The meaning, importance and neglect of public health
Guest post by Janine Elizabeth Ewen, news writer for Politics First UK and specialist in international health research
The concept of public health in the 21st century addresses some of the world’s more serious structural health problems. It concerns itself with a focussed examination of societal problems that are deep-rooted and need to be pulled to the surface for creative and effective interventions. However public health, if we look back on its history, was not always taken so seriously. It seems any method to improve health always faced significant barriers .
Public health is ultimately about all of humanity – how we live together, how we view our shared circumstances and infrastructure (air, water, soil, food, housing water etc.), how we handle some of the necessitates of life. It is a field that provides a rationale for both good and bad health conditions. According to Charles-Edward Amory Winslow, it is ‘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.’
Unfortunately public health is sometimes attacked as unnecessary or ‘nannying’, leaving it with reduced cultural visibility. While few could be against public health – the right to live in an acceptable state of health – when compared to other health aspects it is often low on the list of priorities.
Is public health really a new concept? Or is it the case that it has never been considered at a strategic level, and that we have ignored the key circumstances of everyday lives that prevent individuals from living in conditions of overall good health?
I have great respect for David Hemenway, a US public health specialist working in the field of violence and firearms. Asking the question about the widespread ignorance of public health issues, he suggests it lacks profile because it sits alongside medicine, which has a far higher profile and much more funding. Clearly important medical treatment can be provided by doctors, nurses and other medical related healthcare professionals. Medicine is immediate and hugely effective, and people have engaged with it on a huge scale through acute observations/treatment in hospital and through GP practices. It is easy to identify with medicine, whereas public health is different. It doesn’t have such an immediate impact, and often it can be unclear whether lives have been saved or improved as a result of public health initiatives.
Complex health policies and statistics can obscure the potential and impact of public health initiatives. However, this is also true of other policy fields such as economics and welfare, so there is no compelling reason why this would detract from interest in public health.
Bill Gates has observed that people generally demonstrate a caring attitude, but care involves discovering a passion and getting to the key underlying issues. This must involve research, stakeholder analysis and the formation of partnerships. In fact public health concepts are usually broad and easy to understand in their definition, but perhaps more complicated in practice, including the concepts of partnerships, community development, project management, and even health itself.
The invisibility of public health is not a recent phenomenon. In 1937 Richard Shyrock (1917-72), a UK historian of public health (they do exist), observed that ‘by the simple process of forgetting’ its past efforts, the public health movement had become irrelevant. He expressed a concern that ‘indifference to the past’ might promote ‘complacency in the present’.
Another example of these problems was provided by Lemuel Shattuck, a Boston politician, historian and bookseller, whose plans for the promotion of public health in the city faced objections because they were seen as too complicated, too focused on statistics and too much tending to interfere with private matters and rights.
Health interventions produce moral and social dilemmas. The UK has also experienced these issues. The National Health Service came with a cost. It came into operation at midnight on 4 July 1948. It was the first time anywhere in the world that completely free healthcare was made available on the basis of citizenship rather than the payment of fees or insurance premiums. Despite the high value that has come to be associated with the NHS, it may have been that the issues of a growing dependency, little self-management and huge costs were not appreciated.
It is time for public health to be taken seriously, and for the issues to be proper;ly and widely considered; not just by healthcare professionals, but by all citizens.
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