The scope and definition of public health

Public health is a multidimensional field which requires a multidisciplinary workforce and organisational needs. As established in ancient times, public health contains many concepts, including holistic health, based on evolving scientific advances and applying best practice (1).

Public health is continuously developing from its ancient and recent roots, especially in the past several centuries. There were evolutionary and dramatic leaps forward to deal with new personal and population health and well-being challenges. The New Public Health addresses overall health policy, resource allocations, organisation, management, and medical care and health systems provision. The New Public Health focuses on preventing avoidable diseases, injuries, disabilities and death (1,2). It promotes health environment and optimal conditions for all generations; future and current ones. (1) In contrast, public health was primarily seen in previous centuries as a discipline that studies and implements control of communicable disease, mainly by sanitation and vaccination (1). The sanitary revolution, which led to the current bacteriology, made a massive contribution to improved health (1).

The actual definition of “Public Health” is widely debated among scholars and public health experts, especially when public health scope aligns with the definition. Nevertheless, the widely accepted definition of public health is the one given in the Acheson report, which defines public health as “the science and art of preventing disease, prolonging life, and promoting health through the organised efforts of society” (2).

Another broad but somewhat less expansive definition of public health is the traditional public health definition which focuses on the health of the entire populations instead of an individual patient (3). In population public health, the “patient” is the whole community or population in contrast to medicine where the “patient” is an individual. Public health aims to reduce disease and early death in the population rather than an individual (3). Nonetheless, “Population health as public health” is imprecise and places the responsibilities of dealing with the same health problem on various agents who have dissimilar strategies with little coordination (3).

Another definition of public health applied internationally and domestically is a “human right as public health” (3). The humanitarian definition of public health is unrealistic as it widens the scope of public health into social, economic, and political issues. Consequently, it hinders effective training of the public health professionals and puts strains on the budget for root cause investigation of health problem. It hinders healthcare professionals from tackling traditional public health problems such as infectious disease, poor hygiene and new threats like bioterrorists (3). It is not part of the public health’s mission to eliminate individuals and populations’ health conditions that arises from war, crime, hunger, poverty, illiteracy, homelessness, and human rights abuses (3). Public health professionals should ensure that individuals have a minimum standard of living to support a healthy life while receiving support from all disciplines without using the self-defeating notion of taking human rights into the public health domain (3).

The Institute of Medicine (IOM) report “The Future of Public Health” provided one of the most cited definitions of public health: “Public health is what we, as a society, do collectively to assure the conditions for people to be healthy” (3). This definition is described as vague and failed to clarify the primary objective and scope of public health and to explicitly state that public health is concerned with the community instead of an individual. Furthermore, the IOM report puts public health responsibility to everyone while handing government agencies' primary responsibility. The IOM report also provided with, but not endorsed, more expansive public health definition which is in line with the broad traditional definition of public health: “It’s anything that affects the health of the community on a mass basis” (3).

In summary, public health discipline is multidimensional and continuously evolving; hence, the debate on the scope and definition of public health. There is limited literature about the scope and definition of public health as general. Nevertheless, numerous resources discuss the scope of specific public health topics, such as mental health, hypertension, and public health laws.

References

(1) Tulchinsky TH, Varavikova EA. Chapter 2 - Expanding the Concept of Public Health. In: Tulchinsky TH, Varavikova EA. (eds.) The New Public Health (Third Edition). San Diego: Academic Press; 2014. pp. 43-90.

(2) Detels R, Chuan Tan C. The scope and concerns of public health. In: Detels, R., Gulliford, M., Abdool Karim, Q. and Chuan Tan, C. (eds) Oxford Textbook of Global Public Health. Oxford University Press; 2015.

(3) Rothstein MA. Rethinking the Meaning of Public Health. J Law Med Ethics. 2002; 30 (2): 144-149. Available from: doi: 10.1111/j.1748-720X.2002.tb00381.x Available from: https://doi.org/10.1111/j.1748-720X.2002.tb00381.x .