What is public health about?
What is a population health approach?
What is public health action?
Is there an international model on which public health planning is based?
What sorts of things does the public health sector do?
What is special about public health services?
What is public health about?
Public health is about:
- Promoting wellbeing
- Preventing ill health
It is focussed on promoting the health of populations rather than treating diseases, disorders and disabilities in individuals.
Anne Morrison, Project Manager - Workforce Development, Population Health Service, Waikato DHB, talks about her experience of public health,
"Public health is about using evidence
based prevention and intervention
strategies to help communities grow
their own capacity to address the
issues that effect their population."
What is a population health approach?
Public health takes a population health approach, which places a greater emphasis on the health of the population, the role of the community, health promotion and preventative care, and the need to involve a range of professionals. This also takes into account all factors which determine health (determinants of health) and plans how these factors can be addressed.
The determinants of health are:
- peace
- shelter
- education
- food
- sufficient income
- a stable eco-system
- sustainable resource use
- social justice and equity, etc.
A population health approach can be used by all parts of the health sector. Traditionally, a population health approach has been a public health focus. More recently, the Primary Health Care Strategy (Ministry of Health. 2001) set a new direction for primary health care; services are now to focus on better health for a population and actively work to reduce health inequalities between different groups. There is now a clear interface between public health and primary health care.
What is public health action?
Public health action is an investment in the future wellbeing and prosperity of New Zealanders. It involves activities and programmes provided by the public health sector, the wider health sector and, if we are to address the complex range of factors which determine our health, it must include the actions of organisations and institutions across society. Public health action can?
- Take place at many levels throughout the health sector and beyond
- Be planned and implemented in collaboration with other sectors
- Advise other sectors on the health impact of their activities, and where necessary, regulate these
- Support other parts of the health sector to take a population health approach to service planning and delivery.
"Effective public health activities involve
long-term investments that decrease the
risk of njury and disease, improve the
quality of life, prolong life and
may decrease the need for
health care services."
Strengthening Public Health Action. Ministry of Health. 1997.
Is there an international model on which public health planning is based?
In 1986 in Ottawa, Canada, the World Health Organisation (WHO) developed an approach to improving the health of populations and individuals. This is known as the Ottawa Charter and is used in New Zealand as a framework for planning public health strategies.
The Ottawa Charter shows that to improve the health of populations and individuals there is a need to look wider than just providing health services. If people are able to take responsibility for the health of their families and themselves they need:
- Protection from environmental factors that could lead to health risks
- Adequate housing
- A liveable income
- Employment
- Educational opportunities
- A sense of belonging and being valued
- A sense of control over life circumstances.
What sorts of things does the public health sector do?
The public health sector ensures that potential risks to the health of the population are monitored, managed and promoted by:
Health protection
- Monitoring our environment to ensure risks to the health of the public are managed
- Licensing organisations and premises as required by regulation
- Enforcing public health legislation, including investigating complaints and taking appropriate action
- Planning for emergencies, so that if one does happen things can swing into action without delay to protect our health
- Providing environmental advice for the Government and local bodies on an ‘as required’ basis
- Advocating for policy change at national, regional and local levels
- Being involved in policy development at national, regional and local levels
- Promoting the development of physical and social environments that are conducive to good health
- Raising public awareness to health-related issues
- Developing and managing population-based screening programmes.
Health promotion
- Working with communities and the wider health sector to develop and establish public health programmes
- Assisting schools with the implementation of the Health and Physical Education, curriculum and the development of a health promoting environment
- Working with the media on public health issues – interviews, press releases, talk-back radio programmes
- Advocating for policy change at national, regional and local levels
- Being involved in policy development at national, regional and local levels
- Promoting the development of physical and social environments that are conducive to good health
- Raising public awareness of health related issues
- Developing and distributing resources – pamphlets, posters, videos, newsletters, teaching kits, interactive websites
- Training professionals, community workers and your per educators.
What is special about public health services?
"The major gains in health in this
[20th] century have been attributable
largely to the impact of public health and
disease prevention, rather than to
medical interventions."
The future of public health. Bloom, B.R. Harvard Public Health Review. Fall 2000.
1. Public health services are offered to populations or groups of people, not to individuals. They aim to reach and influence entire population groups – policy makers, communities, organisations, families and groups of individuals.
What sorts of organisations provide public health services?
How do we achieve an improvement in the health of populations, communities and individuals?
2. Public health is about creating or advocating for healthy social, physical, and cultural environments.
A healthy social environment where:
- People have equal opportunities for education and for employment
- Individuals and whānau have adequate incomes
- People feel part of the community and not outside it
- People are not discriminated against
- Communities are peaceful and non-violent
- There are fewer influences – such as tobacco advertising – which support unhealthy lifestyles
- Healthy choices are the easy choices – for example, where nutritious food is cheaper than unhealthy food.
A healthy physical environment where:
- The water we drink is free from contamination by toxins and disease-causing micro-organisms
- Effective sewage and waste water systems are in place
- People are able to travel easily and safely to shops, schools, employment and services
- There are good opportunities with communities for leisure activities
- Adequate housing is available for all.
A healthy cultural environment where:
- There is full participation of tangata whenua in decision making
- The traditions, languages and spiritual beliefs of all cultures are valued and respected.
3. The rewards are sometimes a long time in the future.
There can be immediate benefits to a community from public health activities:
- A water supply becomes contaminated by micro-organisms. The reason for the contamination is quickly identified and communities are advised to boil all drinking-water until further notice. Steps are also taken to prevent similar problems recurring.
Other programmes can take longer to achieve positive outcomes:
- The benefits of a well-balanced diet during childhood may be greatest in middle age
- An effective approach to a community-based public health programme is one that uses a community development process. The service is developed with people in that community, supporting them to design and deliver the programme.
4. Public health services are often invisible.
Everyday, everyone in New Zealand benefits from some public health services. These services:
- Help keep our food, air and drinking-water safe
- Help protect us from infectious diseases
- Help protect us against poisonings and injuries from toxic and hazardous substances and radiation dangers
- We often don’t think about these services unless they fail.
5. Public health services are 'public benefits'.
Public health services, such as those which safeguard our drinking-water and protect New Zealand against exotic insect pests, need to be available to everyone at no cost – not just to those who can afford them. They are funded by the Government to ensure that the health of the whole population is protected.
What sorts of organisations provide public health services?
Around half the funding for public health services goes to Public Health Units in the District Health Boards to provide services in communities. There are 12 Public Health Units providing core public health services across the country. Some cover more than one District Health Board area to provide the most effective coverage across an area. There is usually a component of each contract that requires the delivery of services to Māori and to other specific ethnic populations.
Public Health Units deliver both health protection and health promotion activities, such as monitoring food safety and providing information to the public about nutrition and physical activity.
There are more than 200 non-government organisations (NGOs) that receive the other half of the funding. These providers include:
- Organisations that provide services for the general population
- Māori governed and managed services that provide services specifically for Māori or for the general population
- Pacific governed and managed services that provide services for Pacific people.
Some NGO services are national, some regional and local, and some are a combination of these.
Some providers have services that address a wide range of issues. For example, regional iwi providers deliver Well Child, Auahi Kore (Smokefree), nutrition and physical activity, alcohol and drug, and mental health programmes and services.
Some special interest providers focus on one issue. Examples are the National Heart Foundation and the Mental Health Foundation.
Public health staff in the Ministry of Health are also part of the public health sector. They provide direct advice to the Minister of Health and other sectors and manage public health risks, as well as planning and co-ordinating strategies.
How do we achieve an improvement in the health of populations, communities and individuals?
To achieve this, four things need to be in place:
- All sectors – including education, justice, employment, transport, police and local government – work together with their communities to address the wider determinants of health.
- Public health strategies are planned using a mix of actions related to the Treaty of Waitangi and the five components of the Ottawa Charter framework.
- The strategies include a combination of public health regulation, health protection and health promotion actions.
- They also include both public health programmes and activities and personal health and disability services for individuals and groups of individuals.