Chapter 9: Public Health Practice in the United States

INTRODUCTION

Public health is the science of protecting and improving the health of populations, from small, local communities to entire countries and even regions of the world. It focuses on “what we, as a society, do collectively to assure the conditions in which people can be healthy.”¹ Public health is charged with preventing epidemics and the spread of disease; protecting against environmental hazards; preventing injuries; promoting healthy behaviors; responding to disasters and assisting communities in recovery; and assuring the quality and accessibility of health services.² Core to public health’s mission of health promotion and disease prevention is addressing the social determinants of health—the conditions in the environments in which people live, work, and play that affect health outcomes and can disadvantage communities, often on the basis of characteristics including race, class, gender, wealth, and sexual orientation, among others.³ Unequal distribution of resources and power contribute to avoidable and unjust health inequities in populations.⁴ Public health works at multiple levels: through programs and policies that aim to address broader structural and systems factors that impact health; by implementing community interventions that focus on the social, behavioral, and environmental needs of specific populations; and through programs that help prompt individual behavior change that can improve health status. Public health practice refers to the implementation of programs and delivery of these services to improve the public’s health. This chapter summarizes:

• The history of public health practice

• The core functions and essential services of public health

• The cross-sector partnerships critical for effective public health practice

• The importance of evidence-based decision making in public health

• The distinction between public health practice and public health research

• The alignment of academia and public health practice

HISTORY OF PUBLIC HEALTH PRACTICE

Public health practice in the late nineteenth to twentieth centuries is sometimes referred to as Public Health 1.0.⁵ It was during this time that the health of a population came to also be seen as a public and societal concern, rather than solely the result of individual choices.¹ Increasing urban and industrial environments led to the rise of sanitation and hygienic issues, resulting in the creation of some of the key infrastructures of the public health system. In London, the 1842 General Report on the Sanitary Conditions of the Labouring Population of Great Britain by Edwin Chadwick and the Poor Law Commission influenced the Public Health Act of 1848 and the establishment of national and local boards of health in England and Wales.^1,6 In the United States, survey reports highlighting issues with poor sanitation similarly prompted the development of boards of health.¹ Two such influential reports were The Sanitary Condition of the Labouring Population of New York by John Griscom in 1848 and the 1850 Report of the Massachusetts Sanitary Commission by Lemuel Shattuck. Over the next 50 years, state and local health departments continued to form across the country, along with ...