DEFINING PUBLIC HEALTH

The scope of public health has changed as expansion of medical sciences and public health experience have changed concepts of disease and its causes. In this chapter we examine how this, together with an expanding concept of health, has contributed to the development of the New Public Health. Health was traditionally thought of as a state of absence of disease, pain, or disability, but has gradually been expanded to include physical, mental, and societal well-being. Defining health and disease is basic to the search for methods of prevention. In 1920, C. E. A. Winslow, professor of public health at Yale University, defined public health as follows:

Public health is the Science and Art of (1) preventing disease, (2) prolonging life, and (3) promoting health and efficiency through organized community effort for
(a) the sanitation of the environment,
(b) the control of communicable infections,
(c) the education of the individual in personal hygiene,
(d) the organization of medical and nursing services for the early diagnosis and preventive treatment of disease, and
(e) the development of social machinery to ensure everyone a standard of living adequate for the maintenance of health,
so organizing these benefits as to enable every citizen to enjoy his birthright of health andlongevity.
Source: As quoted in Institute of Medicine. 1988. The Future of Public Health. Washington DC: National Academy Press.

Winslow’s far-reaching definition remains a valid framework but unfulfilled where clinical medicine and public health have grown apart. Isolation from the financing and provision of medical and nursing care services left public health the task of meeting the health needs of the poor and underserved population groups, with inadequate resources and recognition.
Terms such as social hygiene, preventive medicine, community medicine, social medicine, and others have been used to denote public health over the past century. Preventive medicine is a combination of some elements of public health with clinical medicine. Public health deals with the individual just as the clinical health care provider does, as in the case of immunization programs. Clinical medicine also deals in the area of prevention in management of patients with hypertension or diabetes, and in doing so prevents the serious complications of these diseases. Preventive medicine focuses on a medical or clinical function, or what might be called personal preventive care, with stress on risk groups in the community and national efforts for health promotion.