Public Health – concept of public health was a fulfilment of his dream about the State’s
responsibility for the health of its people – The Public Health Act 1848.
History of public health may be referred as four distinct phases:-
i) Disease control phase (1880 – 1920) – during this 19th century Public Health was
largely a matter of sanitary legislation and sanitary reforms aimed at the control of
man’s physical environment, i.e water supply, sewage disposal. These measures
improved largely the health of the people due to the disease and death control.
ii) Health promotional phase (1920 – 1960) – in the beginning of 20th century,
concept of “health promotion” began to take shape. Health of the individual is the
State’s responsibility. Consequently, in addition to the disease control activities.
iii) Social engineering phase (1960 – 1980) – with the advances in preventive
medicine and practice of public health, the disease pattern began to change. Many of
the acute illness problems have been under control, but the new problems in the form
of chronic diseases began to emerge like cancer, diabetes, cardiovascular diseases,
alcoholism & drug addiction especially in the affluent societies, public health entered a
new phase as social engineering. Social & behaviour aspects of disease and health
were given priority. Public health moved into preventive and rehabilitative aspects of
chronic diseases and behavioural problems.
iv) Health for all phase (1981 – 2000 A.D) – Most people in the developed countries
and elite of the developing countries enjoy all the determinants of good health –
adequate income, nutrition, education, sanitation, safe drinking water and
comprehensive health care.
one more goal was added to public health, health promotion of the
individual. It was initiated as personal health services such as MCH, school
health, industrial health, mental health and rehabilitation services.
Two great movements were initiated for human development namely:-
1) Provision of “basic health services” through PHCs and SubCentres for
rural & urban areas. (suggested by the Bhore Committee, 1946).
2) The second great movement was the Community Development
Programme to promote village development through the active
participation of the whole community (fails to survive due to quick
initiative with inadequate resources).
Public health deals with preventing disease and promoting health at the
community or the population level. While doctors treat us when we are
sick, public health professionals try to prevent us from getting sick. For
example, public health professionals try to prevent influenza infections
by promoting hand washing and flu vaccines.
The classical definition of Public Health formulated by Willium as: ‘ The
science and art of preventing diseases, prolonging life and promoting
physical health and efficiency through organized community efforts and
systematic social action, which will ensure to every individual, in the
community, a standard of living adequate for maintenance of health.
Public health is a broad and dynamic field that encompasses various aspects aimed at
improving the health and well-being of populations. Some of the key scopes of public
health:
1. Disease Prevention and Control: This involves efforts to prevent the spread of
diseases through vaccination programs, health education, and the promotion of healthy
behaviours.
2. Health Promotion: Public health initiatives often focus on promoting healthy lifestyles
and behaviours, such as encouraging physical activity, healthy eating, and smoking
cessation.
3. Environmental Health: This area addresses the impact of environmental factors on
health, including air and water quality, waste management, and the control of
environmental hazards.
4. Epidemiology and Surveillance: Public health professionals monitor and analyze
data on disease outbreaks and health trends to form policy and intervention strategies.
5. Health Policy and Management: This involves the development and
implementation of policies that improve health care delivery and access, as well as the
management of health care systems.
6. Global Health: Public health efforts often extend beyond national borders to
address health issues that affect populations worldwide, such as pandemics,
malnutrition, and access to clean water.
7. Community Health: This focuses on improving health outcomes within specific
communities through targeted interventions and programs that address local health
needs.
8. Occupational Health: Ensuring the health and safety of
workers by addressing workplace hazards and promoting safe
work practices.
9. Mental Health: Public health also encompasses efforts to
promote mental well-being and address mental health disorders
through education, prevention, and treatment programs.
10. Health Equity: A critical aspect of public health is
addressing health disparities and ensuring that all individuals
have access to the resources they need to achieve optimal
health.
Functions of public health – broadly three functions:
A) Assessment – means applying the various tools of epidemiology, sociology
and biostatistics to assess the socio-demographic and disease profile of the
community and identifying the community or population needs.
B) Assurance – means assuring that adequate health care services, preventive as
well as curative of acceptable quality and standards are made available at an
affordable cost.
C) Policy development – means making overall statement and laying down
guidelines, including financial provisions for various health promotional,
Epidemiology – it is the basic science of public health. This discipline is
based on principles of statistics and research methodologies and designed to
train professionals to apply the principles and methods of epidemiological
investigation in abroad range of settings.
According to John M Last, 1988, epidemiology has been defined as, “the study
of distribution and determinants of health related states or events in specified
populations and the application of this study to the control of health problems”.
The ultimate aim is to lead to effective action:
i) To eliminate or reduce the health problem or its consequences.
ii) To promote the health and well being of the society as a whole.
Components of epidemiology –
a) Study of disease frequency – this means measurement of frequency of
disease, disability or death and summarising this information in the form of
rates and ratios such as incidence rate & prevalence rate, death rate etc.
These are expressed in terms of rate, ratio and proportion. These rates are
essential for comparing disease frequency in different populations or
subgroups. Such comparison may yield important clues to disease
aetiology. This is a vital step in the development of strategies for prevention
or control of health problems.
b) Distribution of disease - this refers to pattern of disease occurrence in the
community in terms of time, place and person. This also helps to know the trend of
disease occurrence over years, geographical areas and over different population
groups. This study also gives an idea about the variation or pattern of disease
occurrence, its aetiology and modes of transmission which may suggest or lead to
measures to control or prevent the disease. This aspect of epidemiology is known as
descriptive epidemiology. An important outcome of this study is formulation of
aetiological hypothesis.
c) Determinants of disease – this refers to identify the underlying causes (or risk
factors) of disease. The study helps to test the aetiological hypothesis formulated by
descriptive studies. This aspect of epidemiology is known as analytical
epidemiology.
In recent years, analytical studies contributed to have an understanding of the
determinants of chronic diseases, e.g lung cancer and cardiovascular diseases.
Uses of epidemiology – it helps :
1) To study the natural history of a disease.
2) To identify the determinants of the disease and the risk factors.
3) To make community diagnosis.
4) To study the historical rise and fall of disease in the population.
5) To estimate the individual’s risk of a particular disease.
6) In planning and evaluation of health services in the community.
7) To make further researches in epidemiology.
The clinical epidemiology is making predictions about individual patients by counting
clinical events in groups of similar patients and using strong scientific methods to ensure
that the predictions are accurate.
Evidence-based medicine is a modern term for the application of clinical epidemiology to
the care of patients. It includes formulating specific clinical questions, finding the best
available research evidence bearing on those questions, judging whether the information
is strong enough to take clinical decisions on the care of patients.
The purpose of clinical epidemiology is to develop and apply methods of clinical
observation that will lead to good decisions in the care of patients. Example – Frequency –
How often does a disease occur ? Cause – What conditions lead to disease ? What are the
origins of the disease ?
