Principles of Public Health Practice/What are the practice domains of public health?

The interactions of sustainable development: Restore, protect, manage vital resources for social, economic and ecological ends. Agenda 21:Rio+20

In this topic, we will be looking at the practice domains of public health. We will be particularly focusing on the domains of protection, prevention and promotion. Surveillance and monitoring will be viewed in terms of supporting the first three practice domains. You will also continue to work on your Individual Literature Analysis Task. Keep up to date on this and try to get a little ahead. Your first assessment on Monday, 7 April 2014 at 9 a.m.. You will have some oppportunity to support each other in your tutorials.

Learning activity instructions

1. Survey news reports for articles pertinent to public health. Use current news and be mindful as many articles will not necessarily focus on health specifically but there will be many relevant examples from outside the typical health arena. Key questions to consider: How many articles can you find that are relevant to public health? What sort of issues do they discuss? What are some of the keywords that stand out? What determinants of health do they address? Are they economic, social, environmental or political in nature? Why are they written? For example, what are they trying to achieve or change? Who are they trying to influence/educate?
2. Please search for and download the references for the background material and scan through them. You might find them useful for helping to orient you to the subject and for future reference in your assessments. Do not read every word! Just get a feel for what they might offer you.
3. Watch the videos in this playlist. This is the second in a series of plalylists curated for each topic in this subject. You will need this background for the Lectorial and your own work. You do not have to watch all the videos at once. In fact, we would recommend against doing this. Take your time to listen carefully and consider what is being said.
4. Continue to gather articles and videos for yourself and your group to better understand the various concepts for your first assessment.
5. Review the following references: The origins of primary health care and selective primary health care and The Five Primary elements of Primary Health Care.
6. Develop responses to the following questions:

1. How is primary care and primary health care defined?

2. What are the key differences between the two?

3. How do primary care and primary health care consider issues of equity and participation?

What are the three key practice domains of public health and the two supporting practices and how do they interrelate?

When I was younger and still in secondary school, I did my apprenticeship as a forestry technician. Exciting stuff. You fought forest fires in the summer and reseeded and replanted burnt out areas in the winter. I was qualified and working for a wage by the summer of 1972. Two years earlier, on the 22nd of April, a nation-wide event had occurred that inspired me to gain my qualifications: Earth Day (however, see what UNESCO had organised for a month earlier and ask yourself some questions about why one over the other).

Some say Earth Day was the beginning of the modern ecological movement. For a number of reasons, my father and uncle would beg to differ. They were both foresters and had been engaged in ecological practice for years. The tradition that they trained in was generations old. But, this was not the only ecologically oriented tradition. The Aboriginal and Torres Strait Islander peoples of Australia had ecologically-based practices that shaped their environment for tens of thousands of years.

However, the truth of the matter was that until people like E.F. Schumacher started making the general public aware of the dangers in the 1960s and 1970s, most of the people just were not thinking ecologically. It took quite a long time for people to generally understand the issues. Agenda 21 was initiated by the United Nations Conference of Economic Development held in Rio de Janeiro, Brazil, in 1992. Take a little time to think about and research this initiative. What was driving it and where is it now? What might be some of unintended negative consequences of such programs as Agenda 21?

So, protection of the environment from human degradation and protection of humans from harmful environments is one of the practice domains of public health. There are more. To know anything about what is going on, were need information gained through monitoring and surveillance. We need such information for two further domains as well: the prevention of communicable and non-communicable disease and the promotion of health.

Background

We have already introduced the three primary practice domains of public health: Protection, Prevention and Promotion. We will look a little more closely at these in a moment. We have also, in a vague way, mentioned the supporting practices: Monitoring and Surveillance. We need data to drive interventions (QH 2009a). We have also introduced the idea of priorities. Will older terminally ill people be our priority or will children? Can the answer be as clear cut as the question implies? We have also introduced the idea of primary health care, public health and population health. In this background section, we can only take you a little further along the way. You will need to investigate these concepts and their use more thoroughly in order to complete your first assignment and its assessment.

As we have all become aware, protecting the environment from degradation is an important task for public health. If the ecology of our environments are destroyed, so will we be in time. One place on the planet where we can see the remarkable change in the larger habitat which has changed human activities is the Sahara. Ten thousand years ago the region was rich in flora and fauna; humans flourished there as well. Possibly due to a shift in the earth's orbit and shifts in regional climatic systems, as opposed to the impact of human habitation, the region became as dry as the present desert and remains largely uninhabitable (Claussen, Kubatski, Brovkin, Ganopolski et al. 1999). While we could not have influenced the earth's orbit, we can prevent similar changes over large areas due to deforestation. Ensuring safe drinking water and the removal of waste are also important functions. There are strategic International Regulations that have been developed and adopted to help anticipate, prepare for and deal with these issues (WHO 2007b)

Prevention of the spread of communicable diseases (QH 2009b) and the impact of chronic conditions (NPHP 2001) is another area of public health activity. Smallpox once caused the premature death of many in a community. Now, with vaccinations, we can halt the spread of the disease. Something similar is occurring with polio. However, we are not doing as well with chronic conditions. In fact, many young people may have shorter lives than previous generations due to the combined effects of poor diet and lack of exercise. Of course, poor water supply will affect the nutrition of a region and poor waste management can exacerbate existing conditions through poor sanitary habits (Prüss-Üstün & Corvalán 2006). Someone who is suffering from a chronic condition may find that their immune system cannot fight off a local infection caused by stepping on something in the gutter with a sharp edge.

Promoting health is something more than protecting us from danger or preventing the spread of disease (Baum, Freeman, Jolley, Lawless, et al. 2013). It is about giving hope and empowering people to take control of the various factors that influence their lives so as to improve their health. You do not have to be ill to want to get better. This is especially important for groups that have been disenfranchised through some means, such as refugees. There is an increasing social dimension to health promotion that fosters cooperation and equity. It is not about mob rule or the rule of the majority over the rest. It is about ensuring that all people have a stake in what is happening to them. Mental health and emotional and social well-being are often the beneficiaries of health promotion practices (WHO 2001). But, the same is true of physical health and well-being. Still, there is the question of how we set priorities. Will this merely be determined by the greatest good for the greatest numbers? This might overlook whole populations for which strategic interventions with a high initial cost will have long-term personal, social, cultural and economic benefit.

For setting priorities and engaging in practice well, we need good data (WHO 2002). Often times, we are looking for precursor data. We want to know what precedes an event so that we can deal with it more effectively before the issue becomes too entrenched. For instance, monitoring hospital admissions for a certain constellation of symptoms might indicate that an outbreak of Legionnaire's Disease is in the wind both literally and figuratively (WHO 2007a). Asking questions about where people have been in the city will indicate the likely source of the infection so public health officials can isolate the cooling towers and decontaminate them. However, if we have a robust environmental protection plan and a screening program, we can actual identify the bacterial colony, such as Legionella pneumophila, before it can grow to a size for sufficient dispersal to take place to increase the likelihood of infection. We can intervene early and stop an outbreak.

References and Resources

Baum, F., Freeman, T., Jolley, G., Lawless, A., Bentley, M., Vartto, K., Boffa, J., Labonte, R. and Sanders, D. (2013) Health promotion in Australian multi-disciplinary primary health care services: Case studies from South Australia and Northern Territory. Health Promotion International. Advance Access published May 8, 2013, 15 pages.

Claussen, M., Kubatski, C., Brovkin, V., Ganopolski, A., Hoelzmann, P. and Pachur, H-J. (1999) Simulation of an abrupt change in Saharan vegetation in the mid-Holocene. Geophysical Research Letters 26(14):2037-2040.

NPHP (2001) Preventing Chronic Disease: A Strategic Framework. Melbourne, VIC: National Public Health Partnership Secretariat.

Prüss-Üstün, A. and Corvalán, C. (2006) Preventing disease through healthy environments. Towards an estimate of the environmental burden of disease. Geneva: World Health Organization.

QH (2009a) Prevention, Promotion and Protection Health Performance Information Needs 2009–2012. Brisbane, QLD: Queensland Health, Queensland State Government.

QH (2009b) Strategic Directions for Communicable Disease Prevention and Control 2009 –2012. Brisbane, QLD: Queensland Health, Queensland State Government.

WHO (2001) The World Health Report 2001: Mental Health--New Understanding, New Hope. Geneva: World Health Organization.

WHO (2002) The World Health Report 2002: Reducing Risks, Promoting Healthy Life. Geneva: World Health Organization.

WHO (2007a) LEGIONELLA and the prevention of legionellosis. Geneva: World Health Organization.

WHO (2007b) The world Health Report 2007 : A safer future--Global public health security in the 21st century. Geneva: World Health Organization.

Learning Outcomes

Upon completion of this topic, through your own investigations, group preparation, tutorial participation and lectorial explorations, you should be able to:

1. Sketch out the principles, priorities and processes that public health practitioners and advocates engage in as key aspects of their practice.
2. Compare and contrast how these might operate in the three key practice domains of public health (Protection, Prevention and Promotion).
3. Summarise how the two supporting practices (Surveillance and Monitoring) can contribute to the three primary practice domains.
4. Contrast these understandings of public health with a population approach to identify commonalities and distinctions.