What is public health?

Here, we show how the idea of public health and its definition have either evolved or remained the same in Britain since World War II.

What is ‘public health’? Is it about the well-being of the population? Is it about the provision of certain health services? Is it about clean water and air, or encouraging people to give up smoking and fast food? This seemingly simple question defies a simple answer!

When we think about how public health has changed over time, the picture becomes even more complex. In the nineteenth century, for instance, the primary public health concern was combating infectious disease; today we are more focused on chronic conditions like diabetes and obesity.

What is ‘health’?

Let’s begin by considering what is meant by ‘health’. In 1948, the World Health Organization defined health as: “a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity.” ¹

This is a very broad definition of health, but it is one that has had a significant impact, and despite being over 70 years old, you will often see it repeated.

What is the ‘public’?

What about the meaning of the ‘public’? We can break this down into two aspects. Firstly, ‘public’ implies a group of people rather than just one, whether that be a specific community or the whole population. Secondly, ‘public’ refers to collective rather than purely individual action.

This might be the activities of government or wider society. But what does it mean to think about ‘health’ and the ‘public’ together?

What is ‘public health’?

A classic definition of public health was offered by the American public health expert CEA Winslow in 1920. Winslow stated that:

Public Health is the science and the 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 principles 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. ²

Change and continuity over time

In the past, “public health” has commonly, if mistakenly, been rather narrowly interpreted and associated in particular with sanitary hygiene and epidemic disease control. We prefer our broader definition…[which] give[s] as much weight to the importance of lifestyle as to environmental hygiene in the preservation and promotion of health. ³

What Acheson is hinting at is that public health can in part be defined by the challenges it faced. His emphasis on lifestyle also suggests a role for individuals in guaranteeing public health.

So where does this leave us? We can agree that public health is about collective action to benefit the health of the public, but the way in which this is achieved, and the main problems that public health faces, change over time.

If you’d like to learn more about the history of public health, check out the full online course from the London School of Hygiene and Tropical Medicine, below,