Public health professionals track epidemics every day, and while the job isn’t always as glamorous as Hollywood would suggest, it is an essential public health service — one of 10 essential services, in fact.
History
Clinical medicine and public health are often intertwined, but they approach health from two very different perspectives. While medical practitioners are often focused on diagnosing, treating, and caring for the individual patient in front of them, public health takes a wider view—hat of an entire community. When done well, public health can achieve something remarkable: nothing. No outbreaks. No health concerns. No lives lost prematurely. It’s a lofty—and likely unachievable — goal, but it encompasses the most important aspect of public health. That is prevention.
The 10 essential services arose in the early 90s along with the debate over healthcare reform. At the time only three “core functions” for public health were widely recognized: assessment, policy development, and assurance. Public health leaders wanted to provide more specific guidance to health departments and policymakers tasked with protecting the health of their communities. The result was a consensus statement that outlined 10 key services within the overarching framework of the original three core functions that everyone working in public health should strive for.
Here is what they came up with.
There are systems all over the world to help sound alarms if things are amiss. While traditionally they have relied heavily on things like reporting by medical practitioners, conducting surveys, or testing lab samples, the internet has provided new ways to track epidemics in the early stages, or even before they begin. A new field called digital disease detection has emerged to help public health professionals and researchers spot outbreaks quickly by tracking key phrases on social media or combing online news reports. These systems don’t just look for infectious diseases. Monitoring the health status of a community means also looking at things like injuries, chronic diseases, and birth outcomes to see what trends — if any — exist.
This service is critical. After all, before public health officials can do anything to improve the health of a community, they must first figure out what needs to be done.
Epidemiologists collect and analyze data to figure out how diseases or health conditions are distributed in a given population, what key factors those cases have in common, and — most importantly — how that information could be applied to prevent future cases. When there’s a salmonella outbreak, epidemiologists are the ones talking to those who got sick, collecting information on what they ate, and pinpointing what food is the likely culprit so that it can be pulled from the shelves.
One of the most successful examples of this essential service in action was the Back to Sleep campaign. When epidemiologists around the world started to identify sleep position as a risk factor for sudden infant death syndrome, the American Academy of Pediatrics and other health officials in the United States launched an educational campaign urging parents to place their babies down to sleep on their backs, rather than on their stomachs or sides. Pediatricians talked about it with their patients’ families, pamphlets were passed out, and experts went on television to spread the word.
And it looks like it worked. SIDS rates dropped by over 50 percent in the years immediately following the launch of the campaign.
For example, many public health initiatives have turned to local groups and individuals to help combat HIV in marginalized populations. Instead of using authority figures to disseminate key information, programs work within peer networks to reach those most at risk for infection. After all, who better to help influence positive change in a community than the people who are already a part of it?
School immunization requirements, for example, made big strides in increasing vaccination rates and, in turn, combatting vaccine-preventable diseases like measles and chickenpox. Not only did requirements work to protect individual children, but the resulting high immunization rates made it harder for diseases to circulate — a process known as herd immunity — thus helping to protect an even greater number of people in the community.
One of the biggest ways public health departments help link people to services is through public health centers. While often these centers provide direct medical care for low-income and uninsured individuals, they also often provide things like health education, counseling, and referral services. For example, the Special Supplemental Nutrition Program for Women, Infants, and Children — commonly called WIC — is often run by local health departments in an effort to ensure that all kids regardless of income have access to good nutrition in the first few years of life.
To do this, agencies look at a wide range of factors and involve a host of different specialties. Health economists, for example, can help estimate the cost-effectiveness of a given policy change. Epidemiologists look at disease trends among participants of a particular health initiative to see if they’ve improved. Biostatisticians analyze data from surveys and medical records to determine whether certain health indicators in a given population have changed. Not only do the results from these evaluations help to improve programs, but insight gathered can also often be used for the first essential service list above.
So no, public health isn’t exactly glamorous. But it is pretty amazing.
