Practice of Public Health Health Article

PRACTICE OF PUBLIC HEALTH

The phrase "practice of public health" (which will be used interchangeably with the term "public health practice") fails to evoke a single compelling image, even for public health professionals who have spent years working in the field. Unlike medicine, or law, or even engineering, both those who contribute to and those who benefit from public health practice's efforts poorly understand what it is and how it works. This article seeks to illuminate key aspects of public health practice by addressing the following basic questions:

• What is public health practice?
• Where did it come from?
• What does it do?
• How is it organized and structured?
• What challenges does it face in the twenty-first century?

WHAT IS PUBLIC HEALTH PRACTICE?

One approach to describing public health practice is to compare it to some similar activity that most people understand and appreciate. Medical practice appears to fit this bill. The major functions of medical practice are to diagnose diseases and other conditions, develop a treatment plan for those health problems, and see that the treatment regimen achieves its therapeutic goals.

Public health practice has remarkably similar functions that focus on populations rather than individual patients. Public health functions involve identifying health problems and the factors that cause them, developing a strategy to address these problems, and seeing that these strategies are implemented in a way that works. In this light, public health practice is the development and application of preventive strategies and interventions in order to promote and protect the health of populations. Public health practitioners serve the health needs of populations in very much the same ways that physicians tend to the health needs of individual patients. Medical practice focuses primarily on diseases, injuries, and other conditions while public health practice focuses at the community level on factors that contribute to higher rates of these same health problems.

The practice of public health involves both individual and collective efforts. Many different professions and disciplines contribute to public health practice, including public health nurses, nutritionists, health educators, environmental health specialists, and physicians, just to name a few. But public health practice also includes the collective efforts of public health professionals acting in concert with others, often community partners, to identify and address health problems affecting defined populations.

The need for these different disciplines and skills indicates the complexity of the factors contributing to health and disease. Various bacteria and viruses cause many infectious diseases. But other factors can cause or contribute to the development of health problems. For example, the use of tobacco and alcohol contributes to heart disease, cancer, and injuries. Behavioral choices can place an individual at risk of certain infectious diseases (sexually transmitted diseases), chronic diseases (emphysema), injuries (drug overdoses), and other conditions. There are also aspects of the physical environment that affect health (contaminated air, water, or food). The social environment can also determine health risks (low income and education levels, overcrowding, and personal safety). Other social factors related to the use of health and medical services, such as travel distance, the number of providers, and even the availability of day-care services, also influence health. With so many elements affecting health, there is no one body of scientific knowledge that guides public health practice. Instead there are many. These include epidemiology, statistics, environmental sciences, management, biological sciences, and the behavioral sciences such as anthropology, sociology, psychology, and more. Political science, economics, and law are also involved in modern public health practice. Public health is grounded in many different sciences and supported by a variety of other disciplines.

Many people think of public health practice as only those activities performed by governmental public health agencies. Public health practice certainly includes, but is not limited to, the activities of federal, state, and local health agencies (such as the federal Centers for Disease Control, state health departments, and local public health departments). But many other individuals, organizations, institutions, and collaborations contribute to public health practice—and these efforts take place in private and voluntary, as well as in public, settings. For example, hospitals and businesses are often involved in communitywide health fairs and heart and lung associations continuously promote healthy lifestyles.

With so many different participants, the practice of public health can appear to be fragmented and chaotic. But, ideally, public health practice is strategic and purposeful; it is organized (perhaps most effectively at the community level) and it is both interdisciplinary and multidisciplinary. In sum, the practice of public health embodies what a community or society does collectively in order to ensure conditions in which people can be healthy. The skills and competencies necessary for public health practice are both individual and collective.