What is Public Health, and Why is it Important?

What is public health?
Key concepts and components of public health
Conclusion
References
Further reading

Public health involves a collective social effort to enhance health and prevent communicable and non-communicable diseases. Public health fulfills its mission through organized, interdisciplinary efforts that address the physical, mental, and environmental health concerns of communities and populations at risk for disease and injury.

Rooted in the foundational definitions of pioneers like C.E.A. Winslow and Donald Acheson, public health operates across diverse domains, from epidemiology's study of disease patterns to biostatistics' role in data-driven decision-making. Effective health service administration and governance ensure the equitable distribution of public health resources and services.

What is public health?

Public health was defined by C.E.A. Winslow (1920) as "the science and art of preventing disease, prolonging life, and promoting health and efficiency through organized community efforts and informed choices of society, organizations, public and private communities, and individuals." ¹

In 1988, Donald Achenson described public health as "the science and art of preventing disease, prolonging life, and promoting human health through organized efforts and informed choices of society, organizations (both public and private), communities, and individuals." ²

The following are the three main roles of public health: Identifying health issues and priorities by evaluating and monitoring the wellbeing of at-risk groups and communities; Creating public policies to address these regional and national health goals and concerns in partnership with community and government leaders; Ensuring that all populations have access to appropriate and affordable health promotion and disease prevention services, as well as monitoring the success of this care.³

Key concepts and components of public health

Epidemiology

In the scientific field of epidemiology, the distribution (frequency and pattern) and factors of health-related population events are examined, and this research is then applied to prevent and control health problems.

The epidemiologist's role involves gathering relevant data from the field, analyzing and summarizing complex epidemiological data, and developing various strategies for controlling and preventing health issues.⁴ They identify health issues within affected communities, determine the source and method of illness transmission, collect information from clinical studies and disease surveys, conduct interview studies, and examine intricate epidemiological data to conclude.

Epidemiologists also develop action plans to address population health emergencies by producing reports that outline various disease factors. Another aspect of epidemiology involves presenting and disseminating epidemiological data to formulate public health policies. Their work forms the basis for numerous initiatives aimed at raising public health awareness.⁴

Biostatistics

The theoretical foundation for deriving knowledge from data, even in the face of unpredictability and uncertainty, comes from statistical reasoning.⁵ Most empirical research in clinical medicine and public health relies heavily on it; the greatest studies include biostatistical input on everything from study design to data analysis and reporting.

Biostatistics involves complex problem-solving using mathematics, probability, and technological skills like computing. An understanding of the sources of bias, which form the foundation of statistical theory and methodology, is also essential. Developing these skills, along with the ability to conceptualize issues and navigate the complexities between intricate procedures and real-world health challenges, requires in-depth training. The fields of epidemiology and health services research heavily depend on biostatistical methods.⁵

Health service administration

The effective management of health services and the execution of policies are essential components of health service administration. According to the U.S. Bureau of Labor Statistics, health-service administrators in certain facilities are responsible for scheduling employees, hiring and onboarding new employees, and resource management. A health services administrator may be in charge of the facility's overall management in smaller settings.⁶

Health services administration is the discipline that integrates science, business, and policy to manage the financial and human resources required to provide high-quality public health services. Health systems are facing many difficulties in the current global health environment, such as population increase, aging populations, and rising rates of chronic illnesses.

This means that instead of focusing on acute interventions, health managers and leaders at the community level must adjust health services to prioritize long-term care and prevention. Increases in communicable and non-communicable diseases are occurring in countries all over the world, from Asia and Europe to Africa. This has an impact on how health systems must develop and distribute resources.⁷

For societies to perform vital public health tasks, they need to have the necessary infrastructure and resources in place. This system, which is led by public health service administration and governance, makes up the infrastructure of public health. In order to accomplish the fundamental tasks of public health, governance and management collaborate.⁸

Environmental health

Our health is impacted by the environment in many different ways. Human health can be greatly impacted by events connected to climate change or environmental contaminants. Up to 24% of all fatalities globally in 2016 were linked to environmental factors. A few of the contributing factors are growing heat waves and extreme weather, air, water, and sanitation pollution, hazardous chemical exposure, and more. Estimating the disease burden resulting from environmental variables requires knowledge of exposure and exposure-response interactions.⁹

The ability of ecosystems to deliver commodities and services that can be converted into economic advantages for humans, such as values linked to improving health and reducing mortality, is threatened by climate change and anthropogenic forcing. Human health is already suffering from the detrimental effects of this deterioration, and things could get much worse over the next 50 years.

Policies pertaining to the environment and health should be linked because of their close relationship. Improving air quality and ensuring sufficient sources of safe drinking water have a substantial positive impact on people's health and wellbeing. Bathing water quality is also found to have significant societal advantages, which justifies the expenditures of abatement measures. Mitigating the effects of climate change is crucial for improving public health.¹⁰

Social and behavioral sciences

Public health outcomes are frequently shaped by individual behavioral patterns, even though the influence of public health is measured at the population level. Policymakers and practitioners can benefit from behavioral science's understanding of how and why various groups choose behaviors, as well as how those choices can either lessen or increase inequality. Behavioral science can help enhance the whole healthcare system and produce positive health outcomes. ¹¹

The majority of today's public health issues are related to community and individual habits, which differ greatly depending on the situation. Sneezing into one's elbow, for instance, might be a personal, reflexive habit that uses minimal outside resources. Certain behaviors, like being vaccinated, washing your hands, or living a healthy lifestyle, depend on a complicated interaction of psychological, cognitive, social, cultural, environmental, and economic factors.

Developing and assessing public health policies and interventions requires considering expert discussions of behavioral theory and evidence. This approach is crucial due to the complexity of tackling health-related behaviors beyond conventional biomedical methods.¹¹

The goal of public health has always been to lower population-level health hazards through behavior modification. Ideas such as health literacy refer to individual knowledge and abilities that are learned from day-to-day experiences and interactions and are essential for encouraging health-related behaviors.¹²

The Ottawa Charter of WHO states that the goal of health promotion programs is to establish environments that promote healthier choices.¹³ Health and risk communication plays a crucial role in shaping societal norms and providing accurate information during health emergencies.^14,15 Interventions that target housing and food access are examples of social determinants of health that target behaviors at the individual and community levels.¹⁶

In order to address complicated health challenges like chronic diseases, the "fifth wave of public health" places a strong emphasis on incorporating behavioral science. This method looks for evidence-based comprehension and behavior change of habits that are critical to improving health outcomes. Effectively integrating behavioral evidence into public health policies and practices is still a challenge, which frequently leads to the fragmented implementation of behavioral interventions.

Notwithstanding these obstacles, the necessity for a unified behavioral science framework spanning public health disciplines is becoming increasingly apparent.¹⁷ Global institutions such as the World Bank and the WHO are supporting efforts to create evidence-based, comprehensive behavior change initiatives.

Today's leading causes of death include social and behavioral factors such as tobacco use, poor diet, lack of exercise, substance abuse (including drugs and alcohol), risky sexual behavior, and lack of access to healthcare.

Over the past ten years, research has shown that interventions grounded in social and behavioral science theories have been successful in preventing HIV, heart disease, alcohol-related disorders, cancer, homelessness, and mental health issues.¹⁸ These studies highlight the application of behavioral and social sciences to public health practice.

A growing body of research indicates that promoting community health is more likely through multilevel interventions that consider the interactions of social, environmental, biological, and behavioral components.¹⁸

Conclusion

Public health, as defined by C.E.A. Winslow and later articulated by Donald Acheson, underscores its core mission: preventing disease, prolonging life, and promoting health through community-based efforts and informed societal choices. This holistic approach guides the three primary functions of public health: identifying health priorities, crafting effective policies in collaboration with communities and governments, and ensuring equitable access to health services.

Epidemiology, central to this endeavor, analyzes health patterns and develops strategies to control diseases, supported by biostatistics' rigorous data analysis. Effective health service administration, reliant on governance, is pivotal for delivering essential public health services and managing resources. Environmental health research emphasizes the critical impact of environmental factors on public health, advocating for policy interventions to safeguard wellbeing.

Moreover, integrating social and behavioral sciences into public health practices addresses contemporary health challenges, highlighting the importance of comprehensive, multilevel interventions. Together, these components form the bedrock of public health, driving initiatives to enhance community health outcomes and foster a healthier society.

References

1. Winslow, C.E.A. (1920). The untilled fields of public health. Science, 51(1306), 23–33.
2. Acheson, E. D. (1988). On the state of the public health [The Fourth Duncan Lecture]. *Public Health, 102*(5), 431–437. https://doi.org/10.1016/S0033-3506(88)80080-5
3. What is public health? [Online] Stony Brook Medicine. Available from: https://publichealth.stonybrookmedicine.edu/about/whatispublichealth
4. Sharma, D., Hussain, S., Rani, A., et al. (2020). COVID-19: Role of epidemiologist in public health emergency, India. International Journal of Health Sciences Research, 10(9), 264-273.
5. Lee, K. J., Moreno-Betancur, M., Kasza, J., Marschner, I. C., Barnett, A. G., & Carlin, J. B. (2019). Biostatistics: a fundamental discipline at the core of modern health data science. The Medical journal of Australia, 211(10), 444–446.e1. https://doi.org/10.5694/mja2.50372
6. Fisher C. What Are the Differences Between Health Care Administration & Health Service Administration? [Online] Chron. Available at: https://work.chron.com/differences-between-health-care-administration-health-service-administration-30251.html
7. Figueroa, C. A., Harrison, R., Chauhan, A., & Meyer, L. (2019). Priorities and challenges for health leadership and workforce management globally: a rapid review. BMC health services research, 19(1), 239. https://doi.org/10.1186/s12913-019-4080-7
8. Bontá, D., & Cagle, M. (2009). Governance and management of public health programmes. In R. Detels, et al. (Eds.), Oxford Textbook of Public Health (5th ed., chap. 47). Oxford Textbooks. Oxford Academic. https://doi.org/10.1093/med/9780199218707.003.0047
9. Estimating environmental health impacts. [Online] World Health Organization. Available at: https://www.who.int/activities/environmental-health-impacts
10. Remoundou, K., & Koundouri, P. (2009). Environmental effects on public health: an economic perspective. International journal of environmental research and public health, 6(8), 2160–2178. https://doi.org/10.3390/ijerph6082160
11. Behavioral science around the world: volume III: public health. (2024). World Health Organization. Available at: https://www.who.int/publications/i/item/B09046
12. Health Promotion Glossary of Terms. (2021a). [Online] World Health Organization. Available at: https://www.who.int/publications/i/ item/9789240038349.
13. The Ottawa Charter for Health Promotion. (1987). World Health Organization. Available at: https://www.who.int/publications/i/item/ottawa-charter-for-health-promotion
14. WHO Strategic Communications Framework for effective communications. (2017a). World Health Organization. Available at: https://iris.who.int/bitstream/hand le/10665/259807/9789241550208-eng.pdf?sequence=2
15. Communicating risk in public health emergencies: a WHO guideline for emergency risk communication (ERC) policy and practice. (2017b). World Health Organization. Available at: https://www.who.int/docs/default-source/documents/communicating-for-health/ communication-framework.pdf.
16. A conceptual framework for action on the social determinants of health (2010b). World Health Organization. Available at: https://iris.who.int/bitstream/hand le/10665/259807/9789241550208-eng.pdf?sequence=2
17. Davies, S. C., Winpenny, E., Ball, S., Fowler, T., Rubin, J., & Nolte, E. (2014). For debate: A new wave in public health improvement. The Lancet, 384(9957), 1889-1895. https://doi.org/10.1016/S0140-6736(13)62341-7
18. VanDevanter, N., Shinn, M., Niang, K. T., Bleakley, A., Perl, S., & Cohen, N. (2003). The role of social and behavioral science in public health practice: a study of the New York City Department of Health. Journal of urban health : bulletin of the New York Academy of Medicine, 80(4), 625–634. https://doi.org/10.1093/jurban/jtg069

Further Reading

• All Public Health Content
• Social Media, Pseudoscience, and Misinformation: the impact on public understanding of health and medical science
• How Infodemiology Shapes Public Health in the Digital Age
• Sitting is the New Smoking