Nama : Yulio setiadi

Prodi : IKM

Public health

Newspaper headlines from around the world about polio vaccine tests (13 April 1955).

Public health is "the science and art of preventing disease, prolonging life and promoting
health through the organized efforts and informed choices of society, organizations, public
and private, communities and individuals" (1920, C.E.A. Winslow). It is concerned with
threats to the overall health of a community based on population health analysis. The
population in question can be as small as a handful of people or as large as all the inhabitants
of several continents (for instance, in the case of a pandemic). Public health is typically
divided into epidemiology, biostatistics and health services. Environmental, social,
behavioral, and occupational health are other important subfields.

The focus of public health intervention is to prevent rather than treat a disease through
surveillance of cases and the promotion of healthy behaviors. In addition to these activities, in
many cases treating a disease may be vital to preventing it in others, such as during an
outbreak of an infectious disease. Hand washing, vaccination programs and distribution of
condoms are examples of public health measures.

The goal of public health is to improve lives through the prevention and treatment of disease.
The United Nations' World Health Organization defines health as "a state of complete
physical, mental and social well-being and not merely the absence of disease or infirmity."
Contents
 1 Objectives
 2 History of public health
o 2.1 Early public health interventions
o 2.2 Modern public health
 3 Schools of public health
 4 Education and training
 5 Public health programs
 6 Applications in healthcare
 7 See also
 8 Notes
 9 References
 10 External links

Objectives
The focus of a public health intervention is to prevent rather than treat a disease through
surveillance of cases and the promotion of healthy behaviors. In addition to these activities, in
many cases treating a disease can be vital to preventing its spread to others, such as during an
outbreak of infectious disease or contamination of food or water supplies. Vaccination
programs and distribution of condoms are examples of public health measures.

Most countries have their own government public health agencies, sometimes known as
ministries of health, to respond to domestic health issues. In the United States, the front line
of public health initiatives are state and local health departments. The United States Public
Health Service (PHS), led by the Surgeon General of the United States, and the Centers for
Disease Control and Prevention, headquartered in Atlanta, are involved with several
international health activities, in addition to their national duties.

There is a vast discrepancy in access to health care and public health initiatives between
developed nations and developing nations. In the developing world, public health
infrastructures are still forming. There may not be enough trained health workers or monetary
resources to provide even a basic level of medical care and disease prevention. As a result, a
large majority of disease and mortality in the developing world results from and contributes
to extreme poverty. For example, many African governments spend less than USD$10 per
person per year on health care, while, in the United States, the federal government spent
approximately USD$4,500 per capita in 2000.

Many diseases are preventable through simple, non-medical methods. For example, research
has shown that the simple act of hand washing can prevent many contagious diseases.

Public health plays an important role in disease prevention efforts in both the developing
world and in developed countries, through local health systems and through international
non-governmental organizations.
The two major postgraduate professional degrees related to this field are the Master of Public
Health (MPH) or the (much rarer) Doctor of Public Health (DrPH). Many public health
researchers hold PhDs in their fields of speciality, while some public health programs confer
the equivalent Doctor of Science degree instead.

History of public health

In some ways, public health is a modern concept, although it has roots in antiquity. From the
beginnings of human civilization, it was recognized that polluted water and lack of proper
waste disposal spread communicable diseases (theory of miasma). Early religions attempted
to regulate behavior that specifically related to health, from types of food eaten, to regulating
certain indulgent behaviors, such as drinking alcohol or sexual relations. The establishment of
governments placed responsibility on leaders to develop public health policies and programs
in order to gain some understanding of the causes of disease and thus ensure social stability
prosperity, and maintain order.

The term "healthy city" used by today's public health advocates reflects this ongoing
challenge to collective physical well-being that results from crowded conditions and
urbanization.

Early public health interventions

Public health nursing made available through child welfare services in U.S. (c. 1930s)

By Roman times, it was well understood that proper diversion of human waste was a
necessary tenet of public health in urban areas. The Chinese developed the practice of
variolation following a smallpox epidemic around 1000 BC. An individual without the
disease could gain some measure of immunity against it by inhaling the dried crusts that
formed around lesions of infected individuals. Also, children were protected by inoculating a
scratch on their forearms with the pus from a lesion. This practice was not documented in the
West until the early-18th century, and was used on a very limited basis. The practice of
vaccination did not become prevalent until the 1820s, following the work of Edward Jenner
to treat smallpox.

During the 14th century Black Death in Europe, it was believed that removing bodies of the
dead would further prevent the spread of the bacterial infection. This did little to stem the
plague, however, which was most likely spread by rodent-borne fleas. Burning parts of cities
resulted in much greater benefit, since it destroyed the rodent infestations. The development
of quarantine in the medieval period helped mitigate the effects of other infectious diseases.
However, according to Michel Foucault, the plague model of governmentality was later
controverted by the cholera model. A Cholera pandemic devastated Europe between 1829
and 1851, and was first fought by the use of what Foucault called "social medicine", which
focused on flux, circulation of air, location of cemeteries, etc. All those concerns, born of the
miasma theory of disease, were mixed with urbanistic concerns for the management of
populations, which Foucault designated as the concept of "biopower". The German
conceptualized this in the Polizeiwissenschaft ("Science of police").

The science of epidemiology was founded by John Snow's identification of a polluted public
water well as the source of an 1854 cholera outbreak in London. Dr. Snow believed in the
germ theory of disease as opposed to the prevailing miasma theory. Although miasma theory
correctly teaches that disease is a result of poor sanitation, it was based upon the prevailing
theory of spontaneous generation. Germ theory developed slowly: despite Anton van
Leeuwenhoek's observations of Microorganisms, (which are now known to cause many of the
most common infectious diseases) in the year 1680, the modern era of public health did not
begin until the 1880s, with Louis Pasteur's germ theory and production of artificial vaccines.

Other public health interventions include latrinization, the building of sewers, the regular
collection of garbage followed by incineration or disposal in a landfill, providing clean water
and draining standing water to prevent the breeding of mosquitos. This contribution was
made by Edwin Chadwick in 1843 who published a report on the sanitation of the working
class population in Great Britain at the time. So began the inception of the modern public
health. The industrial revolution had initially caused the spread of disease through large
conurbations around workhouses and factories. These settlements were cramped and
primitive and there was no organised sanitation. Disease was innevitable and its incubation in
these areas was encouraged by the poor lifestyle of the inhabitants....

Modern public health

As the prevalence of infectious diseases in the developed world decreased through the 20th
century, public health began to put more focus on chronic diseases such as cancer and heart
disease. An emphasis on physical exercise was reintroduced.[citation needed]

In America, public health worker Dr. Sara Josephine Baker lowered the infant mortality rate
using preventative methods. She established many programs to help the poor in New York
City keep their infants healthy. Dr. Baker led teams of nurses into the crowded
neighborhoods of Hell's Kitchen and taught mothers how to dress, feed, and bathe their
babies. After World War I many states and countries followed her example in order to lower
infant mortality rates.[citation needed]

During the 20th century, the dramatic increase in average life span is widely credited to
public health achievements, such as vaccination programs and control of infectious diseases,
effective safety policies such as motor-vehicle and occupational safety, improved family
planning, chlorination of drinking water, smoke-free measures, and programs designed to
decrease chronic disease.

Meanwhile, the developing world remained plagued by largely preventable infectious

diseases, exacerbated by malnutrition and poverty. Front-page headlines continue to present
society with public health issues on a daily basis: emerging infectious diseases such as SARS,
making its way from China (see Public health in China) to Canada and the United States;
prescription drug benefits under public programs such as Medicare; the increase of HIV-
AIDS among young heterosexual women and its spread in South Africa; the increase of
childhood obesity and the concomitant increase in type II diabetes among children; the
impact of adolescent pregnancy; and the ongoing social, economic and health disasters
related to the 2004 Tsunami and Hurricane Katrina in 2005.[citation needed] These are all ongoing
public health challenges.

Since the 1980s, the growing field of population health has broadened the focus of public
health from individual behaviors and risk factors to population-level issues such as
inequality, poverty, and education. Modern public health is often concerned with addressing
determinants of health across a population, rather than advocating for individual behaviour
change. There is a recognition that our health is affected by many factors including where we
live, genetics, our income, our educational status and our social relationships - these are
known as "social determinants of health." A social gradient in health runs through society,
with those that are poorest generally suffering the worst health. However even those in the
middle classes will generally have worse health outcomes than those of a higher social
stratum. The new public health seeks to address these health inequalities by advocating for
population-based policies that improve health in an equitable manner.

Schools of public health

In the US, the Welch-Rose Report of 1915 has been viewed as the basis for the critical
movement in the history of the institutional schism between public health and medicine
because it led to the establishment of schools of public health supported by the Rockefeller
Foundation. The report was authored by William Welch, founding dean of the Johns Hopkins
Bloomberg School of Public Health, and Wycliffe Rose of the Rockfeller Foundation. The
report focused more on research than practical education. Some have blamed the Rockfeller
Foundation's 1916 decision to support the establishment of schools of public health for
creating the schism between public health and medicine and legitimizing the rift between
medicine's laboratory investigation of the mechanisms of disease and public health's
nonclinical concern with environmental and social influences on health and wellness.

Even though schools of public health had already been established in Europe and North
Africa, the US had still maintained the traditional system of housing faculties of public health
within their medical institutions. However, a year following the Welch-Rose report, the Johns
Hopkins School of Hygiene and Public Health was founded in 1916. By 1922, schools of
public health were established in Columbia, Harvard and Yale universities. By 1999 there
were twenty nine schools of public health in the US, enrolling around fifteen thousand
students.

Over the years, the types of students and training provided have also changed. In the
beginning, students who enrolled in public health schools had already obtained a medical
degree. However, in 1978, 69% of students enrolled in public health schools had only a
bachelors degree. Public health school training had evolved from a second degree for medical
professionals to a primary public health degree with a focus on the six core disciplines of
biostatistics, epidemiology, health services administration, health education, behavioral
science and environmental health.

Education and training

Schools of public health offer a variety of degrees which generally fall into two categories:
professional or academic.

Professional degrees are oriented towards practice in public health settings. The Master of
Public Health (M.P.H.), Doctor of Public Health (Dr.PH.), Doctor of Health Science
(D.H.Sc.) and the Master of Health Care Administration (M.H.A.) are examples of degrees
which are geared towards people who want careers as practitioners of public health in health
departments, managed care and community-based organizations, hospitals and consulting
firms among others. Master of Public Health (M.P.H.) degrees broadly fall into two
categories, those that put more emphasis on an understanding of epidemiology and statistics
as the scientific basis of public health practice and those that include a more eclectic range of
methodologies. A Master of Science of Public Health (M.S.P.H.) is similar to an M.P.H. but
is considered an academic degree (as opposed to a professional degree) and places more
emphasis on quantitative methods and research. The same distinction can be made between
the Dr.PH. and the D.H.Sc. The Dr.PH is considered a professional degree and the D.H.Sc. is
an academic degree.

Academic degrees are more oriented towards those with interests in the scientific basis of
public health and preventive medicine who wish to pursue careers in research, university
teaching in graduate programs, policy analysis and development, and other high-level public
health positions. Examples of academic degrees are the Master of Science (M.S.), Doctor of
Philosophy (Ph.D.), Doctor of Science (Sc.D.), and Doctor of Health Science (D.H.Sc.). The
doctoral programs are distinct from the M.P.H. and other professional programs by the
addition of advanced coursework and the nature and scope of a dissertation research project.

The Association of Schools of Public Health represents Council on Education for Public
Health (CEPH) accredited schools of public health.

Delta Omega is the honorary society for graduate studies in public health. The society was
founded in 1924 at the Johns Hopkins School of Hygiene and Public Health. Currently, there
are approximately 68 chapters throughout the United States and Puerto Rico.

Public health programs

This 1963 poster featured CDC's national symbol of public health, the "Wellbee",
encouraging the public to receive an oral polio vaccine.

Today, most governments recognize the importance of public health programs in reducing the
incidence of disease, disability, and the effects of aging, although public health generally
receives significantly less government funding compared with medicine. In recent years,
public health programs providing vaccinations have made incredible strides in promoting
health, including the eradication of smallpox, a disease that plagued humanity for thousands
of years.

An important public health issue facing the world currently is HIV/AIDS. Antibiotic
resistance is another major concern, leading to the reemergence of diseases such as
Tuberculosis.

Another major public health concern is diabetes. In 2006, according to the World Health
Organization, at least 171 million people worldwide suffered from diabetes. Its incidence is
increasing rapidly, and it is estimated that by the year 2030, this number will double.
However, in a June 2010 editorial in the medical journal The Lancet, the authors opined that
"The fact that type 2 diabetes, a largely preventable disorder, has reached epidemic
proportion is a public health humiliation." (Type 1 diabetes mellitus is not preventable,
however.)

A controversial aspect of public health is the control of smoking.[17] Non-communicable

diseases caused by smoking have been threatening public health because it requires a long
term strategy for improving unlike the communicable diseases which take a shorter period to
be improved. The reason for this is because communicable diseases have been at the top as a
global health priority while non communicable diseases have been at the bottom as a global
health priority. Simultaneously, global health policy making is increasingly aligned with
industrial and trade policies, and is being done hand in hand with business, thus weakening
the firewalls necessary for effective regulation and normative actions both at national and
global levels.[18] Many nations have implemented major initiatives to cut smoking, such as
increased taxation and bans on smoking in some or all public places. Proponents argue by
presenting evidence that smoking is one of the major killers in all developed countries, and
that therefore governments have a duty to reduce the death rate, both through limiting passive
(second-hand) smoking and by providing fewer opportunities for smokers to smoke.
Opponents say that this undermines individual freedom and personal responsibility (often
using the phrase nanny state in the UK), and worry that the state may be emboldened to
remove more and more choice in the name of better population health overall. However,
proponents counter that inflicting disease on other people via passive smoking is not a human
right, and in fact smokers are still free to smoke in their own homes.

There is also a link between public health and veterinary public health which deals with
zoonotic diseases, diseases that can be transmitted from animals to humans. (See also Vector
control).

Applications in healthcare
As well as seeking to improve population health through the implementation of specific
population-level interventions, public health professionals also seek to improve population
health by improving the contribution of medical care to life extension and quality of life.[19]

Such improvements could be identified by assessing what need for health services existed
within the population, and:[20]

1. Assessing current services

2. Ascertaining requirements as expressed by professionals, public and other stakeholders
3. Identifying the most appropriate interventions
4. Considering the effect on resources
5. Agreeing and implementing any necessary changes

In addition public health professionals can improve population health through:

1. Assessing evidence of effectiveness and cost-effectiveness for proposed interventions
2. The evaluation of healthcare to determine whether the activity in question is meeting its
objectives
3. Supporting decision making in healthcare and planning health services[22]