Rachel Fardon and Katie Bretherton
What is Public Health?
“The science and art of promoting and protecting health and well-being, preventing ill-health and prolonging life through the organised efforts of society”
Acheson 1988
Public Health is concerned with helping people to live long, healthy, meaningful lives and protecting them from ill-health and threats to their wellbeing. Unlike other medical specialties, Public Health operates at a population level, rather than with individual patients. This can mean working with the whole population of a geographical area such as England or Manchester, for example in the response to the COVID-19 pandemic. It can also mean working with particular sub-populations, for example specific age groups with childhood immunisations programmes, or with the LGBTQ+ community when promoting the uptake of PrEP (pre-exposure prophylaxis) with men who have sex with men. Public Health Consultants establish when an initiative/service should be offered at a population level and when it should be more targeted, and if that is the case who it should be targeted at.
Public Health uses scientific skills such as epidemiology and critical evaluation of the evidence-base, along with so-called “soft skills” such as communicating complex decisions to the public, influencing decision-makers and policy, and negotiating to bring about necessary changes. At the core of all Public Health practice is the aim to tackle inequalities in health and wellbeing across our populations. This involves creating equitable services to encourage fairer outcomes for all.
Tackling health inequalities often means looking upstream to tackle the ‘causes of the causes’ of ill-health, thinking about housing, income, education and other living and working conditions. As a result, Public Health involves working across organisations to tackle social, economic, environmental, political and cultural factors which influence our health.
Another unique aspect to Public Health is that it is the only medical specialty open to applicants from backgrounds other than medicine too, in this case people from Public Health backgrounds. This makes for a workforce with a diverse range of experiences and skills.
Generally, Public Health is understood to be divided into three overlapping domains, with tackling health inequalities cutting across all three of these:
Health Protection: seeks to prevent and mitigate the impact of infectious diseases, environmental, chemical and radiological threats to health. UKHSA is the national organisation responsible for Health Protection in England.
Health Promotion: seeks to enable people to increase their control over and to improve their health and wellbeing, often seeking to prevent ill health through tackling the ‘causes of the causes’ we described earlier. OHID is the national organisation responsible for Health Promotion in England.
Healthcare Public Health: seeks to maximise the population benefits of healthcare by prioritising available resources, preventing disease and improving health outcomes by designing effective, efficient and accessible healthcare. NHS England is the national organisation responsible for Healthcare Public Health in England.
Health Inequalities: avoidable, unfair and systematic differences in health between different groups of people. Tackling these health inequalities is the overarching theme that runs throughout the three domains.
Stay tuned for Part 2/3, where we discuss the training programme for this specialty!