What is “public health” anyway?

copy-of-p3061598March 1, 2010

As children begin to know about roles and jobs, some will say, “I want to be a doctor.” Their parents buy them a ‘doctor’ kit to play with, and they practice being a doctor. I never hear a child say, “I want to work in public health.” Why is that? What’s wrong with this picture?

Public health isn’t part of the usual high school curriculum, so we don’t get an introduction to what a career in public health might look like. When health education is taught in high school, the course doesn’t introduce students to the public health system. And so, not surprisingly, few of us know what public health is or what the public health system does. 

Public health often treats health as a public good. A public good is something for which the benefits for one of us cannot be separated from the benfits for ‘all’ of us. When I get a flu shot, I am supposed to benefit by not getting the flu. But others benefit because they do not get exposed to the flu from me. 

So monies spent to inspect restaurants or public pools benefit every member of the public who eats at the restaurants or uses the pools, not just one of them. Monies spent for newborn screening programs benefit all of us because we identify conditions at early stages when prevention or care may limit the harm, and all of us benefit by having a friend or neighbor who can be a healthier and more productive citizen.     

School vaccines. Programs for reproductive health. Collection of data about births and deaths–vital statistics that can show patterns and be used to suggest how to improve birth outcomes and decrease deaths. Cancer registries. Programs to prevent disease and accidents. All of these and more are prt of public health’s efforts to promote the public good.

Is the public good “good” for me? Often it is. Sometimes, it may not be.

There are limits to what vaccines I want to be used as gatekeepers to my employment. But there are even more limits to what genetic tests I want to be used as gatekeepers to my free choice to pursue life paths. So the first step is to become aware of what public health means what public does. Then we can advance agendas relating to support for public health and guidelines about where to draw the line in the name of promoting the public’s health.

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54 Responses to “What is “public health” anyway?”

  1. Melissa says:

    I believe that the root cause in the communication gap between the government and public about health starts with education in early adolescence. There is an extreme lack of education provided in so-called “health” classes. Young adults would be better served to be equipped with knowledge and tools for empowering them to take control about their health. They need to learn how to manage insurance policies, how to communicate with the physician, how to obtain information on public health issues, what resources they have, etc.

  2. admin says:

    ..soo true. the idea of health literacy is too broad. health insurance literacy would go a long way toward improving our competence in this era of health care reform.

  3. Cara Mitchell says:

    I think that the fact that the United States is such an individualistic society has a bearing on why we know so little about public health. When I go to get my shots, I think about what this immunization is doing for me, and generally not what it is doing for the public good. I think that this is the way that many of us are brought up to think, and has overflown into the system of public health which is not meant to be individualistic, but collectivistic and benefitting us all.

  4. Karyn Jones says:

    Hi Rox!

    We were just discussing (online, as I am “snowed in” today!)this issue in my class. One of the problems I’ve experienced is that the functions of public health are so difficult to articulate because sometimes even those within the system don’t know how the system works. So you kind of bounce around from one agency/person/organization to another until you find the help you need–and sometimes it’s someone completely outside the system who is the best at helping you navigate. For example, when I applied to have Payton qualified for disability through the state Medicaid System, other parents and a volunteer working with a local Children’s (Emory/Scottish Rite) therapy facility were the ones who told me what I needed to understand about the process. Our DFCS caseworker (yes, you have to go through DFCS for the application process, just like applying for WIC or Medicaid) was no help whatsoever in providing any meaningful information or instructions–she just pushed the paper for us.

  5. admin says:

    …and I heard on ABC news yesterday that one of the biggest liability awards was just decided in favor of a patient due to a medication being dispensed by someone with no specific training but instead just an overview of process… so a mistyped label went unnoticed… so at the organizational level, health care nees to have more quality control related to dispensing medication…

  6. admin says:

    p.s., how snowed in are you?

  7. Melissa says:

    If we had adequate education on simply how to “navigate” the health care system, we might feel more confident about asking the right questions and seeking more information to take control. Rather, we continue to be intimidated by the system and a lot of our concerns and resources that might be available to us slip through the cracks.

  8. Cara Mitchell says:

    Yes I agree Melissa, I am just now learning the ins and outs of health insurance in my Personal Finance Class (I’m a senior in college) and am learning all of this so that I can be an active decision maker in my health and not just passive and letting others make all the decisions for me.

  9. admin says:

    I see some of this being tied to a broader concept that we might call math competence as well… and I believe that our education system has fallen behind in a world where technology and science demand more rather than less math skills to safeguard well-being…

  10. Jingwen says:

    The discussion on public health reminds me the case of the Japanese government’s policy on promoting milk consumption of children and youth. The long-term study of the statistics shows great impact on youth’s height and other related figures. I feel that generally public health policies could not receive short-term immediate outcomes, but will have a long-term influence on the whole nation. The same of the smoking issue.
    Is the public good “good” for me? not necessary, because the conflict between individual and the public always exists. It’s really difficult for the policy maker to balance these competing interests, especially regarding controversial issues like genetics test.

  11. admin says:

    ..and when we don’t know what will happen with our personal health information, it makes thinking collectively difficult..

  12. Karyn Jones says:

    How about a course on public health that included not only the services the system provides, but also educates us on existing/proposed/potential public health policies? Wouldn’t that be a great contribution to our well-being. Something like that should be a part of our current health care reform efforts.

  13. Brittany Carson says:

    I believe the public good is “good” for us because the government needs to have some sort of regulation over health care. Although I believe in a minimal hands on government, every health care facility and public facility in general needs to have guidance and be held accountable to a certain extent. People trust the government to make things safe for us. I was watching on the news the other day that a young girl was getting beat up so she ran into the subway because she knew there would be government officials there. However, once there, the subway officials felt this was out of their hands and literally stood by and watched her get severely injured and beat up. Situations like these, such as chlorine levels in the pools, need to be regulated for the public “good.”

  14. Melissa says:

    Unfortunately, there is SO much information out there, we get intimidated by the information overload — and we don’t know which side to believe.

  15. admin says:

    …this is why social influence theory and research becomes so important to consider when planning strategic public health communication. Why anyone would pay attention needs to be one of our first questions to consider. As we consider it, we need to realize that if we want someone to pay attention, use language that will make them more likely to regard a message as being directed toward them rather than language that talks about a more general population. One reasons doctors seem like our best source of care is that they meet with us one-on-one and they talk to us one-on-one. Public health communication has to make us feel that we are being addressed on-on-one…

  16. Karyn Jones says:

    P.S. Does anyone know if there are any new health education efforts being included as part of the current proposals? Or all those just proposing new programs and services with no education for the public on how best to use those expensive programs and services? I watched a good part of the meeting between dems and repubs on Thursday and I didn’t hear anything that hinted at educational needs/priorities…hmmm…

  17. admin says:

    I have been watching for that as well. I even tried to go online and join in the debate but it didn’t seem to capture anyone’s attention…

  18. Karyn Jones says:

    I am “snowed in” now only because Payton’s school closed early–not much happening out there right now, but it was really coming down a few hours ago! Pretty but wet–no good for making snowmen–good thing because the kids are stuck playing inside while I work anyway. 🙂

  19. Brittany Carson says:

    I love your idea of simply educating on how to “navigate the health care system”!

  20. Jingwen says:

    we talked about the “empowerment of patient” in our previous classes, and I feel in the domain of public health, everybody as an individual in the society needs the empowerment as well. It seems the best way for this empowerment is through education system, and we still also have more possibilities regarding the Internet applications, like social networking tools. Related to what Mellisa said, using social networking tools to empower ourselves and others around regarding public health may be a consideration?

  21. Melissa says:

    This is sort of random, but I think programs like this are great and we need more of them. A friend from home got his master’s in child development, and now he works for “Choosy Kids.” It’s a program to promote healthy lifestyle choices for children and now he travels all over the country educating teachers about the Choosy program: http://www.choosykids.com/CK2/

  22. admin says:

    …what do you think about Michelle Obama’s leadership in childhood obesity? what do you think about her being criticized for getting her daughters to pay more attention to what they are eating?

  23. admin says:

    I bounced over to the Choosy kids internet site.. who is funding them? the state?

  24. Melissa says:

    Thanks, Brittany! I really think a lack of understanding “how stuff works” keeps us from jumping in and finding out what we need to know.

  25. Karyn Jones says:

    Yep–and the messages also have to be consistent with/target our peer groups/social networks as well. A couple of my students on here were starting to comment on the influence of our support networks as compared to government agencies in our discussion prior to class…I am wondering if they might want to comment on that here as well, and tell us some of their ideas for how government could use communication strategies to acknowledge/effectively “compete” with peer/support networks as a source of influence…

  26. admin says:

    I would like to hear comments about peer and support networks as a source of influence.

  27. Melissa says:

    Re: Choosy — I believe so. I know he started working for them as a graduate assistant while obtaining his masters at West Virginia University. Now, he works for them full time. I assume it’s funded by the state.

  28. Cara Mitchell says:

    Of course people will criticize everything…but I believe that if you teach a child young to adapt certain habits then they will hold on to them as they grow older. No one wants to put too much pressure on a young child to be thinking about their diet, but today with so many young kids dealing with obesity we have got to move past that and put eating health on kids’ radars.

  29. Karyn Jones says:

    I listened to an interview with Michelle Obama where she described her campaign and proposed government-funded initiatives a couple of weeks ago–I thought she sounded very thoughtful and intelligent in presenting what she wants to do, and she has some really great ideas that show a lot of insight on the problem. The LAST thing I would have assumed was that she would be attacked for monitoring her kids’ diets to make sure they are eating healthy! Good grief.

  30. admin says:

    I think it is that tension between learning to eat healthy and having young girls especially become weight-obsessed…

  31. Cara Mitchell says:

    The example in our Communicating About Health text about Own Your Own C is a good example of public health promoters using the power of social support networks to influence health decisions.

    It is not just adults, doctors, and public health workers talking about health, but the young people themselves are having a discussion.

    Someone in class mentioned earlier about using the power and capacities of social networks like blogging, twitter, etc. to educate about health and I think this is a great idea.

  32. admin says:

    It is a powerful idea but I find the social media world increasingly ‘cluttered’ just like the more general online information world.

  33. Melissa says:

    Agreed. Its a bit ridiculous and hypocritical. We criticize parents with obese children, yet when we have a person in a position of influence attempting to create a new way of thinking about feeding our children – we are critical again. Way to go, America!

  34. Melissa says:

    It is definitely a fine line with young women. I think it is important to emphasize balance, rather than ‘restriction’ and ‘diet.’

  35. Karyn Jones says:

    Here is the basic problem with public policy (the criticism of Michelle Obama’s childhood obesity efforts)–that one’s political ideology too often interferes with an objective assessment of policy.

    How does one with strong political beliefs (as we would assume most politicians have) separate political ideology from what is “objectively” in the public good?

  36. admin says:

    ..can we name any political figure we think does that… something happened on the way to the 21st century…

  37. Melissa says:

    Dr. Jones asked if it were possible for the government to influence us as equally as our peers, and although it would be a very daunting task — I suppose it is possible. How? Wow, what a great question! I wouldn’t know where to begin! I suppose it only takes one person in your life to have an influence, so targeting niche groups of people with health information pertinent to their particular needs, rather than nationalized blanket coverage would be a start. Again, you can reach people w/o saying “this is a message from the government.”

  38. admin says:

    In rural areas, such as many parts of Pennsylvania, public health is not such a nameless faceless institution… It has more of the feeling of friends and neighbors who influence each other because it is friends and neighbors involved in public health. Community-based participatory public health activities can leverage involvement in ways that take advantage of the positive aspects of being a member of the community and the positive aspects of ‘knowing’ the public health system.

  39. Jingwen says:

    I’m just googling some comments about Michelle Obama’s leadership in childhood obesity. I feel that people tend to interpret information very differently regarding how they understand the rhetorics behind it. Like this example,
    “Specifically, my issues are with how you’re framing this as a strategy to ‘solve the epidemic of childhood obesity within a generation,’ rather than to improve health and well-being across the board, and whipping up fear and disgust of the very fat children you’re supposedly trying to help.”
    To me, they address the same issue, such kind of criticism could be actually good for every part to negotiate and collaborate. However, once the criticism goes to far and people just argue around regardless of the real situation and action, they could be meaningless.

  40. Brittany Carson says:

    When I think about public health even I am not sure what a person in this field does. I feel as if this is a field that is very much behind the scenes. I’m not sure if we can even begin to teach children about all of the professions out there. Rather, I think it is important to teach about the policies that this profession puts in place and the ways in which we should work with these policies and how they can benefit us.

  41. Jingwen says:

    If the government now could not influence us as equally as peers. They at least need to initiate such programs and be an active part of it. Once the conversation starts, like in facebook or blogs, the actual author would become “invisible” to some extent. The platform and construction of such a platform is way more important.

  42. Jingwen says:

    Yes, actually how do we interpret Public Health when we introduce this term to someone else? as an institution? as a government agency? or say, “public health means your health is related to my health!”

  43. Melissa says:

    I agree with Jingwen. Constructing the platform is just as important, if not more, than the actual message. The key is to develop a way to get people to feel empowered to take control of their health and to want to change their unhealthy behaviors on their own — not because someone else wants them to.

  44. Karyn Jones says:

    Some public health programs have been very successful in working within support networks to provide services, educate people, and advance change. The realization has to be that you have to reach people within their existing social networks–not try to target them independently from those networks or their other day-to-day realities.

  45. admin says:

    that sounds like a good place to stop for today… if any of you get a chance, there is a new IOM report out that has to do with taking a poplation-based approach to hypertension… I’ve only heard that it’s out and haven’t reviewed it yet…but I suspect that the emphasis is about building supportive environments to help reduce hypertension rather than relying so heavily on medications and medical visits. thanks for chatting!

  46. Karyn Jones says:

    I love your question about how to describe Public Health, Sally (Jingwen)! Rox, how do you suggest one could/should describe “Public Health” in everyday conversation?

  47. admin says:

    ok, one for the road… it is embedded in my last comment… it is about building supportive environments. safe parks, safe places to walk, affordable nutritious food… these are not the realm of doctors’ efforts but they are a focus of public health efforts to promote well-being from a population-based perspective.

  48. Cara Mitchell says:

    As mentioned above this relates to the way that public health efforts have to matter- why do we care? And Sally has the answer with the quote “your health is related to my health”. Through public health efforts within a community of people who know each other like neighbors – people can be motivated to care about their health and can receive and offer support to make healthy decisions on a daily basis.

  49. Jingwen says:

    Learn a lot! “reach people within their existing social networks”, whichever face-to-face or digital in different local situations.

  50. Jingwen says:

    Thank y’all too! Will look at the report.

  51. Karyn Jones says:

    That was really fun. Thanks for taking this time with us, Rox!

  52. Regina Hall says:

    I agree with what Roxanne and others said about children not being properly educated on what ‘public health’ is, although they come in contact with it all the time. I also have noticed that I find most older educated individuals not really understanding what public health is either. I am a senior in college and pursuing a career in public health and am constantly asked what ‘public health’ is, I often find it hard to fully explain to my peers what it means. Public health incorporates so many things in a person daily living and often people do not take notice of ‘public health’ unless something goes wrong, for example, an ecoli outbreak at a local dinery, a flu epidemic or a bioterriosm attack, all of these scenerios deal with public health.

  53. Liz Lehky says:

    I am currently taking a health communication class, and when we came across the topic of public health, I will admit that I was very unsure of the idea of public health. I wondered why I am so unfamiliar with something that basically sets the agenda for health. After reading this blog, I realized that I am not alone. In Dr. Parrott’s book, Talking About Health: Why Communication Matters, she states, “We all have a suspicion or a nagging and lingering concern that data about our health are somewhere and somehow being used by someone. But efforts to communicate about health as a public good seldom tell us how this all works…” There needs to be communication beginning at an early age that not only teaches us what public health means, but how it works and why it is important. This will allow us to distinguish whether or not the public good is good for us individually, and if it is not, we will know where and how to draw the line.

  54. Guide4Fitness says:

    AWesome Post , keep it up

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