Last updated: 23 December 1998
Public health practice embraces all those actions that are directed
to the assessment of health and disease problems in the population; the
formulation of policies dealing with such problems; and the assurance of
environmental, behavioral, and medical services designed to accelerate
favorable health trends and reduce the unfavorable.
Failure to regulate powerful concerns which damage health serves to
perpetuate the freedom of choice of those with a great deal of power (major
business and others with vested interests in unhealthful products or activities)
to exploit those with relatively little (the public).
Personally, I regard bureaucratization as an endemic mental disease
of the highest contagiousness and high susceptibility. Very few people
seem to be immune. Age obviously offers no protection, on the contrary
young people may be hopelessly affected from the very beginning of their
administrative careers. The splitting up of the unity of the human being
into categories, the establishment of water-tight compartments between
service organizations, the growth of paper and desk decisions, promotion
based on years of experience instead of on qualifications and qualities,
all these must be regarded as malignant tumours in the health services
of today, not to speak of the belief which always grows in any bureaucracy
that problems can be solved by circulars and regulations instead of by
field work. To my mind bureaucratization is the greatest instrinsic enemy
of any service organization dealing with human beings and their problems.
... the new public health addresses the systematic efforts to identify
health needs and organize comprehensive services with a well-defined population
base. (...) Public health encompasses the more narrow concept of medical
care, but not in its technical and interpersonal aspects as applied to
individuals in clinical situations, but rather in its organizational dimension
as related to well-defined groups of providers and users. In addition,
public health includes coordination of those actions that have an impact
on the health of the population, although they go beyond health services
Sadly, I recognize that many of us are infected with a strange illusion: A person has a 'right' to something called health care. Thus, one states a claim to receive the latest assortment of technological therapies, based on some professional's diagnosis, to enable one to survive longer in a situation that is often ugly, injurious, depressing, or just boring.
I believe it is time to state clearly that specific situations and circumstances are 'sickening', rather than that people themselves are sick. The symptoms modern medicine attempts to treat often have little to do with the condition of our bodies; they are, rather, signals pointing to the disorders and presumptions of modern ways of working, playing, and living. Nevertheless, many of us are mesmerized by the glitter of high-tech 'solutions'; we pathetically believe in 'fix-it' drugs; we mistakenly think all pain is an evil to be suppressed; we seek to postpone death at almost any cost".
Public health is the science and art of promoting health. It does so
based on the understanding that health is a process engaging social, mental,
spiritual and physical well-being. Public health acts on the knowledge
that health is a fundamental resource to the individual, to the community
and to society as a whole and must be supported by soundly investing in
living conditions that create, maintain and protect health.
What tends to happen in these and other areas of public health concern,
then, is that health policy becomes a soldier in the war not only to reduce
human misery, but also to save money, souls, and social values.
Not every health problem can be "the most serious of our time",
yet virtually all of them are presented as such. (...) There is thus the
risk that we will become either anesthetized or hysterical in the face
of the apocalyptic claims on behalf of a multitude of health problems,
many of which originate in our own carelessness. Although the extreme reactions
of either an excessively intrusive and paternalist government or a "careless,
lounging" one are not viable, there is the potential that government
will either do too much, and thereby substantially reduce individual freedom,
or too little, and thereby unwittingly contribute to the personal tragedies
and social costs associated with avoidable deaths and illnesses.
... although the reduction of stress, increased recreational activity,
and wiser eating habits all may be indicated for healthier lives, such
choices may be made impossible, or at least considerably more difficult,
given the educational, economic, and cultural constraints of those living
at or near the poverty line.
Clearly, society, and public policymakers, respond differently to innocent
victims of disease than they do to those who have caused their own ill
health through foolish (or perhaps immoral) life-style choices.
Rarely in history has public health policy had as its sole purpose the
promotion of good health or the prevention of disease. As often as not,
it has sought to secure other critical social and political values, including
moral renewal, reduction of power, improved economic efficiency, and strengthening
of national defense.
Prostitution and venereal disease became great issues because of their
larger social and political implications, not because of the health risks
The most important characteristic of an organism is that capacity for
internal self-renewal known as health.
Public health (...) represents an organised response to the protection
and promotion of human health and encompasses a concern with the environment,
disease control, the provision of health care, health education and health
... public health is about social systems and collective decision-making
rather than being exclusively about the isolated activities of individual
members of the public.
The concept of public health (...) is that of a major governmental and
social activity, multidisciplinary in nature and extending to almost all
aspects of society. Here the keyword is "health", not "medicine".
The universe of concern is the health of the public, not the discipline
If advocates of personal prevention hope for really effective disease
prevention, they do have a responsibility to presribe social prevention
as preeminent and to put individual action in a context that indicates
its surrogate role. The very notion that individual people can be conceptually
separated from the society in which they live needs examination. In other
words: the individual-social dichotomy itself is questionable.
Copyright © by Eberhard Wenzel, 1997-2001