What is Public Health?

Look around you. Public health is everywhere. It's been a part of your life since you were born (and way before), and you might not even know it.

Let's start with basic disease prevention. You've likely had multiple vaccines against a slew of once-deadly and now preventable diseases including polio, diphtheria, and smallpox (if you are in your 40s). In fact, the vaccine campaign against smallpox was so effective that by the 1970s the disease was eradicated from the planet and survives only in highly secure government laboratories in the United States and Russia.

This is public health.

Want another example? Go turn on the faucet and drink a cold glass of water. Go ahead. It's OK, We'll wait … You just drank yourself a cold glass of public health. The clean water you drink is part of a public health infrastructure that delivers water from the Delaware River and the Schuylkill  (that's right!) that has been treated at one of three water treatment plants located around the city. Since the middle of the 20^th century, the addition of a small amount of fluoride to most water supplies in the U.S., including Philadelphia, successfully helps fight tooth decay.

This is also public health.

Finally, do you see any smoking advertisements around town? On billboards? On television? At sporting events? No, you don't. And do you know why not? Because a coalition of public health practitioners, from community activists to social scientists, medical professionals and politicians fought tobacco companies tooth and nail to cut back on tobacco advertising to help reduce smoking. And, guess what? It helped. Since the height of tobacco use in the U.S. in the 1950s, smoking rates have dropped by more than half (although the decline has recently slowed dramatically).

This is public health, too.

But public health isn't all victories. Sometimes it's controversial. And it's almost always complicated.

According to the Institute of Medicine, public health is "what we, as a society, do collectively to assure the conditions in which people can be healthy." That's serious business. Plying our trade through prevention, education, and sometimes intervention efforts, public health professionals must balance the needs of the community with the rights of the individual. Of course we want to prevent or reduce the burden of disease, but how far do we go?

Public health has not always behaved in ways deserving the public trust. Such failures haunt our work. The most egregious remains the United States Public Health Service Syphilis Study, an experiment that began in 1932 on approximately 400 African American men in Macon County, Ala. Remembered as the Tuskegee Study, it followed the course of syphilis in these men to study the debunked and racist belief that syphilis was different in blacks than it was in whites. The men were coaxed into the study, went untreated, and never knew what it was they were sick with. Findings from the study were published until public outrage brought it to a halt in 1972 (An apology, from President Clinton, was not forthcoming for another 25 years). The study, along with other examples of medical and public health racism, continues to resonate among African Americans and others as an appalling example of public health gone awfully wrong.

Public health is ultimately both an ideal and a strategy. It is a belief that preventing illness is more effective and humane than treating it, and that interventions should focus on whole populations, not just individuals.

This is public health.

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