FUTURE OF PUBLIC HEALTH

Table 1

Contemplating the future of public health entails noting the historical nature of the field. From time immemorial, public health has embraced determining and analyzing a community's health problems, formulating strategies to deal with them, and implementing social means of attending to those problems. The Institute of Medicine has expressed the public health mission as "fulfilling society's interest in assuring conditions in which people can be healthy."

In the immediate future, public health must be concerned with both communicable and noncommunicable disease control issues. These include the prospect of eradicating poliomyelitis and measles; dealing with the HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome) pandemic; expanding immunization programs against influenza and pneumonia; and using sociobehavioral approaches and screening programs to curtail the major highly fatal conditions that currently prevail in the industrialized world—particularly cardiovascular disease and cancer. Critical to the success of these efforts will be overcoming the health disparities that exist between different racial and ethnic groups and between socioeconomic groups.

In the longer term, public health will have to be concerned with changes in the concept of health and with demographic trends and conditions of life that determine health problems. Up until the latter part of the twentieth century, health was generally regarded as the absence of disease. New views are now emerging, however. The World Health Organization defines health as "a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity," and the Ottawa Charter for Health Promotion calls health "a resource for everyday life." These ideas reflect the fact that people are living into their eighties and nineties and are increasingly free of major diseases during most of their lives. For many people, ideas of achieving health in a positive sense are supplementing ideas of disease avoidance.

In addition to this concept's challenge to public health, the field must attend to health problems arising from major population dynamics, particularly aging and migration. Longevity in the United States increased more than 50 percent during the twentieth century, and life expectancy is advancing after sixty-five years of age as much as in all the years of life up to sixty-five (see Table 1). Public health will hence be shifting its age focus. It will also be necessary to respond to the huge migrations of people from one part of the world to another. These migrations cause health problems associated with changes in both physical and social living conditions.

Public health activity emanates from the ways in which society organizes to protect and advance community health. It has included governmental functions that improve and maintain environmental conditions for health; provide certain medical services that are essential to health (such as immunizations and prenatal care); and promote healthful personal behavior. These governmental activities will evolve in accordance with epidemiological findings and political decisions concerning what should be done about health problems. Formulating policies and proposals for such decisions is a significant component of public health leadership.

In the United States, nongovernmental public health activity has long included work by voluntary health organizations that deal with particular diseases, such as the American Cancer Society, the American Lung Association, and the American Heart Association. During recent years an upsurge of community-based organizations (CBOs) has focused to a considerable extent on health improvement. It appears that neighborhood groups, church-sponsored programs, school-affiliated programs, and other types of community organizational health efforts will constitute an increasingly important aspect of public health. This reflects a growing willingness to improve local health conditions at the grassroots level, beyond what government typically undertakes.

Another boost to public health is coming from the trend to set objectives for achievement within a specific time period. An example is the decennial series Healthy People, established by the U.S. Department of Health and Human Services.

Public health leadership in the future should include not only a delineation of health problems and the formulation and advocacy of means of solving them, but also the development of community consensus regarding objectives and strategies. This should further lead to a genuine partnership with other social agencies and organizations to improve the environmental, medical, and sociobehavioral conditions that affect health.

Lester Breslow

(see also: Access to Health Services; Aging of Population; Communicable Disease Control; Community Health; Demography; Economics of Health; Genetics and Health; Health; Healthy People 2010; History of Public Health; Immigrants, Immigration; Leadership; Life Expectancy and Life Tables; Noncommunicable Disease Control; International Nongovernmental Organizations; Nongovernmental Organizations, United States; World Health Organization )

Bibliography

Institute of Medicine (1988). The Future of Public Health. Washington, DC: National Academy Press.

Lalonde, M. (1974). A New Perspective on the Health of Canadians. Ottawa: Ministry of National Health and Welfare.

U.S. Department of Health and Human Services (2000). Healthy People 2010 Objectives. Washington, DC: Author.

World Health Organization (1985). Basic Documents, 35th edition. Geneva: Author.

—— (1986). Ottawa Charter for Health Promotion. Geneva: Author.