Good Health Goes Beyond Good Medicine

The majority of students in the Harvard MPH program I completed in May were medical students between their third and fourth years or medical professionals who had already completed eight to ten years of training. I was curious about why they were adding this extra year of training to an already long academic course, so I asked them.

Their answers help to explain why public health is important. First, they said they wanted to help more than one person at a time. Second, they recognized that good health goes way beyond good medicine. 

For example, doctors can diagnose lead poisoning and attempt to treat a child with medication. A public health agency, however, can identify neighborhoods with the highest risk for lead poisoning and test all children in those areas. Public health can prevent illness while medicine can cure it. Public health takes a population approach. Medicine takes a patient approach.

What we do outside of the health care system – things as simple as eating right and exercising – matter at least as much as what happens in the doctor’s office.

For example, researchers at Emory University estimate that health care expenditures attributable to obesity will increase to $344 billion by 2018 if the prevalence of obesity continues to increase at its historical rate.  (That’s up from $79 billion in 2008 and $139 billion in 2013.) They project that 21 percent of national health expenditures will be consumed by spending related to obesity by 2018.

The public health perspective recognizes that where you live and who you are – your income, education and race – matter to your health and well-being.

The Food Research and Action Center estimates that poor children in the U.S. are about twice as likely to become obese.  The public health approach addresses social disparities to maximize prevention programs.

Obesity Chart
SOURCE: Based on Research by Kenneth Thorpe, Rollins School of Public Health, Emory

In developing countries, the focus of public health remains on preventing infectious disease such as malaria, HIV, tuberculosis and cholera as well as reducing malnutrition and providing proper vaccinations. In the U.S. and other developed countries, the focus has shifted to chronic conditions such as obesity, diabetes, and heart disease. Public health also includes injury and violence prevention, which is a leading cause of death for people under age 35 in all countries.

Public health involves educating people about making healthy choices and encouraging policies that support healthy lifestyles. Often, the most effective changes are made behind the scenes. Public health regularly requires government intervention and exists at a tension point between individual freedom and the common good. One example is preventing dental decay. Children can be taught one-by-one how to brush their teeth, and parents can be advised to buy fluoridated salt. Or, a country can simply fluoridate all drinking water and require all salt on the market to be fluoridated. That way people don’t even have to think about it.

Yale professor Edward Amory Winslow offered a definition for public health in 1920: “The science and art of preventing disease, prolonging life, and promoting physical health and efficiency through organized community efforts for the sanitation of the environment, the control of community infections, the education of the individual in principals of personal hygiene, the organization of medical and nursing service for the early diagnosis and preventive treatment of disease, and 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.”

This definition remains useful today and serves as a reminder to distinguish health from health care. 

Shana Montrose, Senior Analyst, joined the Colorado Health Institute in June 2013. Shana manages the work focused on health reform implementation, which includes monitoring and evaluating the impact of the Affordable Care Act. Shana works with colleagues and external partners to evaluate how the many aspects of health reform impact cost, access and quality.