Public Health or Public Health Care (including public health ) is the application-oriented field, which deals with the public health (including public health or public health employed), in particular the prevention of disease, promote health and prolong life. In the beginning (as a subject of hygiene or health care ) it was about the containment of infectious diseases . Over time, this developed a comprehensive understanding of the spread and prevention of diseases in the population.
One of the core competencies of Public Health is interdisciplinarity, in which the methods of the most diverse specialist disciplines are applied. These include for example the following sub-areas: epidemiology , social medicine , health promotion and prevention , health services research , health reporting , health economics , health policy and ethics . All sub-areas have the goal of maintaining, improving and strengthening the health of the population.
When considering the health of the population , the focus is on the health of groups of people, parts of the population or entire populations, not the health of the individual. The conceptual approach of Public Health examines the mental, physical, psychological and social conditions of health and illness and their systemic connection. It is about the interaction between society and the individual and the corresponding repercussions on health. The health of the population is more than the sum of the health of individual individuals.
Fight against infectious diseases
Infectious diseases were a scourge of mankind, a major cause of disease and premature death, until the early 20th century. The German doctor Johann Peter Frank (1745–1821) is considered a pioneer in the field of social medicine , public health and one of the founders of hygiene . His main work, the System of a Complete Medical Police , appeared in six volumes between 1779 and 1819. The English doctor Edward Jenner (1749–1823) is considered the father of active vaccination ; He experimented with cowpox lymph in 1796 and thus invented the 'vaccination' against smallpox . Even before the discovery of bacteria and other pathogens , doctors such as John Snow (1813–1858) and William Budd (1811–1880) recognized that infectious diseases could be transmitted as a common feature. They are considered to be the pioneers of public health. Hygiene has become an important basic subject in public health. In Germany, the pathologist Rudolf Virchow (1821–1902) took the view that the spread of infectious diseases could be controlled with social measures. The mathematical modeling of epidemiology , which describes the spread dynamics of infectious diseases, was later developed. As the Covid-19 pandemic of 2020 shows, threatening infectious diseases are not only a thing of history, pandemic prevention remains a central area of work for public health. It is also evident that economically less well off people, city districts, regions and countries suffer significantly more from the health and economic consequences of a pandemic.
Social medicine developed from social hygiene , which is not limited to infectious diseases, it basically deals with all socially conditioned and co-conditioned diseases and includes school doctor services , occupational medicine , as well as medical care for impoverished or socially isolated population groups. The social determinants of disease can be combated with structural prevention and population-based care offers.
The idea of health protection is to limit and control risks to health through legal and police measures. There are a large number of health protection regulations. Examples are the food legislation, the regulation of road traffic, water regulations, the Medicines Act and also the Narcotics Act ; public health should also be weighed and taken into account in a plan approval procedure .
Health Statistics and Epidemiology
From the early epidemiology , which was limited to infectious diseases, today's epidemiology developed , which deals with the spread and causes of all diseases. The research methods were systematically further developed with descriptive and analytical epidemiology, descriptive and conclusive statistics , from which medical statistics developed as an independent specialty. With methods of survey , surveillance and empirical social research with quantitative and qualitative research approaches, the health of the population is recorded and described in health reporting.
Prevention and health promotion
With the epidemiological transition , infectious diseases decreased in importance and chronic diseases gained the upper hand. The research interest shifted to the identification of behavioral, genetic, clinical, environmental, social and structural risk factors and the identification of health-promoting factors ( salutogenesis ).
Ensuring medical care in crises, emergencies and major disasters has long been one of the tasks of the public health system. Health services research poses the question of the best health care for a population. She analyzes and evaluates the outpatient and inpatient care structures and processes in curative and rehabilitative medicine. Health economic analyzes with cost-benefit analysis , cost-benefit analysis and cost-effectiveness analysis can contribute to this. With a view to practical implementation, health management is given more weight. Newer topics are quality assurance and management in health care , the health technology assessment (HTA) and public health genomics .
Public Mental Health
Public Mental Health is a very young branch that deals with mental health in society. Efforts to prevent suicide , programs to support relatives of the mentally ill, especially children, and the promotion of mental health in general are central .
Health systems research
The Health Systems Research ( Health System ) extends the public health approach again by curative care in the context of prevention is and the special role of nursing accounted for by professionals and laymen. The health policy should not be limited to a supply policy, but the health in all policies note and edit.
Due to the comprehensive claim Public Health takes into account the findings of other disciplines of knowledge, of course, from the medicine , the health sociology and medical sociology , but, for example, those from the economics , psychology , mental health care ( psychotherapy , psychosomatic medicine ), social work , political science , social policy , from the law , the sociology and the statistics .
Public health programs
Public health problems are complex. Individual measures alone, such as health education or a selective ban, often have little or no effect. Programs are therefore developed for common or serious problems such as AIDS , diabetes mellitus , depression , heart attacks , tuberculosis and smoking . One example is the WHO Framework Convention on Tobacco Control . The aim is to reduce the incidence of lung cancer , COPD and coronary heart disease . Another example is the global programs to improve maternal health .
Organization worldwide and in individual countries
The World Health Organization, with regional offices on all inhabited continents, coordinates public health worldwide. The standardization of medical diagnoses by the ICD-10 serves the international understanding about diseases such as B. the world report on violence and health proves.
In the European Union, the Commissioner for Health and Food Safety is responsible for public health issues.
The European Center for Disease Prevention and Control (ECDC), based in Stockholm, serves primarily to control and combat infectious diseases in Europe.
The national health authority in Germany is the Federal Ministry of Health , technically the Robert Koch Institute in Berlin . For the public health service locally, the state or local government's health department responsible.
In Switzerland, the Federal Office of Public Health (FOPH) performs a number of public health tasks, in particular the monitoring of infectious diseases (surveillance). Since the control of health care is mainly the responsibility of the cantons , their health departments and the canton doctors perform many tasks, especially in care planning, prevention and health promotion as well as the supervision of the health system.
Civil society and scientific organizations
The specialist representative of Public Health in Germany is the German Society for Public Health eV ( DGPH ) and in Austria the Austrian Society for Public Health (ÖGPH) . Both professional associations are represented at the European level by the EUPHA (see below). Other organizations are
- World Federation of Public Health Associations
- European Public Health Association (EUPHA), a pan-European professional association of mostly national public health associations
- German Society for Social Medicine and Prevention (DGSMP)
- Public Health Switzerland
- Federal Association of Doctors in the Public Health Service
Public health degree
In Germany, the beginnings of public health education go back to a funding initiative by the federal government in 1989, which aimed to establish internationally competitive research and teaching structures for health sciences and public health at German universities . In addition to the Medical University of Hanover with its degree in population medicine and public health, there are various universities across Germany that offer health science courses (e.g. Bielefeld, Berlin, Bremen, Dresden, Düsseldorf, Hamburg, Heidelberg and Munich). Since 1994, Bielefeld University has developed three courses of study (at Bachelor, Master and Doctoral level), which are consecutively structured according to international models , at the so far only independent Faculty of Health Sciences at Bielefeld University . A further three courses are based in advanced training, specifically in the areas of “Epidemiology” (MSE), “Health Administration” (MHA) and “Workplace Health Management” (MWHM). Despite various efforts, other universities in Germany have not yet succeeded in building up the institutional structures in order to establish a department based on the internationally widespread pattern of a "School of Public Health" as in Bielefeld.
The following internationally recognized academic degrees can be obtained:
- Bachelor of Public Health
- Bachelor of Health Communication
- Master of Public Health
- Master of European Public Health
- Master of Science in International Health
- Certificate in Applied Health Sciences (FAG)
- Dr.PH, Dr.sc.hum.
The University of Maastricht in the Netherlands has had a Faculty of Health Sciences for 25 years . It offers a bachelor's degree and nine master's programs with a focus on public health with seven specializations (movement sciences, politics and management in health care, health prevention and education, or work and health). The bachelor's degree in European Public Health is particularly attractive for international students . Here the relations between the European Member States in the field of health are at the center. The main topics range from border-crossing care, cross-border infectious diseases and emergency management to the implementation of European laws in the member states.
Since 2007 the private university for health sciences, medical informatics and technology in Tyrol has been offering bachelor, master and doctoral programs in public health.
In Switzerland, the Swiss School of Public Health organizes several master’s courses in public health. In addition, the Zurich University of Applied Sciences (ZHAW) offers a Bachelor of Science in health promotion and prevention .
- European Journal of Public Health (EUPHA)
- International Journal of Public Health
- American Journal of Public Health
- Bulletin of the World Health Organization
- Journal of Epidemiology and Community Health (edited by the British Medical Association )
- Journal of Public Health Policy
- Asia-Pacific Journal of Public Health
- Pan American Journal of Public Health
- Public Health Reports
- Journal of Public Health Dentistry
- Critical Public Health
Public health care in the pre-modern era
Fighting diseases and promoting health have been in the interests of community associations since the beginning of human history . The conception and interpretation of 'health' as well as the practices and methods conducive to it differed according to the medical, religious and natural philosophical ideas of the respective groups, the available resources and the respective living conditions. In principle, however, it can be stated that only a few premodern societies revealed the stagnation or even indifference to the health and hygienic living conditions that were often ascribed to them. This negative judgment is mostly based on a back-projection of modern medical standards and scientific knowledge on societies whose handling of diseases cannot be measured by knowing bio-indicators , immunological or statistical aids and especially the knowledge of the germ theory . For the premodern it is also important to keep in mind that there was largely no separation between the moral-religious and the physical common good. For example, in European medieval thought, measures to purify community morals were often inseparable from concern for public health.
Health care and disease prevention interventions can be found in nearly all instances where historical communities have left sources . In Southwest Asia, for example, Ayurvedic medicine, followed by Buddhism, promoted employment, diet, and sexual orders and norms aimed at achieving balance in body, life, and community - a conception of health that also influenced traditional Chinese medicine . Population centers maintained general health care institutions and programs under the Maya , Aztec, and other early American civilizations , including the establishment of medicinal herb markets . In Australia, on the other hand, techniques for the protection and maintenance of water and food sources, small-scale land use ( micro zoning ) to limit pollution and fire risks and protective nets to ward off flies were widespread among the Aborigines . These practices were also used in temporary camps only.
Also, Western European , Byzantine and Islamic civilizations promoted public pension programs, mostly on the dominant there Humorallehren of Hippocrates and Galen of Pergamum based. According to these theories, physical condition and health were determined by the balance and balance of body fluids. This equilibrium, according to another basic assumption of galenicism, is strongly influenced by the material environment and must therefore be maintained by a lifestyle that is adapted to the respective season and climatic zone . Therefore, the measures derived from this had to take into account an assessment of the local climate and factors such as topography , wind conditions and the influence of the sun, but also the properties and availability of water and food for humans and non-human animals. Authors of medical, architectural, technical and military manuals and guidance systems explained how these theories could be implemented in the context of different societies under the respective external conditions.
Such interventions and initiatives to reduce health risks could be initiated and organized by a large number of actors in the complex pre - industrial societies. In ancient Greece and Rome, generals learned to take care of the health of their soldiers. This was particularly true of the time beyond the battlefield, when the majority of casualties were among combatants prior to the twentieth century . In Christian monasteries in the Eastern Mediterranean and Western Europe, followed by monks and nuns , at least since the fifth century strict geared to balance orders of life , which - were directed explicitly to the increase in life expectancy - including through dietary requirements. Furthermore, the often mobile royal and princely , but also papal courts adapted their behavior to the environmental conditions of their whereabouts. In some cases, these places were specifically chosen with a view to their health benefits or were prepared accordingly by members of the farm. In the Frankish empire, finally, efforts for broader health care by Charlemagne can be traced, who set up so-called special hospitals and issued instructions for field care to prevent the spread of infectious diseases.
The most permanent evidence of early civilization preventive measures, however, comes from urban health care. Because premodern urban populations faced a whole series of - recognized and more conscious - health risks, which residents and rulers tried to counteract with measures that should be beneficial to the entire population. In many places, measures for obtaining infrastructure such as roads , channels and marketplaces , but also spatial planning taken steps - with the explicit grounds of protecting public health and the threats of pollution, sin , optical effects (ocular intromission) and miasma to to encounter. The guilds who took care of waste disposal and risk limitation through occupational safety among their members were also among the central actors in urban health policy . Physicians, including profit-working doctors, working in conjunction with municipal governments and administrations in the hazard and disaster risk reduction as the identification and isolation of leprosy , a disease with a strong moral connotation. The neighborhood associations organized in neighborhoods were also active in providing health care for their residents. They monitored neighboring risk areas and introduced social and legal measures against those who cause environmental pollution in the craft sector ( e.g. tannery ) or against negligent animal owners. Religious institutions - Islamic as well as Christian - as well as individual and non-profit organizations (e.g. brotherhoods ) promoted the moral and physical health, which is inextricably linked in the zeitgeist, through the foundation of wells , schools and bridges for residents, but also for pilgrims . In Western Europe and the Byzantine Empire, processions were held regularly in this regard , which were intended to serve both the prevention and the purification and healing of the community.
Likewise, in response to disasters such as war , famine , flood, and epidemics , city dwellers and other groups developed preventive measures based on medical theories currently available. The attempt was made to counteract the massive population decline caused by the Black Death (1346-1353) with changes in burial practices and meat consumption . In addition, however, new theories and practices of disaster control have been developed, some of which have been carried into modern times. This included the establishment of quarantine facilities and health committees, which over time became permanent municipal (and later national) offices. Measures to protect urban and surrounding populations also included issuing health passes for travelers, setting up guards to ensure isolation to protect local populations, and collecting data on disease and death rates . These measures relied on improved transport and communication networks that could efficiently disseminate information on human and animal diseases.
Forms of public health care in modern times
In the German-speaking countries from the 18th to the 19th century, the " State Medicines Customer " and " Medical Police " dealt with public health care . Public health can look back on more than 100 years of Anglo-Saxon tradition, such as at the University of Edinburgh , Scotland, or at Harvard University , USA.
With regard to the disciplinary development, a distinction is made between Old Public Health (also: Public Health I) and New Public Health (also: Public Health II). The focus of Old Public Health is the prevention and care of problem groups . The scientific basis is constituted by medicine with theoretical medicine, clinical-practical medicine, hygiene , social medicine and epidemiology as well as the social sciences with health sociology and psychology .
The focus of New Public Health has been the entire health policy since around 1980. Is supplemented old public health through health systems research and health services research, to prevention, health promotion, cure / treatment, rehabilitation and care interlink systematically in. Biomedical and social science working methods complement each other. Economic sciences with health economics , political sciences with health policy and management sciences with quality management have been added to the wreath of reference disciplines .
Development in Germany in the 20th century
A German term for public health at the beginning of the 20th century was public health (the aim of measures was “public health”). As a result of the National Socialist Racial Hygiene , the development of public health in Germany had experienced a major weakening. In contrast to comparable Western European and North American countries, the area was attacked at the same time, namely at the beginning of the 20th century, but was then instrumentalized politically and ideologically in the 1930s and 1940s through the massive interventions of the National Socialist rulers. The approaches of the research of social hygiene , which emerged in the 1920s, as the “science of maintaining and increasing health” in connection with the practical application of population-wide knowledge to ensure public health were eliminated by the totalitarian Nazi regime. Hitler himself, but also Mussolini, used a language that they defined as doctors on the people's body . The main beneficiary of this public health policy was sport , which was already given an important role for public health in Mein Kampf , combined with military strength for men and childbearing ability for women. The leading representatives of health science who already worked with this name, such as Adolf Gottstein , Hans Schlossmann and Ludwig Teleky , were driven out, as were doctors, biologists, psychologists and sociologists who were active in social hygiene. The actions of state organs to establish and maintain public health were placed under the dictum of a despicable political ideology and thus discredited well beyond the early years of the Federal Republic of Germany.
After the end of the Second World War, the well-functioning public health system, as it existed before the National Socialists came to power, could not be fully re-established in both German states.
It was not until the 1980s that the German tradition of health sciences was “reborn” in West Germany, which was tangibly reflected in the fact that medical and natural sciences and humanities, social and economic sciences collaborated to analyze the public and the individual Health was intensively promoted politically over a period of over ten years. The federal and state governments in West Germany supported research associations and academic teaching programs.
In 1993, the first German "Faculty of Health Sciences / School of Public Health" was established at Bielefeld University. The founding dean was Klaus Hurrelmann . Since then, teaching and research institutes for public health with several chairs have also been formed at the University of Bremen, the Berlin universities and the University of Heidelberg.
Development in Switzerland
In Switzerland, the first chair for the subject was established in 1963 at the University of Zurich under the name Institute for Social and Preventive Medicine (ISPM). Its first director Meinrad Schär , together with Federal Councilor Hans-Peter Tschudi, took the initiative to introduce the subject into the compulsory examination material in the state examination for doctors, which the Federal Council decided in 1964 and the medical faculties had to carry out from 1968. In view of this new task, new institutes were founded at the other four medical faculties in Switzerland.
In 2012, the Swiss Tropical and Public Health Institute was created in Basel from the merger of the Swiss Tropical Institute with the ISPM Basel. In 2014, the Institut de santé global was founded as the successor institute in Geneva. In the same year, the ISPM Zurich renamed itself the Institute for Epidemiology, Biostatistics and Prevention (EBPI).
Conflicting goals and criticism
Conflicts of goals arise when particular economic interests, e.g. B. the tobacco or alcohol industry, see endangered by measures to strengthen health. In addition, conflicting goals can arise where there is a need to weigh up between individual and collective health, “under certain circumstances the individual […] is expected to step back in favor of all: Possible vaccine damage is required of individuals if epidemics are to be prevented; Health systems financed by solidarity grant everyone what is medically necessary at best, but not everyone everything that is desirable ”.
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