CHAPTER 9: Community Relations and Public Health

INTRODUCTION

Public health as defined by Charles-Edward A. Winslow 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.”¹The World Health Organization (WHO) defines the whole of public health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”² Public health's charge is to protect the health of the population, which can range in size from a small group of people to several continents. Overall, public health strives to prevent illness and injury by protecting individuals from things they cannot directly control (eg, drinking contaminated water, inhaling tuberculosis bacteria) and promoting healthy behaviors for things they can directly control (eg, eating healthily, exercising regularly, not smoking).

Public health utilizes the elements of epidemiology, surveillance, and prevention. Epidemiology is the study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to control health problems.³Epidemiological investigations are conducted to determine the distribution and determinants of disease and to attempt to categorize disease by person, place, and time.

Surveillance is the ongoing process of collecting, analyzing, and interpreting health data, and disseminating the conclusions to relevant entities. There are several types of surveillance utilized in routine public health practice including passive, active, sentinel, and syndromic. Passive surveillance is frequently utilized at the local and state levels in the form of case reporting. Depending on the locale, there may be well over 50 communicable diseases that must be reported to public health officials when diagnosed or suspected by physicians, laboratories, hospitals, and others. This differs from active surveillance in which public health agencies attempt to proactively identify individuals meeting specific criteria. Finding sexual partners of an individual with HIV or another confirmed sexually transmitted disease would be an example.⁴

Primary prevention, one of the most common public health strategies, includes actions to stop disease from occurring. Examples of primary prevention are childhood immunizations, hand washing, and seat belt use. Secondary prevention involves screening asymptomatic individuals to detect disease in the early stage and thereby preventing clinical manifestations. Examples of secondary prevention include blood pressure screening to detect hypertension, mammography to detect breast cancer, colonoscopy to detect colon cancer, and urine screening in adolescent girls to detect occult sexually transmitted diseases like chlamydia. Tertiary prevention is treatment of clinically manifested disease to halt the progression and complications of the disease.

OBJECTIVES

• Display a general understanding of the history, principles, and core disciplines of public health.

• Discuss the differences between governmental public health departments and the public health system.

• Understand primary, secondary, and tertiary prevention and how they relate to public health and EMS.

• Understand many of the commonalities, synergies, and partnerships, as well as some of ...