Public health  

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Train wreck at Montparnasse (October 22, 1895) by Studio Lévy and Sons.
Train wreck at Montparnasse (October 22, 1895) by Studio Lévy and Sons.

Public health is "the science and art of preventing disease, prolonging life and promoting health through the organised efforts and informed choices of society, organisations, public and private, communities and individuals." It is concerned with threats to the overall health of a community based on population health analysis. The population in question can be as small as a handful of people or as large as all the inhabitants of several continents (for instance, in the case of a pandemic). Public health is typically divided into epidemiology, biostatistics and health services. Environmental, social, behavioral, and occupational health are also important subfields.

The focus of public health intervention is to prevent rather than treat a disease through surveillance of cases and the promotion of healthy behaviors. In addition to these activities, in many cases treating a disease may be vital to preventing it in others, such as during an outbreak of an infectious disease. Hand washing, vaccination programs and distribution of condoms are examples of public health measures.

The goal of public health is to improve lives through the prevention and treatment of disease. The United Nations' World Health Organization defines health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." In 1920, C.E.A. Winslow defined public health as "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals."



In some ways, public health is a modern concept of human development in science, although it has roots in antiquity. From the beginnings of human civilization, it was recognized that polluted water and lack of proper waste disposal spread communicable diseases (theory of miasma). Early religions attempted to regulate behavior that specifically related to health, from types of food eaten, to regulating certain indulgent behaviors, such as drinking alcohol or sexual relations. The establishment of governments placed responsibility on leaders to develop public health policies and programs in order to gain some understanding of the causes of disease and thus ensure social stability prosperity, and maintain order.

The term "healthy city" used by today's public health advocates reflects this ongoing challenge to collective physical well-being that results from crowded conditions and urbanization.

Early public health interventions

thumb|200px|Public health nursing made available through child welfare services in U.S. (c. 1930s)

By Roman times, it was well understood that proper diversion of human waste was a necessary tenet of public health in urban areas. The ancient Chinese medical doctors developed the practice of variolation following a smallpox epidemic around 1000 BC. An individual without the disease could gain some measure of immunity against it by inhaling the dried crusts that formed around lesions of infected individuals. Also, children were protected by inoculating a scratch on their forearms with the pus from a lesion. This practice was not documented in the West until the early-18th century, and was used on a very limited basis. The practice of vaccination did not become prevalent until the 1820s, following the work of Edward Jenner to treat smallpox.

During the 14th century Black Death in Europe, it was believed that removing bodies of the dead would further prevent the spread of the bacterial infection. This did little to stem the plague, however, which was most likely spread by rodent-borne fleas. Burning parts of cities resulted in much greater benefit, since it destroyed the rodent infestations Template:Citation needed. The development of quarantine in the medieval period helped mitigate the effects of other infectious diseases. However, according to Michel Foucault, the plague model of governmentality was later controverted by the cholera model. A Cholera pandemic devastated Europe between 1829 and 1851, and was first fought by the use of what Foucault called "social medicine", which focused on flux, circulation of air, location of cemeteries, etc. All those concerns, born of the miasma theory of disease, were mixed with urbanistic concerns for the management of populations, which Foucault designated as the concept of "biopower". The German conceptualized this in the Polizeiwissenschaft ("Police science").

The science of epidemiology was founded by John Snow's identification of a polluted public water well as the source of an 1854 cholera outbreak in London. Dr. Snow believed in the germ theory of disease as opposed to the prevailing miasma theory. Although miasma theory correctly teaches that disease is a result of poor sanitation, it was based upon the prevailing theory of spontaneous generation. Germ theory developed slowly: despite Anton van Leeuwenhoek's observations of Microorganisms, (which are now known to cause many of the most common infectious diseases) in the year 1680, the modern era of public health did not begin until the 1880s, with Louis Pasteur's germ theory and production of artificial vaccines.

Other public health interventions include latrinization, the building of sewers, the regular collection of garbage followed by incineration or disposal in a landfill, providing clean water and draining standing water to prevent the breeding of mosquitoes. This contribution was made by Edwin Chadwick in 1843 who published a report on the sanitation of the working class population in Great Britain at the time. So began the inception of the modern public health. The industrial revolution had initially caused the spread of disease through large conurbations around workhouses and factories. These settlements were cramped and primitive and there was no organised sanitation. Disease was inevitable and its incubation in these areas was encouraged by the poor lifestyle of the inhabitants.

Modern public health

In the U.S., the role of public health nurse began in Los Angeles in 1898, by 1924 there were 12,000 public health nurses, half of them in the 100 largest cities. Their average annual salary in larger cities was $1390 In addition, there were thousands of nurses employed by private agencies handling similar work. Public health nurses supervised health issues in the public and parochial schools, to prenatal and infant care, handled communicable diseases and tuberculosis and dealt with an aerial diseases.

Disease control

With the onset of the epidemiological transition 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 and heart disease. Previous efforts in many developed countries had already led to dramatic reductions in the infant mortality rate using preventative methods. For instance in the United States, public health worker Dr. Sara Josephine Baker established many programs to help the poor in New York City keep their infants healthy, leading teams of nurses into the crowded neighborhoods of Hell's Kitchen and teaching mothers how to dress, feed, and bathe their babies.

During the 20th century and early in the next, the dramatic increase in average life span is widely credited to public health achievements, such as vaccination programs and control of many infectious diseases including polio, diphtheria, yellow fever and smallpox; effective health and safety policies such as road traffic safety and occupational safety; improved family planning; tobacco control measures; and programs designed to decrease non-communicable diseases by acting on known risk factors such as a person's background, lifestyle and environment. One of the major sources of the increase in average life span in the early 20th century was the decline in the "urban penalty" brought on by improvements in sanitation. These improvements included chlorination of drinking water, filtration and sewage treatment which led to the decline in deaths caused by infectious waterborne diseases such as cholera and intestinal diseases. In Cutler and Miller's, "The Role of Public Health Improvements in Health Advances", they display evidence of the decline in typhoid fever deaths in Chicago, Baltimore, Cincinnati, and Cleveland after these American cities adopted chlorination, filtration, or a sewage improvement.

Meanwhile, large parts of the developing world remained plagued by largely preventable/treatable infectious diseases and poor maternal and child health outcomes, 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 episodes among pregnant women and young children is one public health measure in endemic countries.

Front-page headlines continue to present society with public health issues on a daily basis: emerging infectious diseases such as SARS, rapidly making its way from China (see Public health in China) to Canada, the United States and other geographically distant countries; reducing inequities in health care access through publicly funded health insurance programs; the HIV/AIDS pandemic and its spread from certain high-risk groups to the general population in many countries, such as in South Africa; the increase of childhood obesity and the concomitant increase in type II diabetes among children; the social, economic and health impacts of adolescent pregnancy; and the ongoing public health challenges related to natural disasters such as the 2004 Indian Ocean tsunami, 2005's Hurricane Katrina in the United States and the 2010 Haiti earthquake.

Since the 1980s, the growing field of population health has broadened the focus of public health from individual behaviors and risk factors to population-level issues such as inequality, poverty, and education. Modern public health is often concerned with addressing determinants of health across a population. There is a recognition that our health is affected by many factors including where we live, genetics, our income, our educational status and our social relationships - these are known as "social determinants of health." A social gradient in health runs through society, with those that are poorest generally suffering the worst health. However even those in the middle classes will generally have worse health outcomes than those of a higher social stratum. The new public health seeks to address these health inequalities by advocating for population-based policies that improve health in an equitable manner.

Public Health 2.0

Public Health 2.0 is the term given to a movement within public health that aims to make the field more accessible to the general public and more user-driven. There are three senses in which the term "Public Health 2.0" is used. In the first sense, "Public Health 2.0" is similar to the term "Health 2.0" and is used to describe the ways in which traditional public health practitioners and institutions are reaching out (or could reach out) to the public through social media and health blogs. In the second sense, "Public Health 2.0" is used to describe public health research that uses data gathered from social networking sites, search engine queries, cell phones, or other technologies. In the third sense, "Public Health 2.0" is used to describe public health activities that are completely user-driven. An example this type of Public Health 2.0 is the collection and sharing of information about environmental radiation levels following the March 2011 tsunami in Japan.

In all cases, Public Health 2.0 draws on ideas from Web 2.0, such as crowdsourcing, information sharing, and user-centred design.

See also


Preventive healthcare

Population health

Biological and epidemiological statistics

Infectious and epidemic disease prevention

Food hygiene and safety management

Health behavioral sciences



Unless indicated otherwise, the text in this article is either based on Wikipedia article "Public health" or another language Wikipedia page thereof used under the terms of the GNU Free Documentation License; or on original research by Jahsonic and friends. See Art and Popular Culture's copyright notice.

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