The present meaning of Public Health

Abstract

Starting around 1990, we hear about a “crisis” of Public Health, in connection with the structural adjustments of national economies and with health sector reforms. At the same time, the social determinants of health and of inequities in health receive a particular emphasis. The notion of the social determination of health belongs in the classical definitions of Public Health, which are analyzed in this paper. Criteria for the recognition of Public Health as a branch of Medicine and related professions are specified, v.gr.: it is an area of knowledge; it is a field of action and research; it is social and political activity; and so on. Issues related to the scope of Public Health are reviewed: for example, the viewpoint that restricts it to the functions of health promotion and sickness prevention; its extension to include the treatment and rehabilitation functions; and its extension towrds extrasectorial determinants. It is noted that financial organizations have interfered in recent times with the perspectives and practice of Public Health, by assigning preeminence to economic results over health results. A holistic concept of Public Health is required. This may be based on C.E.Winslow’ s and other classical definitions which are brought together at the beginning of the paper.We suggest adding to them such elements as: the underlying concepts of “human being” and of human and environmental health; the principles of equity, effectiveness and efficiency; the relatinship with health policy and its implementation by the Satate, civil society and the citizens; the design and conduction of the health care system; the integration of the classical functions of the system; and the awareness abd concern for the intra and extrasectorial factors of the health of persons and populations. The components in the Public Health field, and their mutual relationships, are analyzed. In this context, both the Social Medicine concept and the causation networks in health are presented, as well as the value aspect of Public Health and its role in History. The list of references includes other papers published in the series “Foundations of Public Health” in this Journal, which widen the perspectives for a debate and attempt to build, at least in part, a theory of Public Health.