# Public Health
## Introduction

This page about Public Health can be displayed as Wiki2Reveal slides. Single sections are regarded as slides and modifications on the slides will immediately affect the content of the slides. The content addresses the following topics:
* (1) Origin of Public Health
* (2) Interdisciplinary Scope
* (3) Challenges, Requirements and Constraints

## Learning Tasks

* Describe the link between Public Health and One Health.
* What are historical drivers for the establishment of Public Health initiatives?
* Explain the requirements and constraints of international collaboration to fight pandemics and epidemiological risks?
* How does public health "literacy" or awareness of public health risk mitigation strategies contribution the health of society? Identify examples and explain how they work?

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Wiki2Reveal presentations can be used as a collaborative maintained Open Educational Resources
* Internet abuse - (Wiki2Reveal slides)
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* Priority areas
* Organizations and Global perspective

## Objective

This learning resource about Public Health has the objective to be introduced into the origin and current initiatives and concepts in the public health domain and related approaches in the health care system and governmental agencies.

## Learning Moduls

* History
* Society and Culture
* Methods of Public Health
* Ethics

## Overview

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".

### Determinants of Health

Analyzing the determinants of health of a population 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.

### Concept of Health

The concept of health takes into account physical, psychological, and social well-being.

### Interdisciplinary Science

Public health is an interdisciplinary field. For example, epidemiology, biostatistics, social sciences and management of health services are all relevant.

#### Important Sub-fields

Other important sub-fields include environmental health, community health, behavioral health, health economics, public policy, mental health, health education, health politics, occupational safety, disability, oral health, gender issues in health, and sexual and reproductive health.

#### Public Health as part of overall Health Care System

Public health, together with primary care, secondary care, and tertiary care, is part of a country's overall healthcare system.

### Public Health Implementation

Public health is implemented through the surveillance of cases and health indicators, and through the promotion of healthy behaviors.

#### Common Public Health Initiatives

Common public health initiatives include promotion of hand-washing and breastfeeding, delivery of vaccinations, 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 diseases.

#### Access to Health Care Services and Disease Prevention

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.

#### History of Public Health

From the beginnings of human civilization, communities promoted health 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.

#### Sanitation and Disease Prevention

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, "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 care, usually with a public health emphasis, dealing with health across regional or national boundaries.[citation needed] Public health is not the same as public healthcare (publicly funded health care).

#### Preventive Medicine

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".$^{(p1)}$ 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.$^{(pp1,3)}$

#### Population Health

Since the 1990s many scholars in public health have been using the term population health.$^{(p3)}$ There are no medical specialties directly related to population health.$^{(p4)}$ Valles argues that consideration of health equity 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.$^{(p163)}$ 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.$^{(p4)}$

#### Lifestyle 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.$^{(p3)}$ Valles argues that the term social medicine has a narrower and more biomedical focus than the term population health.$^{(p7)}$

### Purposes

The purpose of a public health intervention 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.[citation needed]

### 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, biostatistics, social sciences and management of health services are all relevant.

#### Public Health Sub-Fields

Other important sub-fields include environmental health, community health, behavioral health, health economics, public policy, mental health, health education, health politics, occupational safety, disability, gender issues in health, and sexual and reproductive health.

#### Multidisciplinary Public Health Practice

Modern public health practice requires multidisciplinary teams of public health workers and professionals. Teams might include epidemiologists, biostatisticians, physician assistants, public health nurses, midwives, medical microbiologists, pharmacists, economists, sociologists, geneticists, data managers, environmental health officers (public health inspectors), bioethicists, gender experts, sexual and reproductive health specialists, physicians, and veterinarians.

#### Temporal and spatial Requirements and Constraints

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[citation needed] and public health risks may have temporal and spatial patterns (e.g. communicable diseases and dependencies of mosquito abundance on environmental conditions.

#### Preventive Initiatives

Common public health initiatives include promotion of hand-washing and breastfeeding, delivery of vaccinations, suicide prevention, smoking cessation, obesity education, increasing healthcare accessibility and distribution of condoms to control the spread of sexually transmitted diseases.[citation needed]

## 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 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 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, 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.

### 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 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." As of 2018 , 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 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.