Health Sciences

School of Public Health

What is Public Health?

Public health is the sum of organised and deliberate efforts of society to promote, protect and restore the health of its populations and communities. In this sense 'public health' is a social enterprise. The term also refers to an institutional sector, the public health system, which is defined by its shared commitment to the health of the public.

How the health of populations improves

Public health is concerned with improving the health of populations. Conceptual frameworks for public health build on but go beyond the individual-focused frameworks of the personal health care system and locate these within the wider frameworks of society, the economy and history.

Improving the health of populations involves progress along three inter-related pathways:

• improvements in health care, including in personal preventive services,
• choices towards healthier and safer ways of living; choices which are individual and collective; and
• progress towards safer, healthier and more supportive environments.

Personal health care

Improvements in health care technologies and access to health care contribute significantly to improvements in population health status. The impact of antibiotic treatment on infectious disease illustrates this dramatically. However, the contribution of health care to better health is more complex than simply the aggregate outcome of services provided. One of the important ways in which health care services contribute to improved population health status is through contributing to community-wide knowledge about the conditions for better health. In this respect it also contributes to personal choices for better health and to developing community sentiment about the need for safer and healthier environments.

Personal preventive services

Improvements in population health status also flow from improvements in, and access to, personal preventive services such as cancer screening, blood pressure treatment and communicable disease control. The importance of this pathway is likely to increase as new technologies become available and with movement towards the more organised delivery of personal preventive services.

Safer and healthier physical environments

Safer and healthier physical environments have been a very important route to improved population health status. The dramatic improvements in population health in the industrialised countries from the end of the last century were associated with improvements in the work environment, better housing and the provision of basic amenities such as water supply and sanitation. Access to safe and healthy environments depend partly on public investment in infrastructure (such as water supply) and upon public regulation (for example the occupational environment). However, access to safe and healthy environments also depends upon individual and household buying power (safer jobs, cleaner suburbs, safer transport). Access to good food, for our present purpose an element of healthy environments, is also heavily dependent on individual and household buying power.

Personal choice

Population health status is in some degree a function of personal choices; choices which are social as well as individual. Such choices, and the consequent actions towards safer and healthier ways of living (ways of cooking, eating, working, driving, playing, etc), are located in particular settings (such as home, worksite, farm, school, recreation, etc) and arise out of the social relations which are particular to those settings.

Various technical knowledge, for example, about bodies and health, and relevant personal skills (healthy shopping and cooking, safe driving, conflict resolution, etc) are very important inputs to these personal choices. However, while knowledge and skills may be necessary for improving population health status they are not sufficient. Where people are facing urgent and immediate pressures of survival, making choices for longer term outcomes may be assigned a lower priority, particularly where those choices require significant effort and rearrangement of usual patterns of living. People need to have confidence in their capacity to effect such changes. The experience and expectations of relative powerlessness, including the cumulative experience and expectations of particular communities and 'subcultures', may make the prospect of personal effort for 'better health' seem unreal. Better health at some time in the distant future may matter more for some people than others. In the extreme case, suicide, it has no value. Extreme risk taking and heavy drug and alcohol use may reflect a more ambivalent attitude to personal futures. This kind of ambivalence, with respect to longevity and health, may help to explain some of the health gradients associated with occupational hierarchy and income inequalities.

The concept of the 'social environment' is widely used as a framework for thinking about the ways in which economic, cultural, political factors influence health status. The slogan, 'making healthy choices easier choices', points towards social policies which create more health supportive social environments, for example, by facilitating easier access to fresh fruit and vegetables and lean meat. Creating more supportive environments also includes the creation of the economic wealth which is needed to develop health services and to create safe and healthy environments. However, social environments (supportive or otherwise) are also shaped by the distribution of wealth and the ways in which this may constrain and enable the personal choices for better health that people make. Supportive social environments in this sense are characterised by security, social cohesion and the valuing of people's contributions to their communities.

The work of public health

Public health goals are achieved through public health interventions or public health practice, which are in turn built upon public health intelligence (or the information and knowledge base) and public health infrastructure (the skill base and resources) .

Public health practice (health promotion and disease prevention, health protection and improving health care systems) may be thought of as facilitating social and community progress down these three pathways. However, making such progress is not a project for public health people alone. The projects of public health are undertaken through a web of partnerships:

• with the practitioners and organisations of the personal health care system;
• with practitioners and policy makers in other sectors (production, transport, food, communications, etc), intersectoral collaboration; and
• with citizens, as individuals and as members of families, community and business organisations and as participants in larger social movements (community participation).

The knowledge and skill base of public health

The breadth of this set of challenges explains the very broad range of knowledge and skills which provide the basis for public health practice, reflecting, for example:

• epidemiological and biomedical research and health statistics,
• health services research and related fields such as management and organisation, economics and
• informatics;
• behavioural and sociological research;
• policy and political science research;
• environmental and ecological studies.

All of these different aspects of public health work have a policy dimension. In addition a major focus of public health policy is on capacity building for public health practice; what are the best ways of organising public health work so as to carry out the projects of public health most effectively and efficiently? Within this area of concern different models of public health practice and different strategies for focusing public health work jostle and collaborate.

The Infrastructure for Public Health

The conduct of public health activities require human and financial resources. Public health workforce is necessarily multidisciplinary. It includes full-time specialists - such as environmental health professionals, epidemiologists, health educators, community nutritionists, etc. It also requires the involvement of the broader health workforce (such as doctors and nurses) and expertise in other sectors (such as urban planners) whose roles contribute public health objectives.

Public Health activities are delivered through a range of settings, such as local government, non-government organisations, community health services, GP divisions, etc. These activities are supported through a range of funding programs and through community efforts. Some are also underpinned by specific legislated roles and responsibilities.

A career in public health?

People and jobs contribute to public health at different levels, including full time, specialist public health practitioners and health care practitioners (in various settings) whose work involves in part contributing to public health programs and objectives.

There are employment opportunities for specialist public health practitioners, in government, in NGOs (Non Government Organisations), in research. The number of people in such jobs has been increasing significantly over the last two decades.

There are far more people who contribute to public health from jobs which also involve personal health care or health are management or planning or as community activists.