Introduction

Public health is a broad term that applies to all entities and their work to improve the health of a group of people. Public health focuses on improving the overall health of the group by improving the health of the individuals by various means, including disease prevention, disease screening, and disease treatment, as well as monitoring and modifying the environmental, social, economic, and political environment to improve the health of the public.[1] Public health work includes preventing injuries and educating the population about habits that lead to poor health, such as smoking, inactivity, unhealthy alcohol consumption, workplace injuries, seatbelt safety, radon safety, and food safety, as well as giving a scientific-based solution to health problems. Examples of the many fields with workers that make up public health include restaurant inspectors, health educators, scientists and researchers, nutritionists, community planners, social workers, epidemiologists, outbreak investigators, public health physicians, public health nurses, occupational health and safety professionals, public policymakers, and sanitarians (American Public Health Association (APHA) 2017).

Function

Ten Essential Functions of Public Health

Monitor Health Status

• To help identify and solve public health problems
• Used to identify health risks, assets, resources, vital statistics, and disparities
• This is exemplified by registries on ongoing health assessment and maintenance of the population

Diagnose and Investigate

• Help create timely identification and investigation of health threats
• Creation of response plans that address major health threats
• Helps in the management of health problems and health hazards in the community, e.g., investigation of infectious water, food, and vector-borne disease outbreaks

Inform, Educate, and Empower

• Health education promotion at the individual, family, and population levels
• It helps build knowledge and shape attitudes
• Inform decision-making choices
• Help develop skills and healthy behaviors and living
• Empowerment through advocacy and social marketing

Mobilize Community Partnerships

• To identify and solve health problems
• Create partnerships with the private sector, civic groups, faith communities, and other public entities
• Develop constituencies
• Develop coalitions
• Identify and create partners and stakeholders
• Promote health improvement through formal and informal partnerships

Develop Policies and Plans

• To help support individual and community health efforts
• To aid strategic planning with community health improvement planning
• To Protect and guide public health practice
• For emergency response planning
• To align resources to ensure successful planning

Enforce Laws and Regulations

• To protect population health and ensure safety
• Advocate for regulations that help protect and promote health
• Evaluation, review, and revision of legal authority, laws, and regulations

Link People to Needed Services/Assure Care

• Create access to personal health services
• Identify barriers to care
• Assure provision of health care when otherwise unavailable
• Ensure ongoing care management: initiate transportation and enable services
• Access to care linked with primary care
• Create culturally appropriate and targeted health information for an at-risk population

Assure a Competent Workforce

• Create and access public health and personal health care workforce
• Public health workforce and leadership
• Continuing education and life-long learning
• Leadership development
• Cultural competencies
• Maintaining standards
• Efficient processes of licensing and credentialing requirements
• Public health competencies

Evaluate Health Services

• Performance management
• Ongoing evaluation of personal health services, population-based services, and public health system
• For effectiveness, accessibility, and quality of personal and population-based health services
• Continuous quality improvement and routine evaluation

Research

• Links public health practice and academic/research settings
• For new insights and innovative solutions to health problems
• Cutting-edge research to advance public health
• Research participation, as well as identification and sharing of best practices
• Epidemiological studies, health policy analyses, and public health systems research

Issues of Concern

Common public health issues and concerns include environmental quality (clean air, water, and food), sanitation, climate change, health equity, health reform, access to healthcare, tobacco use and exposure, mental health, injury and violence, physical activity, nutrition, obesity, and vaccination.

Clinical Significance

Climate Change

Effects of climate change are evident in water quality, air quality, agriculture, sanitation, and habitable spaces, to name a few. It is also evident in tribal health, vulnerable populations, and mental wellness. The public health community plays a critical role in educating the mass population about the effects of climate change on health through efforts that include clean and renewable energy initiatives. These include climate justice and partnerships that increase awareness through local, state, national, and international climate and health meetings, such as the Paris Agreement. Many proponents of climate change help provide education on the effects of climate change seen in the most vulnerable populations made up of the poor, communities of color, young children, and individuals with chronic illness, such as the elderly (APHA 2017).[2]

Environmental Health

Public health creates and improves environmental health, justice, and awareness to help maintain the healthiest communities and nations. Certain models are used to advance the field of environmental health through the following initiatives:

1. Improvement of population health through healthy living
2. Promoting health equity and environmental justice across places
3. Providing a voice for environmental health practitioners[3]

APHA’s Environmental Portfolio is comprised of 3 points:

Health Community Design

• Transportation and Health Tool
• Active Transportation
• Smart Growth
• Healthy Housing
• Food Systems
• Consumer Product Safety

Natural Environment

• Climate Change
• Chemical Safety
• Vector-borne Disease
• Water Quality/Safety
• Air Quality
• Fracking

 Partnerships and Systems

• National EH Partnership Council
• National Environmental and Public Health Think Tank
• EH Coalition
• Preparedness Community
• Improving EH Systems
• EH Messaging

The above portfolio helps public health officials bring national attention to environmental health issues and promote sound policies that protect the public's health, well-being, and quality of life in at-risk and affected communities.

Other Issues

Clean Water and Sanitation

Access to clean water remains unobtainable for millions globally. The single largest impact on human health quality in history has been the increasing quality and access to clean water for drinking, cooking, and cleaning. Much of clean water comes from both water purification systems and sanitation and waste management systems to prevent clean water sources from becoming contaminated. Public health took a large step forward in 1854 when Dr. John Snow discovered a cholera outbreak near Broad Street in London due to the local water pump being contaminated by cholera, not by the prevailing theory of miasma circulating then. To this day, clean water is pivotal to public health.

Obesity and Nutrition

In developed nations, obesity and nutrition now account for over half of the population's morbidity and mortality. Obesity and over-nutrition or inappropriate nutrition contribute to diseases including diabetes, hypertension, myocardial infarction, cerebrovascular accidents/strokes, renal failure, arthritis, some cancers, sleep apnea, etc. On the other end, over 2 billion individuals globally suffer from malnutrition with diseases including kwashiorkor, marasmus, scurvy, rickets, osteoporosis, beriberi, pellagra, anemia, goiter, etc.  Public health works on both decreasing obesity and the host of diseases it brings, as well as improving malnutrition through education, access, and modifications to the political and socioeconomic environment in which people live.  Malnutrition is improved by obtaining sources and channels to get the necessary nutrition to the affected populations and addressing the underlying geopolitical and social environment that contributes to or allows malnutrition.[4]

ƒGun Violence

Gun violence is the leading cause of premature death in the United States, resulting in about 30,000 deaths and 60,000 injuries per year. Gun violence is complex. Therefore, it is deeply rooted in American culture, requiring a public health approach to ensure that families and communities remain safe (APHA, 2017). The National Violent Death Reporting System (NVDRS) is a unique source of information and reports on suicide, homicide, unintentional fatal shootings, and law enforcement-related fatalities. The NVDRS, started by the CDC in 2002 with data from 6 States, currently tracks data from 40 states, including the District of Columbia and Puerto Rico. It also reports who the victims are, when, where, and how they were injured (APHA, 2017). The NVDRS is now considered the only state-based active surveillance system that merges, standardizes, and anonymizes data from multiple sources to a detailed picture of violent death in the United States of America. It is considered a valuable asset and partner to Public Health to expand and track data-related violence in all fifty states, making it an asset to policy-makers, health authorities, law enforcement agencies, researchers, and advocacy groups.

Health Equity

The efforts to reframe public health work to achieve better health through equity are at the core of Health People 2020, the United States of America's health objectives for the current decade that defines equity as attaining the highest level of health for all people (APHA, 2017). Health equity achievement involves promoting and valuing everyone equally with focused and ongoing societal efforts. This enables increased efforts to avoid inequalities and historical and contemporary injustices and eliminate health and healthcare disparities. To eliminate inequity, public health, in partnership with government and private sector stakeholders, dedicate resources to serve the most vulnerable, thereby bringing life-saving care to communities that would have otherwise gone without needed healthcare services (APHA, 2017).

Health Reform

This is central to the debate on navigating and providing most Americans with health care coverage and insurance. The Affordable Care Act is the nation’s health reform law, enacted in March 2010 to reform private and public health insurance systems. About 20 million Americans are estimated to be served and covered by the Affordable Care Act, which increases benefits, lowers consumer costs, and provides new public health funding.

Tobacco Use and Exposure

In partnership with stakeholders, the APHA has championed initiatives to help Americans live tobacco-free. This initiative includes laws that create smoke-free workplaces with policies that increase smokers' quitting efforts (American Association of Public Health, 2017). Tobacco is a preventable killer, and tobacco exposure is proportionally associated with other health disparities in teens. About 90% of cigarette smokers started smoking before age 18, and 99% tried smoking before age 26 (CDC, 2017). More than 3200 youth aged 18 years or younger smoke their first cigarette each day in the United States. An additional 2100 youth and young adults become daily cigarette smokers. The flavoring in tobacco products that makes smoking appealing to young adults perhaps influences this. Seventy-three percent of high school students and 56% of middle school students reported using a flavored tobacco product in 2014 (CDC, 2017).

Vaccination

Vaccinations are created to help boost the immune system. Vaccinations have significantly reduced perinatal, infant, and childhood deaths since becoming widespread.  Vaccinations have globally eradicated some diseases (smallpox) while significantly limiting others in certain countries (tuberculosis, Haemophilus influenzae type B meningitis, varicella-zoster virus, tetanus, measles, mumps, rubella, hepatitis B, diphtheria).  Vaccines also decrease the global disease burden for all populations (influenza, varicella-zoster, hepatitis A, human papillomavirus, rotavirus). Most vaccines contain weakened or killed microorganisms that cause the human body to increase its immunity to certain diseases. Some vaccines contain a live, weakened version of the disease-causing agent, while others contain a killed detoxified version of the agent it is a target to protect against. Routes of administration included injection, oral, or nasal spray. Many vaccines are given in multiple doses over time. In most cases, booster shots are administered to maintain the body’s immunity against diseases of interest (American Association of Public Health, 2017).[5]

Enhancing Healthcare Team Outcomes

The interprofessional healthcare team members need to view their duties in the larger context of public health, in addition to their direct patient responsibilities and team interactions. Adopting this "big picture" approach can contribute to overall societal healthcare delivery, illuminate individual roles in the big picture, and optimize patient care and outcomes. Population-based studies continue to contribute to the body of knowledge needed to adjust public health policy. All providers must remain current on the latest developments in research and legal and administrative changes at the community, region, or national level.