Public health and preventive medicine
The most well-known definition of public health, points out that this is a branch of medicine whose fundamental interest is the concern for health phenomena in a collective perspective, that is, of those situations that, for different circumstances, can adopt Massive patterns in your development.
In 1920, Winslow defined the Public Health in the following terms:
" public health is science and the art of preventing diseases, prolonging life and promoting health and physical efficiency through organized community efforts to clean up the environment, control community infections and educate the individual regarding the principles of personal hygiene; Organize medical and nursing services for early diagnosis and preventive treatment of diseases, as well as developing social machinery that ensures each individual of the community an adequate standard for health care ".
Subsequently, Winslow changed the term " physical health " by the & quot, physical and mental health " .
The definition of health proposed by the World Health Organization (WHO: 1946), which points out that " health is not only the absence of disease, but the state of complete physical, mental and social well-being of the individual " It determines that a good part of the work of public health expands to new and emerging areas in contemporary societies.
means, in good accounts, the explicit manifestation that medicine should worry about both sick and healthy.
Following Milton Terris, who proposes in 1990 a contemporary adaptation to the definition of Winslow, the Public Health is defined as:
" science and the art of preventing ailments and disabilities, prolong life and promote health and physical and mental efficiency, through organized community efforts to clean up the environment, control infectious diseases and not infectious, as well as injuries; Educate the individual on the principles of personal hygiene, organize services for the diagnosis and treatment of diseases and rehabilitation, as well as developing the social machinery that ensures each member after the community a level of living suitable for maintenance of health ".
Public health thus considered is constituted from the recognition of the existence of collective disease processes and problems. This implied that organizations, groups or institutions should take charge of them, because these could not be resolved at the level of individuals.
As a non-clinical specialty of medicine, this discipline focuses on the issue of health in a collective context, seeking through the application of various approaches to intervention, positively influence the occurrence of illness.
by character " no clinical " From public health, it may be thought that medical action is capable of being fragmented in an individual environment, of clinical order, and another of a collective nature, with less technical protagonism, represented by public health.
However, today is universally accepted that the health of individuals elapses on a continuous vital axis, in which moments of individual interaction between it and their means, as well as complex collective relations supported by an intricate mesh of interactions Social that individuals develop in their communities. Then, it is logical to perceive the individual as a member of a collective, without him losing his character as an individual person.
Therefore, from the perspective of the health care of individuals, it is advisable to emphasize that there is only one type of medicine, in which the task of disciplines is present with diverse and complementary scope, which are deployed according to the Nature and development of health events.
Different interpretations of the concept of public health
The term " public health " It is, in the opinion of some authors, loaded with ambiguous meanings and various imprecisions. In its history, five connotations have been prominent.
The first equips the adjective " public " With government action, this is, with the public or state sector.
A second meaning is even broader by including not only the participation of the State but that of the organized community.
Third use identifies public health with calls " non-personal health & quot services; ie, those that apply to the environment (for example, environmental sanitation) or community (for example, education Massive in health) and that therefore are not appropriate by a single individual in a specific way, as could be a medical consultation or the application of a diagnostic procedure.
The fourth use is an extension of the third, as long as a series of personal services of a preventive nature addressed to vulnerable groups (for example, maternal-child care programs).
Finally, the expression & quot is often used; public health problem ", especially in non-technical language, to refer to high-frequency or hazardness in the population.
There are also associations between these different meanings. For example, in some industrialized countries there has been a tendency that the private health sector provides most of the personal therapeutic services, while the public or state sector has assumed responsibility for preventive and non-personal services, so necessary for community. This has reinforced the idea of public health as a separate subsystem of services provided by the State and parallel to the mainstream of high-tech curative medicine.
A more comprehensive point of view has recently emerged on the concept of public health. This argues that the adjective " public " It does not denote a set of services in particular, nor a form of ownership, nor a type of problem, but a specific level of analysis, namely a population level. Unlike clinical medicine, which operates at an individual level, and biomedical research, which analyzes the subindividual level, the essence of public health is that it adopts a perspective based on human groups or populations. This population perspective inspires its two applications, as a field of knowledge and as a scope for action.
Public health requires for its proper development of the active collaboration of a set of disciplines, without which, the explanation and intervention on health problems would be materially impossible, as well as incomplete. Since its inception as a matter of study and during the course of this century, public health has been seen as a social science (Virchow R.) to which a set of disciplines concur. It is the joint contribution of these that finally determines a more comprehensive level of understanding of health-disease processes. As a central axis of these contributions, biological medical disciplines are found and particularly epidemiology, which has a central role for understanding a large part of health phenomena.
Among these disciplines can be indicated directly directly to the biomedical sphere, which have necessarily been added from other areas of knowledge, particularly those of the field of social sciences, inexplicably postponed for a long time.
A major obstacle to achieving the integration of these different disciplines has been the tendency to identify each level of analysis with some of these disciplines. For example, there is a confusion that the basic sciences are only applicable to individual and subindividual levels, while the population is the Absolute Heritage of the Social Sciences.
All human populations are organized in societies, hence the social sciences are indispensable for a fully understanding of the health of populations, that is, public health. In this area, social sciences have exercised remarkable influence on the study of some psycho-social health determinants that began being explored in a very reductionist manner in the epidemiological environment. As an example, in recent years, the contribution of these disciplines in the study of socioeconomic determinants and inequalities in health have opened a new world in the understanding of interactions between biological and social factors.
However, there is also a biological dimension of human populations, expressed in its genetic characteristics, group immunity and the interaction of the human population with other populations, such as microbiological interaction (dimension that gives rise to seroepidemiology , bioepidemiology and genetic epidemiology).
The future of public health
On the newly drawn plane is currently public health, coining and consolidating the achievements of the past and projecting their work in proposals for the future. Public health has great social responsibility to promote full and healthy development of individuals and communities in which they are inserted (health promotion).
The current reality challenges public health so that it indicates the directions to be followed in society in terms of health care and care in a scenario of extraordinary complexity. In our communities today, very heterogeneous situations occur, in which infectious diseases with other chronicles coexist, and health systems should be adapted to encompass the control of them.
Environmental health problems offer another field of interest and challenge for this discipline. The study and management of environmental health constitutes a specialty of public health.
Finally, the introduction of the social component in the analysis of the health situation and the living conditions of the population requires a versatile and creative public health to be able to face these and other future challenges.
