Health and Public Health

What is Health?

According to the World Health Organization, health is "a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity". A variety of definitions have been used for different purposes over time. Health can be promoted by encouraging healthful activities, such as regular physical exercise and adequate sleep, and reducing or avoiding unhealthful activities or situations, such as smoking or excessive stress. Some factors that affect health care are individual choices, such as whether to engage in high-risk behaviour. In contrast, others are due to structural causes, such as whether the society is arranged to make it easier or harder for people to get necessary healthcare services. Still, other factors are beyond both individual and group choices, such as genetic disorders.

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The concept of health can also be viewed from two diverging philosophical perspectives. In the natural scientific perspective, which constitutes the foundation of modern medicine, health represents the opposite pole to disease. Because medical interpretation focuses on disease, "health" comes into the picture as "non-disease". This notion of health is therefore intrinsically residual in nature. From this ontological perspective, a human being is a physiological and neurophysiological system composed of an unlimited number of subsystems that are all functional parts of the whole. Diseases are considered disturbances in one or more subsystems, resulting in somatic, psychological, or social dysfunctions. This particular type of reasoning about disease and health originates from a mechanistic view of the functioning of human beings. Because health is seen as a non-disease, it can only be viewed as a condition through causal mechanisms.

Philosophy of Health/Functions of Public Health

Within the modern perspective of health promotion, there seems to be a renaissance of a different view of health, rather like that of the classical Greeks. In this holistic view, health is seen as an expression of how an individual can achieve an existential equilibrium. This equilibrium is not static but continuously in motion. Pathological disturbances of the equilibrium must be interpreted from different angles. Thus, we find what we will call the natural mechanistic perspective and also the social systemic and hermeneutic perspectives entering the health promotion stage. The notion of disease/non-disease is insufficient; concepts like sickness and illness seem to be indispensable to our understanding of health, both as a condition and as an enterprise for human beings.


Health is the ability of a biological system to acquire, convert, allocate, distribute, and utilise energy sustainably. The World Health Organization (WHO) defined human health in a broader sense in its 1948 constitution as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” This definition has been subject to controversy, particularly as lacking operational value, the ambiguity in developing cohesive health strategies, and the problem created by the use of the word "complete", which makes it practically impossible to achieve. This definition promoted for the first time that, in addition to physical and mental health, social welfare is an integral component of overall health because health is closely linked to the social environment and living and working conditions.

All modern health concepts recognise health as more than the absence of disease, implying a maximum capacity of the individual for self-realisation and self-fulfilment. This should equilibrate the human inner forces and possibilities with the feeling of pleasure or dissatisfaction in their relations with the environment. Social medicine and the public health approach to health advocate that we should observe the health of the individuals and the health of the groups and the community as a result of the interaction of the individuals with the social environment.


The holistic concept of health is contained in the expression of wholeness. Health is a relative state in which one can function well physically, mentally, socially, and spiritually to express the full range of one’s unique potentialities within the environment in which one lives. Both health and illness are dynamic processes. Each person is located on a graduated scale or continuous spectrum (continuum) ranging from wellness and optimal functioning in every aspect of one’s life, at one end, to illness culminating in death at the other.

Today, three types of definitions of health seem to be possible and are used. The first is that health is the absence of any disease or impairment. The second is that health is a state that allows the individual to adequately cope with all demands of daily life (also implying the absence of disease and impairment). The third definition states that health is a state of balance, an individual's equilibrium within himself and between himself and his social and physical environment.


According to Suresh Vatsyayann 1995, "Health is an ever-evolving state of mind, body and relationships perceived by an individual, a family, a group or a community for self in a particular time, space and context."

According to -Webster, “ Health is the condition of being sound in body, mind and spirit, especially freedom from physical disease or pain.”

According to Tarlov (1996), Health is defined as the capacity relative to potential and aspirations for living fully in the social environment.”

Biomedical Concept of Health: Traditionally, health has been viewed as an “absence of disease”, and if one has free from disease, then the person is considered healthy. This concept, known as the “biomedical concept”, has the basis in the ‘germ theory of disease.’

Ecological Concept of Health: The ecologist put forward an attractive hypothesis which viewed health as a dynamic equilibrium between man and his environment.

Psychosocial Concepts of Health:  Health is not only a biomedical phenomenon but also influenced by social, psychological, cultural, economic and political factors of the people concerned.

Holistic Concept of Health: The holistic model synthesises all the above concepts.  It recognised the stronger social, economic, political and environmental influences on health.  The holistic approach implies that all sectors of society affect health, particularly agriculture, animal husbandry, food, industry, education, housing, public works, communications, and other sectors. The emphasis is on the promotion and protection of health.


Philosophy of Health

o It is a fundamental human right (right to medical care, a healthy environment, good food, reproductive health)

o It’s a social investment

o It’s intersectoral; 

o It’s an integral part of a development

o It’s personal

Five Dimensions of Health/Wellness

There are five (5) dimensions of health: physical, mental, emotional, spiritual, and social. These five (5) dimensions of health provide a complete picture of health as a change in any dimension affects the others.  

Dimensions/Levels of Health/Wellness

Physical Dimension of Health

The physical dimension of health refers to the bodily aspect of health. It refers to the more traditional definitions of health as the absence of disease and injury. Physical health ranges in quality along a continuum where a combination of diseases such as cancer, diabetes, cardiovascular disease or hypertension are at one end, and a person at optimum physical condition (think health, not fitness) is at the other. Physical health can affect the other dimensions of health as a decline in physical health can result in a decline in other forms of health. E.g. a person who suddenly gets the flu is often isolated socially so as not to infect others, struggles to focus on studying or learning anything new, and may feel sad due to their isolation.


Mental Dimension of Health

Mental health refers to the cognitive aspect of health. Often mental health is linked to or includes emotional health; I want to distinguish the two. Mental health is more about the brain's functioning, while emotional health refers to the person's mood, often connected to their hormones. Mental health then includes many mental health issues such as Alzheimer's and dementia. It refers to the person's ability to use their brain and think. This may be to solve problems or recall information, but the focus is on the cognitive aspect of the person. Mental healthcare affects the other dimensions of health. An increase in mental health can come from increased physical activity, and good mental health can then lead to an increase in self-esteem as mental performance improves. Greater self-esteem then leads to more confidence in social situations and can lead one to ask the larger questions about life, leading to increased spiritual health.


Emotional Dimension of Health

Emotional health is about the person's mood or general emotional state. We can recognise and express feelings adequately. It relates to your self-esteem and your ability to control your emotions to maintain a realistic perspective on situations. The relationship between emotional and mental health is clear, and as such, some illnesses relate to both, such as depression and anxiety. Emotional health affects the other dimensions of health. A person with good self-esteem is more confident in social settings, makes friends quickly, and often performs better in physical activity.


Spiritual Dimension of Health

Spiritual health relates to our sense of overall purpose in life. People often find this purpose from a belief or faith system, while others create their own purpose. A person who has a purpose in life is said to be healthier than those who don’t see a purpose to live. Spiritual health will very easily affect emotional and mental health as having a purpose in life can help you to apply yourself to achieving goals. Having a purpose in life can also help people to maintain a proper perspective on life and overcome adversity. Often, spiritual people meet together regularly around their spiritual purpose, which helps improve their social health.


Social Dimension of Health

The social dimension of health refers to our ability to make and maintain meaningful relationships with others. Good social health includes having relationships, behaving appropriately, and keeping socially acceptable standards. The basic social unit of relationships in the family and these relationships impact a person's life the most. Other key relationships are close friends, social networks, teachers, and youth leaders. Social health affects the different dimensions of health in many ways. A bad social life can lead a person to question their purpose in life or feel isolated and unwanted. Such feelings can demotivate people from physical activity and lead them to depression.

Read Also: Levels of Health/Medical Care

What is Public Health?

Public health consists of organised efforts to improve the health of communities. The operative components of this definition are that public health efforts are organised and directed to communities rather than to individuals. Public health practice does not rely on a specific body of knowledge and expertise but instead on science and social approaches. The definition of public health reflects its central goal—reducing disease and improving health in a community.


Public Health is an empiric and multidisciplinary field whose goal is to ensure conditions for people to be healthy. While medicine mainly focuses on treating illness in separate individuals, it is the central goal of public health activities to increase health at the population level. The ruling principle of public health is to deal with the population's health in its totality. Health interventions on the population level include community hygiene, sanitation, health education, immunisation, and nutrition promotion. Public health covers preventive, curative, and rehabilitative actions. The success of public health depends on adhering to the basic rules of equity, partnerships, social justice, and the mobilisation of local, national, and international resources.

Public health is defined as the science of protecting the safety and improving the health of communities through education, policy-making and research for disease and injury prevention. It promotes and protects the health of people and the communities where they live, learn, work, and play. It focuses on the entire spectrum of health and well-being, not only the eradication of particular diseases.


While a doctor treats sick people, those of us working in public health try to prevent people from getting ill or injured in the first place. We also promote wellness by encouraging healthy behaviours.

From conducting scientific research to educating about health, people in public health work to ensure the conditions people can be healthy. That can mean vaccinating children and adults to prevent the spread of disease. Or educating people about the risks of alcohol and tobacco. Public health sets safety standards to protect workers and develops school nutrition programs to ensure kids have access to healthy food. 

Public health works to track disease outbreaks, prevent injuries and shed light on why some of us are more likely to suffer from poor health than others. The many facets of public health include speaking out for laws that promote smoke-free indoor air and seatbelts, spreading the word about ways to stay healthy and giving science-based solutions to problems.

Public health is defined as the science of increasing the health and safety of communities through education, policy-making and research for disease and injury prevention.


In 1920, C.E.A. Winslow provided the following definition of public health practice: “Public health is the science and art of preventing disease, prolonging life, and promoting physical health and efficiency through organised community efforts for the sanitation of the environment, the control of community infections, the education of the individual in principles of personal hygiene, the organisation of medical and nursing services for the early diagnosis and preventive treatment of disease, and the development of social machinery which will ensure to every individual in the community a standard of living adequate for the maintenance of health.”

Almost 70 years later, in 1988, the Institute of Medicine (IOM) published its classic report, The Future of Public Health, similarly defining public health as an “organised community effort to address the public interest in health by applying scientific and technical knowledge to prevent disease and promote health.” Then, the mission of public health is to ensure conditions that promote the community's health.


Sir Donald Acheson 1988 defined it as: ‘the science and art of preventing disease, prolonging life and promoting, protecting and improving health through the organised efforts of society.’

The field pays special attention to the social context of disease and health. It focuses on improving health through society-wide measures like vaccinations, the fluoridation of drinking water, or policies such as seatbelt and non-smoking laws.

Public health is considered about the health of people or communities instead of individual health - it is everyone's responsibility. The art and science of disease prevention are known as public health, and it entails:

a) prolonging life and promoting health ––both mental and physical

b) sanitation

c) personal hygiene

d) control of infectious diseases

e) organisation of health services


Epidemics, such as the plague, spurred public efforts to shield people from disease, although such disease was often considered a sign of the poor moral and spiritual condition. The poor and the common soldier or sailor typically suffered the brunt of epidemic diseases, premature death, and squalid living conditions.

The concept of public health is not unique and has changed over the years due to changes in the population's health status and the determining situations of health. This definition of public health is directly linked to the broader definition of health, found in the preamble of the constitution of the World Health Organisation (1948), where health is referred to as "a state of complete physical, mental and social well-being and not merely the absence of disease.


This means that public health aims to create the right conditions to provide this state of health for the benefit of society.

History of Public Health

In 1920, Charles-Edward A. Winslow, an American public health leader, defined public health as "the science and art of preventing disease, extending life, and promoting physical health and efficiency through organised community efforts for environmental sanitation, infection control, education of individuals in personal hygiene principles, and the organisation of medical and nursing services for early diagnosis and preventive care." While a modern nosologist might add mental aspects of health to the physical, Winslow's concept has not been surpassed. It served as the foundation for the World Health Organization's definition of health as "a condition of complete physical, mental, and social well-being, rather than simply the absence of sickness or disability" (1948).

The history of public health may be traced back to ancient times. For example, in the Middle Ages, health measures included the quarantine of leprosy afflicted. In Europe and the Middle East, the first worldwide initiatives in disease control took place in national quarantines. The relationship between disease and the environment became more known and refined over time, and plague epidemics from the 14th century onwards prompted efforts to improve sanitation.


The present public health system has been shaped by two forces over the previous 150 years:

a) The spread of scientific information regarding the causes of sickness and how to treat it

b) Increasing public recognition of illness prevention as a viable option and a shared duty

This article begins with a basic definition of public health before moving on to a brief history of public health from the Middle Ages to today.

Since the late 16th century, England's Poor Laws have been in place to assist the deserving but struggling poor affected by:

a) misfortune

b) death of a breadwinner

c) unemployment

d) sickness

e) inadequate wages

The standard of living was low, and occasionally, the able-bodied were obliged to work in a poorhouse or workhouse to support themselves. Poor legislative support was considered a last resort, as it could undermine the drive to labour.

Although medical treatments did not account for a significant portion of Poor Law care for the unfortunate, many Poor Law Guardians employed the services of local physicians.



By the eighteenth century, quarantine was frequently utilised to contain contagious sickness. By this time, the right of each human being to health (together with the rights to life, liberty, and the pursuit of happiness) had been established. The relationship between individual rights and the state's obligation has not always been straightforward.

The Poor Laws were increasingly recognised as ineffectual and incompatible with the era's new economic circumstances. In America, as the population of specific communities increased, more formal systems for the care of the sick were necessary. In Europe, population growth and a growing awareness of newborn mortality and the deplorable circumstances seen in jails and mental institutions.

By the late eighteenth century, some cities in America, including Boston and New York, had adopted permanent quarantine and isolation procedures. These initiatives indicated a shift in perspective on sickness away from the individual and toward governmental responsibility - where the disease was theoretically controllable through public action.


The Nineteenth Century

The nineteenth-century ushered in a new era of public health. The causal relationship between disease and the environment was established in the fourth and fifth centuries BCE, for example, in the work of Hippocrates, whose book Airs, Waters, and Places served as the theoretical framework for the epidemic disease until the nineteenth century, when the new sciences of bacteriology and immunology emerged.

The nineteenth-century witnessed what has been named "the great sanitary awakening" (Winslow, 1923) –– when pollution was discovered as a source of disease and a route of transmission –– and societal reforms became concentrated on sanitation. Sanitation improvements occurred concurrently in a few European countries and the United States.


The health and welfare of common labourers decreased as the industrial revolution progressed. Population growth has intensified the prevalence of filthy environmental conditions, particularly in working-class neighbourhoods, and therefore the incidence of sickness. For example, smallpox, cholera, typhoid, and tuberculosis became prevalent in London.

By the mid-nineteenth century, hospitals had established themselves as a permanent component of the medical scene. Though there were limitations: hospitals admitted patients only after they had succumbed to illness; they were curative in nature rather than preventative.

In England, Edwin Chadwick (1800–90) went beyond the established link between poverty and disease, arguing that disease also contributed to poverty in his Report on the Sanitary Conditions of the Working Population of Great Britain (1842). Chadwick claimed a clean water supply system and the abolition of refuge.


The 1875 Public Health Act in England addressed housing, ventilation, sewage drainage, water supply, nuisances, dangerous trades, contagious diseases, and other public issues, laying the groundwork for the world's most successful health system. Until the end of World War I, the 1875 Act established the requirements for British sanitary administration.

Advances in public health in England had a significant impact on the United States. There was a similar need for an effective administrative structure for supervising and regulating community health. Following the communist revolution in Russia, rural medical services were significantly expanded to meet the entire population's needs. Since then, similar companies in other European and Asian countries have been inspired by the method.


The twentieth century

At the turn of the twentieth century, further advancements in community healthcare occurred. In the United Kingdom, the Poor Law was re-examined by a royal commission in 1909. This resulted in a proposal for a more integrated state medical system ––a predecessor to the 1946 National Health Service Act.

Recent public health efforts have shifted to cancer, cardiovascular disease, lung illness, and arthritis. Investigations into the relationship between these illnesses and the environment have been conducted. Health education focused on illness prevention has become a growing priority.


Functions of Public Health

1. Surveillance, analysis and evaluation of the population’s health status

o   Monitor health status to identify population or community health problems

o Diagnose and investigate health problems and health hazards in the community

o  Monitor environmental and health status to identify and solve community environmental health problems

o   Diagnose and investigate environmental health problems and health hazards in the community

o  Act as quickly as possible with efficacy in solving and improving these problems

2. Develop policies and plans that support individual and community health efforts: Once the health problem is identified, public health seeks the best interventions and strategies to solve the public health problem and identify health and/or social actors or agents that can be carried out in the best way possible

3. Health Promotion: This is a public health function that tries to promote the population's health, educating in health from the other health, education and mass media facilities.

4. Disease Prevention: There are two strategies to address diseases prevention, the high-risk approach and the population approach

o High-risk approach: The high-risk approach is aimed at individuals particularly predisposed to an illness, and an individual prevention manner is offered to them

o Population approach: The population approach attempts to control the factors of the population as a whole without focusing on a specific collective matter. There are three levels of prevention:

a)   Primary Prevention: to intervene before the disease appears

b)   Secondary Prevention: to intervene in pre-symptomatic phases

c)  Tertiary Prevention: to intervene when the individual is already ill. Try to mitigate the effects of the disease.

2. To develop effective programs and health facilities to protect health: The development and implementation of programmes that promote health improvement of the population as a whole, with the condition that they are based on efficacy, scientific evidence-based, and help increase the population’s quality of life.

3. Evaluation of public health policies, strategies and facilities: Having just been implemented, whatever process included in society to solve or improve the health problems must be evaluated to check its proper performance and functioning and analyse if it is associated with an improvement of the health problems for which were developed.


The Scope of Public Health

1.      Prevention and control of chronic disease and injuries.

2.      Look after environmental health.

3.      Advocate for creating policies at work, school, daycare/home in all places.

4.      Provide services in natural and man-made disasters.

5.      Prevention of communicable and non-communicable diseases.


Functions of Public Health Professionals

As a public health professional, you will be trained to perform one or more of these ten essential services:

Monitor the health status of a community to identify potential problems

Diagnose and investigate health problems and hazards in the community

Inform, educate, and empower people about health issues, particularly the underserved and those at risk

Mobilise community partnerships to identify and solve health problems

Develop policies and plans that support individual and community health efforts

Enforce laws and regulations that protect health and ensure safety

Link people to needed personal health services and ensure the provision of health care when otherwise unavailable

Ensure competent public health and private health care workforce

Evaluate effectiveness, accessibility, and quality of personal and population-based health services

Research new insights and innovative solutions to health problems.

Social Workers' Role in Public Health

Public health research incorporates a broad array of studies that address systems, policies, and personnel that work to prevent disease, prolong life, and promote better health care within the vast array of public health research studies specific to public health social work practice, an area of practice that has strong historical roots in the social work profession.  Public health social work practice uses a research-based epidemiologic approach to identify and address social problems that affect population groups' health status and social functioning.  Public health social work emphasises primary prevention interventions and includes practice at multiple levels, including individuals, groups, communities, and populations.

Health promotion is a core function of public health. It effectively reduces the burden of disease (both from communicable and non-communicable diseases) and mitigates the social and economic impact of such conditions. WHO support focuses on promoting healthy living, creating an empowering environment, and generating evidence for programmes and policies that aim to reduce lifestyle-based risk factors for individuals and communities.

WHO provides support for policy development, regulation, public and professional education, guidelines development, media interventions and research that address the determinants of health. Supports are also provided for mass awareness through school-based and other approaches. Partnerships with public and private sectors, academic institutions and civil society groups are promoted.

Awareness campaign on healthy lifestyle and health risks predisposed to ill health conducted through workshops, media interventions and observance of World Health Day.

Strategy on the promotion of health of elderly citizens.

Short course on health education and promotion.

Training manual on non-communicable disease prevention for health workers.

Development of national health promotion policy.

Healthy processed food initiative.

Advocacy for sustainable financing for health promotion activities using sin taxes

Public health social workers are often responsible for helping people diagnosed with chronic, life-threatening or altering diseases and disorders, helping connect patients with plans and resources to help them cope. One of the most challenging things a person can go through is dealing with acute, chronic, and terminal illnesses and these social workers provide services to ease these patients’ processes. These services include advising family caregivers, providing patient education and counselling, making referrals to other services, case management interventions, planning hospital discharge, and organising support groups. These social workers are often employed at health care centres, assisted living homes or hospitals.

Social Workers play a huge role in Public Health. Public Health Social Workers focus on prevention and identifying children, adults, families, and communities with needs; and provide intervention services to help these clients discover ways of meeting their needs and preventing future problems.

One of the ways Public Health Social workers do this involves helping individuals and families make behavioural and situational life changes to improve their overall health and well-being. Their focus extends to communities, and a significant part of that addresses broad public health issues. Public Health Social Workers conduct the following direct client service activities: (Informing and Awareness Building, Collectivization; Establishing Dialogical relationships, Advocacy).

Coordinate clients’ involvement with community agencies.

Refer clients and families dealing with emotional, physical and social issues.

Empower clients to assess their own needs and advocate for themselves.

Enhance clients’ coping abilities.

Link clients to resources for optimal outcomes.

Provide an understanding of client psychosocial and environmental factors for the multidisciplinary health care team.

Provide assessment, counselling, and referral services regarding health promotion in clinical and multidisciplinary settings

Enhance information sharing and research alliances

Improve the competence of communities to develop strategies for helping older adults define and reach their goals.

Participate in community management

Advocate regarding the development and maintenance of community infrastructures

Encourage better use of available resources

Develop partnerships among key players and stakeholders in the community

Promote economic developments that will lead to better health practices among the general population.

Community-Based Family Health Centers

Understanding of common ethical and legal issues in social work practise in health care settings 

Biopsychosocial–spiritual assessment 

Use of the strength’s perspective 

Client and family engagement in all aspects of social work intervention 

Case management/care management/care coordination/health care navigation 

Discharge and transition planning 

Client concordance with and adherence to the plan of care 

Advance care planning 

Palliative care, including pain and symptom management 

Hospice and end-of-life care 

Identification of child/elder/vulnerable adult abuse, trauma, neglect, and exploitation 

Crisis intervention 

Facilitation of benefits and resource acquisition to assist clients and families, including an understanding of related policies, eligibility requirements, and financial and legal issues 

Advocacy with other members of the interdisciplinary team and within the health care institution to promote clients’ and families’ decision making and quality of life 

Client, family, interdisciplinary, and community education.

Family systems issues, including the impact of health care concerns, illness, and disease on family relationships; life cycles; and caregiving roles and support needs.

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