So what the heck is public health?

I have spent two years studying public health at one of the United States’ most respected schools of public health. I have read hundreds of articles, countless books, and more data than I can possibly quantify. Perhaps it is a good time to ask, just what the heck is public health, and how is it communicated. Do people understand what public health experts say, and how well do public health people communicate what we do?

An oft-repeated definition of public health by C.E.A. Winslow (1920) describes it as “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 principles of personal hygiene, the organization of medical and nursing services for the early diagnosis and preventive treatment of disease, and the development of the social machinery which will ensure to every individual in the community a standard of living adequate for the maintenance of health.”

Well, phew. That was exhausting.

Here’s another, this time from an Institute of Medicine report, from 1988. In the IOM’s words, public health is “fulfilling society’s interest in assuring conditions in which people can be healthy.” This implies a population focus, namely interventions that aim to prevent disease and promote health that affect everyone.

However, the world of public health, when it attempts to explain itself to the wider public, often resorts to graphs that, despite being conceptually rich and research based, appear downright confusing and at times bizarre, at least to outsiders I fear. I remember one lecturer I heard in January 2012 say, “Public health people love boxes and arrows.” To that add circles, diagrams, squiggly lines, and a range of other symbols. Does this help public health, or simply make the general public confused about what public health is? Or, should we continue to stick with what we, in the field, have come to believe are best communications practices?

To those who have very little experience with public health, I present three images of population health, public health interventions, and the social determinants of health. The first diagram is of factors influencing population health.

Population health model
Public health wheel of interventions
A model explaining the social determinants of health

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