The dimensions of public health The tropical environment
Modern public health The ecological approach to public health
Key public health functions References and further reading
When this textbook was first published in 1973, it was designed to fill a gap in the medical literature. It directed attention to the special problems of disease prevention in the tropics and it emphasized major health problems peculiar to the tropics with particular reference to parasitic infections and other communicable diseases that are prevalent in warm climates. However, it was not a textbook of parasitology or microbiology in that it provided epidemiological approaches to disease control. In effect it approached public health from the viewpoint of tropical countries.
Over the past few decades, the science and practice of public health has evolved and its mandate has been enlarged. Rather than being strictly confined to limited role in disease prevention, public health has progressively become a central feature of the health sector through its involvement in policy-making, management and evaluation at every level of the health services.
The evolution of the discipline has highlighted the confusing nomenclature that is used to describe public health and its component elements. The oldest term, hygiene, embodied the early knowledge about value of sanitation and personal cleanliness. The name still persists in the title of some old institutions (e.g. London School of Hygiene and Tropical Medicine). As knowledge grew, the term hygiene was felt to be too narrow and a broader term public health was used more widely. The term public health did not survive unchallenged as new terms were introduced to define special aspects of the discipline. Some used the term 'preventive medicine'; others preferred 'social medicine', 'community medicine', or 'community health'.
Winslow's classical definition suggests that the term 'public health' encompasses all the ideas contained in the newer names (Box 1.1).
In a modern interpretation of Winslow's definition, Beaglehole and Bonita (1997) identified the following essential elements of modern public health:
♦ collective responsibility;
♦ prime role of the state in protecting and promoting the public's health;
♦ partnership with the population served;
♦ emphasis on prevention;
♦ recognizing underlying socio-economic determinants of health and disease;
Box 1.1: Winslow's definition of public health
'... the science and art of preventing disease, prolonging life, and promoting physical health and efficiency, through organized community efforts, for the sanitation of the environment, the control of community infections, the education of the individual in the principles of personal hygiene, the organization of medical and nursing service for the early detection and preventive treatment of disease, and the development ofthe social machinery which will ensure to every individual in the community a standard of living adequate for the maintenance of health.'
■ identifying and dealing with proximal risk factors;
■ multidisciplinary basis for action.
Or succinctly, Acheson summarized public health as:
'the science and art of preventing disease, promoting health and prolonging life, through organized effort of society'.
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