Home  »  » Public Health

Public Health


Sri Lanka has an excellent network of PH officers in the Medical Officer of Health (MoH), together with the Public Health Midwife (PHM)

What is Public Health? Obviously it is to do with health and the public, or the wider community or the entire population. That is why Public Health is sometimes called Community Health or even Population Health.

It is easier to define who the public are but more difficult to define health. However, the term "Health" in Public Health is not merely the absence of illness. In addition, Public Health is concerned with both those people labeled "sick" and under the care of physicians and those people who are not thus labeled.

So far, we have tried to define the noun Public Health. There is also another definition of Public Health, which is the speciality or discipline of Public Health, the practice or even the methods employed in public health. In most countries the speciality of public health is associated with the medical profession. The leaders of public health are doctors. This continues to be the case even though the determinants of health and ill-health are outside the scope of subjects traditionally taught in medical school.

The origins of Public Health (the specialty) in the West date back to the late 19th century. It was mostly concerned with sanitation. However, PH did not for long remain concerned only with sanitation but embraced many other fields such as nutrition, infectious disease, maternal and child health, occupational health etc. All the same, the initial concern with sanitation has influenced the attitude of the public and some medical professionals towards PH. PH practitioners were not looked up to with the same respect or awe as were the doctors who treated patients. They were not considered to be proper doctors. This negative attitude resulted in difficulty in recruitment of young doctors to the specialty. Also, PH doctors tended to earn much less than doctors in other specialties.

The poor public image of PH doctors prompted the leaders of the field to change the name of the specialty to Community Medicine, Preventive Medicine, Social Medicine or even Public Health Medicine. It will be noticed that all the revised terms had "Medicine" included. This tendency, in my opinion, was not due to confusion between health and medicine but due to the glamour associated with "medicine" However, no other term describes the specialty better than "Public Health".

Why is Public Health Important?

It is important because health is important. PH is concerned with the nation’s health. And the nation’s health matters above all else. Health is Wealth is true for an individual as well as the country. The most important function of a government should be to maintain the health and well being of the population and that is the main and only function of the Public Health profession.

The PH practitioners are the only category of health professionals employed full time in health promotion and disease prevention. PH is concerned not only with the people outside the patient care system i.e. the so called "well" population. It is also concerned (or should be concerned) with those under the patient care system, both in-patients as well as outpatients, in government as well as the private sector. PH practitioners help the patient care system by reducing the numbers of patients needing care. Therefore they help to reduce the cost of patient care. It is almost unnecessary to mention here that the best option is not to get the disease in the first place, thus avoiding the need of treatment entirely. It must also be remembered that some (nay, most) diseases cannot be cured but are eminently preventable and it is the PH system that attempts to do so. The techniques routinely used in PH practice such as statistics and epidemiology are used to monitor, evaluate and improve the quality and reduce the of cost of patient care.

How are we doing with regard to PH in Sri Lanka? I must say that we have done very well. It is quite a common practice of politicians to proudly declare that Sri Lanka has excellent health indicators and we are better than most countries in the region. What they forget and maybe don't know is that the good health indicators are the result of correct PH policies of previous governments (and free education). One of the first Health Centers in the world (which at the time were popular as centers of public health practice) was started at Kalutara in 1926

Public Health Services under the Ministry of Health continued to enjoy equal status with the curative services until the 1960s and 1970s. The elimination of vaccine preventable diseases, malaria, filariasis and lately end of the mother to infant transmission of HIV in Sri Lanka are the end results of the enlightened policies of the past. We in Sri Lanka has an excellent network of PH officers in the Medical Officer of Health (MoH), together with the Public Health Midwife (PHM) and Public Health Inspector (PHI) better called the Environmental Health Officer. The area covered by each MoH is or should be coterminous with that covered by the Divisional Secretary and the local government. This arrangement is ideal for the promotion of health. I don't know whether this arrangement was put in place with the intention of promoting good health, but we should make better use of the Medical Officer of Health system than we seem to be doing at present. Particularly by means of some arrangement for regular contact between the three local institutions.

Since the beginning of the 1980s there has been a noticeable downplaying of PH. This phenomenon is not confined to Sri Lanka. The timing of the decline of PH paralleled the growth of Neo-liberalism. This is hardly surprising, because PH does not add to GDP or economic growth. On the other hand treatment of disease is good for the economy. One of the growth areas in Sri Lanka in the last ten years has been private hospitals, pharmacies, blood and urine testing establishments. There were Health Education programs broadcast on Sri Lankan TV then, now we have Disease Education programmes. Even globally Primary Health Care has been replaced by Primary Care, Health for All has been replaced by Universal Access to Health Care (read Medical Care).

I think it is time that the public took an interest in their health. This seems obvious and a strange thing to say. What I mean is that there should be pressure on the government to improve public health. We must insist that the policies of the government do not damage the health of the public. There is a need for a Public Health Movement. It seems strange that there isn't one when there are pressure groups fighting for almost everything else. A public health movement should be broad based and not confined to health professionals. As stated earlier the determinants of health are outside the medical field. After all, "Health is Everybody's Business"

Dr Lal Jayasinghe
(The writer is a member of Public Health Writers Collective)

animated gif
Processing Request
Please Wait...