In this series of public health articles, you will be able to learn about the fundamentals of public health which will serve you well for your medical school interviews. These principles will help you to understand how medicine and public health are intertwined especially as a result of the Coronavirus pandemic.
Traditional Approach
The traditional approach to health as generally accepted in the 1960-70s was heavily focused on advancements in science and biomedicine and practice of medicine. Health insurance for hospital and medical care was the focus of most health policies. Public health was very low in the priority. This highlights a very “cure” approach to health rather than prevention and promotion. However, in 1974 the Minister for Health, Marc Lalonde, released the ‘A New Perspective on the Health of Canadians’ report which is largely recognised as a ground-breaking document which recognised that strategies beyond biomedical approaches are needed to improve the health of the population. This brought about the Health Field Concept which identifies human biology, lifestyle, environment and health care systems as the four principal determinants of health. This brought attention to the importance of public health and provided the basis for the health promotion movement.
The health field concept directed more attention towards personal behaviours and health issues such as smoking, diet and physical activity, as well as inequalities in the health system. The Lalonde report promoted major global health developments across the globe leading to the Millennium Development Goals, and the follow-up Sustainable Development Goals. It is clear then how Marc Lalonde really changed the perspective of health around the world towards a health promotion perspective which research showed was much more cost-effective and beneficial to quality of life than the traditional focus on health expenditure on medical care.
Biology - all genetic aspects of physical and mental health
Environmental: factors over which the individual has little or no controlling in terms of the physical and social environment
Lifestyle - the accumulation of personal decisions (i.e. over which the individual has control) that can be said to contribute to, or cause, illness or death
Health care organisation: e.g. hospitals, GP surgeries, dental surgeries and paramedic services
Along with human biology, lifestyle, environment and health systems also play a huge role in health and this was becoming more prominent from epidemiological studies identifying risk factors such as smoking, lack of exercise, poor diet. Research now has linked things like smoking to lung cancer, lack of physical activity to cardiovascular disease and hypertension, and poor diet to obesity related illnesses. The environment also plays a considerable role in health with aspects such as poverty, education, housing and other social inequalities hugely affecting the health of individuals and societies. And finally, health systems and organisations which consist of the arrangements and resources that are used in the provision of healthcare plays a considerable role. A big example of this is primary care services which aims to provide easy access to health services for individuals and promotes the key idea of ‘health for all’.
All these ideas formed from the Lalonde report stimulated the First International Conference on Health Promotion in 1986 which produced the first formal definition of health promotion: “the process of enabling people to increase control over, and to improve, their health. To reach a state of complete physical, mental and social well-being, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment. Therefore, health promotion is not just the responsibility of the health sector but goes beyond healthy lifestyles to well-being.”
As we can see from this definition, health promotion creates a world where not individual’s, but group’s and society’s health are also improved.
The Health Field Concept has stimulated the epidemiological transition which highlights the shift in focus from predominance of infectious diseases to the overwhelming dominance of non-communicable diseases over the past century. These epidemiological transitions have been possible because of the shift in perspective around health which has enabled us to see the associations between determinants and outcomes, rather than focusing on biomedical methods of cure. It is vital that doctors understand these key concepts which have shaped health policies in improving the health of the population through health promotion. Doctors are responsible for the promotion of such ideas and in understanding the principal determinants of health.