Public health, the art and science of preventing disease, prolonging life, and promoting physical and mental health, sanitation, personal hygiene, control of infectious diseases, and organization of health services. From the normal human interactions involved in dealing with the many problems of social life, there has emerged a recognition of the importance of community action in the promotion of health and the prevention and treatment of disease, and this is expressed in the concept of public health.
polio vaccineA health care worker giving a polio vaccine to a child in Katsina state, Nigeria, 2014.Alford Williams/Centers for Disease Control and Prevention (CDC)
Comparable terms for public health medicine are social medicine and community medicine; the latter has been widely adopted in the United Kingdom, and the practitioners are called community physicians. The practice of public health draws heavily on medical science and philosophy and concentrates especially on manipulating and controlling the environment for the benefit of the public. It is concerned therefore with housing, water supplies, and food. Noxious agents can be introduced into these through farming, fertilizers, inadequate sewage disposal and drainage, construction, defective heating and ventilating systems, machinery, and toxic chemicals. Public health medicine is part of the greater enterprise of preserving and improving the public health. Community physicians cooperate with diverse groups, from architects, builders, sanitary and heating and ventilating engineers, and factory and food inspectors to psychologists and sociologists, chemists, physicists, and toxicologists. Occupational medicine is concerned with the health, safety, and welfare of persons in the workplace. It may be viewed as a specialized part of public health medicine since its aim is to reduce the risks in the environment in which persons work.
The venture of preserving, maintaining, and actively promoting public health requires special methods of information-gathering (epidemiology) and corporate arrangements to act upon significant findings and put them into practice. Statistics collected by epidemiologists attempt to describe and explain the occurrence of disease in a population by correlating factors such as diet, environment, radiation exposure, or cigarette smoking with the incidence and prevalence of disease. The government, through laws and regulations, creates agencies to oversee and formally inspect and monitor water supplies, food processing, sewage treatment, drains, and pollution. Governments also are concerned with the control of epidemic diseases, establishing guidelines for appropriate medical responses and isolation procedures, and issuing travel warnings to prevent the spread of disease from affected areas.
Ministry of Public Health worker administering water-purifying tablets in Kabul, 2005.Tomas Munita/AP
Various public health agencies have been established to help control and monitor disease within societies, on both national and international levels. For example, the United Kingdom’s Public Health Act of 1848 established a special public health ministry for England and Wales. In the United States, public health is studied and coordinated on a national level by the Centers for Disease Control and Prevention (CDC). Internationally, the World Health Organization (WHO) plays an equivalent role. WHO is especially important in providing assistance for the implementation of organizational and administrative methods of handling problems associated with health and disease in less-developed countries worldwide. Within these countries, health problems, limitations of resources, education of health personnel, and other factors must be taken into account in designing health service systems.
Advances in science and medicine in developed countries, including the generation of vaccines and antibiotics, have been fundamental in bringing vital aid to countries afflicted by a high burden of disease. Yet, despite the expansion of resources and improvements in the mobilization of these resources to the most severely afflicted areas, the incidence of preventable disease and of neglected tropical disease remains exceptionally high worldwide. Reducing the impact and prevalence of these diseases is a major goal of international public health. The persistence of such diseases in the world, however, serves as an important indication of the difficulties that health organizations and societies continue to confront.
History of public health
A review of the historical development of public health, which began in ancient times, emphasizes how various public health concepts have evolved. Historical public health measures included quarantine of leprosy victims in the Middle Ages and efforts to improve sanitation following the 14th-century plague epidemics. Population increases in Europe brought with them increased awareness of infant deaths and a proliferation of hospitals. These developments in turn led to the establishment of modern public health agencies and organizations, designed to control disease within communities and to oversee the availability and distribution of medicines.
Beginnings in antiquity
Most of the world’s ancient peoples practiced cleanliness and personal hygiene, often for religious reasons, including, apparently, a wish to be pure in the eyes of their gods. The Bible, for example, has many adjurations and prohibitions about clean and unclean living. Religion, law, and custom were inextricably interwoven. For thousands of years societies looked upon epidemics as divine judgments on the wickedness of humankind. The idea that pestilence is due to natural causes, such as climate and physical environment, however, gradually developed. This great advance in thought took place in Greece during the 5th and 4th centuries bce and represented the first attempt at a rational, scientific theory of disease causation. An association between malaria and swamps, for example, was established very early (503–403 bce), even though the reasons for the association were obscure. In the book Airs, Waters, and Places, thought to have been written by Greek physician Hippocrates in the 5th or 4th century bce, the first systematic attempt was made to set forth a causal relationship between human diseases and the environment. Until the new sciences of bacteriology and immunology emerged well into the 19th century, this book provided a theoretical basis for the comprehension of endemic disease (that persisting in a particular locality) and epidemic disease (that affecting a number of people within a relatively short period).
Hippocrates, undated bust.© Photos.com/Thinkstock