Principles of Public Health Practice/What is public health?

Aboriginal mural at Community Health Service

This week we get to know the domain of public health and start to see it in practice. You will start work on your Individual Literature Analysis assignment, and begin to consider the differences between Primary Care and Primary Health Care.

Learning activity instructions

1. Watch the videos in this playlist. This is the first of a series of playlists curated for each topic in this subject.
2. Photograph examples of public health in your local area. Upload your best photos to Wikimedia Commons and include a title, a description of why the image is an example of public health, and use the category "Public Health". Use the Wikimedia Commons App, or upload on the website.
3. Begin work on your Literature Analysis assignment. Work with a team to collect information on: a) public health b) primary care and primary health care, c) population health and d) health promotion. Look for information that explains these concepts and gives examples on how they are put into practice. Here are some keywords to help your search: Public health, health promotion, primary health care, primary care, population health, quality, evidence, policies, resources, equity, participation, capacity development, determinants, outcomes, processes, perspectives, inter-disciplinary, communities and consumers/patients. Try to find information from the perspective of a practitioner, consumer/patient, policy maker and community health group. Here are some examples: Rural Public Health Capacity; A MPH graduate's understanding of public health; Turn a Stack of Papers Into a Literature Review
4. Join a discussion on how equity and participation relate to what you have found.
5. Developing an understanding of primary care versus primary health care.

What is public health and what have the Aboriginal and Torres Strait Islander people taught us about the importance of explicit principles?

I have been privileged to work with Aboriginal and Torres Strait Islander communities for many years now. I have gained a great deal from this. One of the things that I value is the hope which has been sustained in the midst of grave difficulties. Hope is based on a realistic vision of a future in which all participate humanely. This is not an easy thing to maintain when your land, lore and language are removed.

Other cultures and peoples have had this experience as well. But, the Indigenous peoples of Australia had been on the continent for 40-60 thousand years before the arrival of Europeans. They had adopted practices that would sustain them in the land. In part, this was because they believed that the land would sustain them, if they respected the land. They have complex cultural systems to remind them of what this respect means. Their principles, processes and priorities have been very explicit. As public health practitioners, so should ours. A key principle is that health involves the whole of life and not just some subsection.

But, health is not the purpose of our lives, it is a resource for living according to the various documents of the World Health Organization. The purpose of living might be seen more in other principles, such as the principle of equity. Justice means that each should get their due from others; but, what this means, specifically, is open to question. Equity means that we each have a responsibility to ensure that others have a way of participating in the meaningful activities of life regardless of their past circumstances or present situations. Benefit should come to those who bear the burden of living.

Participation in life, in all of its many dimensions, is a fundamental human right. This subject is founded on such an understanding which was made explicit after the great loss of life in World War II. The United Nations Declaration of Human Rights (UNDHR), properly understood, is an statement of the principles underlying public health. It is no coincidence that the World Health Organization and the UNDHR share a common heritage. We have a great responsibility in this 21st Century. The Aboriginal and Torres Strait Islander people of Australia have shown us that we can bear it with hope.

Background

Public health is a public good (NCoB 2007:6-8). It is a good that each of us can share in without diminishing the availability of the good. If you share a private good with someone, you will have less of it than you had to begin with. On the other hand, sharing a private good with others is one of the ways that we create public goods. Let me give an example; if I have learned to read and write well, I have a private good. I can use it to spend time reading for pleasure and writing my friends. If I share this time with you teaching you how to read and write, then I lose the private good of my own free time. However, I share in the public good of a literate community which can investigate situations and communicate new possibilities from which I might benefit.

Losing my tax dollar is the loss of a private good, a portion of my wage. If it is spent wisely on your health care when you are sick, it becomes a public good when you become well and are able to work and care for your family again. You might be the leader of the local volunteer group caring for our community garden. I now benefit from your involvement in the day to day running of the communal project. Public health is what we gain when we use various resources to promote health, prevent the spread of communicable diseases or decrease the affects of chronic conditions, and when we protect people from the environment or the environment from people (WHO 2006:8-14).

But, who decides? Who decides how much of my wage should be used for a public good? Who decides what sort of health care facilities are available, where and at what cost? Who decides how we use common land? Will it be a community garden or a cricket pitch? Who decides whether the public money is used to care for the terminally ill through new, but expensive, pharmaceuticals or for the very young to ensure that they have access to affordable childcare so that their parents can participate in the economy? Will we buy up all the vaccines for a dangerous influenza so that other countries have no access to protection even though their populations are at greater risk and we are likely to have to throw out our stockpiles when they are not used? What will be the ethical framework with which we will to answer these questions (Fisher & Gormally (2001)? These are serious policy related issues (WHO 2008b)

Population health is primarily about how interventions at a population level can have significant impacts on the overall health benefit to a society (Wilkinson & Marmot 2003). But, this can overlook the role of people as participants in the assessing, decision-making, planning, implementing and evaluating of interventions. People can be dis-empowered by paternalistic processes which are driven solely by a privileged few. Interestingly, we are discovering that the explicit sharing of our resources with one another through transparent processes over which we have some control has a health dividend in its own right (Wiklinson & Pickett 2009, 2010).

Aboriginal and Torres Strait Islander communities have understood this for tens of thousands of years. Sharing is built into their cultures. Through colonisation, many of the original peoples of this and other continents have lost their language, lore and land. This was often done without their knowledge because others had control of the decision-making processes (Anderson, Baum & Bentley 2007:IX-XVI). Participation in the processes relating to public health is one of those public goods. Being able to access the resources that we need in the most affordable, acceptable and accessible means possible brings two goods: the good of primary health care for those in need of it and the good of public health which is a benefit to the whole population (WHO 1998:3; WHO 2008a).

References

1. Anderson, I., Baum, F. and Bentley, M. (Eds.) (2007) Beyond Bandaids: Exploring the underlying social determinats of Aboriginal health. Casuarina, NT: Cooperative Research Centre for Aboriginal Health.
2. Fisher, A. and Gormally, L. (2001) Healthcare Allocation: An ethical framework for public policy. London: The Linacre Centre.
3. NCoB (2007) Public Health: Ethical Issues. London: Nuffield Council on Bioethics.
4. WHO (1998) Health Promotion Glossary. Geneva: World Health Organization.
5. WHO (2006) Neurological Disorders: Public health challenges. Geneva: World Health Organization.
6. WHO (2008a) Primary Care: Putting people first. In, World Health Report: Primary Health Care (Now More Than Ever). Geneva: World Health Organization, pp. 41-60.
7. WHO (2008b) Public policies: For the public's health. In, World Health Report: Primary Health Care (Now More Than Ever). Geneva: World Health Organization, pp. 63-78.
8. Wilkinson, R. and Marmot, M. (2003) (2nd Ed.) The Social Determinants of Health: The solid facts. Geneva: World Health Organization.
9. Wilkison, R. and Pickett, K. (2009, 2010) The Spirit Level: Why equality is better for everyone. London: Penguin.

Learning Outcomes

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

1. Identify and explain the similarities and differences between public health, population health, primary health care and empowerment.
2. Identify the key themes that you will engage and use during the semester to begin to solve problems in the lectorials, tutorials and the larger context.
3. Outline the various tasks that you will be undertaking to both learn your craft and demonstrate your learning through group work and assessment tasks.
4. Explain to a class-mate what to do if they are experiencing difficulties in the subject or the course so that they can access and use appropriate resources