Monday, February 1, 2010

What is public health?

Public health tackles non-clinical factors that influence health. Which is practically everything: The natural and built environments, education, housing, transportation, business, food and nutrition, recreational activities, the list goes on. The focus is on health promotion and disease prevention, since the best treatment is to never get sick or injured. That sounds reasonable enough.

But public health is criticized for placing population health over individual health. For example, reductions in breast cancer screening might be better for the population in that they reduce costs and the burden of over-diagnoses, but that reduction could lead to harm in some women who have high-risk cancers despite being in low-risk, un-screened groups.

I wanted to share some stories from the front lines of public health. Just like doctors, public health professionals work one-on-one with individuals. We are not just population specialists, but struggle to balance sympathy for individuals with their legal rights and responsibilities, threats to the public’s well-being, and our sometimes limited powers of enforcement or mitigation.

I serve as the local town health officer, probably the smallest unit of public health in terms of population impact. My small town community is sandwiched between a small city and more rural countryside. There is a tired history of agriculture and granite quarrying, education and income levels are low, and the housing stock is old.

Some typical calls:

Chickens being raised on a paved driveway in a residential neighborhood. Neighbors complain of early morning rooster crowing, and worry about excrement attracting flies and running off onto their property when it rains. But mitigation is complicated by an agricultural heritage that supports micro-farming, and no local ordinances prohibiting the raising of chickens in that setting. So the egg laying continues.

Tenants complain that their drafty apartment is sickening their child, and their doctor agrees. But temperature readings on a cold day find the unit warm enough. Landlord and tenant are in open conflict, and I leave having done very little but encourage both sides to work it out.

A trailer with countless health and fire code violations, tenants not paying and landlord not complying. Hygiene is frightening for the young parents and children. Even after we haul off a ton of maggot-infested garbage, the smell of the unit is gagging. Eventually the tenants move out, but the troubled unit remains.

Neighborhood cats turn a daycare center’s playground into their litter box. But we don’t know the offending cats. So the unsatisfied owner is told to take pictures of the offending creatures.

A grandparent worried about the care of their grandchild. The discussion unearths potential parenting problems, and all I can do is recommend that a report to state child protective workers.

We could go on for several pages. Some common themes? These are everyday small scale people-problems that plague the planet. They certainly aren’t sexy (no Grey’s Anatomy episode fodder here), and frequently come down to negotiation and the sense that even when the problem is addressed, it may never really be fixed.

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1 comment:

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