Public Health

Public health is a dynamic, interdisciplinary field that combines clinical, behavioral, and societal strategies to improve the well-being of individuals and societies. It is therefore of great relevance to the study, prevention, and treatment of trauma. Like the field of social work, with which it overlaps, public health focuses on mental health and psychosocial well-being, and is concerned with the “state of complete physical and emotional well-being, not merely the absence of disease and infirmity,” as defined by the World Health Organization. Public health also overlaps with the professional fields of medicine, public policy, and law. In contrast to the field of social work, the field of public health concerns itself with physical as well as mental and psychological concerns. In contrast to medicine, public health focuses on population rather than individual health, though it includes systems of health care delivery, where it overlaps with the field of medicine. By the same token, public health emphasizes disease prevention and well-being in contrast to detecting and treating disease. Examples of public health interventions include legislation requiring the use of seat belts, smoking prevention programs, epidemic surveillance, health systems design, and water and sanitation programs. In the United States, the field of public health is distinguished from the field of medicine, as reflected by separate institutional structures for the study of public health and medicine in higher education.

Increasingly, however, a new movement termed global health incorporates both population and clinical health concerns. This movement attempts to define health within a global context and value system that promotes health equity not within national borders but rather across communities around the world. Global health, then, represents a more contemporary form of public health.

Public health as a field is highly interdisciplinary and intersectoral, is value-anchored, and has rapidly professionalized during the past 20 years as it continues to evolve. The core disciplines of public health in the United States include epidemiology, or the study of disease patterns and causes; demography; bio-statistics; behavioral sciences; environmental health sciences; and health systems management. Many schools of public health include faculty members trained in the fields of medicine and clinical professions (nursing, veterinary science), sociology, law, anthropology, mathematics and statistics, biological sciences, environmental sciences and engineering, and business. Among professional schools on university campuses in the United States, the faculty composition of schools of public health is the most interdisciplinary. Because of this breadth, the field has sometimes been criticized at times for a lack of clarity of scope and focus.

However, the breadth of its scope also is the reason that the field claims success in solving some [Page 509]societal health challenges. The elimination of smallpox through a combination of disease surveillance and strategic vaccination campaigns is a 20th-century example. Control of other severe infectious diseases such as measles, chicken pox, various forms of hepatitis, and yellow fever through vaccination programs are examples of other successes. The reduction of traffic fatalities through a combination of public policies and legal instruments is another.

Increasingly, comparative health systems research is uncovering strategies and approaches that address gross inequities in access to health care resources. Recent success in making antiretroviral therapy available to HIV-infected persons throughout the world is a striking example. Success required a combination of strategies to make expensive drugs available at affordable prices, advocacy efforts for international financial support, health systems strengthening to enable required testing/therapy, and the shifting of clinical tasks that previously required sophisticated laboratory or diagnostic capacity to routine health facilities. New initiatives are now being piloted to make chemotherapy available to cancer patients no matter where they live. Countries around the world are now learning how to creatively configure health care workers through task shifting, or empowering frontline health workers to take on more responsible roles. Results to date have been promising, including dramatic reduction in malaria morbidity and mortality, one of the more entrenched health problems of the developing world during the 20th century. A revolution in mortality reduction is occurring worldwide because of these social-technical approaches.

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