Public Health Services
Public Health Services, services that provide collective action to protect the health of populations, often through state-funded agencies. Public health includes four major areas: (1) the promotion of positive health and vitality; (2) the prevention of infectious and non-infectious disease as well as injury; (3) the organization and provision of services for diagnosis and treatment of illness; and (4) the rehabilitation of sick and disabled people to their highest possible level of function. Inclusion of these four major areas among the concerns of public-health agencies was expressed on a worldwide scale in 1948, when health was defined by the World Health Organization (WHO) to include physical, mental, and social well-being and not merely the absence of disease or infirmity.
II PROMOTION OF HEALTH
This broad area of health promotion represents, in a sense, a rediscovery of ancient concepts. As long ago as 3000 bc, cities on the Indian subcontinent had developed environmental sanitation programmes such as the provision of underground drains and public baths. Essential aspects of health were woven into daily activities, including personal hygiene, health education, exercise, codes of conduct and self-discipline, dietary practices, food and environmental sanitation, and treatment of minor ailments and injuries. By 1400 bc, this society’s so-called science of life, or ayurveda, mainly featured total health care through health promotion and education, although advances were also made in curative medicine and surgery.
This tradition was also highly developed in ancient Greece and Rome. The Hippocratic tradition concentrated on the patient rather than the disease and emphasized prevention (see Hippocrates). It used a system of dietetics to preserve and restore health through appropriate regimens for acquiring fitness and treating sickness. Its emphasis on health regimens was linked to a culture that revered an idealized body in a cult of athletics. Many Hippocratic authors linked their therapeutic regimens to the health of athletes. Under the influence of Greek physicians, Roman medicine equally emphasized the importance of personal regimens and dietetics to ward off disease. This was promoted above all by the most famous Greek physician of the Roman Empire, Galen, in his discussion of the natural (innate constitutional), non-natural (environmental), and preternatural (pathological) causes of health and disease that produced variations in the pulse and affected the balance of humours within the body. Galen adapted the philosophy of the humours into a system of physiology and pathology in which blood was regarded as the primary humour, claiming that all disease could be controlled or treated by its regulation. Galenic dietetics used dietary rules and protocols of personal hygiene, behaviour, and exercise to maintain healthy humoral balance. See also Medicine, Classical.
In 18th-century Europe, doctors of the Enlightenment revived the Hippocratic philosophy of prolonging life and preserving individual health through dietetics, regimen, and exercise. The massive increase in health advice books throughout Europe in the 18th century reflected the popularity of personal health cults. The same revival of classical values encouraged concern with environmental health regulation because the relationship between the health and wealth of nations was not lost on early modern political and economic thought. See also Medicine, Eighteenth-Century.
The early modern political philosophy of mercantilism stressed the need to measure the strength of the state by assessing levels of health. The growth of public health paralleled the rise of centralized government in this period. As the modern state began to emerge from the late 16th century onward, so incipient ideas of national health slowly gained ground. Methods for assessing the strength of the state by calculating population health were developed by political arithmeticians throughout the 18th century. The term statistik (statecraft) was invented by the professor of law and politics at the University of Göttingen, Gottfried Achenwall (1719-1772), to describe catalogues and surveys illustrating “the condition and prospects of society”. Early modern exploration of probability and population had a powerful influence on the development of public health. Statistics provided essential methods for enquiring into the health and disease profile of populations.
Political rhetoric about health and the political state was also significantly influenced by the Enlightenment philosophy of democratic citizenship. Democratic revolutions in America and France asserted new principles regarding the state and the health of its subjects. Thomas Paine did not include health among the property rights to which all free men are innately entitled but Thomas Jefferson declared that sick populations were the product of sick political systems. According to Jefferson, despotism produced disease, democracy liberated health. Jefferson believed that a life of political “liberty and the pursuit of happiness” would automatically be a healthful one. He told his co-signer of the Declaration of Independence, the physician and patriot Benjamin Rush, that the iniquity of European absolutism was reflected in its peoples’ wretchedly unhealthy and demoralized condition. French revolutionaries added health to the rights of man asserting that health should be a right of democratic citizenship in which the modern state was obliged to take measures to protect populations through the prevention of disease and the provision of medical services.
Eighteenth-century methods for calculating the health of populations and Enlightenment rhetoric of health citizenship provided the prerequisites for systematic disease prevention and the political legitimization for state intervention to procure public health in the 19th century. See also Medicine, Nineteenth-Century.
By the middle of the 20th century, dramatic reductions in infectious diseases and the creation of health care provision, together with a general rise in affluence, created new patterns of disease distribution and extended life expectancy in Western societies (see Medicine, Twentieth-Century). A longer life did not, however, necessarily mean a sweeter one and as a result a resurgence of interest in positive health occurred. Interest in the scientific basis of health led to new areas of research, such as the effect of malnutrition in pregnant women upon the physical and mental development of their children, and research into the effects of diet supplementation in improving the health and vitality of undernourished populations; the influence of optimal levels of temperature and other environmental conditions upon human comfort and ability to function; and the influence of diet and physical exercise in achieving positive health and well-being.
Beyond scientific research a variety of utopian philosophies developed in the 20th century that advocated their own ideals of health and alternative life styles. Furthermore, enterprising entrepreneurs in Europe and the United States took up the commercial potential of promoting methods for maintaining a healthy body. New intellectual discourses surrounding health have been expressed in the promotion of physical cultures that adopted their own moral tones imbued with cultural anxieties about social and biological degeneration and decline.
Concerns over the promotion of health have, from the early 19th century, been significantly overshadowed by the pressing need for and innovations in the prevention and treatment of disease.