement économiques, ''OCDE'') is an intergovernmental organisation with 38 member countries, founded in 1961 to stimulate ...
amounted to $12.47 billion which amounted to 11.4% of its total bilateral aid.
In 2009, Multilateral donors were found to spend 15.3% of their total aid on bettering public healthcare.
International health aid debates
Debates exist questioning the efficacy of international health aid. Supporters of aid claim that health aid from wealthy countries is necessary in order for developing countries to escape the
poverty trap. Opponents of health aid claim that international health aid actually disrupts developing countries' course of development, causes dependence on aid, and in many cases the aid fails to reach its recipients.
For example, recently, health aid was funneled towards initiatives such as financing new technologies like
antiretroviral medication,
insecticide-treated mosquito nets, and new vaccines. The positive impacts of these initiatives can be seen in the eradication of smallpox and
polio
Poliomyelitis, commonly shortened to polio, is an infectious disease caused by the poliovirus. Approximately 70% of cases are asymptomatic; mild symptoms which can occur include sore throat and fever; in a proportion of cases more severe sy ...
; however, critics claim that misuse or misplacement of funds may cause many of these efforts to never come into achievement.
Economic modeling based on the
Institute for Health Metrics and Evaluation and the
World Health Organization
The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level o ...
has shown a link between international health aid in developing countries and a reduction in adult mortality rates.
However, a 2014–2016 study suggests that a potential confounding variable for this outcome is the possibility that aid was directed at countries once they were already on track for improvement.
That same study, however, also suggests that 1 billion dollars in health aid was associated with 364,000 fewer deaths occurring between ages 0 and 5 in 2011.
Sustainable development goals for 2030
To address current and future challenges in addressing health issues in the world, the
United Nations
The United Nations (UN) is an intergovernmental organization whose stated purposes are to maintain international peace and security, develop friendly relations among nations, achieve international cooperation, and be a centre for harmoni ...
have developed the
Sustainable Development Goals
The Sustainable Development Goals (SDGs) or Global Goals are a collection of 17 interlinked objectives designed to serve as a "shared blueprint for peace and prosperity for people and the planet, now and into the future".United Nations (2017) R ...
to be completed by 2030. These goals in their entirety encompass the entire spectrum of development across nations, however Goals 1–6 directly address
health disparities
Health equity arises from access to the social determinants of health, specifically from wealth, power and prestige. Individuals who have consistently been deprived of these three determinants are significantly disadvantaged from health inequiti ...
, primarily in developing countries.
These six goals address key issues in
global public health,
poverty, hunger and
food security
Food security speaks to the availability of food in a country (or geography) and the ability of individuals within that country (geography) to access, afford, and source adequate foodstuffs. According to the United Nations' Committee on World ...
, health, education,
gender equality
Gender equality, also known as sexual equality or equality of the sexes, is the state of equal ease of access to resources and opportunities regardless of gender, including economic participation and decision-making; and the state of valuing d ...
and
women's empowerment
Women's empowerment (or female empowerment) may be defined in several ways, including accepting women's viewpoints, making an effort to seek them and raising the status of women through education, awareness, literacy, and training.Kabeer, Naila ...
, and
water
Water (chemical formula ) is an inorganic, transparent, tasteless, odorless, and nearly colorless chemical substance, which is the main constituent of Earth's hydrosphere and the fluids of all known living organisms (in which it acts as ...
and
sanitation.
Public health officials can use these goals to set their own agenda and plan for smaller scale initiatives for their organizations. These goals are designed to lessen the burden of disease and inequality faced by developing countries and lead to a healthier future. The links between the various sustainable development goals and public health are numerous and well established.
History
Until the 18th century
From the beginnings of
human civilization, communities promoted
health
Health, according to the World Health Organization, is "a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity".World Health Organization. (2006)''Constitution of the World Health Organ ...
and fought
disease at the population level.
Definitions of health as well as methods to pursue it differed according to the medical, religious and natural-
philosophical ideas groups held, the resources they had, and the changing circumstances in which they lived. Yet few early societies displayed the hygienic stagnation or even apathy often attributed to them. The latter reputation is mainly based on the absence of present-day
bioindicators, especially
immunological
Immunology is a branch of medicineImmunology for Medical Students, Roderick Nairn, Matthew Helbert, Mosby, 2007 and biology that covers the medical study of immune systems in humans, animals, plants and sapient species. In such we can see the ...
and
statistical
Statistics (from German: '' Statistik'', "description of a state, a country") is the discipline that concerns the collection, organization, analysis, interpretation, and presentation of data. In applying statistics to a scientific, industr ...
tools developed in light of the
germ theory of disease
The germ theory of disease is the currently accepted scientific theory for many diseases. It states that microorganisms known as pathogens or "germs" can lead to disease. These small organisms, too small to be seen without magnification, invade ...
transmission.
Public health was born neither in
Europe
Europe is a large peninsula conventionally considered a continent in its own right because of its great physical size and the weight of its history and traditions. Europe is also considered a Continent#Subcontinents, subcontinent of Eurasia ...
nor as a response to the
Industrial Revolution
The Industrial Revolution was the transition to new manufacturing processes in Great Britain, continental Europe, and the United States, that occurred during the period from around 1760 to about 1820–1840. This transition included going f ...
. Preventive health interventions are attested almost anywhere historical communities have left their mark. In
Southeast Asia
Southeast Asia, also spelled South East Asia and South-East Asia, and also known as Southeastern Asia, South-eastern Asia or SEA, is the geographical south-eastern region of Asia, consisting of the regions that are situated south of mainland ...
, for instance,
Ayurvedic medicine and subsequently
Buddhism
Buddhism ( , ), also known as Buddha Dharma and Dharmavinaya (), is an Indian religion or philosophical tradition based on teachings attributed to the Buddha. It originated in northern India as a -movement in the 5th century BCE, and ...
fostered occupational, dietary and sexual regimens that promised balanced bodies, lives and communities, a notion strongly present in
Traditional Chinese Medicine
Traditional Chinese medicine (TCM) is an alternative medical practice drawn from traditional medicine in China. It has been described as "fraught with pseudoscience", with the majority of its treatments having no logical mechanism of acti ...
as well. Among the
Mayans,
Aztecs and other early civilizations in the
Americas
The Americas, which are sometimes collectively called America, are a landmass comprising the totality of North America, North and South America. The Americas make up most of the land in Earth's Western Hemisphere and comprise the New World. ...
, population centers pursued hygienic programs, including by holding
medicinal herbal markets. And among
Aboriginal Australians
Aboriginal Australians are the various Indigenous peoples of the Australian mainland and many of its islands, such as Tasmania, Fraser Island, Hinchinbrook Island, the Tiwi Islands, and Groote Eylandt, but excluding the Torres Strait ...
, techniques for preserving and protecting water and food sources, micro-zoning to reduce pollution and fire risks, and screens to protect people against
flies were common, even in temporary camps.
Western European,
Byzantine
The Byzantine Empire, also referred to as the Eastern Roman Empire or Byzantium, was the continuation of the Roman Empire primarily in its eastern provinces during Late Antiquity and the Middle Ages, when its capital city was Constantinopl ...
and
Islamicate civilizations, which generally adopted a
Hippocratic,
Galen
Aelius Galenus or Claudius Galenus ( el, Κλαύδιος Γαληνός; September 129 – c. AD 216), often Anglicized as Galen () or Galen of Pergamon, was a Greek physician, surgeon and philosopher in the Roman Empire. Considered to be o ...
ic or
humoral medical system, fostered preventive programs as well. These were developed on the basis of evaluating the quality of local
climate
Climate is the long-term weather pattern in an area, typically averaged over 30 years. More rigorously, it is the mean and variability of meteorological variables over a time spanning from months to millions of years. Some of the meteorologi ...
s, including
topography
Topography is the study of the forms and features of land surfaces. The topography of an area may refer to the land forms and features themselves, or a description or depiction in maps.
Topography is a field of geoscience and planetary sc ...
, wind conditions and exposure to the sun, and the properties and availability of water and food, for both
human
Humans (''Homo sapiens'') are the most abundant and widespread species of primate, characterized by bipedalism and exceptional cognitive skills due to a large and complex brain. This has enabled the development of advanced tools, cultu ...
s and nonhuman
animal
Animals are multicellular, eukaryotic organisms in the biological kingdom Animalia. With few exceptions, animals consume organic material, breathe oxygen, are able to move, can reproduce sexually, and go through an ontogenetic stage ...
s. Diverse authors of
medical,
architectural,
engineering
Engineering is the use of scientific principles to design and build machines, structures, and other items, including bridges, tunnels, roads, vehicles, and buildings. The discipline of engineering encompasses a broad range of more speciali ...
and
military manuals explained how to apply such theories to groups of different origins and under different circumstances. This was crucial, since under Galenism bodily constitutions were thought to be heavily shaped by their material
environments
Environment most often refers to:
__NOTOC__
* Natural environment, all living and non-living things occurring naturally
* Biophysical environment, the physical and biological factors along with their chemical interactions that affect an organism or ...
, so their balance required specific regimens as they traveled during different
seasons and between climate zones.
In
complex,
pre-industrialized societies, interventions designed to reduce health risks could be the initiative of different stakeholders. For instance, in
Greek and
Roman antiquity
In modern historiography, ancient Rome refers to Roman civilisation from the founding of the city of Rome in the 8th century BC to the collapse of the Western Roman Empire in the 5th century AD. It encompasses the Roman Kingdom (753–50 ...
, army generals learned to provide for soldiers' wellbeing, including off the
battlefield, where most combatants died prior to the twentieth century. In
Christian monasteries across the
Eastern Mediterranean and western Europe since at least the fifth century
CE,
monk
A monk (, from el, μοναχός, ''monachos'', "single, solitary" via Latin ) is a person who practices religious asceticism by monastic living, either alone or with any number of other monks. A monk may be a person who decides to dedic ...
s and
nuns pursued strict but balanced regimens, including nutritious
diets, developed explicitly to extend their lives. And
royal
Royal may refer to:
People
* Royal (name), a list of people with either the surname or given name
* A member of a royal family
Places United States
* Royal, Arkansas, an unincorporated community
* Royal, Illinois, a village
* Royal, Iowa, a ...
, princely and
papal courts, which were often mobile as well, likewise adapted their behavior to suit environmental conditions in the sites they occupied. They could also choose sites they considered salubrious for their members and sometimes had them modified.
In
cities, residents and rulers developed measures to benefit the general
population
Population typically refers to the number of people in a single area, whether it be a city or town, region, country, continent, or the world. Governments typically quantify the size of the resident population within their jurisdiction usi ...
, which faced a broad array of recognized
health risks. These provide some of the most sustained evidence for preventive measures in earlier civilizations. In numerous sites the upkeep of
infrastructures, including roads, canals and marketplaces, as well as
zoning policies, were introduced explicitly to preserve residents' health. Officials such as the
muhtasib in the Middle East and the
Road master in Italy, fought the combined threats of
pollution
Pollution is the introduction of contaminants into the natural environment that cause adverse change. Pollution can take the form of any substance (solid, liquid, or gas) or energy (such as radioactivity, heat, sound, or light). Pollutants, th ...
through
sin,
ocular intromission and
miasma. Craft
guild
A guild ( ) is an association of artisans and merchants who oversee the practice of their craft/trade in a particular area. The earliest types of guild formed as organizations of tradesmen belonging to a professional association. They sometim ...
s were important agents of waste disposal and promoted
harm reduction through honesty and
labor safety among their members. Medical practitioners, including public physicians, collaborated with urban governments in predicting and preparing for calamities and identifying and isolating people perceived as
lepers, a disease with strong moral connotations.
Neighborhoods were also active in safeguarding local people's health, by monitoring at-risk sites near them and taking appropriate social and legal action against artisanal polluters and neglectful owners of animals. Religious institutions, individuals and charitable organizations in both
Islam
Islam (; ar, ۘالِإسلَام, , ) is an Abrahamic monotheistic religion centred primarily around the Quran, a religious text considered by Muslims to be the direct word of God (or '' Allah'') as it was revealed to Muhammad, the ...
and Christianity likewise promoted moral and physical wellbeing by endowing urban amenities such as wells, fountains, schools and bridges, also in the service of
pilgrim
A pilgrim (from the Latin ''peregrinus'') is a traveler (literally one who has come from afar) who is on a journey to a holy place. Typically, this is a physical journey (often on foot) to some place of special significance to the adherent of ...
s. In western Europe and Byzantium, religious
processions commonly took place, which purported to act as both preventive and curative measures for the entire community.
Urban residents and other groups also developed preventive measures in response to calamities such as
war,
famine
A famine is a widespread scarcity of food, caused by several factors including war, natural disasters, crop failure, population imbalance, widespread poverty, an economic catastrophe or government policies. This phenomenon is usually accompan ...
,
flood
A flood is an overflow of water ( or rarely other fluids) that submerges land that is usually dry. In the sense of "flowing water", the word may also be applied to the inflow of the tide. Floods are an area of study of the discipline hydrol ...
s and
widespread disease. During and after the
Black Death (1346–53), for instance, inhabitants of the
Eastern Mediterranean and
Western Europe
Western Europe is the western region of Europe. The region's countries and territories vary depending on context.
The concept of "the West" appeared in Europe in juxtaposition to "the East" and originally applied to the ancient Mediterranean ...
reacted to massive population decline in part on the basis of existing medical theories and protocols, for instance concerning meat consumption and burial, and in part by developing new ones. The latter included the establishment of
quarantine facilities and health boards, some of which eventually became regular urban (and later national) offices. Subsequent measures for protecting cities and their regions included issuing health
passports for travelers, deploying guards to create
sanitary cordons for protecting local inhabitants, and gathering morbidity and mortality statistics. Such measures relied in turn on better transportation and communication networks, through which news on human and animal disease was efficiently spread.
After the 18th century
With the onset of the
Industrial Revolution
The Industrial Revolution was the transition to new manufacturing processes in Great Britain, continental Europe, and the United States, that occurred during the period from around 1760 to about 1820–1840. This transition included going f ...
, living standards amongst the working population began to worsen, with cramped and unsanitary urban conditions. In the first four decades of the 19th century alone,
London
London is the capital and List of urban areas in the United Kingdom, largest city of England and the United Kingdom, with a population of just under 9 million. It stands on the River Thames in south-east England at the head of a estuary dow ...
's population doubled and even greater growth rates were recorded in the new industrial towns, such as
Leeds
Leeds () is a city and the administrative centre of the City of Leeds district in West Yorkshire, England. It is built around the River Aire and is in the eastern foothills of the Pennines. It is also the third-largest settlement (by popul ...
and
Manchester
Manchester () is a city in Greater Manchester, England. It had a population of 552,000 in 2021. It is bordered by the Cheshire Plain to the south, the Pennines to the north and east, and the neighbouring city of Salford to the west. The ...
. This rapid
urbanization
Urbanization (or urbanisation) refers to the population shift from rural to urban areas, the corresponding decrease in the proportion of people living in rural areas, and the ways in which societies adapt to this change. It is predominantly th ...
exacerbated the spread of disease in the large
conurbations that built up around the
workhouse
In Britain, a workhouse () was an institution where those unable to support themselves financially were offered accommodation and employment. (In Scotland, they were usually known as poorhouses.) The earliest known use of the term ''workhouse' ...
s and
factories. These settlements were cramped and primitive with no organized
sanitation. Disease was inevitable and its incubation in these areas was encouraged by the poor lifestyle of the inhabitants. Unavailable housing led to the rapid growth of
slums and the
per capita death rate
Mortality rate, or death rate, is a measure of the number of deaths (in general, or due to a specific cause) in a particular population, scaled to the size of that population, per unit of time. Mortality rate is typically expressed in units of d ...
began to rise alarmingly, almost doubling in
Birmingham
Birmingham ( ) is a city and metropolitan borough in the metropolitan county of West Midlands in England. It is the second-largest city in the United Kingdom with a population of 1.145 million in the city proper, 2.92 million in the We ...
and
Liverpool
Liverpool is a City status in the United Kingdom, city and metropolitan borough in Merseyside, England. With a population of in 2019, it is the List of English districts by population, 10th largest English district by population and its E ...
.
Thomas Malthus warned of the dangers of overpopulation in 1798. His ideas, as well as those of
, became very influential in government circles in the early years of the 19th century.
The latter part of the century brought the establishment of the basic pattern of improvements in public health over the next two centuries: a social evil was identified, private philanthropists brought attention to it, and changing public opinion led to government action.
The 18th century saw rapid growth in voluntary hospitals in
England
England is a country that is part of the United Kingdom. It shares land borders with Wales to its west and Scotland to its north. The Irish Sea lies northwest and the Celtic Sea to the southwest. It is separated from continental Europe ...
.
The practice of
vaccination
Vaccination is the administration of a vaccine to help the immune system develop immunity from a disease. Vaccines contain a microorganism or virus in a weakened, live or killed state, or proteins or toxins from the organism. In stimulat ...
began in the 1800s, following the pioneering work of
Edward Jenner in treating
smallpox
Smallpox was an infectious disease caused by variola virus (often called smallpox virus) which belongs to the genus Orthopoxvirus. The last naturally occurring case was diagnosed in October 1977, and the World Health Organization (WHO) c ...
.
James Lind's discovery of the causes of
scurvy
Scurvy is a deficiency disease, disease resulting from a lack of vitamin C (ascorbic acid). Early symptoms of deficiency include weakness, feeling tired and sore arms and legs. Without treatment, anemia, decreased red blood cells, gum disease, ch ...
amongst sailors and its mitigation via the introduction of
fruit
In botany, a fruit is the seed-bearing structure in flowering plants that is formed from the ovary after flowering.
Fruits are the means by which flowering plants (also known as angiosperms) disseminate their seeds. Edible fruits in partic ...
on lengthy voyages was published in 1754 and led to the adoption of this idea by the
Royal Navy
The Royal Navy (RN) is the United Kingdom's naval warfare force. Although warships were used by English and Scottish kings from the early medieval period, the first major maritime engagements were fought in the Hundred Years' War against Fr ...
. Efforts were also made to promulgate health matters to the broader public; in 1752 the British physician Sir
John Pringle published ''Observations on the Diseases of the Army in Camp and Garrison'', in which he advocated for the importance of adequate ventilation in the
military
A military, also known collectively as armed forces, is a heavily armed, highly organized force primarily intended for warfare. It is typically authorized and maintained by a sovereign state, with its members identifiable by their distinct ...
barracks and the provision of
latrines for the soldiers.
Public health legislation in England
The first attempts at sanitary reform and the establishment of public health institutions were made in the 1840s.
Thomas Southwood Smith
Thomas Southwood Smith (17881861) was an English physician and sanitary reformer.
Early life
Smith was born at Martock, Somerset, into a strict Baptist family, his parents being William Smith and Caroline Southwood. In 1802 he won a scholarshi ...
, physician at the
London Fever Hospital
The London Fever Hospital was a voluntary hospital financed from public donations in Liverpool Road in London. It was one of the first fever hospitals in the country.
History
Originally established with 15 beds in 1802 in Gray's Inn Road, it mo ...
, began to write papers on the importance of public health, and was one of the first physicians brought in to give evidence before the
Poor Law Commission in the 1830s, along with
Neil Arnott
Dr Neil Arnott FRS LLD (15 May 1788March 1874) was a Scottish physician and inventor. He was the inventor of one of the first forms of the waterbed, the Arnott waterbed, and was awarded the Rumford Medal in 1852 for the construction of the ...
and
James Phillips Kay
Sir James Phillips Kay-Shuttleworth, 1st Baronet (20 July 1804 – 26 May 1877, born James Kay) of Gawthorpe Hall, Lancashire, was a British politician and educationist. He founded a further-education college that would eventually become Plymo ...
. Smith advised the government on the importance of
quarantine and sanitary improvement for limiting the spread of infectious diseases such as
cholera and
yellow fever
Yellow fever is a viral disease of typically short duration. In most cases, symptoms include fever, chills, loss of appetite, nausea, muscle pains – particularly in the back – and headaches. Symptoms typically improve within five days. ...
.
The Poor Law Commission reported in 1838 that "the expenditures necessary to the adoption and maintenance of measures of prevention would ultimately amount to less than the cost of the disease now constantly engendered". It recommended the implementation of large scale government
engineering
Engineering is the use of scientific principles to design and build machines, structures, and other items, including bridges, tunnels, roads, vehicles, and buildings. The discipline of engineering encompasses a broad range of more speciali ...
projects to alleviate the conditions that allowed for the propagation of disease.
[ The Health of Towns Association was formed at Exeter Hall London on 11 December 1844, and vigorously campaigned for the development of public health in the ]United Kingdom
The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom (UK) or Britain, is a country in Europe, off the north-western coast of the continental mainland. It comprises England, Scotland, Wales and ...
. Its formation followed the 1843 establishment of the Health of Towns Commission, chaired by Sir Edwin Chadwick, which produced a series of reports on poor and insanitary conditions in British cities.[
These national and local movements led to the ]Public Health Act
Public Health Act is a stock short title used in the United Kingdom for legislation relating to public health.
List
*The Public Health Act 1848 (11 & 12 Vict c 63)
*The Sanitary Act 1866 (29 & 30 Vict c 90) is sometimes called the Public Health A ...
, finally passed in 1848. It aimed to improve the sanitary condition of towns and populous places in England and Wales by placing the supply of water, sewerage, drainage, cleansing and paving under a single local body with the General Board of Health as a central authority. The Act was passed by the Liberal government
A government is the system or group of people governing an organized community, generally a state.
In the case of its broad associative definition, government normally consists of legislature, executive, and judiciary. Government i ...
of Lord John Russell, in response to the urging of Edwin Chadwick. Chadwick's seminal report on ''The Sanitary Condition of the Labouring Population'' was published in 1842 and was followed up with a supplementary report a year later. During this time, James Newlands (appointed following the passing of the 1846 Liverpool Sanatory Act championed by the Borough of Liverpool Health of Towns Committee) designed the world's first integrated sewerage system, in Liverpool (1848-1869), with Joseph Bazalgette later creating London's sewerage system (1858-1875).
The Vaccination Act 1853 introduced compulsory smallpox vaccination in England and Wales. By 1871 legislation required a comprehensive system of registration run by appointed vaccination officers.
Further interventions were made by a series of subsequent Public Health Acts
Public Health Act is a stock short title used in the United Kingdom for legislation relating to public health.
List
*The Public Health Act 1848 (11 & 12 Vict c 63)
*The Sanitary Act 1866 (29 & 30 Vict c 90) is sometimes called the Public Health A ...
, notably the 1875 Act. Reforms included the building of sewers, the regular collection of garbage followed by incineration or disposal in a landfill, the provision of clean water and the draining of standing water to prevent the breeding of mosquitoes.
The Infectious Disease (Notification) Act 1889 mandated the reporting of infectious diseases to the local sanitary authority, which could then pursue measures such as the removal of the patient to hospital and the disinfection of homes and properties.
Public health legislation in other countries
In the United States, the first public health organization based on a state health department and local boards of health was founded in New York City
New York, often called New York City or NYC, is the List of United States cities by population, most populous city in the United States. With a 2020 population of 8,804,190 distributed over , New York City is also the L ...
in 1866.
In Germany during The Weimar Republic the country faced many public health catastrophes. The Nazi Party
The Nazi Party, officially the National Socialist German Workers' Party (german: Nationalsozialistische Deutsche Arbeiterpartei or NSDAP), was a far-right political party in Germany active between 1920 and 1945 that created and supported t ...
formed with a goal of modernizing health care with ''The Volksgesundheit'', German for ''public health folk''; this modernization was based on the growing field of eugenics
Eugenics ( ; ) is a fringe set of beliefs and practices that aim to improve the genetic quality of a human population. Historically, eugenicists have attempted to alter human gene pools by excluding people and groups judged to be inferior o ...
and measures prioritizing group health over any care for the health of individuals. The end of World War 2 led to the Nuremberg Code, a set of research ethics concerning human experimentation.
Epidemiology
The science of epidemiology
Epidemiology is the study and analysis of the distribution (who, when, and where), patterns and determinants of health and disease conditions in a defined population.
It is a cornerstone of public health, and shapes policy decisions and evi ...
was founded by John Snow's identification of a polluted public water well as the source of an 1854 cholera outbreak in London. Snow believed in the germ theory of disease as opposed to the prevailing miasma theory. By talking to local residents (with the help of Reverend Henry Whitehead
Henry Whitehead (22 September 1825 – 5 March 1896) was a Church of England priest and the assistant curate of St Luke's Church in Soho, London, during the 1854 cholera outbreak.
A former believer in the miasma theory of disease, Whitehead ...
), he identified the source of the outbreak as the public water pump on Broad Street (now Broadwick Street
Broadwick Street (formerly Broad Street) is a street in Soho, City of Westminster, London. It runs for 0.18 miles (0.29 km) approximately west–east between Marshall Street and Wardour Street, crossing Berwick Street.
Broad Street was not ...
). Although Snow's chemical and microscope examination of a water sample from the Broad Street pump
Soho is an area of the City of Westminster, part of the West End of London. Originally a fashionable district for the aristocracy, it has been one of the main entertainment districts in the capital since the 19th century.
The area was develop ...
did not conclusively prove its danger, his studies of the pattern of the disease were convincing enough to persuade the local council to close the well pump by removing its handle.
Snow later used a dot map to illustrate the cluster of cholera cases around the pump. He also used statistics to illustrate the connection between the quality of the water source and cholera cases. He showed that the Southwark and Vauxhall Waterworks Company was taking water from sewage-polluted sections of the Thames and delivering the water to homes, leading to an increased incidence of cholera. Snow's study was a major event in the history of public health and geography. It is regarded as the founding event of the science of epidemiology
Epidemiology is the study and analysis of the distribution (who, when, and where), patterns and determinants of health and disease conditions in a defined population.
It is a cornerstone of public health, and shapes policy decisions and evi ...
.
Control of infectious diseases
With the pioneering work in bacteriology of French chemist Louis Pasteur and German scientist Robert Koch, methods for isolating the bacteria
Bacteria (; singular: bacterium) are ubiquitous, mostly free-living organisms often consisting of one biological cell. They constitute a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria were am ...
responsible for a given disease and vaccines for remedy were developed at the turn of the 20th century. British physician Ronald Ross identified the mosquito as the carrier of malaria
Malaria is a mosquito-borne infectious disease that affects humans and other animals. Malaria causes symptoms that typically include fever, tiredness, vomiting, and headaches. In severe cases, it can cause jaundice, seizures, coma, or death. ...
and laid the foundations for combating the disease. Joseph Lister
Joseph Lister, 1st Baron Lister, (5 April 182710 February 1912) was a British surgeon, medical scientist, experimental pathologist and a pioneer of antiseptic surgery and preventative medicine. Joseph Lister revolutionised the craft of ...
revolutionized surgery
Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pa ...
by the introduction of antiseptic surgery
Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pa ...
to eliminate infection
An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable di ...
. French epidemiologist Paul-Louis Simond
Paul-Louis Simond (30 July 1858 – 3 March 1947) was a French physician, chief medical officer and biologist whose major contribution to science was his demonstration that the intermediates in the transmission of bubonic plague from rats to h ...
proved that plague
Plague or The Plague may refer to:
Agriculture, fauna, and medicine
*Plague (disease), a disease caused by ''Yersinia pestis''
* An epidemic of infectious disease (medical or agricultural)
* A pandemic caused by such a disease
* A swarm of pes ...
was carried by flea
Flea, the common name for the order Siphonaptera, includes 2,500 species of small flightless insects that live as external parasites of mammals and birds. Fleas live by ingesting the blood of their hosts. Adult fleas grow to about long, ...
s on the back of rats, and Cuban scientist Carlos J. Finlay and U.S. Americans Walter Reed and James Carroll demonstrated that mosquitoes carry the virus responsible for yellow fever
Yellow fever is a viral disease of typically short duration. In most cases, symptoms include fever, chills, loss of appetite, nausea, muscle pains – particularly in the back – and headaches. Symptoms typically improve within five days. ...
. Brazilian scientist Carlos Chagas
Carlos Justiniano Ribeiro Chagas, or Carlos Chagas (; July 9, 1879 – November 8, 1934), was a Brazilian sanitary physician, scientist, and bacteriologist who worked as a clinician and researcher. He discovered Chagas disease, also called ''A ...
identified a tropical disease
Tropical diseases are diseases that are prevalent in or unique to tropical and subtropical regions. The diseases are less prevalent in temperate climates, due in part to the occurrence of a cold season, which controls the insect population by f ...
and its vector.
Society and culture
Education and training
Education and training of public health professionals is available throughout the world in Schools of Public Health, Medical Schools, Veterinary Schools, Schools of Nursing, and Schools of Public Affairs. The training typically requires a university degree with a focus on core disciplines of biostatistics, epidemiology
Epidemiology is the study and analysis of the distribution (who, when, and where), patterns and determinants of health and disease conditions in a defined population.
It is a cornerstone of public health, and shapes policy decisions and evi ...
, health services administration, health policy, health education, behavioral science, gender issues, sexual and reproductive health, public health nutrition, and occupational and environmental health.
In the global context, the field of public health education has evolved enormously in recent decades, supported by institutions such as the World Health Organization
The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level o ...
and the World Bank
The World Bank is an international financial institution that provides loans and grants to the governments of low- and middle-income countries for the purpose of pursuing capital projects. The World Bank is the collective name for the Inte ...
, among others. Operational structures are formulated by strategic principles, with educational and career pathways guided by competency frameworks, all requiring modulation according to local, national and global realities. It is critically important for the health of populations that nations assess their public health human resource needs and develop their ability to deliver this capacity, and not depend on other countries to supply it.
Schools of public health: a US perspective
In the United States
The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country Continental United States, primarily located in North America. It consists of 50 U.S. state, states, a Washington, D.C., ...
, the Welch-Rose Report of 1915 has been viewed as the basis for the critical movement in the history of the institutional schism between public health and medicine because it led to the establishment of schools of public health supported by the Rockefeller Foundation. The report was authored by William Welch, founding dean of the Johns Hopkins Bloomberg School of Public Health, and Wickliffe Rose of the Rockefeller Foundation. The report focused more on research than practical education. Some have blamed the Rockefeller Foundation's 1916 decision to support the establishment of schools of public health for creating the schism between public health and medicine and legitimizing the rift between medicine's laboratory investigation of the mechanisms of disease and public health's nonclinical concern with environmental and social influences on health and wellness.
Even though schools of public health had already been established in Canada
Canada is a country in North America. Its ten provinces and three territories extend from the Atlantic Ocean to the Pacific Ocean and northward into the Arctic Ocean, covering over , making it the world's second-largest country by to ...
, Europe
Europe is a large peninsula conventionally considered a continent in its own right because of its great physical size and the weight of its history and traditions. Europe is also considered a Continent#Subcontinents, subcontinent of Eurasia ...
and North Africa
North Africa, or Northern Africa is a region encompassing the northern portion of the African continent. There is no singularly accepted scope for the region, and it is sometimes defined as stretching from the Atlantic shores of Mauritania in ...
, the United States had still maintained the traditional system of housing faculties of public health within their medical institutions. A $25,000 donation from businessman Samuel Zemurray
Samuel Zemurray (born Schmuel Zmurri; January 18, 1877 – November 30, 1961), nicknamed "Sam the Banana Man", was an American businessman who made his fortune in the banana trade. He founded the Cuyamel Fruit Company and later became president o ...
instituted the School of Public Health and Tropical Medicine at Tulane University in 1912 conferring its first doctor of public health degree in 1914. The Yale School of Public Health was founded by Charles-Edward Amory Winslow in 1915. The Johns Hopkins School of Hygiene and Public Health was founded in 1916 and became an independent, degree-granting institution for research and training in public health, and the largest public health training facility in the United States. By 1922, schools of public health were established at Columbia
Columbia may refer to:
* Columbia (personification), the historical female national personification of the United States, and a poetic name for America
Places North America Natural features
* Columbia Plateau, a geologic and geographic region i ...
and Harvard on the Hopkins model. By 1999 there were twenty nine schools of public health in the US, enrolling around fifteen thousand students.
Over the years, the types of students and training provided have also changed. In the beginning, students who enrolled in public health schools typically had already obtained a medical degree; public health school training was largely a second degree for medical professionals. However, in 1978, 69% of American students enrolled in public health schools had only a bachelor's degree
A bachelor's degree (from Middle Latin ''baccalaureus'') or baccalaureate (from Modern Latin ''baccalaureatus'') is an undergraduate academic degree awarded by colleges and universities upon completion of a course of study lasting three to si ...
.
Degrees in public health
Schools of public health offer a variety of degrees generally fall into two categories: professional or academic. The two major postgraduate degrees are the Master of Public Health (MPH) or the Master of Science
A Master of Science ( la, Magisterii Scientiae; abbreviated MS, M.S., MSc, M.Sc., SM, S.M., ScM or Sc.M.) is a master's degree in the field of science awarded by universities in many countries or a person holding such a degree. In contrast t ...
in Public Health (MSPH). Doctoral studies in this field include Doctor of Public Health (DrPH) and Doctor of Philosophy
A Doctor of Philosophy (PhD, Ph.D., or DPhil; Latin: or ') is the most common degree at the highest academic level awarded following a course of study. PhDs are awarded for programs across the whole breadth of academic fields. Because it is ...
(PhD) in a subspecialty of greater Public Health disciplines. DrPH is regarded as a professional degree and PhD as more of an academic degree.
Professional degrees are oriented towards practice in public health settings. The Master of Public Health, Doctor of Public Health, Doctor of Health Science (DHSc/DHS) and the Master of Health Care Administration are examples of degrees which are geared towards people who want careers as practitioners of public health in health departments, managed care and community-based organizations, hospitals and consulting firms, among others. Master of Public Health degrees broadly fall into two categories, those that put more emphasis on an understanding of epidemiology and statistics as the scientific basis of public health practice and those that include a more wide range of methodologies. A Master of Science of Public Health is similar to an MPH but is considered an academic degree (as opposed to a professional degree) and places more emphasis on scientific methods and research. The same distinction can be made between the DrPH and the DHSc. The DrPH is considered a professional degree and the DHSc is an academic degree.
Academic degrees are more oriented towards those with interests in the scientific basis of public health and preventive medicine who wish to pursue careers in research, university teaching in graduate programs, policy analysis and development, and other high-level public health positions. Examples of academic degrees are the Master of Science
A Master of Science ( la, Magisterii Scientiae; abbreviated MS, M.S., MSc, M.Sc., SM, S.M., ScM or Sc.M.) is a master's degree in the field of science awarded by universities in many countries or a person holding such a degree. In contrast t ...
, Doctor of Philosophy
A Doctor of Philosophy (PhD, Ph.D., or DPhil; Latin: or ') is the most common degree at the highest academic level awarded following a course of study. PhDs are awarded for programs across the whole breadth of academic fields. Because it is ...
, Doctor of Science
Doctor of Science ( la, links=no, Scientiae Doctor), usually abbreviated Sc.D., D.Sc., S.D., or D.S., is an academic research degree awarded in a number of countries throughout the world. In some countries, "Doctor of Science" is the degree used f ...
(ScD), and Doctor of Health Science (DHSc). The doctoral programs are distinct from the MPH and other professional programs by the addition of advanced coursework and the nature and scope of a dissertation research project.
Notable people
* John Graunt (1620–1674) was a British citizen scientist who laid the foundations for epidemiology.
* Edward Jenner (1749–1823) created the smallpox vaccine, the first vaccine in the world. He is often known as "the father of immunology
Immunology is a branch of medicineImmunology for Medical Students, Roderick Nairn, Matthew Helbert, Mosby, 2007 and biology that covers the medical study of immune systems in humans, animals, plants and sapient species. In such we can see ther ...
."
* Benjamin Waterhouse
Benjamin Waterhouse (March 4, 1754, Newport, Colony of Rhode Island and Providence Plantations – October 2, 1846, Cambridge, Massachusetts) was a physician, co-founder and professor of Harvard Medical School. He is most well known for being ...
(1753–1846) introduced the smallpox vaccine in the United States.
* Lemuel Shattuck
Lemuel Shattuck (15 October 1793, Ashby, Massachusetts – 17 January 1859, Boston, Massachusetts) was a Boston politician, historian, bookseller and publisher.
Biography
He taught at Troy and Albany, NY and from 1818 to 1821 at the frontier o ...
(1793–1859) has been described as an "architect" and "prophet" of American public health
* Sir Joseph William Bazalgette (1819–1891) created a sewer network for central London in response to the Great Stink
The Great Stink was an event in Central London during July and August 1858 in which the hot weather exacerbated the smell of untreated human waste and industrial effluent that was present on the banks of the River Thames. The problem had been m ...
of 1858. This proved instrumental in relieving the city from cholera epidemics.
* Louis Pasteur (1822–1895) conducted research that laid the foundation for our understanding of the causes and preventions of diseases.
* Charles V. Chapin
Charles Value Chapin (January 17, 1856 – January 31, 1941) was an American pioneer in public health research and practice during the Progressive Era. He was superintendent of health for Providence, Rhode Island between 1884 and 1932. He ...
(1856–1941) public health advocate and researcher credited with planting "the roots of quality in public health" in the United States
* Sara Josephine Baker
Sara Josephine Baker (November 15, 1873 – February 22, 1945) was an American physician notable for making contributions to public health, especially in the immigrant communities of New York City. Her fight against the damage that widespread ur ...
(1873–1945) was an "instrumental force in child and maternal health"
* Nora Wattie
Nora Wattie (1900–1994) MBChB (Aberdeen), DPH (Cambridge) was a pioneer of social medicine, setting up Glasgow’s internationally renowned ante-natal care service (both before and after the creation of the National Health Service).
Througho ...
(1900–1994) led the development of public health services and sanitation, and education in improving women and child health in the poorest slums of Glasgow
Glasgow ( ; sco, Glesca or ; gd, Glaschu ) is the most populous city in Scotland and the fourth-most populous city in the United Kingdom, as well as being the 27th largest city by population in Europe. In 2020, it had an estimated popu ...
, for which she received the OBE.
* Jonas Salk (1914–1995) developed one of the first polio vaccines and campaigned vigorously for mandatory vaccinations.
* Ruth Huenemann (1910-2005) She became a pioneer in the study of childhood obesity in the 1960s studying the diet and exercise habits of Berkeley teenagers.
Country examples
Canada
In Canada, the Public Health Agency of Canada is the national agency responsible for public health, emergency preparedness and response, and infectious and chronic disease control and prevention.
Cuba
Since the 1959 Cuban Revolution the Cuban government
Cuba has had a socialist political system since 1959 based on the "one state – one party" principle. Cuba is constitutionally defined as a Marxist–Leninist state. The present Constitution of Cuba, which was passed in a 2019 referendum, also ...
has devoted extensive resources to the improvement of health conditions for its entire population via universal access to health care. Infant mortality has plummeted. Cuban medical internationalism
After the 1959 Cuban Revolution, Cuba established a program to send its medical personnel overseas, particularly to Latin America, Africa
Africa is the world's second-largest and second-most populous continent, after Asia in both case ...
as a policy has seen the Cuban government sent doctors as a form of aid and export to countries in need in Latin America, especially Venezuela
Venezuela (; ), officially the Bolivarian Republic of Venezuela ( es, link=no, República Bolivariana de Venezuela), is a country on the northern coast of South America, consisting of a continental landmass and many islands and islets in th ...
, as well as Oceania and Africa countries.
Colombia and Bolivia
Public health was important elsewhere in Latin America in consolidating state power and integrating marginalized populations into the nation-state. In Colombia, public health was a means for creating and implementing ideas of citizenship. In Bolivia, a similar push came after their 1952 revolution.
Ghana
Though curable and preventive, malaria remains a major public health issue and is the third leading cause of death in Ghana. In the absence of a vaccine, mosquito control, or access to anti-malaria medication, public health methods become the main strategy for reducing the prevalence and severity of malaria. These methods include reducing breeding sites, screening doors and windows, insecticide sprays, prompt treatment following infection, and usage of insecticide treated mosquito nets. Distribution and sale of insecticide-treated mosquito nets is a common, cost-effective anti-malaria public health intervention; however, barriers to use exist including cost, household and family organization, access to resources, and social and behavioral determinants which have not only been shown to affect malaria prevalence rates but also mosquito net use.
France
Mexico
United States
The United States lacks a coherent system for the governmental funding of public health, relying on a variety of agencies and programs at the federal, state and local levels.
Between 1960 and 2001, public health spending in the United States tended to grow,
based on increasing expenditures by state and local government, which made up 80-90% of
total public health spending. Spending in support of public health in the United States peaked in 2002 and declined in the following decade. State cuts to public health funding during the Great Recession
The Great Recession was a period of marked general decline, i.e. a recession, observed in national economies globally that occurred from late 2007 into 2009. The scale and timing of the recession varied from country to country (see map). At ...
of 2007-2008 were not restored in subsequent years.
As of 2012, a panel for the U.S. Institute of Medicine panel warned that the United States spends disproportionately far more on clinical care than it does on public health, neglecting "population-based activities that offer efficient and effective approaches to improving the nation's health." , about 3% of government health spending was directed to public health and prevention. This situation has been described as an "uneven patchwork" and "chronic underfunding".
The COVID-19 pandemic
The COVID-19 pandemic, also known as the coronavirus pandemic, is an ongoing global pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The novel virus was first identi ...
has been seen as drawing attention to problems in the public health system in the United States and to a lack of understanding of public health and its important role as a common good
In philosophy, economics, and political science, the common good (also commonwealth, general welfare, or public benefit) is either what is shared and beneficial for all or most members of a given community, or alternatively, what is achieved by c ...
.
See also
* Effects of climate change on human health
The effects of climate change on human health include direct effects of extreme weather, leading to injury and loss of life, as well as indirect effects, such as undernutrition brought on by crop failures or a lack of access to safe drinking water ...
* European Public Health Association
The European Public Health Association (EUPHA) is an organization of public health associations and institutes in Europe. It was founded in 1992.
Its central office is based at the NIVEL (Nederlands instituut voor onderzoek van de gezondheidszo ...
(EUPHA) is an umbrella organization for public health associations and institutes in Europe
* List of national public health agencies
References
{{DEFAULTSORT:Public Health
Euthenics
Health economics
Health policy
Medical humanities
Sanitation