Principles Of Public Health

Public health is the science and art of disease prevention, prolonging life and promoting health and well-being through organized community effort for the sanitation of the environment, the control of communicable diseases, the organization of medical and nursing services for the early diagnosis and prevention of disease, the education of the individual in personal health and the development of the social machinery to ensure for everyone a standard of living adequate for the maintenance or improvement of health (1). The goal of public health is to fulfil every society's ambition to create conditions in which all people can be healthy. Public health addresses the health of the population as a whole rather than the treatment of individuals. WHO defines health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity" (2). "Healthy people in healthy communities" is the ultimate goal of all public health interventions, which are aimed at promoting physical and mental health and preventing disease, injury and disability (3). Public health is particularly concerned with threats to the overall health of the community. As interventions are aimed primarily at prevention, monitoring the health of the community through surveillance of cases assumes great importance as does the promotion of a healthy lifestyle and healthy behaviour. In many cases, however, treating a disease can be vital to preventing it in other people, such as during an outbreak of a communicable disease. Another way of describing public health is "collective action for sustained population-wide health improvement" (4). This definition highlights the focus on actions and interventions that need collaborative actions, sustainability (i.e. the need to embed policies within supportive systems) and the goals of public health (population-wide health improvement and the reduction of health inequalities).

Since the 1980s, the focus of public health interventions has broadened towards population-level issues such as inequity, poverty and education and has moved away from advocating for change in the behaviour of individuals. The health of people is affected by many elements ranging from genetics to socioeconomic factors such as where they live, their income, education and social relationships. These are the social determinants of health, and they pervade every society in the world. Predictably, poor people have more health problems and worse health than the better-off sections of populations (5 ). Today public health seeks to correct these inequalities by advocating policies and initiatives that aim to improve the health of populations in an equitable manner.

The extension of life expectancy and the ageing of populations globally are predicted to increase the prevalence of many noncommunicable, chronic, progressive conditions including neurological disorders. The increasing capacity of modern medicine to prevent death has also increased the frequency and severity of impairment attributable to neurological disorders. This has raised the issue of restoring or creating a life of acceptable quality for people who suffer from the sequelae of neurological disorders.

Public health plays an important role in both the developed and developing parts of the world through either the local health systems or the national and international nongovernmental organizations. Though all developed and most developing countries have their own government health agencies such as ministries or departments of health to respond to domestic health issues, a discrepancy exists between governments' public health initiatives and access to health care in the developed and developing world. Many public health infrastructures are non-existent or are being formed in the developing world. Often, trained health workers lack the financial resources to provide even basic medical care and prevent disease. As a result, much of the morbidity and mortality in the developing world results from and contributes to extreme poverty.

Though most governments recognize the importance of public health programmes in reducing disease and disability, public health generally receives much less government funding compared with other areas of medicine. In recent years, large public health initiatives and vaccination programmes have made great progress in eradicating or reducing the incidence of a number of communicable diseases such as smallpox and poliomyelitis. One of the most important public health issues facing the world nowadays is HIV/AIDS. Tuberculosis is also re-emerging and is a major concern because of the rise of HIV/AIDS-related infections and the development of strains resistant to standard antibiotics.

As the rate of communicable diseases in the developed world decreased throughout the 20th century, public health began to put more focus on chronic diseases such as cancer, heart disease and mental and neurological disorders. Much ill-health is preventable through simple, non-medical methods: for example, improving the quality of roads and enforcing regulations about speed and protective measures such as helmet use help to reduce disability as a result of head injuries.

To increase the awareness of professionals and people in general about the public health aspects of neurological disorders, and to emphasize the need for the prevention of these disorders and the necessity to provide neurological care at all levels including primary health care, WHO launched a number of international public health projects including the Global Initiative on Neurology and Public Health. The outcome of this large collaborative endeavour, which involved many health professionals from all parts the world, clearly indicated that there was a paucity of information about the prevalence and burden of neurological disorders and a lack of policies, programmes and resources for their treatment and management (6-8).

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