The purpose of this paper is to describe the history of public health, including pertinent dates and significant events and the different aspects of public and community-based health. Public health is the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals (Winslow, 1920). It is concerned with threats to health based on population health analysis. The population in question can be as small as a handful of people or as large as all the inhabitants of several continents (for instance, in the case of a pandemic). The dimensions of health can encompass “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”, as defined by the United Nations World Health Organization. Public health incorporates the interdisciplinary approaches of epidemiology, biostatistics and health service. Environmental health, community health, behavioral health and occupational health are other important subfields.
The focus of public health intervention is to improve health and quality of life through the prevention and treatment of disease and other physical and mental health conditions, through surveillance of cases and the promotion of healthy behaviors. Promotion of hand washing and breastfeeding, delivery of vaccinations, and the distribution of condoms to control the spread of sexually transmitted diseases are examples of common public health measures. The origins of the Public Health Service can be traced to the passage of an act in 1798 that provided for the care and relief of sick and injured merchant seamen. Reorganization in 1870 converted the loose network of locally controlled hospitals into a centrally controlled Marine Hospital Service, with its headquarters in Washington, D.C. The position of Supervising Surgeon (later Surgeon General) was created to administer the Service, and John Maynard Woodworth was appointed as the first incumbent in 1871.
The commissioned officer corps (now known as the Commissioned Corps of the U.S. Public Health Service or the Public Health Service Commissioned Corps) was established by legislation in 1889. At first open only to physicians, over the course of the twentieth century, the Corps expanded to include veterinarians, dentists, Physician Assistants, sanitary engineers, pharmacists, nurses, sanitarians, scientists, and other health professionals. Quarantine was originally a state function rather than federal, but the National Quarantine Act of 1878 vested quarantine authority to the Marine Hospital Service and the National Board of Health. The National Board was not reauthorized by Congress in 1883 and its powers reverted to the Marine Hospital Service. Over the next half a century, the Marine Hospital Service increasingly took over quarantine functions from state authorities. As immigration increased dramatically in the late nineteenth century, the Federal Government also took over the processing of immigrants from the states, beginning in 1891.
Because of the broadening responsibilities of the Service, its name was changed in 1902 to the Public Health and Marine Hospital Service, and again in 1912 to just the Public Health Service. As the century progressed, PHS commissioned officers served their country by controlling the spread of contagious diseases such as smallpox and yellow fever, conducting important biomedical research, regulating the food and drug supply, providing health care to underserved groups, supplying medical assistance in the aftermath of disasters, and in numerous other ways. Today the mission of the Commissioned Corps of the PHS is “Protecting, promoting, and advancing the health and safety of the Nation.” The Public Health Service Act of 1944 structured the United States Public Health Service (PHS) as the primary division of the Department of Health, Education and Welfare (HEW), which later became the United States Department of Health and Human Services.
As one of the United States seven uniformed services, the PHS Commissioned Corps fills public health leadership and service roles within federal government agencies and programs. The PHS Commissioned Corps includes officers drawn from many professions, including environmental and occupational health, medicine, nursing, dentistry, pharmacy, psychology, social work, hospital administration, health record administration, nutrition, engineering, science, veterinary, health information technology, and other health-related occupations. Agencies within the Public Health Service are: * Administration for Children and Families (ACF)
* Administration on Aging (AoA)
* Agency for Healthcare Research and Quality (AHRQ)
* Agency for Toxic Substances and Disease Registry (ATSDR)
* Centers for Disease Control and Prevention (CDC)
* Centers for Medicare & Medicaid Services (CMS)
* Federal Occupational Health (FOH)
* Food and Drug Administration (FDA)
* Health Resources and Services Administration (HRSA)
* Indian Health Service (IHS)
* National Institutes of Health (NIH)
* Substance Abuse and Mental Health Services Administration (SAMHSA)
According to “CHHS” (2007), “The California Health and Human Services Agency (CHHS) oversees twelve departments and one board that provide a range of health care services, social services, mental health services, alcohol and drug treatment services, income assistance and public health services to Californians from all walks of life. Major programs include no-cost and low-cost health care coverage for low-income Californians (Medi-Cal); income support for the aged, blind or disabled (SSI/SSP); income support for CalWORKs recipients, low-cost public health insurance (Healthy Families) for children from working families.
Other large programs administered by CHHS departments include food stamps, child welfare services, in-home supportive services, support for the developmentally disabled, foster care, mental health services, drug and alcohol treatment, and vocational rehabilitation. CHHS directly serves millions of Californians in health and human service programs, while touching the lives of all Californians through statewide efforts such as public health protection and emergency preparedness and response.”
Public Health Nursing Practice is the synthesis of nursing theory and public health theory applied to promoting and preserving the health of populations. The focus of practice is the community as a whole and the effect of the community’s health status (resources) on the health of individuals,
families, and groups. Care is provided within the context of preventing disease and disability, and promoting and protecting the health of the community as a whole (Stanhope & Lancaster, 2008). It is mainly composed of the following areas: Behavioral Science/Health Education, Biostatistics, Emergency Medical Services, Environmental Health, Epidemiology, Health Services Administration/Management, International/Global Health, Maternal and Child Health, Nutrition, Public Health Laboratory Practice, Public Health Policy, Public Health Practice (“What Is Public Health?”, n.d.).
Community Health Nursing Practice is the synthesis of nursing theory and public health theory applied to promoting, preserving, and maintaining the health of populations through the delivery of personal health care services to individuals, families, and groups. The focus of practice is to preserve the health of individuals, families, and groups and the effect of their health status on the health status of the community as a whole (Stanhope & Lancaster, 2008). Community nursing works with the individual in hospitals, nursing homes, home healthcare, and hospice. Nurses in this field work in government and private agencies, clinics, and other private settings. They focus on populations, working with individuals, groups, and families to improve the overall health of communities. They educate about health care issues, disease prevention, nutrition, and childcare, and also work with community leaders, teachers, parents, and physicians in community health education.
In conclusion, public health is concerned with protecting the health of entire populations. Its’ vision is Healthy People in Healthy Communities. Its’ mission is to Promote Physical and Mental Health and Prevent Disease, Injury, and Disability. This is accomplished by preventing epidemics and the spread of disease; protecting against environmental hazards; preventing injuries; promoting and encouraging healthy behaviors; responding to disasters and assists communities in recovery; and, assures the quality and accessibility of health services.
Through public education, health promotion and disease prevention, the public will have the opportunity to take control of their own personal health. Research and analysis help to guide recommendations and teaching. As new information is discovered, the teaching for health promotion changes. Public health is put into action by legislation and political acts. Community healthcare may be for profit, nonprofit or government run healthcare delivery systems for individuals. Policy and recommendations are done through public health and delivered through community health. Public health nursing is vital to the health and well-being of the nation as a whole.
CHHS. (2007). Retrieved from http://www.chhs.ca.gov/Pages/default.aspx
Stanhope, M., & Lancaster, J. (2008). Population-centered health care in the community (7th ed.). St. Louis, MO: Mosby Elsevier. U.S. Department of Health &Human Services. (n.d.). Retrieved from http://www.hhs.gov/about/ What is Public Health?. (n.d.). Retrieved from http://www.whatispublichealth.org/what/index.html Winslow, Charles-Edward Amory (1920 Jan 9). “The Untilled Fields of Public Health”. Science 51 (1306): 23–33).