Public Health

1. The definition of public health

The term “public health” has been defined in a variety of ways, with the following hotly debated questions making it difficult to establish a precise definition [1]:

• Where does public health stand in relation to medical care, social security systems and occupational safety, and health measures? 
• What economic and social variables (such as income or housing circumstances) should be taken into consideration when it comes to public health? 
• What exactly are the boundaries of public health? 

Accordingly, many definitions vary in the subtopics they explicitly include or exclude [1-3].

One thing they all have in common, however, is that every definition is based on the objectives of public health – which are to prevent sickness and to improve health [1, 4, 7].

A simple explanation, which by no means claims to be the one true definition of public health, might, for example, be [1]:

“Public health comprises all collective measures designed to permanently improve the health of the population.”

To clarify which topics and subtopics this can involve, it helps to take a look at the functions of public health [3].

2. The functions of public health

As there is no clear-cut definition of public health or its boundaries as a field of research, experts also differ in how broadly they define its remit. The following however are fundamental principles [1-3, 5]:

• An emphasis on collective responsibility for health and on the primary role of government in protecting and promoting the health of the population→ Due to the scope of the challenge, government should – alongside numerous institutions – be a main driver. 
• A focus on entire population groups→ In contrast to a doctor’s appointment, the spotlight here is less on the individual and more on society as a whole. In the end, the measures benefit everyone. 
• An emphasis on prevention, especially on what is known as primary prevention→ Far more effective than treating existing diseases is preventing them from occurring in the first place. Primary prevention strives to avoid the onset of illness; examples include vaccination or lifestyle measures such as stopping smoking.
• Observation of the underlying socio-economic determinants of health and sickness and the specific risk factors→ In order to effectively prevent disease it is essential to understand the circumstances that cause it – and the strength of their effect.
• A multi-disciplinary basis that includes quantitative and qualitative methods as appropriate→ As the research field is so wide and can involve almost all areas of life, there is no “one specialist for everything”. Instead, close communication between different disciplines and the inclusion of a wide variety of survey types are always necessary.
• A partnership with the respective population groups→ Good research is never one-sided. Truly understanding the causes and determinants of health conditions therefore requires excellent communication with all involved parties – including the population itself.

3. Public health - goals

The two overarching goals of public health are to prevent illness and to improve health. As these are however rather general, numerous secondary goals are required to achieve the primary goals [1, 4, 7].

These include [1, 6]:

• Monitoring health status to identify health problems within the population→ Only with careful monitoring of which illnesses occur to what extent and in what form within the population is it possible to comprehensively analyze the problem and develop suitable solution strategies. The goal of having high-quality national cancer registries would be one example.
• Diagnosis and examination of illnesses and health risks in society→ This aspect shows how closely public health is intertwined with the day-to-day work of physicians. Standardized diagnosis of diseases is fundamental to establishing reliable case numbers within the population. One goal here would therefore be to ensure good healthcare provision throughout all regions of a country.→ This aspect shows how closely public health is intertwined with the day-to-day work of physicians. Standardized diagnosis of diseases is fundamental to establishing reliable case numbers within the population. One goal here would therefore be to ensure good healthcare provision throughout all regions of a country.
• Informing, educating, and empowering the population regarding health issues→ This is the vast field of health communication, a responsibility that also falls to more than just one profession. Physicians, researchers, journalists, and many others can play a crucial role here, and promoting communication is an important goal.
• Mobilizing partnerships in the community in order to identify and resolve healthcare problems→ It is essential that all players mutually exchange information in order to benefit from the full range of information flows and findings. This is a very important goal. 
• Developing strategies and plans to support individual and communal healthcare efforts→ Even once a specific health risk has been identified, the findings still have to be put into practice if they are to reach individuals. 
• Enforcing laws and regulations to protect health and ensure safety→ Certain areas have such a massive impact while also holding such significant potential for abuse that they require state intervention. Minimum quality standards for drinking water would be one example.
• Connecting people to the requisite personal health services and ensuring the provision of healthcare services if these are not otherwise available→ Even where certain healthcare services – such as sexual health clinics or family planning services – exist, they are not much use if the relevant population groups are unaware of them.
• Ensuring that staff in public healthcare systems is competent→ Even experts occasionally require further training, and ensuring that it is provided is an important goal.
• Assessing the effectiveness, accessibility and quality of personal and population-based healthcare services→ The quality standards of all providers must be systematically and regularly reviewed.
• Research into new findings and innovative solutions to health problems→ Researchers in a wide range of disciplines play a crucial role in advancing public health, and state-of-the-art research is an indispensable goal here.

It is not hard to imagine that all the above-described goals in turn have their own sub-goals, highlighting the immense scope of public health as a field of research.

3.1. Public health is global health

All the above-mentioned goals demand major effort and significant financial outlay. Enabling absolutely everyone to be healthier therefore requires global thinking [1].

Poorer countries, in particular, frequently face even more fundamental challenges. From a global point of view, the following additional goals are therefore paramount [1]:

• Better recording of healthcare statistics→ In principle, this is just as possible in poorer countries, but it is frequently under threat for political reasons.
• Achieving political consensus on the high priority of education and healthcare services→ Globally, these priorities are far from the norm, and must therefore be continuously promoted. 
• Enabling female autonomy→ This too is a field in which there are significant inequalities worldwide. However, the best possible health outcomes can of course only be achieved if everyone is able to make free and independent choices.
• Guaranteeing sufficient nutrition→ What is considered normal in prosperous countries remains an existential problem for many people around the world. But good nutrition is indispensable to good health.
• Creating efficient and accessible healthcare services, including preventive services→ This too is an immense challenge. Poorer countries have significantly lower densities of physicians and clinics, and good medical care is unaffordable for many people.

All these are good reasons why public health can be considered on a significantly broader scale than mere concern for individual health risks and specific high-risk groups within a population. However, they also make the field significantly more complex [1].