Distinction between Public health, Community Health, Social Medicine and Community Medicine

First and foremost, among these four terms the words ‘Health’ and ‘Medicine’ used should be distinguished. We define health as “a complete state of physical, mental, social and (newly added) spiritual well-being not merely absence of disease or injury” and medicine as “the science or practice of the diagnosis, treatment, and prevention of disease”. Thus, these two words separate the meaning of ‘public health’ and ‘community health’ with ‘social medicine’ and ‘community medicine’....Read More...

Public Health Ethics: Social Health Justice

Public health ethics involves a systematic process to clarify, prioritize and justify possible courses of public health action based on ethical principles, values and beliefs of stakeholders, and scientific and other information...Read More...

What is Public Health?

In 1920, Charles Edward Amory Winslow built up a fitting meaning of Public Health: “The science and art of preventing disease and promoting health and efficiency through organized community effort.”

Public health is about taking the responsibility for improving the health of the public, our community’s health. Doctors treat individual patients for a specific disease or injury. Public health professionals monitor and diagnose the health concerns of entire communities and promote healthy practices and behaviors to assure that populations stay healthy.....Read More...

A Short History of Public Health

Although medicine and public health share a lot of the same concerns relating to human health, the two disciplines approach the problem differently. Public health primarily focuses on treating the population, but these concerns about the population are tempered by concerns about the individual, the emphasis is on prevention and health promotion for the entire community and the intervention is in the areas of the environment, human behavior and medical care. Medicine focuses on the treatment of the individual, the emphasis is on diagnosis and treatment of the patient and the predominant emphasis is on medical care.....Read More...

International Public Health: Health for All Movement

In 1977, the World Health Assembly adopted the historic resolution on 'Health for All by the Year 2000'. Several debates on the links between health and social, environmental, economical, political factors yielded this fruitful result.

'Health for All by the Year 2000' meant that, by the year 2000, people would use better approaches than they had before for preventing and controlling diseases and alleviating unavoidable illness and disability. People will attain level of health that will permit them to lead a socially and economically productive life through organized application of local, state, national, and international resources of health.

While almost all the countries aimed at the universal goal for Health for All movement, they also realized that the gap was widening between the health 'haves' in the affluent countries and the 'have-nots' in the developing countries. Thus, the obstacles in closing such wide gaps in the health status and resources were clearly recognized by the world community at the international conference jointly organized by WHO and UNICEF, at Alma-Ata in the then USSR, on September, 1978. This conference was another landmark in public health development and signaled a new era of public health.

Developing countries saw the Alma-Ata primary health care conference as an opportunity for restructuring their health systems to reach the goal of Health for All by 2000. A series of innovative approaches aimed at interesting Primary health Care were organized. there was considerable recognition of comprehensive health system in most of the developing countries.

But debates began either or not to favor for comprehensive primary health care approach. Later resources constraints and external pressure forced the government to be more selective in health development.

Democracy in developing countries aroused devolution of authority to local bodies. However, it was proving economically impossible to bear the cost of extension and expansion of public sector health services to the entire population.

But then, large-scale use of health volunteers, after receiving a minimal training program, proved successful in many countries.

Another notable program was the expanded program on immunization (EPI). In 1980, following a historic global campaign of surveillance and vaccination, the World Health Assembly declared smallpox eradication - the only infectious disease to achieve this distinction. With this inspiration, the WHO/UNICEF promoted the EPI program for six main vaccine-preventable diseases: polio, measles, diphtheria, pertussis, tetanus, tuberculosis. As a result, the lives of approximately two million children were saved. The outstanding coverage was possible because of improvements in the production, transport, and storage of vaccines, and also by extended social mobilization efforts.

Age of Socialized Public Health

The 1970s and 1980s were regarded as economically and politically unstable decades worldwide. The dominance of biomedical science approach, without adequate focus on the community, led to the failure of many mass disease control campaigns. By 1970, developing countries and the international community at large had become increasingly aware that, despite 20 years of large foreign investments and top-down development efforts, the socioeconomic status of the people including their health status had not risen to the desired level.

Many countries especially those that had achieved independence in the late 1960s and 1970s, were still struggling for socioeconomic growth. While the New World economic order was being formulated, a new philosophy of public health development with principles of social justice and equity slowly evolved.

The initial ideas of social medicine or the social dimension of public health had emerged around the early twentieth century.

New knowledge about NCDs (Non-communicable diseases), such as cancer, diabetes, and tobacco-related diseases, became available in the late 1950s and 1960s.

The social and behavioral aspects of diseases were also recognized and many social interventions were proposed as part of health promotion.

Education systems, institutions considered public health to be the same as preventive and social medicine. Socialized health care had become the most reasonable, workable and acceptable approach. Virchow had stated during mid-1880s that medicine was a social science and politics was medicine on a large scale.

People became more aware of the social and economic determinants impacting health. empirical evidence was collected from both the developed and developing countries.

There were debates on the links between health and social, environmental, economic and political factors. There were many comments on the need to give a social and political dimension to international public health.

Next, Go to International Public Health: Health for All Movement

Colonial Public Health

Trading around the world during the 18th and 19th centuries for the explanation and exploitation of natural resources led to the discovery of new territories. Europeans and Americans were engaged in an intense rivalry with each other for colonial possessions. In order to expand their control, these colonial powers made massive shifts of people from one continent to another, using both military and economic forces. 

The colonials established their own administrative, legal, and medical care systems with varying degree of anatomy and authority. To protect the health of their own people and the workers, the colonial rulers established laws similar to those in their home countries. For e.g. Public Health Act, Local Government Act, Vaccination Act, Civil Registration Act, etc. which some are still in place even today in many developing countries in Asia, Africa where British, Spanish, French, Americans or Dutch colonies existed. European countries adopted Bismark's model of national social health insurance scheme which later spread to other countries, especially in Asia and Americas.

Some colonial powers introduced their identity through religious group and education systems. The late eighteenth century saw an increasing momentum in public health education with the establishment of undergraduate and postgraduate courses designed specifically for public health, first in the home countries and later in the colonies.

Later the education system includes research in tropical diseases as well Through the support of the Rockfeller foundation, the London School of Tropical Medicine was transformed into the London School of Hygiene and Tropical Medicine in 1920, expanding the scope of research and teaching on tropical medicine, medical statistics, and epidemiology.

However, the actual development of Public Health and medical care services for the general public remained rudimentary in these former colonial countries and territories. Moving millions of people to unfamiliar areas had led to a high incidence of death and disability from diseases like malaria, typhus, small pox, typhoid, yellow fever, leprosy, yaws, syphilis, etc.

Later, colonials launched a major international public health initiative in the prevention and control of small pox, through vaccination, first among the people working in the colonial administration and later among the workers employed.

Another notable experience was the massive community health development projects for the prevention and control of communicable diseases, mainly initiated through the support of the Rockfeller Foundation in few Asian and Latin American countries. The attempt was aimed at developing pilot disease control projects that could be applied or replicated in other parts of the world.

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Public Health Concept in Developing Countries

The history of Public health development in the developing countries can be traced in four major topics:

1. Empirical Public Health
2. Colonial Public Health 
3. Age of Socialized Public Health
4. International Public Health: Health for All Movement

Each topic has been explained as different sub-topics:

1. Empirical Public Health:

Since ancient times, human life has been threatened with diseases of all kinds. Diseases like syphilis, measles, smallpox, cholera, leprosy, tuberculosis, etc. were rampant in all parts of the world for many centuries. Traditional medicine was significantly followed for management of illness at an individual level rather than public level.

Sanitation measures were enforced through royal decrees. The treatise on economics and government by Kautaliya (around 300 B.C.), during the early Maurya dynasty in India, showed how a king ensured the health and prosperity of his subjects through various measures and regulations.

Quarantine and prohibition were major measures used historically to protect people from the transmission of the diseases. Miasma theory, disease due to decayed organic matter was also popular in these days.

However, most of the historians have related the development of modern public health to the advert of basic medical sciences. The discovery of microscope, animal cells and bacteria, chemicals and other substances, other scientific knowledge and skills including those related to statistical and epidemiological methods in the developed world had provided the basis for a scientific explanation of the causes of diseases and illnesses as well as their mode of transmission. All these discoveries had some influences in developing world as well. Industrial revolution encouraged social interest in the prevention and control of diseases.

Owing to the scarcity of records, the health situation in the developing countries in the early centuries is little known. However, interest in social, environmental, and political aspects of diseases and their prevention grew tremendously.


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Critical Review of differences on Public Health Concept

The term 'Public Health' came into general use around 1840. It arose from the need to protect the people from the spread of communicable diseases. later various national and local movements by great pioneers and advocates of public health like Sir Edwin Chadwick, led to the formation of law, Public Health Act in England in 1848. The act was formed in order to crystallize the efforts organized by society to protect, promote and restore people's health.

In 1920, CEA Winslow defined Public Health as "the science and art of preventing diseases, prolonging life, and promoting health through organized community efforts."

Later WHO Expert Committee on Public Health Administration, adopted Winslow's earlier definition and defined Public Health as: 

          "the science and art of preventing diseases, prolonging life and promotion health and efficiency through organized community efforts for the sanitation of environment, control of communicable infections, education of the individuals in principles of personal hygiene, organization of medical and nursing services for early diagnosis and preventive treatment of disease, and the development of the social machinery which will ensure to every individual in the community a standard of living adequate for the maintenance of health, so organizing benefits as to enable every citizens to realize his birthright of health and longevity."

Likewise, a EURO symposium in 1966 suggested that the definition of public health should be expanded to include the organization of medical care services.

With adoption of the goal of 'Health for All', a new public health was evident worldwide, which may be defined as:

           "the organized application of local, state, national and international resources to achieve 'Health for All', i.e. attainment by all the people of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life."

Institute of Medicine (IOM), 1988 in classic report "the future of Public Health" has defined Public Health as 

           "an organized community efforts to address the public interest in health by applying scientific and technical knowledge to prevent disease and promote health."

Thus, Public health is both a body of knowledge and also a means to apply that knowledge. Public health, in its present form, is a combination of scientific disciplines (e.g. epidemiology, biostatistics, demography, etc.) and skills and strategies (e.g. epidemiological investigations, planning and management, interventions, surveillance, evaluation) that are directed to the maintenance and improvement of the health of the people.