SEE ALSO autonomy; communicable disease; environmental health; globalization; health promotion; Maternal, Newborn and Child Health; non-communicable disease; volunteerism
Public health aims to promote health, prevent disease, treat illnesses, prolong life, care for the infirm and to provide health services. The public health system can provide a framework to encompass the different sectors that contribute to the health of the public (Hunter, Marks and Smith, 2010).
The definition of public health remains a contested term given the competing perspectives, priorities and the services that it delivers and the specialist fields that it covers including health promotion, community health and health improvement. Traditionally, public health goals have been to curb the spread of infectious diseases and to protect the well-being of the general population; however, others see a much greater role in regulation and reducing inequalities in health (Baggott, 2010).
The new public health is a contemporary application of a broad range of evidence-based scientific, technological and management systems implementing measures to improve health. Its main objectives are the political and practical application of lessons learned to combat existing, evolving and re-emerging health threats, risks and inequalities (Tulchinsky and Varavikova, 2010). The term, new public health, emerged in the 1990s to denote an agenda on equity, an understanding of the determinants of health, empowerment and inter-sectoral action. What is new is not the originality of strategies used but the manner in which the dominant public health framework of disease prevention becomes redefined as a result of changing health patterns and advances in health knowledge (Baum, 2008).
Public health law is the legal powers and duties held by the state in collaboration with various partners to ensure the conditions for people to be healthy for the common good. Public health law aims to pursue the highest level of physical and mental health in the population, consistent with the values of social justice, and examines the authority of the government at various levels to improve health. Public health law also considers the autonomy, privacy, liberty, propriety or other legal interests of individuals, groups and communities (Gostin, 2008). The success of many of public health’s past achievements have been supported by legislation including the ones on sanitation, housing standards, passive smoking, improved motor vehicle safety, safer workplaces and human rights. For example, the Public Health Act 1875 was introduced in the United Kingdom to combat filthy urban living conditions which caused the spread of diseases such as cholera and typhus. The Act required all new residential constructions to include running water and an internal drainage system and that every public health authority had to have a medical officer and a sanitary inspector to ensure that the laws were enforced (Berridge, 2007).
Community health is concerned with the study and improvement of the health characteristics of communities. Health improvement aims to find ways of preventing ill health, protecting good health and promoting better health. This is achieved by working with local communities and organizations across public, private and voluntary sectors to address the personal, socio-economic and cultural factors that influence health and well-being (Jirojwong and Liamputtong, 2009).
The declaration of Alma Ata was adopted at the international conference on primary health care in September 1978 (WHO, 1978) and emphasized the importance of prevention, participation and the need for social and political action to address poor health. More recently the World Health Organization has updated its interpretation of primary health care as an ultimate goal of better health for all and in so doing identified five key elements to achieving that goal: reducing exclusion and social disparities in health (universal coverage reforms); organizing health services around people’s needs and expectations (service delivery reforms); integrating health into all sectors (public policy reforms); pursuing collaborative models of policy dialogue (leadership reforms); and increasing stakeholder participation (WHO, 2008a). Primary health care includes health education for the whole community about proper nutrition, safe water and basic sanitation, maternal and child health care, family planning, immunization and the provision of essential drugs. The most practical way forward in differentiating between primary health care and public health is to view the latter as encompassing the former as a range of educational, skills development and basic service provision activities.
Universal health care (also called universal health coverage, universal coverage or universal care) refers to a health system organized around providing a specified package of benefits to all citizens with the goal of providing financial risk protection, improved access to health services and improved health outcomes. The way health systems are financed is critical for reaching universal coverage since they determine whether health services exist and are available and whether people can afford to use health services when they need them. Health financing is concerned with how resources are generated, allocated and used in health systems and focuses on how to achieve a more equitable and efficient health service. Universal health care is not a one-size-fits-all concept, nor does it imply coverage for all people for all health needs. Universal health care has been achieved by using a mixed model of funding. General taxation revenue is the primary source of funding but this is usually supplemented by specific levies (which may be charged to the individual and/or an employer) or with the option of private payments (either direct or via optional insurance) for services beyond those covered by the public system (WHO, 2010).
The different interests within public health help to shape what it looks like and the directions it takes as a professional practice, by the need to compete for limited resources, the control over decisions and the development of national policies. As a profession, public health is driven and largely controlled by government departments, private sector agencies or non-governmental organizations. These people are employed to improve or maintain the health of individuals, groups and communities (Turner and Samson, 1995). Public health therefore entails some power relationship between its different stakeholders, primarily between practitioners and the range of people who act as the recipients of the information, resources and services being delivered through public health policies and programmes.
In practice, public health still belongs primarily to people employed in the health sector, in the sense that it provides conceptual models and professional legitimacy. Public health practitioners may therefore be titled health promoters or community health workers and because of its wide scope many more who look to the idea of public health occupy jobs such as health visitors, nurses and environmental health officers.
KEY TEXTS
•Baggott, R. (2010) Public Health: Policy and Politics. 2nd edn (Basingstoke: Palgrave Macmillan)
•Baum, F. (2008) The New Public Health. 3rd edn (Oxford: Oxford Higher Education)
•Hanlon, P. et al. (2012) The Future Public Health (Maidenhead, USA: Open University Press)
SEE ALSO capacity building; inequalities agenda; injury; mental health; volunteerism
Disability is an umbrella term for impairments, activity limitations and participation restrictions. A person may be considered disabled if he or she has a condition that affects his or her ability to function without assistance at a level needed to maintain their health and well-being (WHO, 2011).
Definitions of disability vary and are not just about medical conditions but are often characterized by the discrimination and harmful social norms that people with such conditions have to contend with. Disability refers to the negative aspects of the interaction between individuals with an impairment, any loss or abnormality of psychological, physiological or anatomical structure or function, and personal and environmental factors such as negative attitudes, inaccessible public buildings and limited social supports. Disability can encompass people with a wide range of impairments including physical, sensory, intellectual and mental health and with a common experience of stigma and exclusion (United Nations, 2006a).
More than a billion people are estimated to live with some form of disability, about 15% of the world’s population. Of these, approximately 110 million people have significant difficulties in functioning and 80% are estimated to live in low-income countries and have limited or no access to basic health, social and rehabilitation services (WHO, 2011).
The International Classification of Functioning, Disability and Health provides a list of body functions and structure, activity and participation related to disability. Since an individual’s functioning and disability occurs in a context the International Classification of Functioning, Disability and Health also includes a list of environmental factors (WHO, 2001). The United Nations Convention on the Rights of Persons with Disabilities (United Nations, 2006a) aims to promote, protect and ensure the full and equal enjoyment of all human rights and fundamental freedoms by all persons with disabilities, and to promote respect for their inherent dignity.
Community-based rehabilitation (CBR) is a strategy within general community development for the rehabilitation, equalization of opportunities, poverty reduction and social inclusion of people with disabilities. CBR programmes are mostly in resource-poor countries and are usually implemented through the combined efforts of people with disabilities, their families, community workers, health professionals and communities. It includes work to promote social inclusion, empowerment, access to education, work opportunities and to preventive, rehabilitative and curative health services (ILO, UNESCO and WHO, 2004).
Discrimination is the prejudicial treatment of individuals based on their actual or perceived membership in a certain group or category in a way that is worse than the way people are usually treated. Ableism, also called disability discrimination and disability oppression, is a form of discrimination against people with disabilities. Social stigma can be explained as the extreme disapproval of a person or group on socially characteristic grounds that are perceived, and serve to distinguish them, from other members within a society. Stigma is affixed to a person by society because he or she is perceived to differ from the cultural norm and can manifest in many different forms including in regard to disability and mental health issues but also in regard to obesity and specific diseases such as leprosy. Many people who have been stigmatized feel as though they are devalued by others and this affects them directly through mechanisms of discrimination and indirectly through threats to personal and social identity. Social identity threat creates involuntary stress responses and attempts at threat reduction through coping strategies. Stress responses and coping efforts affect important outcomes such as self-esteem, academic achievement and health outcomes (Major and O’Brien, 2005).
Disability pressure groups work to gain more control to influence economic, political and social change in regard to disability, for example, by changing health and welfare policy. ‘Every Australian Counts’ is a civil society campaign for a National Disability Insurance Scheme in Australia. The scheme will be a new support system for people with a disability, their families and carers to ensure people are better supported and to enable them to have greater choice and control. The campaign is designed to lobby government and to advocate for change in the existing system using information sharing through Facebook and twitter. The lobbying targets politicians and other influential people and recruits ‘champions’, such as media personalities, to support their cause (Every Australian Counts, 2012).
The World Report on Disability (2011) has assembled the best evidence to improve the lives of people with disabilities and facilitate the implementation of the UN convention on the rights of persons with disabilities. The report recommendations include better access to mainstream systems and services, investment in disability programmes, national strategies and plans of action for disability, build capacity, increase public awareness about disability and provide adequate funding for disability actions.
KEY TEXTS
•Oliver, M. (2009) Understanding Disability: From Theory to Practice. 2nd edn (Basingstoke: Palgrave Macmillan)
•World Health Organization (2001) ‘The International Classification of Functioning, Disability and Health (ICF)’. Resolution WHA 54.21 (Geneva: World Health Organization)
•World Health Organization (2011) World Report on Disability (Geneva: World Health Organization)