Introduction to public health

Introduction
Definition of terms

Health

 “Persons are healthy when they are doing their activities with no apparent
symptoms of disease in them.” (Lay Point of view)
 “The state of being free from illness or injury”. (The New Oxford Dictionary
of English)
 “A measure of the state of the physical bodily Organs, and the ability of
the body as a whole to function. It refers to freedom from medically defined
diseases.” (Professional points of view)
 “A state of complete physical, mental, and social well-being and not merely
the absence of disease or infirmity.” (The world Health Organization (WHO)
in1948)
 As evident from the above definitions, health is multidimensional. The
WHO definition envisages three specific dimensions (physical, mental, and
social), some other dimensions like spiritual and emotional may also be
included.
 Physical health- is concerned with anatomical integrity and physiological
functioning of the body. It means the ability to perform routine tasks
without any physical restriction. E.g., Physical fitness is needed to walk
from place to place.
 Mental Health- is the ability to learn and think clearly and coherently. E.g.,
a person who is not mentally fit (retarded) could not learn something new
at a pace in which an ordinary normal person learns.
 Social health- is the ability to make and maintain acceptable interaction
with other people. E.g. to celebrate during festivals; to mourn when a close
family member dies; to create and maintain friendship and intimacy, etc.
 Emotional health - is the ability of expressing emotions in the appropriate
way, for example to fear, to be happy, and to be angry. The response of the
body should be congruent with that of the stimuli. Emotional health is
related to mental health and includes feelings. It also means maintaining
one’s own integrity in the presence of stressful situation such as tension,
depression and anxiety.

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  Spiritual Health - Some people relate health with religion; for others it has
to do with personal values, beliefs, principles and ways of achieving mental
satisfaction, in which all are related to their spiritual wellbeing.

Recently, the WHO definition of health is facing different criticisms. The main
problematic aspects of the WHO definition have been summarized below.

1. The “complete well-being,” which means a state so extreme that it is nearly

impossible to achieve. Certainly, it is never achievable for older people or
patients affected by chronic illness, which represent an ever increasing
population due to the growth of the aging rate and the improvement of the
survival rates for several diseases. Nevertheless, a complete state of
wellbeing is a problem also for other people, because common experiences
in life suggest that a long period free of physical and mental symptoms is
highly improbable: scientific evidence shows that the average adult
experiences about 4 symptoms in a 14-day period. This definition proposes
unattainable health standards that make almost all people unhealthy
most of the time.
2. This definition is not useful in real situations because it is neither
operational nor measurable.
3. This conception of health is potentially so broad that it conflates scientific
assessments with moral and political arguments: a complete state of
physical, mental, and social well-being implies a life free of poverty, vices,
iniquity, discrimination, violence, oppression, and war, which are
essentially problems of living and should not be considered medical
problems.
4. Increasing of the medicalization of society. The broad range of this
definition and the positive conception of wellness lead to medicalization of
all aspects of life and, consequently, problems which belong to a social
sphere or other fields are seen as belonging to the medical domain. As a
result, for many non-medical problems a medical solution will be looked
for, rather than any other type of solution.
5. WHO definition assumes that well-being is always linked to health, but it
does not consider that this assumption may not be corrected in all cases.
When individuals are coping with a negative event, they feel sorrow, not
well-being: this reaction cannot be considered a loss of health, otherwise
everybody would lose health nearly every day. The lack of well-being in
these common situations must be considered an objective sign of an
appropriate sense of reality, and paradoxically a complete state of well-

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 being in similar situations may indicate an alteration in the subjective
experience of reality and therefore a loss of health.
6. The WHO definition assumes that physical, psychological, and social
wellbeing always have a positive correlation among them. But it cannot
take account of some exceptions, like risk-taking behaviors, in which a
decrease of physical well-being may be linked to an increase of
psychological or social well-being, or vice versa.

Nowadays, some authors suggest that the WHO definition should be seen as an
inspirational goal rather than a real definition of health.

The Epistemological Perspective

Health is continuously created by individuals and groups who interact among

themselves in different social contexts. In other words, health may be seen as
the contingent result of actions, choices, intentions, and so on, embedded in a
network of social ideas, expectations, social practices, and institutions. This
implies that health cannot have a unique definition in isolation; instead, health
embodies as many definitions as there are people who use it.

Instead of continuing to look for a new definition for substituting the WHO
definition, it is time to accept that the complexity of phenomenon obliges us to
have many definitions of health, among which no one will be truer, or more
comprehensive, or more exact than others, because each definition can only be
more or less useful for achieving some specific operational and knowledge
purposes in a specific context of application. Effectively many different scopes of
application are inside the clinical sciences: for example, planning public health
policies is very different from measuring individual’s health level before and after
a treatment, and assessing health among chronic patients may be very different
from doing it in acute diseases.

A New Potential Definition of Health

This newly proposed definition configures health as the capability to cope with
and to manage one’s own malaise and well-being conditions.

In more operative terms, health may be conceptualized as the capability to react

to all kinds of environmental events having the desired emotional, cognitive, and
behavioral responses and avoiding those undesirable ones.

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Disease

 Disease is the pathological change in the body, which is measured by

health professional by observing clinical sign and symptoms, through
physical examination and lab investigation.
 Disease can refer to a combination of signs and symptoms, phenomena
associated with a disorder of function or structure or illness associated
with a specific cause(s).

Illness

 Illness is feeling of pain or distress or discomfort by the patient. It is view

or feeling of a patient it is not tangible.

Public health

 Public health is defined as the science and art of preventing diseases,

prolonging life, promoting health and efficiencies through organized
community effort.
 It is concerned with the health of the whole population and the prevention
of disease from which it suffers.
 American Public Health Association (APHA) defines it as “the practice of
preventing disease and promoting good health with in group of people,
from small communities to entire countries.
 APHA further states it includes health professionals from many fields
working together with the common purpose of protecting the health of the
population.

History of public health

The concept of public health was being practiced in different times in different
places. Chinese medicine, Ayurvedic medicine in India (400 BC), Hippocrates in
Greece (460–377 BC) and Galen (AD 129–199) in Rome and their followers were
aware of the influences of season, diet, the winds and lifestyle for individual
people’s health.

Throughout the time there were different thinking about the cause of the
diseases and their respective treatments or prevention mechanisms. The
occurrence of different diseases like measles, influenza, small pox, syphilis,
dysentery, malaria, HIV/AIDS etc. in different times leads to the invention of
several thinking, concepts and instruments which contribute to the evolution of
the public health concept. Especially in 19th and 20th centuries different models,
that explains the causes of the diseases, become popular.
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Nineteenth-century models

Each effort to prevent disease in the 19th century was based on one or the other
three theories of disease causality. These are:

1. Contagion theory

This theory hypothesizes that illness is contagious. It required:

 Keeping sick people away from well people.

 Isolation of households if they were infected,
 Fumigating or washing the bedding and clothing of the sick

Problems confounded the acceptance of this theory were:

 There were too many instances where people become ill regardless
of their isolation from human contact and
 Too many others where brave souls nursed the dying and carried
their bodies to the graveyard yet remained well.
2. Supernatural theory

Proponents of this theory argue that supernatural forces cause disease. Disease
prevention measures based on this theory were important to the religious people.
The view among them was that disease is a punishment for transgression of
God’s laws. (i.e. the cause of the of disease is the sin practiced by people).

3. Personal behavior theory

This theory held that disease results from wrong personal behavior. People
caused their own disease by living fully unhealthy. Hence, improper diet, lack of
exercise, poor hygiene and emotional tension become the focus of preventive
actions.

4. Miasma theory

This theory argues that disease is caused by the odor of decaying of organic
materials. It dates back to the Hippocratic idea that disease is related to climate.
It contrasted sharply from the other three theories since it conceptually
separated the source of the disease from the victim of the disease.

Twenty-century models

The 20th century theory focuses on:

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 1. The Germ Theory

This theory held the notion that microorganisms cause diseases and it is possible
to control diseases using antibiotics and vaccines. There was criticism on this
theory by Thomas Mckeown that stated as the incidence of all major infectious
diseases begun to fall several decades before the introduction of vaccines and
antibiotics. Thus rising of living standards was responsible for the reduction of
disease not the discovery of antibiotics and vaccines.

2. The Life Style Theory

This holds that unhealthy lifestyles are causes for diseases. This hypothesis
blames stress, lack of exercise, the use of alcohol and tobacco improper nutrition
for most chronic diseases. This theory rejects the notion central to the classic
germ theory, that a single disease has a single etiology. Instead they emphasize
the interrelatedness of many variables in disease causality, principally those
under the control of the individual. The critics surrounding this theory state that
the change for lifestyle requires overall social change.

3. The Environmental Theory

Environmental theory explains that significant number of chronic disease are

caused by toxins in the environment and it implies that disease prevention,
instead of requiring medical treatments or personal hygiene, demands change in
the industrial production. The first aspect of the environmental hypothesis is
occupational hazards, the second concentrates on toxic substances in the air
water and soil (advocates of this theory places particular emphasis on
radioactivity), and the third aspect focus on synthetic additives to foods “organic
foods”.

4. The Multi Causal Theory

It is also called the web of disease causation. The theory express that there are
multiple factors for a cause of a single disease entity. But it is incapable of
directing a truly effective disease prevention policy as the theories it replaces. Its
shortcomings are it gives few clues about how to prevent disease

Core activities in public health

1. Preventing epidemics
2. Protecting the environment, work place, food and water;
3. Promoting healthy behavior;
4. Monitoring the health status of the population;
5. Mobilizing community action;
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 6. Responding to disasters;
7. Assuring the quality, accessibility, and accountability of medical care;
8. Reaching to develop new insights and innovative solutions and
9. Leading the development of sound health policy and Planning

Three Core Functions of Public Health are:

 Assessment -Systematically collect, analyze, and make available

information on healthy communities
 Policy Development - Promote the use of a scientific knowledge base in
policy and decision making
 Assurance - Ensure provision of services to those in need

Ten Essential Public Health Services

1. Monitor Health 6. Enforce Laws

2. Diagnose and Investigate 7. Link to/Provide Care
3. Inform, Educate, Empower 8. Assure a Competent Workforce
4. Mobilize Community 9. Evaluate
Partnership 10. Research
5. Develop Policies
Different perspectives on health

Health is viewed as a right, as consumption good, and as an investment.

Some view health as a right similar to justice or political freedom. The WHO
constitution sates that “. . . the enjoyment of the highest attainable standard of
health is one of the fundamental rights of every human being without distinction
of race, religion, political belief, economic or social condition”.

Others view health as an important individual objective of material aspect i.e. as

consumption good.

The third view considers health as an investment, indicates health as an

important prerequisite for development because of its consequence on the overall
production through its effect on the productive ability of the productive force.
These different views indicate differences in the emphases given to health by
governments.

Major disciplines in public health (public health sciences)

 Nutrition: is the science of food, the nutrients and other substances

therein, their action, interaction and balance in relation to health and
disease.

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  Reproductive health: is a state of complete physical, mental and social
being not only absence of disease or infirmity, in all matters relating to
reproductive system and to its functions and process.
 Environmental Health: focuses on extrinsic factors that influence the
health of human being directly or indirectly.
 Health Education is defined as a combination of learning experiences
designed to facilitate voluntary actions conducive to health. It is an
essential part of health promotion.
 Epidemiology is the study of frequency, distribution, and determinants of
diseases and other related states or events in specified populations and
application of this study to the promotion of health and to the prevention
and control of health problems.
 Health Economics is concerned with the alternative uses of resources in
the health services sector and with the efficient utilization of economic
resources such as manpower, material and financial resources.
 Biostatistics is the application of statistics to biological problems;
application of statistics especially to medical problems, but its real
meaning is broader.
 Health Service Management is getting people to work harmoniously
together and to make efficient use of resources in order to achieve
objectives.
 Ecology: is the study of relationship among living organisms and their
environment.
 Research is a conscious action to acquire deeper knowledge or new facts
about scientific or technical subjects
 Demography is the study of population, especially with reference to size
and density, fertility, mortality, growth, age distribution, migration, and
the interaction of all those with social and economic conditions.

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