Historically, public health has served the nation through sanitation, immunization, and other disease-prevention activities (e.g., disease tracking and quarantine). For example, public health developed wastewater treatment programs to help fight typhoid fever during the industrial revolution. It also helped educate the public (and the food industry) on safely preparing and preserving foods. As a result, we have seen many once highly prevalent diseases become rare.
Public health continues its work in these areas. But today, it focuses increasingly on preventing chronic disease, improving environmental health, and addressing equity in health and within the health care system. It does this through a commitment to public service and through a lens of social justice.
We need a strong public health infrastructure
Due to its many successes, some people question the utility of public health in today’s society. Do we still need a broad public health infrastructure to keep us healthy? Particularly in light of the COVID-19 pandemic, the answer is obvious: Yes, a robust public health system is as relevant today as ever. If not more so.
Public health utilizes many tools for the prevention of disease. One essential tool, in my view, is health education. The CDC and other public health agencies are responsible for many public service announcements that help keep people aware of immediate and distant health threats. Because of the pandemic, for better or for worse, the news media are also playing an increased role in public health education. As the news media has been providing frequent and detailed coverage of COVID-19.
Health education is an essential aspect of public health by recognizing significant threats in our environment to the entire population’s health and safety. The teaching of families and children is also crucial from a public health viewpoint. Families are the smallest functional units in society that operate collectively. They consume and model lifestyle changes advised by public health professionals, quasi-public health representatives, and health care professionals.
The ten essential public health services
In addition to health education, the American Public Health Association (APHA) identifies ten essential public health services that provide a structure for public health. The ten essential public health services are intended to serve communities by promoting health for all population segments. APHA has broken up the ten essential functions of public health into three categories: assessment, policy development, and assurance.
Assessment seeks to identify systemic and structural barriers to health equity accurately. An activity that falls into the assessment category is community health assessments. A community’s fundamental health needs are identified and documented to be followed-up. The two essential assessment services are:
- Assess and monitor population health and investigate
- Diagnose, and address health hazards and root causes
Policy development can be described as activities directed to build awareness for a public health issue and the associated steps to establish a positive change platform. The four essential services of policy development are:
- Communicate effectively to inform and educate
- Strengthen, support and mobilize communities and partnerships
- Create, champion, and implement policies, plans, and laws
- Utilize legal and regulatory actions
Assurance relates to initiating and sustaining elements to protect the population’s health, such as supporting a volunteer emergency preparedness team. The four essential services of assurance are:
- Enable equitable access
- Build a diverse and skilled workforce
- Improve and innovate through evaluation, research and quality improvement
- Build and maintain a strong organizational infrastructure for public health
Public health and medicine overlap in many ways
Public health and medicine are essential partners in advancing health. Many public health principles overlap with those in medicine. But I think examining how public health differs from medicine is helpful. Public health emphasizes the health of populations and communities. In contrast, medicine focuses more narrowly, centering on the individual’s health.
Health education offers a useful example of where there are similarities and differences. Both public health and medicine are essential partners in delivering health education. But public health professionals develop, test, and relay broad messages to the general public. Health care providers, by contrast, deliver similar science-driven messages but in a more tailored and individualized way. Providers also deliver these messages using skills such as motivational interviewing.
Epidemiology, biostatistics, health policy and education, and many other areas of specialization make up the field of public health. In medicine, there are also many public health-related medical specialties. These include preventive medicine, occupational medicine, global health, addiction medicine, aviation medicine, and even toxicology. Physicians have the opportunity to train in these public health-related specialties as residents. Or they may train as fellows after residency or at any point in their career.
For example, I am a preventive medicine resident at the University of Massachusetts. My program is two years long, involves a master’s in public health (MPH) and is a split between clinical and non-clinical education. As a preventive medicine physician, I will have the opportunity to earn board certification in preventive medicine. I will also have the chance to work in occupational medicine following residency and be eligible for the occupational medicine board examination after two years working in the clinical field of occupational medicine as a provider. I may also have the opportunity to work in public health as a local or county medical director.
The value of a public health education for physicians
One reason physicians may want to consider a public health degree is to integrate medicine and public health into their careers. An MPH provides an education that fosters the idea that it is essential to advocate for realistic measures to improve our communities’ care. From my personal experience, I have seen that it is associated with helping physicians identify gaps in community health and engage more fully in civic life.
Understanding the principles and functions of public health can be eye-opening to the reality of health in the United States. Physicians working in suburban communities can become isolated from the challenges patients in urban and rural poor communities face. Public health is also helpful for those who want training and education in public health geared towards understanding the U.S. healthcare system’s shortcomings and successes. I think an MPH is a rewarding and valuable experience that others may find worth pursuing.
A frustrating resistance to public health
The critical relationship between public health and medicine could not be more apparent during the current COVID-19 pandemic.
Chronic underfunding of public health in the U.S. has left the country poorly-prepared for–and our medical system unable to cope with–a global emergency on the scale of COVID-19. The U.S. has faced tremendous (and surprising) political challenges to conveying appropriate recommendations and scientific matters to the public. There has not been consistent political support for our nation’s premier public health institution, the CDC, or the global health agency, the WHO. And the data now shows that in some states, the government and public’s resistance to following public health recommendations (e.g., mask-wearing and social distancing) has resulted in an increased incidence of COVID-19 illness.
Contact tracing is one of public health’s critical tools for outbreak investigations. It, too, has been met with resistance. Conspiracy theorists have argued it is an invasion of privacy. And the political system in the U.S. is so divided along party lines that efficiently ramping up contact tracing to the level needed has not been possible due to a lack of coordination at the federal and state level. As a result, the U.S. has greatly underutilized this tool. While not an alternative to contact tracing, one promising tool for monitoring viral activity in communities is using wastewater surveillance sampling. SARS-CoV-2 can be detected in the sewage system, helping alert local authorities of COVID-19 outbreaks.
Addressing health disparities is an important focus of public health. And through the pandemic, we have seen that racial, ethnic, and minority health disparities are present in every aspect of how COVID-19 illness infects our communities. The elderly population has seen some of the worst effects of the sickness, with mortality rates reaching up to 40 percent in some nursing homes. Racial and ethnic minorities have also faced a disproportionate risk for death from COVID-19 infection. These findings reveal the current state of health and health care in our country. And they may serve as a cause for change with the new presidential administration.
Public health and medicine will remain essential partners
Healthcare planning is a growing interest among students of public health. And it makes sense for public health to encompass healthcare planning in its policy development function. We can learn from the mistakes with the initial and current management of the national response to the pandemic. If we can focus greater attention on equity in our continuing response, and particularly with the upcoming expected release of a vaccine, we can make remarkable leaps in our response to the pandemic. But the job will not be complete once the pandemic is over. Both public health and medicine are essential partners that will need to convene, plan better for future pandemics, and correct areas of weakness to advance the health of the U.S.
Benjamin Eovaldi, DO