Public health is defined as the science and art of improving the population’s health through the organized efforts of society, using techniques of disease prevention, health protection and health promotion.
The United States Health and Human Services Public Health Service lists 10 core activities of public health as follows:
- Preventing epidemics
- Protecting the environment, workplaces, food and water
- Promoting healthy behaviour
- Monitoring the health status of the population
- Mobilizing community action
- Responding to disasters
- Assuring the quality, accessibility, and accountability of medical care
- Reaching out to link high-risk and hard-to-reach people to needed services
- Researching to develop new insights and innovative solutions
- Leading the development of sound health policy and planning.
From the definition above and the list of the core activities of public health, it is clear no single individual or profession can lay claim to possessing all the skills required to effectively carry out public health functions. The practice of public health thus lays emphasis on team work, with members of the public health team consisting of diverse groups including healthcare workers, scientists, economists, financial experts, media practitioners, politicians, security agents and others as the situation may dictate. As a medical specialty this makes it subject to some vagueness, and I been asked by several people including family and friends what exactly public health is.
Many persons have asked me why I “refused to practice medicine despite spending many years in medical school”. Some will patiently listen as I try to explain what it is I do, and how public health is a specialty in medicine like any other but mainly non-clinical; when I am done with my explanation however, they still ask me if I don’t think I would have been of more service in the hospitals where doctors are needed. It seems some go and make further enquiries because the feedback I get later is something like “oh, I learnt public health is very good, it gives you opportunity to work with international agencies and non-governmental organizations, there is money there”; or something like “that is HIV medicine right?”. I ran into a secondary school classmate some years ago, and when I said I was a public health practitioner, he said “that means you are just a sanitary inspector”. Although the gaps in knowledge about public health is related to educational levels of individuals and countries, the misconceptions are widespread, as a colleague once told me that he wasn’t bold enough to even contemplate not being in clinical practice.
Professor Ichiro Kawachi, a professor of social epidemiology at Harvard School of Public Health succinctly captured the issue of artificial hierarchy within professions in his foreword to the second edition of the Oxford Handbook of Public Health Practice. He told the story of how he was warned by senior colleagues when making the switch from clinical medicine to public health. He was told that in medicine, the prestige of any given specialty is inversely proportional to the size of the object it addresses; and he gave the example of how those who deal with microscopic objects such as genes and chromosomes have more prestige and funding, than those who deal with population issues such as poverty. Those who deal with patients find themselves somewhere in between the two extremes. As a physician I have resisted any pressure because of this lack of prestige associated with public health practice, and I know some public health physicians who feel superior to clinicians (erroneously, as all specialties have their unique roles); however many colleagues seem to cave in to the pressure, and you hear them when addressing an audience say things like “I still see patients, in fact I performed a Caesarean Section just yesterday”. I sense that some frustration comes from much of the work done in public health largely going unnoticed and unappreciated. Separating Siamese twins certainly sounds more intriguing than controlling a cholera outbreak in a refugee camp, or better still, preventing it from happening in the first place; unless one reflects deeply that hundreds or thousands of lives have been saved (or would have died – the negative and dreaded usually evoking stronger reaction than the pleasant).
“Hence to fight and conquer in all your battles is not supreme excellence; supreme excellence consists in breaking the enemy’s resistance without fighting” Sun Tzu, The Art of War
The quote above illustrates the hallmark of public health – prevention, through the use of evidence and paying attention to details while planning.
I hope that through The Public Health Corner (TPHC), I will be able to shed more light on what we do as public health practitioners and researchers, by sharing personal experiences and also publishing articles on issues of public health importance. Thus TPHC should appeal to those who do not know much about public health as well as the experts in the field. I hope that through this, we would truly improve health globally through efforts from everyone!
Dr Ande Elisha