Let’s start out by dispelling the misconception that physicians are trained in public health and therefore should be consulted as experts during public health crises. For the most part, this is NOT TRUE. Physicians are trained to provide medical care – to diagnose, treat, and manage individual health problems. While some medical schools do teach epidemiology (the science of public health), it is not enough to head out into the world as a public health professional. If you’re a physician with a Master of Public Health (like I will be!), then you certainly have more credibility to speak on matters of public health as a physician. And the reverse is true as well – experts in public health who did not go to medical school are not doctors! The medical and public health professions need to work together beyond times of crisis and both need to be consulted by policy makers. Doctors alone should not be asked how to contain a pandemic – simply put, we are not trained to give that advice.
So, let’s get into it. What exactly is public health?
Public health is the science of protecting and improving the health of people and their communities. While medical care focuses on improving the health of individuals, public health is concerned with populations – from your local neighborhood or county to a single country or an entire region of the world. We can see the work of public health throughout history, from the sanitation measures of the Greeks and Romans in 500 BCE and the initiative to distribute the polio vaccine to eradicate the disease from existence to the preparedness of governments to respond to all types of disasters (from biological warfare to hurricanes) and laws that ban smoking in public places.
In the United States, the premier public health agency is The Centers for Disease Control and Prevention (CDC). I will be the first (and definitely not the only) one to admit that the CDC has been tarnished by the coronavirus pandemic. There has been an obvious shift away from sharing science in the interest of the public health towards the interest of political goals. Science doesn’t lie ya’ll. Yes, it may change, but that doesn’t mean we shun new discoveries and call them lies. Once upon a time, we didn’t have electricity. Then, after using the principles of science, we did! Wow! Do you want to go back to the days of oil lamps and firelight because you don’t believe in the science of electricity? That’s how I feel about people denying the science of COVID-19.
Now that I’ve gotten my sass out of the way, I do want to take a moment to highlight the incredible career researchers at the CDC, who have made immense strides to prevent illness and injury and promote healthy behaviors since the agency was founded in 1946. Fun fact: the CDC gets its acronym from it’s previous name as the Communicable Disease Center, which was created from the Office of Malaria Control in War Areas. The original CDC was established in 1942 to limit the impact of malaria and other mosquito borne illnesses on U.S. military personnel.
How The Work of Public Health Gets Done
There are three core functions of public health: assessment, policy development, and assurance. And within those core functions, there are 10 essential public health services. Each level of government (federal, state, and local) has a public health role to play and uses these core functions to direct their work. Let’s look deeper at each function and service.
- Assessment is the systematic collection, analysis, and distribution of available information on healthy communities.
- Policy Development is rather self explanatory and it promotes the use of a scientific knowledge in policy and decision making.
- Assurance ensures the provision of services to those in need.
These three core functions form an ongoing cycle – once you provide services, it’s time to re-assess and make sure they are reaching the set goals. If not, it’s time for new policy development based on the new assessment. Then another around of assurance as you provide new services. And around and around we go.
The 10 Essential Public Health Services (EPHS) describe the public health activities that all communities should undertake. The EPHS framework was originally released in 1994 and was just updated this year! They are intended to promote the health of all people in all communities. The 10 Essential Public Health Services are:
- Assess and monitor population health status, factors that influence health, and community needs and assets
- Investigate, diagnose, and address health problems and hazards affecting the population
- Communicate effectively to inform and educate people about health, factors that influence it, and how to improve it
- Strengthen, support, and mobilize communities and partnerships to improve health
- Create, champion, and implement policies, plans, and laws that impact health
- Utilize legal and regulatory actions designed to improve and protect the public’s health
- Assure an effective system that enables equitable access to the individual services and care needed to be healthy
- Build and support a diverse and skilled public health workforce
- Improve and innovate public health functions through ongoing evaluation, research, and continuous quality improvement
- Build and maintain a strong organizational infrastructure for public health
Under each of the core functions and EPHS’s are actions or programs likely familiar to you. The federal government’s national tobacco public health surveillance project is an example of assessment and EPHS 1 and 2. A state increasing a tax on tobacco products falls under policy development and EPHS 3, 4, and 5. A locality offering resourcing to help smokers quit in multiple languages fits into assurance and EPHS 5 -10.
Now that I’ve given you the underpinning of how public health does it’s work, you might asking: what do they work on??
All the things: alcohol, tobacco, and other drugs; the environment; disability; food and nutrition; health technology; injury prevention; HIV/AIDS; sexual and reproductive health; school health; physical activity; oral and vision health; occupational health; mental health; international health; maternal and child health; the law….really, when I wrote all the things, I meant all the things. Public health experts examine questions like “Who gets certain diseases and why?” or “How should health care delivery be changed to improve access and treatment?”
The work of public health professionals influences so many aspects of our every day lives. If you want to know more about the work of public health, I recommend checking out the American Public Health Association, Trust for America’s Health, and the Public Health Institute.