Public Health - The Basics

In many countries, the practice of Public Health is divided into two parts - health promotion and health protection. In the UK, health protection has come to be taken to relate to communicable diseases, disaster management and emergency planning, and threats to the population from issues such as bioterrorism. The history of health promotion is lengthy and complex.

The Ottawa Charter for Health Promotion encourages the use of multiple strategies by identifying five action areas for health promotion practice. These five action areas are:

1. Building healthy public policy

2. Create supportive environments

3. Strengthen community action

4. Developing personal skills

5. Re-orienting health services

Health promoters have worked on these five action areas through the use of multiple, complementary strategies. Some of the key strategies include:

Key strategies

• Health communication - Use of communication techniques and technologies to positively influence individuals, populations and organizations for promoting conditions conducive to human and environmental health

• Health education

• Constructed opportunities for learning involving communication to improve health literacy, including improving knowledge and life skills to improve individual and community health

• Self help/mutual aid - a process by which people who share common experiences, situations or problems can offer each other support

• Organizational change - Working within settings for health, such as schools, worksites, universities, to create supportive environments that enable healthier choices

• Community development and mobilization - Collective efforts by communities directed toward increasing community control over determinants of health

• Advocacy - a combination of individual and social actions to gain political commitment or support for a particular health goal or program

• Policy development - the process of developing legislation and regulatory measures that protect the health of communities and make it easier for individuals to make healthy choices

Theories. There are a number of underlying theories underlying the practice of health promotion:

Here is a list of selected theories and models that are used for health promotion and disease prevention (from the Rural Health Information Hub in the USA - chosen to show here as the links are easy to access and very clear)

• Ecological Models
• The Health Belief Model
• Stages of Change Model (Transtheoretical Model)
• Social Cognitive Theory
• Theory of Reasoned Action/Planned Behavior

Health Protection can be considered as a separate discipline, and has been defined in this Editorial: Health protection and promotion as:

"Health protection offers equality of opportunity for people to enjoy the highest attainable level of health, and is achieved through the development and implementation of legislation, policies and programmes in the areas of environmental health protection and community care facilities. Health protection in the modern public health age focuses mainly on:

• preventing and controlling infectious diseases
• protecting against radiation, chemical and environmental hazards."

Disease Prevention or Health Promotion

What is disease prevention?

Disease prevention is the branch of public health practice concerned with the prevention of chronic diseases contributing to premature mortality (e.g., heart disease, cancer, stroke, diabetes).

Most public health texts refer to three levels of prevention.

• Primary prevention - engaging in actions preventing the initial occurrence of disorders or diseases by focusing on the risk factors and risk conditions which are associated with, or cause increased susceptibility to, specific diseases.
• Secondary prevention - stopping or slowing down the progress of a disease or disorder as soon as possible before medical treatment is required.
• Tertiary prevention - reducing the occurrence of relapses of a chronic disease or disorder.

Comparison with Health Promotion

Health promotion also focuses on the prevention of disease and shares many of the same strategies as disease prevention. However, health promotion has a number of features and values that distinguish it from traditional disease prevention efforts. These include:

• focus on assets and strengths as well as risk factors and conditions;
• commitment to participatory approaches that build the capacity of individuals and communities to address their health concerns; and
• greater focus on the social, economic and environmental causes of health and illness. Disease prevention initiatives, by contrast, focus mainly on modifying the health behaviours of individuals.

Global health law

Often forgotten in the context of promoting health, "Global health advocates often turn to medicine and science for solutions to enduring health risks, but law is also a powerful tool." as Gostin and colleagues remind us in The global health law trilogy: towards a safer, healthier, and fairer world.The abstract continues: "No state acting alone can ward off health threats that span borders, requiring international solutions. A trilogy of global health law—the Framework Convention on Tobacco Control, International Health Regulations (2005), and Pandemic Influenza Preparedness Framework—strives for a safer, healthier, and fairer world. Yet, these international agreements are not well understood, and contain gaps in scope and enforceability. Moreover, major health concerns remain largely unregulated at the international level, such as non-communicable diseases, mental health, and injuries. Here, we offer reforms for this global health law trilogy."

No space here to discuss in any detail, but this does allow us to at least raise the issue of regulation as a Public Health intervention, and you can access the full text of the paper through the link above if you wish.