Philosophy and purpose of
public health
Dadi s Argadiredja
LEARNING OBJECTIVE
• To state definitions of health
• To state definitions and scopes of public
health, preventive medicine, social
medicine, & community medicine
• To describe scientific approaches used in
public health
• To describe goals and strategies of public
health
DEFINITION OF HEALTH (1)
a state of relative equilibrium of body form and
function which results from its successful dynamic
adjustment to forces tending to disturb it. It is not
passive interplay between body substance and forces
impinging upon it but an active response of body
forces working toward readjustment (Perkins, 1938)
something positive, a joyful attitude toward life, and a
cheerful acceptance of the responsibilities that life
puts upon the individual (Sigerist, 1941)
DEFINITION OF HEALTH (2)
a state of complete physical, mental, and social
well-being and not merely the absence of disease
or infirmity (WHO, 1948)
a state characterized by anatomic integrity, ability
to perform personally valued family, work, and
community roles; ability to deal with physical,
biologic, and social stress; a feeling of wellbeing; and freedom from the risk of disease and
untimely death (Stokes et al., 1982)
DEFINITION OF HEALTH (3)
a state of equilibrium between humans and the
physical, biologic, and social environment,
compatible with full functional activity (Last,
1987)
keadaan sejahtera dari badan, jiwa dan sosial
yang memungkinkan setiap orang hidup
produktif secara sosial dan ekonomis (a state of
physical, mental and social well-being that
enables any individual to achieve socially and
economically productive life) (Act No. 23, 1992)
DEFINITION OF PUBLIC HEALTH
the science and the art of:
(1) preventing disease,
(2) prolonging life, and
(3) promoting physical health and efficiency through organized community efforts for:
(a) the sanitation of the environment,
(b) the control of community infections,
(c) the education of the individual in principles of
personal hygiene,
(d) the organization of medical and nursing service for
the early diagnosis and preventive treatment of disease, and
(e) the development of the social machinery which will ensure to every individual
in the community a standard of living adequate for the maintenance of
health
so organizing these benefits as to enable every citizen to realize his birthright of
health and longevity
(Winslow, 1920)
DEFINITION OF PUBLIC HEALTH (cont’d)
 efforts organized by society to protect, promote and
restore the people’s health. It is the combination of
science, skills and beliefs that is directed to the
maintenance and improvement of the health of all
people through collective or social actions (Last, 1988)
 what we, as a society, do collectively to assure the
conditions for people to be healthy (IOM, 1988)
 the organization and application of public resources to
prevent, dependency, which would otherwise result
from disease or injury (Pickett & Hanlon, 1990)
PREVENTIVE MEDICINE
is the science & art of
preventing disease,
prolonging life, &
promoting physical & mental health
& efficiency
For groups & community by
public health practitioners
(specialized practice of PM)
PUBLIC HEALTH PRACTICE
For individuals & families by
private health practitioners
(general practice of PM)
MEDICAL & DENTAL
PRACTICE
Through
Intercepting disease
Processes by community
& individual action
Leavell & Clark, 1958
Preventive Medicine:
a specialized field of medical practice composed
of distinct disciplines which utilize skills
focusing on the health of defined populations in
order to promote and maintain health and wellbeing and prevent disease, disability, and
premature death (Last, 1987)
Social Medicine :
a term used to emphasize the importance of man’s
environment to his health. In this sense, environment
includes the human society in which man lives and the
multitude of complex interpersonal relationships that so
profoundly affect his health
(Leavell & Clark, 1958)
COMMUNITY MEDICINE
• a field of knowledge and practice concerned with the interaction of the
individual and the world with regard to health and illness. Its activities are
expressed in teaching, research and service with special attention to the
health of human populations in communities where thy live. Certain
characteristics distinguish the field:
• (1) it integrates knowledge from various disciplines, e.g. the physical,
biological, and behavioural sciences in order to understand health and
illness both in individuals and in communities;
• (2) it also attempts to apply that knowledge explicitly in regard to taking
action to promote health and alleviate illness in the population; and
• (3) the achievement of both the integration and application requires that
it have an interdisciplinary focus in the identification and resolution of
health care problems in communities
• (Coe & Pepper, 1978)
COMMUNITY MEDICINE
(cont’d)
that branch of medical science which is concerned with
the health needs and interventions of population
groups of known size and composition. That is, it is
concerned with health of what is commonly known as
defined population groups
(Lathem, 1979)
Scientific approaches in Public
Health
•
•
•
•
•
Epidemiology
Biostatistics
Biological & physical sciences
Social sciences
Demographic science
Ultimate goal of public health
• The prevention of disease
• The promotion of health
Different between developed & developing countries
Prevention can be achieved
through:
• Emphasizing preventive aspects of medical
care
• Health education & behavioral modification
• Control of the environment for health
• Cultivating political will for public health
initiatives
Public Health Strategies
• Surveillance
• Intervention:
- reducing the number of individuals
susceptible to infectious & chronic
disease
- treating people early in the course of
disease
- modifying the environment
- promoting healthy behavior of both
communities & individuals
• Evaluation
Reading assignment
1. Leavell HR, Clark EG. Preventive medicine for the doctor
in his community: an epidemiologic approach. 2nd ed.
New York: McGraw-Hill Book Company Inc.; 1958, p. 7-13.
2. Detels R, Breslow L. Current scope and concerns in public
health. In: Detels R, Holland WW, McEwen J, Omenn GS,
editors. Oxford Textbook of Public Health. New York:
Oxford University Press; 1997, p. 10-17.
3. Schutchfield FD, Keck CW. Chapter 1: Concepts and
Definitions of Public Health Practice. In: Principles of
Public Health Practice. 2nd edition. New York: Delmar
Learning; 2003