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.

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.

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, fluoridation of drinking water, anti-smoking 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 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 2005 Tsunami and Hurricane Katrina in 2006. 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 (WHO, 2003). The new public health seeks to address these health inequalities by advocating for population-based policies that improve the health of the whole population in an equitable fashion.

The burden of treating conditions caused by unemployment, poverty, unfit housing and environmental pollution have been calculated to account for between 16-22% of the clinical budget of the British National Health Service. [2]

UK Public health functions include:
  • Health surveillance, monitoring and analysis
  • Investigation of disease outbreaks, epidemics and risk to health
  • Establishing, designing and managing health promotion and disease prevention programmes
  • Enabling and empowering communities to promote health and reduce inequalities
  • Creating and sustaining cross-Government and intersectoral partnerships to improve health and reduce inequalities
  • Ensuring compliance with regulations and laws to protect and promote health
  • Developing and maintaining a well-educated and trained, multi-disciplinary public health workforce
  • Ensuring the effective performance of NHS services to meet goals in improving health, preventing disease and reducing inequalities
  • Research, development, evaluation and innovation
  • Quality assuring the public health function

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