The document discusses the key concepts of public health, including definitions, core functions, and differences from medical care. It outlines the main disciplines of public health - epidemiology, statistics, biomedical sciences, environmental health, social and behavioral sciences, and health policy/management. It also covers the public health approach of defining problems, identifying risks, developing interventions, implementation, and monitoring effectiveness.

1. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com.
CHAPTER 1
Public Health:
Science, Politics,
and Prevention

2. Copyright
©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
What Is Public Health?
 C.E.A. Winslow provided the definition of public health in 1920 that is still valid
today.
 IOM’s The Future of Public Health refocused attention on public health and
revitalized the field.
– Mission is “fulfillment of society’s interest in assuring the conditions in which people
can be healthy.”
– Substance is “organized community efforts aimed at the prevention of disease and
the promotion of health.”

3. Copyright
©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Core Functions of Public Health
 Core functions of public health:
– Assessment
– Policy development
– Assurance

4. Copyright
©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Public Health Versus Medical Care
 In medicine, the patient is the individual; in public health, the patient is the
community.
 Public health diagnoses the health of the community using public health
sciences.
 Treatment of a community involves new policies and interventions.
 Goal of medicine is to cure; goal of public health is to prevent disease and
disability.
 Less than 3% of the nation’s total health spending is devoted to public health.
 Life expectancy of Americans has increased by 30 years over the 20th century,
and only 5 of the 30 years are attributed to modern medicine.

5. Copyright
©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Public Health: Science and Politics
 Science is how we understand threats to health, determine what interventions
might work, and evaluate whether the interventions worked.
 Politics is how we as a society make decisions about what policies to
implement.
 Politics is part of both the policy development and assurance functions of public
health.
 Community pays for public health initiatives through taxes.

6. Copyright
©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Public Health Disciplines
 Epidemiology
 Statistics
 Biomedical Sciences
 Environmental Health Science
 Social and Behavioral Sciences
 Health Policy and Management

7. Copyright
©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Epidemiology
 Epidemiology is the basic science of public health.
 The study of epidemics:
– Focuses on human populations, usually starting with an outbreak of disease in a
community
– Looks for common exposures, seeking the causative factor
 Deciphers causes of new disease and prevents spread of old, well-understood
diseases
 Epidemiologists are mainstays of local public health departments.
– “Shoe-leather epidemiology”

8. Copyright
©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Statistics
 Governments collect health data on the population.
 These numbers are diagnostic tools for the health of the community.
 The science of statistics is used to calculate risks and benefits.
 Statistical analysis is an integral part of any epidemiological study
seeking the cause of a disease.
 Statistical analysis is an integral part of any clinical study testing the
effectiveness of a new drug.

9. Copyright
©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Biomedical Sciences
 A major portion of human disease is caused by microorganisms.
 Control of infectious diseases was a major public health focus in the 19th and
early 20th centuries.
 Biomedical research remains important to understanding and control of new
diseases and noninfectious diseases.
– Chronic diseases
– Genetics

10. Copyright
©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Environmental Health Science
 A classic component of public health:
– Much of the public health improvement in the U.S. in the 20th century was due to
improved environmental health.
 Health is affected by exposure to environmental factors:
– Air quality
– Water quality
– Solid and hazardous wastes
– Safe food and drugs
– Global environmental change
 Thousands of new chemicals enter the environment every year, and little is
known about their effect on human health.

11. Copyright
©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Social and Behavioral Sciences
 Behavior is now the leading concern of factors that affect people’s health.
 A theory of health behavior is that social environment affects people’s behavior.
– Major health threats are tobacco, poor diet, and physical inactivity and injuries.
– Blacks have a lower overall life expectancy than whites even when incomes are
similar.
– Other ethnic minority groups are also at increased risk for a variety of health
problems.

12. Copyright
©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Health Policy and Management or Health Administration
 This area of study examines the role of medical care in public health.
 Cost of medical care in the U.S. is out of control.
 U.S. has a high percentage of population without health insurance.
– These people often lack access to medical care.
 Quality of medical care can be measured and is often questionable.
 Medical care has eaten up profits that could be used more beneficially for
education, housing, and the environment.

13. Copyright
©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Public Health: Prevention and Intervention
 Primary prevention prevents an illness or injury from occurring at all.
 Secondary prevention minimizes the severity of the disease or injury once it has
occurred.
 Tertiary prevention minimizes disability by providing medical care and
rehabilitation services.

14. Copyright
©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Public Health Approach
 Define the health problem.
 Identify risk factors associated with the problem.
 Develop and test community-level interventions to control or prevent the cause
of the problem.
 Implement interventions to improve the health of the population.
 Monitor interventions to assess their effectiveness.

15. Copyright
©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Chain of Causation
 Chain of Causation involves:
– Agent
– Host
– Environment
 This is a traditional approach to dealing with infectious diseases.
 Interventions can focus on any of these targets.
 This model can also be used for other kinds of illnesses or injuries.

16. Copyright
©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Public Health and Terrorism
 Events of 9/11 and the anthrax letters highlighted the importance of public
health.
 Public health response to disasters, natural and man-made, helps to control the
damage and to prevent further harm to survivors and rescuers.
 Public health response to 9/11 was essentially the same as needed for other
disasters, such as factory explosions and plane crashes.
 Bioterrorism is recognized primarily through classic public health measures
similar to those used for natural epidemics.
 The threat of bioterrorism did more to teach the public about public health than
any educational program.

17. Copyright
©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Discussion Question 1
 Describe actions that governments have taken to ensure that people are safer
and healthier today than people were 100 years ago.

18. Copyright
©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Discussion Questions 2
 What are the three core functions of public health?
 How do these functions compare with the functions of medical care?
 How are the six disciplines of public health used to accomplish the core
functions?

19. Copyright
©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Discussion Question 3
 Identify a health problem in your community.
 What are some risk factors associated with the problem?
 Suggest a possible intervention that the community could take to ameliorate the
problem.

20. Copyright
©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Discussion Question 4
 Visit the website for American Public Health Association (APHA),
www.apha.org.
– Read the highlights from the current issue of the American Journal of Public Health.
– Which of the public health sciences does each of these articles belong to?
 Visit the website for The Nation’s Health, the official newspaper of APHA,
thenationshealth.aphapublications.org/.
– Read the headlines of the current issue to get an idea of the range of topics
encompassed by the field of public health.