What is Public Health?

When the topic of public health finds its way into a conversation, our initial thoughts usually gravitate around doctors, nurses, and hospitals. Even though these three factors play a pivotal part in our health care system, public health is so much more than that. Public health can be found everywhere, from the foods we buy to the clothes we wear, public health plays an important role in our society. This is because public health aims to protect and improve the health of populations before people need to go to a hospital. Since these activities take place before people need medical care, public health measures are often seen as upstream approaches. As a result, public health is made up of many intricate systems, all focussing on the health and wellbeing of individuals within a community. To accomplish this, there are three pillars of public health: principles, policy and standardised protocols, and programmes. These three pillars need to work harmoniously for our health care system to function properly and be as equitable towards everyone as possible. 

Principles act as the foundation of public health, ensuring that policies and programmes are supported and become sustainable. Public health principles in action can take many forms, including promoting equity and accessibility, food and health literacy, partnerships and collaborations, and understanding social determinants of health [1]. These activities help protect the health of communities by setting health and safety standards, while also educating the public on issues that might affect their health, like the risks of eating too much sugar, or the benefits of exercising daily. For example, the Food Literacy for Life programme by Public Health Ontario is an initiative that strives to prevent chronic diseases, promote healthy growth and child development, and contribute to the health of children and youth [2]. Other examples of public health principles in action include the Ontario Tobacco Monitoring Report, which summarises trends in tobacco use [3]. This type of information can help health units across Ontario determine whether they need to develop new policies or change existing ones to reduce the impact of tobacco use on the community. 

Equity is arguably one of the most important principles in public health. Equity is defined as treating individuals or groups according to their needs while offering the highest level of care for all [4]. For example, the elderly population are at greater risks of health complications because of factors such as existing chronic diseases; therefore, healthcare providers must provide extra precautionary measures to accommodate for their conditions. We cannot discuss equity without touching upon health disparities. The difference in health between multiple population groups in association with their healthcare needs are health disparities [4]. We know that the elderly population needs additional care and attention because of existing conditions such as chronic illnesses, impaired mobility, and communication barriers. This results in a large gap between those who need additional resources and those who may not require as much, such as the elderly population compared to the working class. 

Public health can also play a formal role in protecting the health of populations. This is achieved by establishing policies and standardised protocols. In Ontario, the most common public health policies and protocols that people will see are ones that deal with food safety and water quality. As defined by Public Health Ontario, food safety is “the science of handling, preparing and storing food to reduce the risk of foodborne illnesses” [5]. Food safety is important since bacteria such as campylobacter, listeria, salmonella, E. coli, and Yersinia still cause foodborne illness [5]. Other than food safety, public health policies also address issues relating to disease preparedness and response, outbreak prevention and surveillance, community engagement, systems evaluation, and healthcare capacity. Recently, disease preparedness and response, as well as outbreak prevention and surveillance, have taken centre stage as organisations like the Public Health Agency of Canada are working with provincial health agencies to combat COVID-19. However, the Public Health Agency of Canada also works to:  

“promote health, prevent and control chronic disease and injuries, prevent and control infectious diseases, prepare for and respond to public health emergencies, serve as a central point for sharing Canada’s expertise with the rest of the world, apply international research and development to Canada’s public health programmes, and strengthen intergovernmental collaboration on public health and facilitate national approaches to public health policy and planning” [6].

Provincial health agencies and local health units also work towards similar goals through policies, but also through protocols. Public health protocols are effective methods in establishing a sustainable approach to address the issues presented above. For example, the Population Health Assessment and Surveillance Protocol were established to examine and identify current and possible health issues within a specific community [1,7]. 

In order to deliver healthcare services to communities, there needs to be programmes in place through health promotion. There are five main categories of health programmes: chronic diseases and injuries, emergency preparedness, environmental health, family health, and infectious diseases [1]. The health care units of each province have the responsibility to examine the needs of specific communities and develop programmes tailored to their needs. Going back to the topic of food safety, which belongs to the environmental health category, each community has different needs when it comes to access, types of food, and understanding of food and nutrition. As a result, local health units will have to look at their data, specific to the community, and develop initiatives that are in line with their needs. Another example is infectious disease prevention, which plays a large role in keeping populations and communities healthy. For Canada’s health system to maintain its health and safety standards for its residents, local health units must continuously monitor and analyze health data. This will enable doctors and decision-makers to react quick enough and mitigate possible outbreaks and epidemics [1]. 

All in all, public health requires all three pillars to operate together with Canada’s health care system to establish sustainable and equitable access to health services and programmes. Whether it’s promoting food safety, ensuring workplaces are safe or preventing chronic diseases by addressing factors like smoking early on, public health is a way to put upstream approaches into effect. Public health agencies from all levels of government, like the Public Health Agency of Canada, to provincial ones, like Public Health Ontario, to local health units, use the three pillars of principles, policy and protocols, and programming to promote and protect the health of communities. These actions go beyond the individual level to make sure all members of the population can live their healthiest life. 

Reference

1. Valaitis R, MacDonald M, Kothari A, O’Mara L, Regan S, Garcia J, Murray N, Manson H, Peroff-Johnston N, Bursey G, Boyko J. (2016). Moving towards a new vision: implementation of a public health policy intervention. BMC Public Health, 16(1), 1-7. 

2. Public Health Ontario. (2017). A Call to Action for Healthy Eating: Using a Food Literacy Framework for Public Health Program Planning, Policy, and Evaluation [Internet]. Locally Driven Collaborative Project: July 2017 [cited 2020 June 27]. 12 p. Available from: https://www.publichealthontario.ca/-/media/documents/L/2017/ldcp-food-literacy-call-to-action.pdf?la=en. 

3. Baskerville NB, Berenbaum E, Moloughney B, Muir S, Oei T, Philipneri A, Singh H, Tanna S. (2019). Ontario Tobacco Monitoring Report 2018 [Internet]. Queen’s Printer for Ontario: November 2019 [cited 2020 June 27]. 89 p. Available from: https://www.publichealthontario.ca/-/media/documents/t/2019/tobacco-report-2018.pdf?la=en. 

4. Braveman, P. (2014). What are Health Disparities and Health Equity? We Need to Be Clear. Public Health Reports, 129(1_suppl2), 5–8. https://doi.org/10.1177/00333549141291S203

5. Public Health Ontario. Food Safety [Internet]. Ontario: Public Health Ontario; 2020 [updated 2019 May 7]. Available from: https://www.publichealthontario.ca/en/health-topics/environmental-occupational-health/food-safety. 

6. Public Health Agency of Canada. (2019). Canada: Government of Canada; 2019 [updated 2019 November 22]. Available from: https://www.canada.ca/en/public-health/corporate/mandate/about-agency.html. 

7. Ontario Ministry of Health and Long-Term Care. (2018). Population Health Assessment and Surveillance Protocol, 2018. Ministry of Health and Long-Term Care. Retrieved from http://www.health.gov.on.ca/en/pro/programs/publichealth/oph_standards/docs/protocols_guidelines/Population_Health_Assessment_Surveillance_2018_en.pdf