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Public health

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.
Afifi, Abdelmonem A. & Breslow, Lester (1994), The maturing paradigm of public health. In: Annual Review of Public Health, Vol. 15, 223-235, here: 232

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).
Downie, R.S., Fyfe, C. & Tannahill, A. (1990), Health promotion. Models and values. Oxford (Oxford University Press), 1990, 55

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.
Evang, Karl, Health service, society, and medicine. Present day health services in their relation to medical science and social structures. London (Oxford University Press), 1960, 139

... 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 strictly speaking.
Frenk, Julio (1993), The new public health. In: Annual Review of Public Health, Vol. 14, 469-490, here: 477

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".
Illich, Ivan (1996), Brave new biocracy. A critique of health care from womb to tomb. In: Chesworth, J. (ed.), The ecology of health. Identifying issues and alternatives. Thousand Oaks (Sage), 17-29, here: 27

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.
Kickbusch, Ilona, Good planets are hard to find. Copenhagen (WHO-EURO, Healthy Cities Papers, No 5), 1989, 13

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.
Leichter, Howard M., Free to be foolish. Politics and health promotion in the United States and Great Britain. Princeton, N.J. (Princeton University Press), 1991, 95

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.
Leichter, Howard M., Free to be foolish. Politics and health promotion in the United States and Great Britain. Princeton, N.J. (Princeton University Press), 1991, 255

... 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.
Leichter, Howard M., Free to be foolish. Politics and health promotion in the United States and Great Britain. Princeton, N.J. (Princeton University Press), 1991, 85

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.
Leichter, Howard M., Free to be foolish. Politics and health promotion in the United States and Great Britain. Princeton, N.J. (Princeton University Press), 1991, 81

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.
Leichter, Howard M., Free to be foolish. Politics and health promotion in the United States and Great Britain. Princeton, N.J. (Princeton University Press), 1991, 32

Prostitution and venereal disease became great issues because of their larger social and political implications, not because of the health risks they posed.
Leichter, Howard M., Free to be foolish. Politics and health promotion in the United States and Great Britain. Princeton, N.J. (Princeton University Press), 1991, 56

The most important characteristic of an organism is that capacity for internal self-renewal known as health.
There are two organisms whose processes of self-renewal have been subjected to human interference and control. One of these is man himself (medicine and public health). The other is land (agriculture and coservation).
The effort to control the health of land has not been very successful.
Leopold, Aldo (1970), A Sand County Almanac. New York (Ballantine Books), here: 272

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 promotion.
Research Unit in Health and Behavioural Change, University of Edinburgh (1989), Changing the public health. Chichester (Wiley), xvii

... public health is about social systems and collective decision-making rather than being exclusively about the isolated activities of individual members of the public.
Research Unit in Health and Behavioural Change, University of Edinburgh (1989), Changing the public health. Chichester (Wiley), xiii

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 of medicine.
Terris, Milton (1992), Current trends in public health in the Americas. In: Pan American Health Organization (ed.), The crisis of public health. Reflections for the debate. Washington, D.C. (PAHO), 166-183, here: 178

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.
Tesh, Sylvia N. (1990), Hidden arguments. Political ideology and disease prevention policy. New Brunswick (Rutgers University Press), 83


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