Tutorial Module 1: What Is Public Health?

For many, the concept of health is usually attributed to a medical professional – most often a physician. When people are sick they seek medical care to regain their health. However, there is a side of health that many do not see, but are directly affected by – public health. This module provides an outline that defines public health, its role, and its relationship with medicine.

Public health addresses the health of the population as a whole rather than medical health care, which focuses on treatment of the individual ailment. According to the Institute of Medicine, the mission of public health is defined as "fulfilling society's interest in assuring conditions in which people can be healthy."(1) A similarly broad vision guides the Public Health Data Standards Consortium, which is healthy people in healthy communities and the mission that promotes physical and mental health and prevents disease, injury, and disability.(2) Public health includes the assessment of air quality, seatbelt safety, bioterrorism preparedness, and infectious disease surveillance, as well as the provision of services to those populations who are most vulnerable or disadvantaged by virtue of their special health needs, economic status, race and ethnicity, disability, age, or area of residence.

Function of Public Health

A number of activities make up public health, including, but not limited to, the following:

• Preventing epidemics and the spread of disease;

• Protecting against environmental hazards;

• Preventing injuries;

• Promoting and encouraging healthy behaviors;

• Responding to disasters and assisting communities in recovery; and

• Assuring the quality and accessibility of health care for underserved populations.

The scope of public health varies at the local, state, and federal levels. (See Module #2 for more information on structure and function of public health agencies.)

In 1988, the Institute of Medicine describes three core functions of public health that help to define the roles and responsibilities of public health agencies:

• Assessment: assessment and monitoring of the health of communities and populations at risk to identify health problems and priorities;

• Policy development: formulating public policies, in collaboration with community and government leaders, designed to solve identified local and national health problems and priorities; and

• Assurance: assuring that all populations have access to appropriate and cost-effective care, including health promotion and disease prevention services, and evaluation of the quality and effectiveness of that care.(3)

In order to elaborate on the core functions and link them to specific actions, the  ten essential services of public health were established. Each service falls under at least one of the three functions described above. The services are as follows in Exhibit 1.

Exhibit 1: Core Functions and Essential Services

The functions and services are shown together in Exhibit 2.

The IOM’s 2003 report entitled The Future of the Public’s Health builds upon previous thinking and describes the public health system as made up of several actors working together to improve population health and eliminate disparities. Actors include government public health agencies, health care delivery system, public health and health sciences academia, communities, business and employers and media.(5)

Major Accomplishments in Public Health

The roles of public health are easier to understand by reviewing some of the major achievements over the last two centuries. The following are examples of major accomplishments in public health.

Immunization

In the early 20th Century, polio epidemics began to spread throughout the United States. From 1910 to 1914, the number of polio cases was 6 per 100,000 population. By 1952, the rate had increased to 37 cases per 100,000 population. In 1955, an oral vaccine to the disease was offered to the public. The result was the virtual elimination of the disease in the United States by 1979.(6) Though a success of medicine, public health was instrumental in getting the vaccine to people throughout the country. Through immunization programs nationwide, public health workers continue to reach large numbers to prevent diseases.

Infant Mortality

"The infant mortality rate is the number of deaths of infants less than one year old per 1,000 live births in a population."(7) According to Exhibit 3, the infant mortality rate has decreased significantly over the past 20 years. Though many actions have contributed to this occurrence, public health’s role cannot be understated. Improvements in access to and utilization of prenatal care and monitoring risky behaviors of mothers have impacted the infant mortality rate. Public health programs targeting minority health have also contributed to the decreased disparity between blacks and white. Although significant disparities remain between blacks and whites, infant mortality for both races has decreased and the gap between the two has narrowed.

Exhibit 3: Infant Mortality Rate by Race of Mother, 1980-1998

Source: Centers for Disease Control and Prevention, National Center for Health Statistics (July 24, 2000). National Vital Statistics Reports: Table 27 - Infant, neonatal, and postneonatal mortality rates by race and sex: United States, 1940, 1950, 1960, 1970 and 1975-98, Vol. 48, No. 11.

Various reports from other countries showed a relationship between a prone sleeping position for infants and a higher incidence of Sudden Infant Death Syndrome (SIDS). Using this research, the American Academy of Pediatrics (AAP) recommended that healthy infants should be placed on their sides or back to sleep.(8) The work of the AAP in conjunction with the National Back to Sleep Campaign in 1994 resulted in a 30 percent drop in SIDS rates from 1992 to 1995.

Lead Poisoning

"Over the past quarter century, progress on childhood lead poisoning in the United States has been remarkable: the mean blood lead level of US children fell by 80 percent, and the number of children with elevated blood leads declined by 90 percent. These changes did not occur spontaneously or by chance. Strict regulation of many lead uses … has gradually detoxified the air, water, and food supply. The evidence is clear that controlling ongoing sources of lead exposure produces immediate and significant health benefits ..."(9)

Future Accomplishments

There are significant opportunities for continued improvement of population health, including reductions in mortality and morbidity associated with such conditions as HIV/AIDS, certain cancers, and other emergency conditions. Most of these opportunities for improvement in morbidity are in the prevention and management of chronic disease (i.e., heart disease, obesity, diabetes, depression, dementia, and substance abuse). Public health will play an important role in prevention activities.

Public Health vs. Medicine

Public health and medical health have many differences, yet both use data to perform their job. Medical personnel look at information to treat disease, while public health personnel look at information to develop methods to prevent disease occurrence. According to Kristine Gebbie, DrPH, RN (a distinguished public health advisor and academic leader), "Public health and medical practice both use the same data; they just look at it differently."(10) The following table shows some of the key differences in the attributes of public health and medicine.

Exhibit 4: Key Differences Between the Attributes of Medicine and Public Health

Despite the differences between medical and public health, the two have often worked together to solve many health needs. In the past, medical and public health practitioners had a much stronger working relationship than they do today, as neither could address the problem of infectious disease without the other. Most importantly, public health needed the vaccines developed by physicians. Public health also needed the influence of physicians on policy makers and the public to institute sanitary reforms and establish health boards. Physicians needed public health workers to address the causes of infectious disease.(11) It is only during the last sixty years that the two professions have maintained independence from one another. Now, in the face of many new and complex health related issues, the two professions are beginning to find usefulness in collaboration.

Internet References

The following are links to other sources of information regarding public health and the different types of work that public health performs.

• American Public Health Association

• Association of Schools of Public Health Listing of Schools of Public Health

• Association of State and Territorial Health Organizations

• Center for Disease Control and Prevention (CDC)

• Healthy People 2010

• Health Resources and Services Administration

• National Association for Public Health Statistics and Information Systems

• National Association of County and City Health Officials (NACCHO)

• Public Health Foundation

• Public Health Infrastructure Resource Center (PHF)

• Public Health Service

The following are links to additional training resources developed by other organizations. The Consortium does not take responsibility for the quality of the content.

Public Health Training Resources

• Ask SPHERE: A Clearinghouse of Public Health Training Resources

• Association of Public Health Laboratories - Education Training

• CDC Public Health Training Network Catalog of courses and resources by media, topic, audience

• Public Health Foundation TrainingFinder.org

Public Health Tutorials

• Principles of Public Health

• Overview of Public Health Surveillance

• History of Public Health

• Public Health Services and Systems

• Ten Great Public Health Achievements from CDC

Endnotes

(1) Institute of Medicine, Committee for the Study of the Future of Public Health, Division of Health Care Services (1988). The Future of Public Health.
(2) In line with Healthy People 2010.
(3) Institute of Medicine, Committee for the Study of the Future of Public Health, Division of Health Care Services (1988). The Future of Public Health.
(4) National Association of County and City Health Officials (October 2001). LPHA Infrastructure, A Chartbook.
(5) Institute of Medicine Committee on Assuring the Health of the Public in the 21st Century. Board on Health Promotion and Disease Prevention. (2003). The Future of the Public’s Health in the 21st Century. National Academies Press. Washington, DC 2003.
(6) National Academy of Sciences (1999). Vaccines for the 21st Century: A Tool for Decisionmaking, Page 23. {On-line] Available: http://www.nap.edu/openbook/0309056462/html/23.html.
(7) Centers for Disease Control and Prevention. National Center for Health Statistics (February 13, 2003). NCHS Definitions [On-line] Available: http://www.cdc.gov/nchs/datawh/nchsdefs/list.htm#I
(8) American Academy of Pediatrics Task Force on Infant Positioning and SIDS (1992). Positioning and SIDS. Pediatrics, Vol. 89, 1120.6.
(9) American Public Health Association. Protecting Children From Lead Poisoning and Building Healthy Communities. [On-line] Available: http://www.apha.org/journal/editorials/edryan.htm.
(10) Lumpkin, John R. Illinois Department of Public Health. Public Health in the 21st Century. Presentation. [On-line] Available: http://www.ehcca.com/presentations/HIPAA4/lumpkin.pdf
(11) Lakser, Roz D. and the Committee on Medicine and Public Health. The New York Academy of Medicine (1997). Medicine and Public Health: The Power of Collaboration, pp. 13.