View source for Public health

{{Short description|Promoting health through informed choices}}
{{About|public health|public health care|publicly funded health care}}
{{Use dmy dates|date=October 2019}}
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<noinclude>{{multiple image
| perrow            = 2
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| image1            = Community Health Worker treats child (19165929668).jpg
| alt1              = Delivery of malaria treatment by community health worker in Djénébougou, Mali. October 2013.
| image2            = COVID-19 vaccination center, fair grounds Cologne, 1st vaccination-8237.jpg
| alt2              = COVID-19 vaccination center, fair grounds Cologne, 1st vaccination
| image4            = The Addl. Secretary, Ministry of Health and Family Welfare, Shri Keshav Desiraju addressing at the launch of the media campaign of National Tobacco Control Programme, in New Delhi. The WHO Representative.jpg|thumb|The Addl. Secretary, Ministry of Health and Family Welfare, Shri Keshav Desiraju addressing at the launch of the media campaign of National Tobacco Control Programme, in New Delhi. The WHO Representative
| alt4              = The Addl. Secretary, Ministry of Health and Family Welfare, Shri Keshav Desiraju addressing at the launch of the media campaign of National Tobacco Control Programme, in New Delhi on February 02, 2012. The WHO Representative, Dr. Nata Menabde and other dignitaries are also seen.
| image3            = Seattle - Installing E. 80th Street pipeline, 1931.jpg|thumb|Seattle – Installing E. 80th Street pipeline, 1931
| alt3              = Installing E. 80th Street pipeline, Seattle, Washington, USA, 1931
| footer            = Various aspects of public health: From top to bottom : [[Community health worker]] in Mali, [[vaccination]] example ([[COVID-19 vaccine|COVID-19 vaccination]] in Germany), historical [[Combined sewer|sewer]] installation photo from the United States, [[anti-smoking campaign]] in India.
}}

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{{Public health sidebar}}

'''Public health''' is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals".<ref name="Gatseva">{{cite journal | vauthors = Gatseva PD, Argirova M |title=Public health: the science of promoting health |journal=Journal of Public Health |date= June 2011 |volume=19 |issue=3 |pages=205–206 |doi=10.1007/s10389-011-0412-8 |s2cid=1126351 |language=en |issn=1613-2238|doi-access=free}}</ref><ref name="Winslow_1920">{{cite journal | vauthors = Winslow CE | title = The untilled fields of public health | journal = Science | volume = 51 | issue = 1306 | pages = 23–33 | date = January 1920 | pmid = 17838891 | doi = 10.1126/science.51.1306.23 | bibcode = 1920Sci....51...23W | url = https://zenodo.org/record/1448241 | author-link = Charles-Edward Amory Winslow }}</ref> Analyzing the determinants of [[health]] of a [[population]] and the threats it faces is the basis for public health.<ref name="Centers for Disease Control Foundation">{{Cite web|url=https://www.cdcfoundation.org/content/what-public-health|title=What is Public Health|website=Centers for Disease Control Foundation|publisher=Atlanta, GA: Centers for Disease Control|access-date=27 January 2017}}</ref> The ''public'' can be as small as a handful of people or as large as a village or an entire city; in the case of a [[pandemic]] it may encompass several continents. The concept of ''health'' takes into account physical, [[psychological]], and [[Well-being|social well-being]], among other factors.<ref name="What is the WHO definition of health">[https://web.archive.org/web/20190307113324/https://www.who.int/about/who-we-are/frequently-asked-questions What is the WHO definition of health?] from the Preamble to the Constitution of WHO as adopted by the International Health Conference, New York, 19 June – 22 July 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of WHO, no. 2, p. 100) and entered into force on 7 April 1948. The definition has not been amended since 1948.</ref>

Public health is an [[Interdisciplinarity|interdisciplinary]] field. For example, [[epidemiology]], [[biostatistics]], [[social science]]s and [[management]] of [[health services]] are all relevant. Other important sub-fields include [[environmental health]], [[community health]], [[behavioral health]], [[health economics]], [[public policy]], [[mental health]], [[health education]], [[health politics]], [[occupational safety and health|occupational safety]], [[disability]], [[oral health]], [[gender issues]] in health, and [[sexual and reproductive health]].<ref name="Perdiguero_2001">{{cite journal| vauthors = Perdiguero E |date=2001-07-01|title=Anthropology in public health. Bridging differences in culture and society.|journal=Journal of Epidemiology & Community Health|volume=55|issue=7|pages=528b–528|doi=10.1136/jech.55.7.528b|issn=0143-005X|pmc=1731924}}</ref> Public health, together with [[primary care]], secondary care, and [[tertiary care]], is part of a country's overall [[health care|healthcare]] system. Public health is implemented through the [[Disease surveillance|surveillance]] of cases and [[health indicators]], and through the [[Behavior change (public health)|promotion of healthy behaviors]]. Common public health initiatives include promotion of [[hand washing|hand-washing]] and [[breastfeeding]], delivery of [[vaccination]]s, promoting ventilation and improved air quality both [[indoor air quality|indoors]] and [[air quality|outdoors]], [[suicide prevention]], [[smoking cessation]], [[Obesity|obesity education]], increasing [[Health care|healthcare]] accessibility and distribution of [[condom]]s to control the spread of [[sexually transmitted disease]]s.

There is a significant disparity in access to health care and public health initiatives between [[Developed country|developed countries]] and [[Developing country|developing countries]], as well as within developing countries. In developing countries, public health infrastructures are still forming. There may not be enough trained [[healthcare workers]], monetary resources, or, in some cases, sufficient knowledge to provide even a basic level of medical care and disease prevention.<ref name="Chen_2006" /><ref name="Jamison 15–22" /> A major public health concern in developing countries is poor [[Maternal health|maternal]] and [[Pediatric nursing|child health]], exacerbated by [[malnutrition]] and poverty coupled with governments' reluctance in implementing public health policies. Developed nations are at greater risk of certain public health crises, including childhood obesity, although overweight populations in low- and middle-income countries are catching up.<ref>{{Cite news |date=2023-07-25 |title=Obesity catches up with low- and middle-income countries |url=https://www.lemonde.fr/en/health/article/2023/07/25/obesity-catches-up-with-low-and-middle-income-countries_6067132_14.html |access-date=2024-08-21 |language=en}}</ref>

From the beginnings of [[human civilization]], communities promoted [[health]] and fought [[disease]] at the population level.<ref name="Rosen_2015" /><ref name="Porter_1999" /> In [[Complex society|complex]], [[Pre-industrial society|pre-industrialized societies]], interventions designed to reduce health risks could be the initiative of different stakeholders, such as army generals, the clergy or rulers. Great Britain became a leader in the development of public health initiatives, beginning in the 19th century, due to the fact that it was the first modern [[Urbanization|urban nation]] worldwide.<ref name="Crook_2016" /> The public health initiatives that began to emerge initially focused on [[sanitation]] (for example, the Liverpool and [[London sewerage system]]s), control of [[Infection|infectious diseases]] (including vaccination and [[quarantine]]) and an evolving infrastructure of various sciences, e.g. statistics, microbiology, epidemiology, sciences of engineering.<ref name="Crook_2016" />

{{TOC level|3}}

== Definition ==
[[File:A_community_health_worker_conducting_a_survey_in_the_Korail_slum,_Bangladesh_(8630810827).jpg|thumb|A community health worker in Korail Basti, a slum in [[Dhaka]], Bangladesh]]
Public health has been defined as "the science and art of [[Preventive healthcare|preventing disease]]", prolonging life and improving [[quality of life]] through organized efforts and informed choices of [[society]], [[organization]]s (public and private), [[Community|communities]] and [[individual]]s.<ref name="Winslow_1920" />  The ''public'' can be as small as a handful of people or as large as a village or an entire city. The concept of ''health'' takes into account physical, [[psychological]], and [[Well-being|social well-being]]. As such, according to the [[World Health Organization]], "health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity".<ref name="What is the WHO definition of health" />

=== Related terms ===
[[File:World_Health_Organisation_building_from_west.jpg|thumb|The [[World Health Organization|WHO]] is the predominant agency associated with [[global health]].]]
Public health is related to [[global health]] which is the health of populations in the worldwide context.<ref>{{cite journal | vauthors = Brown TM, Cueto M, Fee E | title = The World Health Organization and the transition from "international" to "global" public health | journal = American Journal of Public Health | volume = 96 | issue = 1 | pages = 62–72 | date = January 2006 | pmid = 16322464 | pmc = 1470434 | doi = 10.2105/AJPH.2004.050831 }}</ref> It has been defined as "the area of study, [[research]] and practice that places a priority on improving health and achieving equity in "[[Health for all]]" people worldwide".<ref name="Koplan">{{cite journal | vauthors = Koplan JP, Bond TC, Merson MH, Reddy KS, Rodriguez MH, Sewankambo NK, Wasserheit JN | title = Towards a common definition of global health | journal = Lancet | volume = 373 | issue = 9679 | pages = 1993–1995 | date = June 2009 | pmid = 19493564 | pmc = 9905260 | doi = 10.1016/S0140-6736(09)60332-9 | s2cid = 6919716 | citeseerx = 10.1.1.610.7968 }}</ref> International health is a field of [[health]] care, usually with a public health emphasis, dealing with health across regional or national boundaries.<ref>{{Cite web |date=2024-07-30 |title=International Health {{!}} Johns Hopkins {{!}} Bloomberg School of Public Health |url=https://publichealth.jhu.edu/departments/international-health |access-date=2024-08-21 |website=publichealth.jhu.edu |language=en}}</ref> Public health is not the same as public healthcare ([[publicly funded health care]]).

The term '''preventive medicine''' is related to public health. The American Board of Preventive Medicine separates three categories of preventive medicine: aerospace health, [[Occupational safety and health|occupational health]], and public health and general preventative medicine. Jung, Boris and Lushniak argue that preventive medicine should be considered the medical specialty for public health but note that the American College of Preventive Medicine and American Board of Preventive Medicine do not prominently use the term "public health".<ref name="Jung_2017">{{cite journal | vauthors = Jung P, Lushniak BD | title = Preventive Medicine's Identity Crisis | journal = American Journal of Preventive Medicine | volume = 52 | issue = 3 | pages = e85–e89 | date = March 2017 | pmid = 28012813 | doi = 10.1016/j.amepre.2016.10.037 | doi-access = free }}</ref>{{rp|page=1}} Preventive medicine specialists are trained as [[clinician]]s and address complex health needs of a population such as by assessing the need for [[Preventive healthcare|disease prevention]] programs, using the best methods to implement them, and assessing their effectiveness.<ref name="Jung_2017" />{{rp|pages=1,3}}

Since the 1990s many scholars in public health have been using the term '''population health'''.<ref name="Valles_2018">{{cite book | vauthors = Valles SA |url=https://www.worldcat.org/oclc/1035763221 |title=Philosophy of population health : philosophy for a new public health era |date=2018 |isbn=978-1-351-67078-4 |location=London | publisher =  Routledge, Taylor & Francis Group |oclc=1035763221}}</ref>{{rp|page=3}} There are no medical specialties directly related to population health.<ref name="Jung_2017" />{{rp|page=4}} Valles argues that consideration of [[health equity]] is a fundamental part of population health. Scholars such as Coggon and Pielke express concerns about bringing general issues of wealth distribution into population health. Pielke worries about "stealth issue advocacy" in population health.<ref name="Valles_2018" />{{rp|page=163}} Jung, Boris and Lushniak consider population health to be a concept that is the goal of an activity called public health practiced through the specialty preventive medicine.<ref name="Jung_2017" />{{rp|page=4}}

[[Lifestyle medicine]] uses individual lifestyle modification to prevent or revert disease and can be considered a component of preventive medicine and public health. It is implemented as part of [[primary care]] rather than a specialty in its own right.<ref name="Jung_2017" />{{rp|page=3}} Valles argues that the term [[social medicine]] has a narrower and more [[biomedical]] focus than the term population health.<ref name="Valles_2018" />{{rp|page=7}}

== Purpose ==
The purpose of a [[public health intervention]] is to prevent and [[Mitigation|mitigate]] diseases, [[Injury|injuries]], and other health conditions. The overall goal is to improve the health of individuals and populations, and to increase [[life expectancy]].<ref>{{Citation |last1=Smith |first1=Peter G. |title=Types of intervention and their development |date=2015-06-01 |work=Field Trials of Health Interventions: A Toolbox. 3rd edition |url=https://www.ncbi.nlm.nih.gov/books/NBK305514/ |access-date=2024-08-21 |publisher=OUP Oxford |language=en |last2=Morrow |first2=Richard H. |last3=Ross |first3=David A.}}</ref><ref>{{Cite web |title=A Look At Public Health Interventions |url=https://onlinedegrees.kent.edu/college-of-public-health/community/public-health-interventions |access-date=2024-08-21 |website=Kent |language=en}}</ref>

== Components ==
Public health is a complex term, composed of many elements and different practices. It is a multi-faceted, [[Interdisciplinarity|interdisciplinary]] field.<ref name="Crook_2016">{{Cite book| vauthors = Crook T |title=Governing systems: modernity and the making of public health in England, 1830–1910|date=2016|isbn=978-0-520-96454-9|location=Oakland, California | publisher = University of California Press |oclc=930786561}}</ref> For example, [[epidemiology]], [[biostatistics]], [[social science]]s and [[management]] of health services are all relevant. Other important sub-fields include [[environmental health]], [[community health]], [[behavioral health]], [[health economics]], [[public policy]], [[mental health]], [[health education]], [[health politics]], [[occupational safety and health|occupational safety]], [[disability]], [[gender issues]] in health, and [[sexual and reproductive health]].<ref name="Perdiguero_2001" />

Modern public health practice requires [[Interdisciplinarity|multidisciplinary]] teams of public health workers and professionals. Teams might include [[epidemiology|epidemiologists]], [[biostatistics|biostatisticians]], [[physician assistant]]s, [[public health nursing|public health nurses]], [[midwives]], [[microbiologist|medical microbiologists]], [[pharmacist]]s, [[economists]], [[sociologists]], [[geneticists]], [[data management|data managers]], [[environmental health officer]]s ([[public health inspector]]s), [[Bioethics|bioethicists]], gender experts, sexual and reproductive health specialists, [[physicians]], and [[veterinarian]]s.<ref>{{cite book|author1=Joint Task Group on Public Health Human Resources|title=Building the public health workforce for the 21st century|author2=Advisory Committee on Health Delivery & Human Resources|author3=Advisory Committee on Population Health & Health Security|publisher=Public Health Agency of Canada|year=2005|location=Ottawa|oclc=144167975}}</ref>

The elements and priorities of public health have evolved over time, and are continuing to evolve.<ref name="Crook_2016" /> Common public health initiatives include promotion of [[hand washing|hand-washing]] and [[breastfeeding]], delivery of [[vaccination]]s, [[suicide prevention]], [[smoking cessation]], [[Obesity|obesity education]], increasing [[Health care|healthcare]] accessibility and distribution of [[condom]]s to control the spread of [[sexually transmitted disease]]s.<ref>{{Cite web |last=CDC |date=2024-06-12 |title=National Health Initiatives, Strategies & Action Plans |url=https://www.cdc.gov/public-health-gateway/php/communications-resources/national-health-initiatives-strategies-action-plans.html |access-date=2024-08-21 |website=Public Health Professionals Gateway |language=en-us}}</ref>

== Methods ==
[[File:Salk headlines.jpg|thumb|Newspaper headlines from around the world about [[polio vaccine]] tests (13 April 1955)]]
Public health aims are achieved through surveillance of cases and the [[health promotion|promotion of healthy behaviors]], [[healthy community design|communities]] and [[environmental protection|environments]]. Analyzing the determinants of [[health]] of a [[population]] and the threats it faces is the basis for public health.<ref name="Centers for Disease Control Foundation" />

Many diseases are [[Preventable causes of death|preventable]] through simple, nonmedical methods. For example, research has shown that the simple act of [[hand washing|handwashing]] with soap can prevent the spread of many [[Infection|contagious diseases]].<ref>Global Public-Private Partnership for Handwashing with Soap. [http://www.globalhandwashing.org/handwashing-resources ''Handwashing research''] {{webarchive|url=https://web.archive.org/web/20101216125536/http://globalhandwashing.org/handwashing-resources |date=16 December 2010 }}, accessed 19 April 2011.</ref> In other cases, treating a disease or controlling a [[pathogen]] can be vital to preventing its spread to others, either during an outbreak of [[infectious disease]] or through [[food contamination|contamination of food]] or [[water contamination|water]] supplies.

Public health, together with [[primary care]], secondary care, and [[tertiary care]], is part of a country's overall [[health care]] system. Many interventions of public health interest are delivered outside of [[Health facility|health facilities]], such as [[food safety]] surveillance, distribution of [[condom]]s and [[Needle-exchange programme|needle-exchange programs]] for the prevention of transmissible diseases.

Public health requires [[Geographic information system|Geographic Information Systems]] (GIS) because risk, vulnerability and exposure involve geographic aspects.<ref>{{cite journal | vauthors = Wang F | title = Why Public Health Needs GIS: A Methodological Overview | journal = Annals of GIS | volume = 26 | issue = 1 | pages = 1–12 | date = 2020-01-02 | pmid = 32547679 | pmc = 7297184 | doi = 10.1080/19475683.2019.1702099 | bibcode = 2020AnGIS..26....1W }}</ref>

== Ethics ==
[[File:Public Health Prayer by Dr Edmond Fernandes.jpg|alt=A Public Health Prayer - Dr Edmond Fernandes|thumb|A Public Health Prayer - Dr Edmond Fernandes]]
A dilemma in public health ethics is dealing with the conflict between [[Individual and group rights|individual rights]] and maximizing [[right to health]].<ref name="Holland_2015">{{Cite book | vauthors = Holland S |title=Public health ethics |date=2015 |isbn=978-0-7456-6218-3 |edition=Second | publisher = Polity Press |location=Cambridge |oclc=871536632}}</ref>{{Rp|page=28}} Public health is justified by [[Consequentialism|consequentialist]] [[Utilitarianism|utilitarian]] ideas,<ref name="Holland_2015" />{{Rp|page=153}} but is constrained and critiqued by [[Liberalism|liberal]],<ref name="Holland_2015" /> [[Deontology|deontological]], [[Principlism|principlist]] and [[libertarianism|libertarian]] philosophies<ref name="Holland_2015" />{{Rp|page=|pages=99,95,74,123}} Stephen Holland argues that it can be easy to find a particular framework to justify any viewpoint on public health issues, but that the correct approach is to find a framework that best describes a situation and see what it implies about public health policy.<ref name="Holland_2015" />{{Rp|page=154}}

The definition of [[health]] is vague and there are many conceptualizations. Public health practitioners definition of health can different markedly from members of the public or [[clinician]]s. This can mean that members of the public view the values behind public health interventions as alien which can cause resentment amongst the public towards certain interventions.<ref name="Holland_2015" />{{Rp|page=230}} Such vagueness can be a problem for [[health promotion]].<ref name="Holland_2015" />{{Rp|page=241}} Critics have argued that public health tends to place more focus on individual factors associated with health at the expense of factors operating at the population level.<ref name="Valles_2018" />{{Rp|page=9}}

Historically, public health campaigns have been criticized as a form of "[[healthism]]", <!-- Note that Healthism points at a section of medicalization. I don't know if it is best practice to have a direct link here... --> as moralistic in nature rather than being focused on health. Medical doctors, Petr Shkrabanek and James McCormick wrote a series of publications on this topic in the late 1980s and early 1990s criticizing the UK's ''the Health of The Nation'' campaign. These publications exposed abuse of epidemiology and statistics by the public health movement to support lifestyle interventions and screening programs.<ref>{{cite book | vauthors = Fitzpatrick M |url=https://books.google.com/books?id=qpqBAgAAQBAJ&pg=PA85 |title=The Tyranny of Health: Doctors and the Regulation of Lifestyle |date=2002-01-04 |publisher=Routledge |isbn=978-1-134-56346-3 |language=en}}</ref>{{Rp|page=85}}<ref name="Sim_2011">{{cite book | vauthors = Sim F, McKee M |url=https://books.google.com/books?id=Jn8xC6_UW8YC&pg=PA7 |title=Issues In Public Health |date=2011-09-01 |publisher=McGraw-Hill Education (UK) |isbn=978-0-335-24422-5 |language=en}}</ref> A combination of inculcating a fear of ill-health and a strong notion of individual responsibility has been criticized as a form of "health fascism" by a number of scholars, objectifying the individual with no considerations of emotional or social factors.<ref>{{Cite book | vauthors = Fitzpatrick K, Tinning R |url=https://books.google.com/books?id=rm3MAgAAQBAJ&pg=PA8 |title=Health Education: Critical perspectives |date=2014-02-05 |publisher=Routledge |isbn=978-1-135-07214-8 |language=en}}</ref>{{Rp|page=8}}<ref name="Sim_2011" />{{rp|page=7}}<ref>{{cite book | vauthors = Zembylas M |url=https://books.google.com/books?id=YzorEAAAQBAJ&pg=PA81 |title=Affect and the Rise of Right-Wing Populism: Pedagogies for the Renewal of Democratic Education |date=2021-05-06 |publisher=Cambridge University Press |isbn=978-1-108-83840-5 |language=en}}</ref>{{rp|page=81}}

== Priority areas ==
=== Original focal areas ===
[[File:Somali boy receives a polio vaccination.jpg|thumb|A [[Somali people|Somali]] boy is injected with inactivated poliovirus vaccine ([[Mogadishu]], 1993).]]
When public health initiatives began to emerge in England in modern times (18th century onwards) there were three core strands of public health which were all related to statecraft: Supply of clean water and [[sanitation]] (for example [[London sewerage system]]); control of [[Infection|infectious diseases]] (including [[vaccination]] and [[quarantine]]); an evolving infrastructure of various sciences, e.g. statistics, microbiology, epidemiology, sciences of engineering.<ref name="Crook_2016" /> Great Britain was a leader in the development of public health during that time period out of necessity: Great Britain was the first modern [[Urbanization|urban nation]] (by 1851 more than half of the population lived in settlements of more than 2000 people).<ref name="Crook_2016" /> This led to a certain type of distress which then led to public health initiatives.<ref name="Crook_2016" /> Later that particular concern faded away.

=== Changing focal areas and expanding scope ===
[[File:Marlboro_warning_death.jpg|thumb|Cigarette packet warnings as part of [[anti-smoking campaign]]s]]
With the onset of the [[epidemiological transition]] and as the prevalence of [[Infectious disease in the 20th century|infectious diseases decreased through the 20th century]], public health began to put more focus on [[chronic diseases]] such as [[cancer]] and [[heart disease]]. Previous efforts in many developed countries had already led to dramatic reductions in the [[infant mortality rate]] using preventive methods. In Britain, the infant mortality rate fell from over 15% in 1870 to 7% by 1930.<ref>{{Cite report | vauthors = Newell AT, Gazeley I | title = The Declines in Infant Mortality and Fertility: Evidence from British Cities in Demographic Transition | work = IZA Discussion Paper No. 6855 | date = 2012 | doi = 10.2139/ssrn.2157997 |url=https://www.sussex.ac.uk/webteam/gateway/file.php?name=wps-48-2012.pdf&site=24|access-date=17 December 2012| hdl = 10419/67297 | hdl-access = free }}</ref>

A major public health concern in [[Developing country|developing countries]] is poor [[Maternal health|maternal]] and child health, exacerbated by [[malnutrition]] and poverty. The [[WHO]] reports that a lack of [[Breastfeeding#Duration and exclusivity|exclusive breastfeeding]] during the first six months of life contributes to over a million avoidable child deaths each year.<ref name="World Health Organization" />

Public health surveillance has led to the identification and prioritization of many public health issues facing the world today, including [[HIV/AIDS]], [[diabetes]], [[waterborne diseases]], [[zoonosis|zoonotic diseases]], and [[antibiotic resistance]] leading to the reemergence of infectious diseases such as [[tuberculosis]]. [[Antibiotic resistance]], also known as drug resistance, was the theme of [[World Health Day|World Health Day 2011]].

For example, the WHO reports that at least 220 million people worldwide have diabetes. Its incidence is increasing rapidly, and it is projected that the number of diabetes deaths will double by 2030.<ref>World Health Organization. [https://www.who.int/mediacentre/factsheets/fs312/en/ ''Diabetes Fact Sheet N°312'', January 2011]. Accessed 19 April 2011.</ref> In a June 2010 editorial in the medical journal ''[[The Lancet]]'', the authors opined that "The fact that type 2 diabetes, a largely preventable disorder, has reached epidemic proportion is a public health humiliation."<ref>{{cite journal | title = Type 2 diabetes--time to change our approach | journal = Lancet | volume = 375 | issue = 9733 | pages = 2193 | date = June 2010 | pmid = 20609952 | doi = 10.1016/S0140-6736(10)61011-2 | s2cid = 31166680 | vauthors = ((The Lancet)) }}</ref> The risk of [[type 2 diabetes]] is closely linked with the growing problem of [[obesity]]. The WHO's latest estimates {{as of|2016|June|lc=y}} highlighted that globally approximately 1.9 billion adults were [[overweight]] in 2014, and 41 million children under the age of five were overweight in 2014.<ref>World Health Organization. [https://www.who.int/mediacentre/factsheets/fs311/en/ ''Obesity and overweight Fact sheet N°311'', Updated June 2016.] Accessed 19 April 2011.</ref> Once considered a problem in high-income countries, it is now on the rise in low-income countries, especially in urban settings.<ref>{{Cite web |title=Obesity and overweight |url=https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight |access-date=2024-08-21 |website=www.who.int |language=en}}</ref>

Many public health programs are increasingly dedicating attention and resources to the issue of obesity, with objectives to address the underlying causes including [[healthy diet]] and [[physical exercise]]. The [[National Institute for Health and Care Research]] (NIHR) has published a review of research on what [[Local government in England|local authorities]] can do to tackle obesity.<ref name="how-local">{{Cite journal |date=19 May 2022 |title=How can local authorities reduce obesity? Insights from NIHR research |url=https://evidence.nihr.ac.uk/how-local-authorities-can-reduce-obesity/ |journal=NIHR Evidence}}</ref> The review covers interventions in the food environment (what people buy and eat), the [[Built environment|built]] and [[natural environment]]s, schools, and the community, as well as those focussing on [[active travel]], [[Leisure centre|leisure services]] and public sports, [[Weight loss programs|weight management programmes]], and [[Systems approach|system-wide approaches]].<ref name="how-local"/>

Health inequalities, driven by the social determinants of health, are also a growing area of concern in public health.  A central challenge to securing health equity is that the same social structures that contribute to health inequities also operate and are reproduced by public health organizations.<ref>{{cite journal | vauthors = Flynn MA | title = Im/migration, Work, and Health: Anthropology and the Occupational Health of Labor Im/migrants | journal = Anthropology of Work Review | volume = 39 | issue = 2 | pages = 116–123 | date = November 2018 | pmid = 31080311 | pmc = 6503519 | doi = 10.1111/awr.12151 }}</ref> In other words, public health organizations have evolved to better meet the needs of some groups more than others. The result is often that those most in need of preventative interventions are least likely to receive them<ref>{{cite journal | vauthors = Victora CG, Vaughan JP, Barros FC, Silva AC, Tomasi E | title = Explaining trends in inequities: evidence from Brazilian child health studies | journal = Lancet | volume = 356 | issue = 9235 | pages = 1093–1098 | date = September 2000 | pmid = 11009159 | doi = 10.1016/s0140-6736(00)02741-0 | s2cid = 32450895 }}</ref> and interventions can actually aggravate inequities<ref>{{Cite journal |title=Coaccess |url=https://apps.crossref.org/coaccess/coaccess.html?doi=10.51952%2F9781847423221.ch005 |access-date=2023-06-06 |website=apps.crossref.org |doi=10.51952/9781847423221.ch005}}</ref> as they are often inadvertently tailored to the needs of the normative group.<ref>{{cite journal | vauthors = Flynn MA, Check P, Steege AL, Sivén JM, Syron LN | title = Health Equity and a Paradigm Shift in Occupational Safety and Health | journal = International Journal of Environmental Research and Public Health | volume = 19 | issue = 1 | pages = 349 | date = December 2021 | pmid = 35010608 | pmc = 8744812 | doi = 10.3390/ijerph19010349 | doi-access = free }}</ref> Identifying bias within public health research and practice is essential to ensuring public health efforts mitigate and don't aggravate health inequities.

=== Organizations ===

==== World Health Organization (WHO) ====
The [[World Health Organization]] (WHO) is a [[List of specialized agencies of the United Nations|specialized agency of the United Nations]] responsible for international public health.<ref name="Jan 24">{{Cite web|date=24 January 2019|title=The U.S. Government and the World Health Organization|url=https://www.kff.org/global-health-policy/fact-sheet/the-u-s-government-and-the-world-health-organization/|url-status=live|archive-url=https://web.archive.org/web/20200318223306/https://www.kff.org/global-health-policy/fact-sheet/the-u-s-government-and-the-world-health-organization/|archive-date=18 March 2020|access-date=18 March 2020|website=The Henry J. Kaiser Family Foundation|language=en-US}}</ref> The WHO Constitution, which establishes the agency's governing structure and principles, states its main objective as "the attainment by all peoples of the highest possible level of health".<ref>{{Cite web|title=WHO Constitution, Basic Documents, Forty-ninth edition |website=WHO |date=2020 |url=http://apps.who.int/gb/bd/pdf_files/BD_49th-en.pdf#page=7|url-status=live|archive-url=https://web.archive.org/web/20200401095256/https://apps.who.int/gb/bd/pdf_files/BD_49th-en.pdf#page=7|archive-date=1 April 2020}}</ref> The WHO's broad mandate includes advocating for universal healthcare, monitoring public health risks, coordinating responses to health emergencies, and promoting human health and well-being.<ref>{{Cite web|title=What we do|url=https://www.who.int/about/what-we-do|url-status=live|archive-url=https://web.archive.org/web/20200317145801/https://www.who.int/about/what-we-do|archive-date=17 March 2020|access-date=17 March 2020|website=World Health Organization|language=en}}</ref> The WHO has played a leading role in several public health achievements, most notably the [[Eradication of infectious diseases|eradication]] of [[smallpox]], the near-[[Polio eradication|eradication of polio]], and the development of an [[Ebola vaccine]]. Its current priorities include [[communicable disease]]s, particularly [[HIV/AIDS]], [[Ebola]], [[Coronavirus disease 2019|COVID-19]], [[malaria]] and [[tuberculosis]]; [[non-communicable disease]]s such as heart disease and cancer; [[Healthy eating|healthy diet]], nutrition, and [[food security]]; [[occupational health]]; and [[substance abuse]].<ref>{{Cite web |title=Core priorities |url=https://www.who.int/europe/about-us/our-work/core-priorities |access-date=2024-08-21 |website=www.who.int |language=en}}</ref><ref>{{Cite web |last1=Magazine |first1=Harvard Public Health |last2=Ghebreyesus |first2=Tedros Adhanom |date=2023-04-05 |title=75 years of WHO: Tedros' 5 priorities for a healthier world |url=https://harvardpublichealth.org/global-health/global-health-past-and-future-the-who-at-75/ |access-date=2024-08-21 |website=Harvard Public Health Magazine |language=en-US}}</ref>

==== Others ====
Most countries have their own governmental public health agency, often called the ministry of health, with responsibility for domestic health issues.

For example, in the [[United States]], state and local [[health department]]s are on the front line of public health initiatives. In addition to their national duties, the [[United States Public Health Service]] (PHS), led by the [[Surgeon General of the United States|Surgeon General of the United States Public Health Service]], and the [[Centers for Disease Control and Prevention]], headquartered in [[Atlanta, Georgia|Atlanta]], are also involved with international health activities.<ref>{{Cite book| vauthors = Alkhuli MA |url=https://books.google.com/books?id=PYZPDwAAQBAJ&q=In+the+United+States,+state+and+local+health+departments+are+on+the+front+line+of+public+health+initiatives.+In+addition+to+their+national+duties,+the+United+States+Public+Health+Service+(PHS),+led+by+the+Surgeon+General+of+the+United+States,+and+the+Centers+for+Disease+Control+and+Prevention,+headquartered+in+Atlanta,+are+also+involved+with+international+health+activities.&pg=PA242|title=English for Nursing and Medicine|publisher=دار الفلاح للنشر والتوزيع|isbn=978-9957-552-36-7|language=en}}</ref>

=== Public health programs ===

Most governments recognize the importance of public health programs in reducing the incidence of disease, disability, and the effects of [[aging]] and other physical and mental health conditions. However, public health generally receives significantly less government funding compared with medicine.<ref>{{cite report|publisher =World Health Organization |chapter = Public health principles and neurological disorders|title =Neurological Disorders: Public Health Challenges |location = Geneva|date= 2006 |chapter-url =https://www.who.int/mental_health/neurology/neurodiso/en/index.html}}</ref> Although the collaboration of local health and government agencies is considered best practice to improve public health, the pieces of evidence available to support this is limited.<ref>{{cite journal | vauthors = Hayes SL, Mann MK, Morgan FM, Kelly MJ, Weightman AL | title = Collaboration between local health and local government agencies for health improvement | journal = The Cochrane Database of Systematic Reviews | volume = 2012 | issue = 10 | pages = CD007825 | date = October 2012 | pmid = 23076937 | pmc = 9936257 | doi = 10.1002/14651858.CD007825.pub6 }}</ref> Public health programs providing [[vaccination]]s have made major progress in promoting health, including substantially reducing the occurrence of [[cholera]] and [[polio]] and eradicating [[smallpox]], diseases that have plagued humanity for thousands of years.<ref name="Butcher">{{cite journal | vauthors = Butcher L |title=Pandemic puts all eyes on public health |journal=Knowable Magazine |date=17 November 2020 |doi=10.1146/knowable-111720-1|doi-access=free |url=https://knowablemagazine.org/article/health-disease/2020/pandemic-puts-all-eyes-public-health |access-date=2 March 2022}}</ref>

[[File:Directors of Global Smallpox Eradication Program.jpg|thumb|Three former directors of the [[Smallpox#Eradication|Global Smallpox Eradication Program]] reading the news that smallpox had been globally eradicated, 1980]]

The World Health Organization (WHO) identifies core functions of public health programs including:<ref>World Health Organization. [https://www.who.int/about/role/en/ ''The role of WHO in public health''], accessed 19 April 2011.</ref>
* providing leadership on matters critical to health and engaging in partnerships where joint action is needed;
* shaping a [[research]] agenda and stimulating the generation, translation and [[dissemination]] of valuable knowledge;
* setting norms and standards and promoting and monitoring their implementation;
* articulating ethical and [[evidence-based policy]] options;
* monitoring the health situation and assessing health trends.

In particular, public health surveillance programs can:<ref>World Health Organization. [https://www.who.int/topics/public_health_surveillance/en/ ''Public health surveillance''], accessed 19 April 2011.</ref>
* serve as an [[early warning system]] for impending public health emergencies;
* document the impact of an intervention, or track progress towards specified goals; and
* monitor and clarify the epidemiology of health problems, allow priorities to be set, and inform [[public health policy|health policy]] and strategies.
* diagnose, investigate, and monitor health problems and health hazards of the community

The "Truth" campaign, launched by the American Legacy Foundation in 2000. This campaign aimed to educate and discourage young people from smoking by exposing the tobacco industry's deceptive practices. Through a combination of powerful visuals, persuasive storytelling, and relatable messaging, the "Truth" campaign successfully reduced smoking rates among teenagers and young adults. <ref>https://placebased.media/blog/public-health-advertising</ref>

=== Behavior change ===
[[File:HarmCausedByDrugsTableDetailed.svg|thumb|350px|The 2010 [[Independent Scientific Committee on Drugs|ISCD]] study "Drug Harms in the UK: a [[Multicriteria decision analysis|multi-criteria decision analysis]]" found that [[alcohol (drug)|alcohol]] scored highest overall and in '''Economic cost''', '''Injury''', '''Family adversities''', '''Environmental damage''', and '''Community harm'''.]]
{{Main|Behavior change (public health)}}

Many health problems are due to maladaptive personal behaviors. From an [[evolutionary psychology]] perspective, over consumption of novel substances that are harmful is due to the activation of an evolved [[reward system]] for substances such as drugs, tobacco, [[Alcohol (drug)|alcohol]], [[Salt|refined salt]], [[fat]], and [[carbohydrate]]s. New technologies such as modern transportation also cause reduced [[physical activity]]. Research has found that [[Behavior change (public health)|behavior is more effectively changed]] by taking evolutionary motivations into consideration instead of only presenting information about health effects. The marketing industry has long known the importance of associating products with high status and attractiveness to others. Films are increasingly being recognized as a public health tool, with the [[Harvard University]]'s [[Harvard T.H. Chan School of Public Health|T.H. Chan School of Public Health]] categorizing such films as "impact filmmaking."<ref>{{Cite web |date=2023-08-30 |title=Impact Filmmaking As A Tool For Public Health Change |url=https://www.hsph.harvard.edu/event/impact-filmmaking-as-a-tool-for-public-health-change/ |access-date=2024-08-21 |website=Harvard T.H. Chan School of Public Health |language=en-US}}</ref> In fact, [[Public Health Film Festival|film festivals]] and [[International Public Health Film Competition|competitions]] have been established to specifically promote films about health.<ref>{{cite journal | vauthors = Botchway S, Hoang U | title = Reflections on the United Kingdom's first public health film festival | journal = Perspectives in Public Health | volume = 136 | issue = 1 | pages = 23–24 | date = January 2016 | pmid = 26702114 | doi = 10.1177/1757913915619120 | s2cid = 21969020 }}</ref> Conversely, it has been argued that emphasizing the harmful and undesirable effects of tobacco smoking on other persons and imposing smoking bans in public places have been particularly effective in reducing tobacco smoking.<ref>{{cite book | vauthors = Curtis V, Aunger R | chapter = Motivational mismatch: Evolved motives as the source of–and solution to–global public health problems. Applied evolutionary psychology | date = November 2011 | pages = 259–275 | veditors = Roberts SC | title = Applied Evolutionary Psychology | doi = 10.1093/acprof:oso/9780199586073.001.0001 | publisher = Oxford University Press | isbn = 978-0-19-958607-3 }}</ref> Public libraries can also be beneficial tools for public health changes. They provide access to healthcare information, link people to healthcare services, and even can provide direct care in certain situations.<ref>{{cite journal | vauthors = Philbin MM, Parker CM, Flaherty MG, Hirsch JS | title = Public Libraries: A Community-Level Resource to Advance Population Health | journal = Journal of Community Health | volume = 44 | issue = 1 | pages = 192–199 | date = February 2019 | pmid = 29995303 | pmc = 6329675 | doi = 10.1007/s10900-018-0547-4 }}</ref>

===Applications in health care===
As well as seeking to improve population health through the implementation of specific population-level interventions, public health contributes to medical care by identifying and assessing population needs for health care services, including:<ref>{{cite book| veditors = Gillam S, Yates J, Badrinath P |title=Essential Public Health: theory and practice |publisher=Cambridge University Press |year=2007 |oclc=144228591}}</ref><ref>{{cite book | veditors = Pencheon D, Melzer D, Gray M, Guest C |title=Oxford Handbook of Public Health Practice | location = Oxford |publisher=Oxford University Press |year=2006 |oclc=663666786 | isbn =  978-0-19-158541-8 }}</ref><ref>{{cite book | vauthors = Smith S, Sinclair D, Raine R, Reeves B |title=Health Care Evaluation |series=Understanding Public Health |publisher=Open University Press |year=2005|oclc=228171855}}</ref><ref>{{cite book | vauthors = Sanderson CJ, Gruen, Reinhold R |title=Analytical Models for Decision Making |series=Understanding Public Health |publisher=Open University Press |year=2006 |oclc=182531015 }}</ref>
* Assessing current services and evaluating whether they are meeting the objectives of the [[health care system]]
* Ascertaining requirements as expressed by [[health care provider|health professionals]], the public and other stakeholders
* Identifying the most appropriate interventions
* Considering the effect on resources for proposed interventions and assessing their cost-effectiveness
* Supporting decision making in health care and planning health services including any necessary changes.
* Informing, educating, and empowering people about health issues

=== Conflicting aims ===
Some programs and policies associated with public [[health promotion]] and prevention can be controversial. One such example is programs focusing on the prevention of [[HIV]] transmission through [[safe sex]] campaigns and [[needle-exchange programme|needle-exchange program]]s. Another is the control of [[tobacco smoking]]. Many nations have implemented [[tobacco smoking#Public policy|major initiatives]] to cut smoking, such as increased taxation and bans on smoking in some or all public places. Supporters argue by presenting evidence that smoking is one of the major killers, and that therefore governments have a duty to reduce the death rate, both through limiting [[Passive smoking|passive (second-hand) smoking]] and by providing fewer opportunities for people to smoke. Opponents say that this undermines individual freedom and personal responsibility, and worry that the state may be encouraged to remove more and more choice in the name of better population health overall.<ref>{{Cite web |last=updated |first=The Week Staff last |date=2022-06-10 |title=The pros and cons of a total smoking ban |url=https://theweek.com/news/science-health/957026/the-pros-and-cons-of-a-total-smoking-ban |access-date=2024-08-21 |website=theweek |language=en}}</ref>

Psychological research confirms this tension between concerns about public health and concerns about personal liberty: (i) the best predictor of complying with public health recommendations such as hand-washing, mask-wearing, and staying at home (except for essential activity) during the [[COVID-19 pandemic]] was people's perceived duties to prevent harm but (ii) the best predictor of flouting such public health recommendations was valuing liberty more than equality.<ref>{{cite journal | vauthors = Byrd N, Białek M | title = Your health vs. my liberty: Philosophical beliefs dominated reflection and identifiable victim effects when predicting public health recommendation compliance during the COVID-19 pandemic | journal = Cognition | volume = 212 | pages = 104649 | date = July 2021 | pmid = 33756152 | pmc = 8599940 | doi = 10.1016/j.cognition.2021.104649 | doi-access = free }}</ref>

Simultaneously, while communicable diseases have historically ranged uppermost as a [[global health]] priority, [[non-communicable disease]]s and the underlying behavior-related risk factors have been at the bottom. This is changing, however, as illustrated by the [[United Nations]] hosting its first General Assembly Special Summit on the issue of non-communicable diseases in September 2011.<ref>United Nations. [https://www.un.org/News/briefings/docs//2010/100513_Diseases.doc.htm ''Press Conference on General Assembly Decision to Convene Summit in September 2011 on Non-Communicable Diseases''.] New York, 13 May 2010.</ref>

== Global perspectives ==
[[File:Village_health_worker_checks,_Zimbabwe_(36273604714).jpg|thumb|A village health worker in [[Zimbabwe]] conducting a pediatric examination]]

=== Disparities in service and access ===
There is a significant disparity in access to health care and public health initiatives between [[Developed country|developed countries]] and [[Developing country|developing countries]], as well as within developing countries. In developing countries, public health infrastructures are still forming. There may not be enough trained [[health workforce|health workers]], monetary resources or, in some cases, sufficient knowledge to provide even a basic level of medical care and disease prevention.<ref name="Chen_2006">{{cite book | vauthors = Chen LC, Evans D, Evans T, Sadana R, [[Barbara Stilwell|Stilwell B]], Travis P, Van Lerberghe W, Zurn P |title=World Health Report 2006: working together for health |location=Geneva |publisher=WHO |year=2006 |oclc=71199185 }}</ref><ref name="Jamison 15–22">{{cite journal | vauthors = Jamison DT, Mosley WH | title = Disease control priorities in developing countries: health policy responses to epidemiological change | journal = American Journal of Public Health | volume = 81 | issue = 1 | pages = 15–22 | date = January 1991 | pmid = 1983911 | pmc = 1404931 | doi = 10.2105/ajph.81.1.15 }}</ref> As a result, a large majority of disease and mortality in developing countries results from and contributes to extreme [[poverty]]. For example, many African governments spend less than [[United States dollar|$]]100 USD per person per year on health care, while, in the United States, the [[federal government of the United States|federal government]] spent approximately $10,600 USD per capita in 2019.<ref>{{Cite web |title=World Bank Open Data |url=https://data.worldbank.org/ |access-date=2024-05-18 |website=World Bank Open Data}}</ref> However, expenditures on health care should not be confused with spending on public health. Public health measures may not generally be considered "health care" in the strictest sense. For example, mandating the use of seat belts in cars can save countless lives and contribute to the health of a population, but typically money spent enforcing this rule would not count as money spent on health care.
[[File:Malaria_rapid_diagnostic_test_3.jpg|thumb|A [[malaria]] test in [[Kenya]]. Despite being preventable and curable, malaria is a leading cause of death in many developing nations.<ref>{{Cite web |date=2021-01-26|title= Malaria – Malaria Worldwide – Impact of Malaria|url=https://www.cdc.gov/malaria/malaria_worldwide/impact.html|access-date=2021-10-19|website=CDC |language=en-us}}</ref><ref>{{Cite web|title=Fact sheet about Malaria|url=https://www.who.int/news-room/fact-sheets/detail/malaria|access-date=2021-10-19|website=World Health Organization|language=en}}</ref>]]
Large parts of the world remained plagued by largely preventable or treatable infectious diseases. In addition to this however, many developing countries are also experiencing an [[Epidemiological transition|epidemiological shift]] and [[Social polarization|polarization]] in which populations are now experiencing more of the effects of chronic diseases as life expectancy increases, the poorer communities being heavily affected by both chronic and infectious diseases.<ref name="Jamison 15–22" /> Another major public health concern in the developing world is poor [[Maternal health|maternal]] and child health, exacerbated by [[malnutrition]] and poverty. The [[WHO]] reports that a lack of [[Breastfeeding#Duration and exclusivity|exclusive breastfeeding]] during the first six months of life contributes to over a million avoidable child deaths each year.<ref name="World Health Organization">{{cite web |publisher=World Health Organization |url=https://www.who.int/features/factfiles/breastfeeding/en/index.html |title=10 facts on breastfeeding |access-date=20 April 2011}}</ref> [[Intermittent preventive therapy]] aimed at treating and preventing [[malaria]] episodes among pregnant women and young children is one public health measure in [[endemic (epidemiology)|endemic]] countries.

Since the 1980s, the growing field of [[population health]] has broadened the focus of public health from individual behaviors and [[risk factor]]s to population-level issues such as [[health equity|inequality]], poverty, and education. Modern public health is often concerned with addressing determinants of health across a population. There is a recognition that health is affected by many factors including class, race, income, educational status, region of residence, and [[social relation]]ships; these are known as "[[social determinants of health]]". The upstream drivers such as environment, education, employment, income, food security, housing, [[Social exclusion|social inclusion]] and many others effect the distribution of health between and within populations and are often shaped by policy.<ref>{{Cite book|url=https://books.google.com/books?id=7JxutqCmctUC&q=health+policy+interventions+-+the+United+Nations&pg=PP2|title=Equity, Social Determinants and Public Health Programmes |date=2010|publisher=World Health Organization|isbn=9789241563970}}</ref> A social gradient in health runs through society. The poorest generally have the worst health, but even the middle classes will generally have worse health outcomes than those of a higher social level.<ref>{{cite book |title=The Solid Facts: Social Determinants of Health | veditors = Wilkinson RG, Marmot MG |publisher=WHO |year=2003 |oclc=54966941 }}</ref> The new public health advocates for population-based policies that improve health in an equitable manner.

The health sector is one of Europe's most labor-intensive industries. In late 2020, it accounted for more than 21 million employment in the [[European Union]] when combined with social work.<ref>{{Cite web |title=Health and social care employees in Europe in 2021 |url=https://www.statista.com/statistics/554930/health-and-social-care-employment-in-europe/ |access-date=2024-05-18 |website=Statista |language=en}}</ref> According to the [[World Health Organization|WHO]], several countries began the [[COVID-19 pandemic]] with insufficient health and care professionals, inappropriate skill mixtures, and unequal geographical distributions. These issues were worsened by the pandemic, reiterating the importance of public health.<ref>{{Cite web | author = European Investment Bank |date=2023-02-02 |title=Health Overview 2023 |work=European Investment Bank |url=https://www.eib.org/en/publications/20220314-health-overview-2023 |language=EN}}</ref> In the United States, a history of underinvestment in public health undermined the public health workforce and support for population health, long before the pandemic added to stress, mental distress, job dissatisfaction, and accelerated departures among public health workers.<ref name="Jonathon">{{cite journal | vauthors = Leider JP, Yeager VA, Kirkland C, Krasna H, Hare Bork R, Resnick B | title = The State of the US Public Health Workforce: Ongoing Challenges and Future Directions | journal = Annual Review of Public Health | volume = 44 | issue = 1 | pages = 323–341 | date = April 2023 | pmid = 36692395 | doi = 10.1146/annurev-publhealth-071421-032830 | s2cid = 256192725 }}</ref> 

=== Health aid in developing countries ===
{{Further|Aid|Global Health Initiatives}}
[[File:ASC_Leiden_-_Coutinho_Collection_-_A_30_-_Surgery_in_Sara,_Guinea-Bissau_-_Continuing_the_operation_-_1974.tif|thumb|A Cuban doctor performs an open air operation in [[Guinea-Bissau]]. Cuba [[Cuban medical internationalism|sends more medical personnel]] to the developing world than all [[G8]] countries combined.<ref name="HuishKirk07">{{cite journal | vauthors = Huish R, Kirk JM | date =  2007 | title = Cuban Medical Internationalism and the Development of the Latin American School of Medicine | journal = Latin American Perspectives | volume = 34 | issue = 6 | pages = 77–92 | doi = 10.1177/0094582X07308119 }}</ref>]]
[[Aid|Health aid]] to developing countries is an important source of public health funding for many developing countries.<ref name="Bendavid_2014">{{cite journal | vauthors = Bendavid E, Bhattacharya J | title = The relationship of health aid to population health improvements | journal = JAMA Internal Medicine | volume = 174 | issue = 6 | pages = 881–887 | date = June 2014 | pmid = 24756557 | pmc = 4777302 | doi = 10.1001/jamainternmed.2014.292 }}</ref> Health aid to developing countries has shown a significant increase after World War II as concerns over the spread of disease as a result of [[globalization]] increased and the HIV/AIDS epidemic in sub-Saharan Africa surfaced.<ref name="Twumasi_1981">{{cite journal | vauthors = Twumasi PA | title = Colonialism and international health: a study in social change in Ghana | journal = Social Science & Medicine. Medical Anthropology | volume = 15B | issue = 2 | pages = 147–151 | date = April 1981 | pmid = 7244686 | doi = 10.1016/0160-7987(81)90037-5 }}</ref><ref name="Afridi_2013">{{Cite journal|date=1 March 2013|title=Impact of health aid in developing countries: The public vs. the private channels|journal=Economic Modelling|volume=31|pages=759–765|doi=10.1016/j.econmod.2013.01.009|issn=0264-9993| vauthors = Afridi MA, Ventelou B }}</ref> From 1990 to 2010, total health aid from developed countries increased from 5.5 billion to 26.87 billion with wealthy countries continuously donating billions of dollars every year with the goal of improving population health.<ref name="Afridi_2013" /> Some efforts, however, receive a significantly larger proportion of funds such as HIV which received an increase in funds of over $6 billion between 2000 and 2010 which was more than twice the increase seen in any other sector during those years.<ref name="Bendavid_2014" /> Health aid has seen an expansion through multiple channels including private philanthropy, [[non-governmental organization]]s, private foundations such as the [[Rockefeller Foundation]] or the [[Bill & Melinda Gates Foundation]], bilateral donors, and multilateral donors such as the [[World Bank]] or [[UNICEF]].<ref name="Afridi_2013" /> The result has been a sharp rise in uncoordinated and fragmented funding of an ever-increasing number of initiatives and projects. To promote better strategic cooperation and coordination between partners, particularly among bilateral development agencies and funding organizations, the [[Swedish International Development Cooperation Agency]] (Sida) spearheaded the establishment of ESSENCE,<ref>{{cite web|url=https://www.who.int/tdr/partnerships/essence/en/ | archive-url =  https://web.archive.org/web/20161203233606/https://www.who.int/tdr/partnerships/essence/en/| archive-date = 3 December 2016 |title=ESSENCE on Health Research | work = Special Programme for Research and Training in Tropical Diseases | publisher = World Health Organization }}</ref> an initiative to facilitate dialogue between donors/funders, allowing them to identify synergies. ESSENCE brings together a wide range of funding agencies to coordinate funding efforts.

In 2009 health aid from the [[OECD]] amounted to $12.47 billion which amounted to 11.4% of its total bilateral aid.<ref name="Shwank">{{cite web |url= http://www.un.org/en/development/desa/policy/wess/wess_bg_papers/bp_wess2012_schwank.pdf |website=UN |title=Global Health Initiatives and Aid Effectiveness in the Health Sector| vauthors = Shwank O }}</ref> In 2009, Multilateral donors were found to spend 15.3% of their total aid on bettering public healthcare.<ref name="Shwank" />

==== International health aid debates ====
Debates exist questioning the efficacy of international health aid. Supporters of aid claim that health aid from wealthy countries is necessary in order for developing countries to escape the [[poverty trap]]. Opponents of health aid claim that international health aid actually disrupts developing countries' course of development, causes dependence on aid, and in many cases the aid fails to reach its recipients.<ref name="Bendavid_2014" /> For example, recently, health aid was funneled towards initiatives such as financing new technologies like [[antiretroviral medication]], [[insecticide-treated mosquito net]]s, and new vaccines. The positive impacts of these initiatives can be seen in the eradication of smallpox and [[polio]]; however, critics claim that misuse or misplacement of funds may cause many of these efforts to never come into achievement.<ref name="Bendavid_2014" />

Economic modeling based on the [[Institute for Health Metrics and Evaluation]] and the [[World Health Organization]] has shown a link between international health aid in developing countries and a reduction in adult mortality rates.<ref name="Afridi_2013" /> However, a 2014–2016 study suggests that a potential confounding variable for this outcome is the possibility that aid was directed at countries once they were already on track for improvement.<ref name="Bendavid_2014" /> That same study, however, also suggests that 1 billion dollars in health aid was associated with 364,000 fewer deaths occurring between ages 0 and 5 in 2011.<ref name="Bendavid_2014" />

=== Sustainable development goals for 2030 ===
{{Further|Sustainable Development Goals#Health}}
To address current and future challenges in addressing health issues in the world, the [[United Nations]] have developed the [[Sustainable Development Goals]] to be completed by 2030.<ref>{{Cite web|title=2015 – United Nations sustainable development agenda|url=https://www.un.org/sustainabledevelopment/development-agenda/|access-date=25 November 2015|website=United Nations Sustainable Development |url-status=live |archive-url= https://web.archive.org/web/20151127081930/https://www.un.org/sustainabledevelopment/development-agenda/ |archive-date= Nov 27, 2015 }}</ref> These goals in their entirety encompass the entire spectrum of development across nations, however Goals 1–6 directly address [[health disparities]], primarily in developing countries.<ref name="UN2015">{{Cite web|title=Sustainable development goals |url=https://www.un.org/sustainabledevelopment/sustainable-development-goals/|access-date=25 November 2015|website=United Nations Sustainable Development |url-status=live |archive-url=https://web.archive.org/web/20151126091509/https://www.un.org/sustainabledevelopment/sustainable-development-goals/ |archive-date= Nov 26, 2015 }}</ref> These six goals address key issues in [[Global health|global public health]], [[poverty]], hunger and [[food security]], health, education, [[gender equality]] and [[women's empowerment]], and [[Drinking water|water]] and [[sanitation]].<ref name="UN2015" /> Public health officials can use these goals to set their own agenda and plan for smaller scale initiatives for their organizations. These goals are designed to lessen the burden of disease and inequality faced by developing countries and lead to a healthier future. The links between the various sustainable development goals and public health are numerous and well established.<ref name="UNhealth2015">{{Cite web|title=Health |url=https://www.un.org/sustainabledevelopment/health/|access-date=25 November 2015|website=United Nations Sustainable Development |url-status=live |archive-url=https://web.archive.org/web/20151202122238/https://www.un.org/sustainabledevelopment/health/ |archive-date= Dec 2, 2015 }}</ref><ref>{{Cite journal|title=World Development Report|url=https://openknowledge.worldbank.org/handle/10986/2124|access-date=25 November 2015|website=Open Knowledge Repository |url-status=dead |archive-url=https://web.archive.org/web/20160113162318/https://openknowledge.worldbank.org/handle/10986/2124  |archive-date= Jan 13, 2016 }}</ref>

==History==
{{Further|History of water supply and sanitation}}

===Until the 18th century===
[[File:Doutielt3.jpg|thumb|upright=1.35|Mass burials during the second plague pandemic (a.k.a. [[Black Death|the Black Death]]; 1346–1353) intensified urban responses to disaster on the basis of earlier practices. Miniature from "The Chronicles of Gilles Li Muisis" (1272–1352). Bibliothèque royale de Belgique, MS 13076–77, f. 24v.|alt=]]

From the beginnings of [[human civilization]], communities promoted [[health]] and fought [[disease]] at the population level.<ref name="Rosen_2015">{{Cite book| vauthors = Rosen G |title=A history of public health (Revised expanded)|date=2015|isbn=978-1-4214-1601-4|location=Baltimore | publisher = Johns Hopkins University Press |oclc=878915301}}</ref><ref name="Porter_1999">{{Cite book|title=Health, Civilization and the State: A History of Public Health from Ancient to Modern Times| vauthors = Porter D |publisher=Routledge|year=1999|isbn=978-0415200363|location=London and New York}}</ref> Definitions of health as well as methods to pursue it differed according to the medical, religious and natural-[[philosophical]] ideas groups held, the resources they had, and the changing circumstances in which they lived. Yet few early societies displayed the hygienic stagnation or even apathy often attributed to them.<ref>{{Cite book|title=Storia della medicina e della sanità in Italia: dalla peste nera ai giorni nostri| vauthors = Cosmacini G |publisher=Laterza|year=2005|location=Bari}}</ref><ref>{{Cite book| vauthors = Shephard RJ |title=An illustrated history of health and fitness, from pre-history to our post-modern world |publisher=Springer |date=2015|isbn=978-3-319-11671-6|location=Cham|oclc=897376985}}</ref><ref>{{cite book | vauthors = Berridge V |title=Public Health: A Very Short Introduction |date=2016 |publisher=Oxford University Press |location=Oxford, United Kingdom ; New York, NY, United States of America |isbn=978-0-19-968846-3 |edition=First}}</ref> The latter reputation is mainly based on the absence of present-day [[bioindicator]]s, especially [[Immunology|immunological]] and [[Statistics|statistical]] tools developed in light of the [[germ theory of disease]] transmission.<ref>{{Cite web |date=2020-05-25 |title=Public Health During the Industrial Revolution Facts, Worksheets & Issues |url=https://schoolhistory.co.uk/industrial/industrial-revolution/public-health-during-the-industrial-revolution/ |access-date=2024-08-21 |website=School History |language=en-US}}</ref><ref>{{Citation |title=National Center for Biotechnology Information |date=2004 |work=Science, Medicine, and Animals |url=https://www.ncbi.nlm.nih.gov/books/NBK24649/ |access-date=2024-08-21 |publisher=National Academies Press (US) |language=en}}</ref>

Public health was born neither in [[Europe]] nor as a response to the [[Industrial Revolution]]. Preventive health interventions are attested almost anywhere historical communities have left their mark. In [[Southeast Asia]], for instance, [[Ayurveda|Ayurvedic]] medicine and subsequently [[Buddhism]] fostered occupational, dietary and sexual regimens that promised balanced bodies, lives and communities, a notion strongly present in [[Traditional Chinese medicine#Concept of disease|Traditional Chinese Medicine]] as well.<ref>{{Cite journal| vauthors = Chattopadhyay A |date=1968|title=Hygienic Principles in the Regulations of Food Habits in the Dharma Sūtras|journal=Nagarjun|volume=11|pages=194–99}}</ref><ref>{{cite book | vauthors = Leung AK | chapter = Hygiène et santé publique dans la Chine pré-moderne | trans-chapter = Hygiene and public health in pre-modern China | title = Les hygienists. Enjeux, modèles et practiques | trans-title = The hygienists. Issues, models and practices | language = fr | veditors = Bourdelais P | pages = 343–371 | location = Paris | publisher = Belin | date = 2001 }}</ref> Among the [[Maya peoples|Mayans]], [[Aztecs]] and other early civilizations in the [[Americas]], population centers pursued hygienic programs, including by holding [[Medicinal plants|medicinal herbal]] markets.<ref>{{cite journal | vauthors = Harvey HR | title = Public health in Aztec society | journal = Bulletin of the New York Academy of Medicine | volume = 57 | issue = 2 | pages = 157–165 | date = March 1981 | pmid = 7011458 | pmc = 1805201 }}</ref> And among [[Aboriginal Australians]], techniques for preserving and protecting water and food sources, micro-zoning to reduce pollution and fire risks, and screens to protect people against [[flies]] were common, even in temporary camps.<ref>{{Cite book | vauthors = Memmott P |date= September 2008 |title=Gunyah, Goondie + Wurley: the Aboriginal architecture of Australia | publisher = University of Queensland Press | isbn = 978-0-7022-3245-9 }}</ref><ref>{{Cite book|title=Biggest Estate on Earth: How Aborigines made Australia.| vauthors = Gammage B |date=2014|publisher=Allen & Unwin|isbn=978-1-74269-352-1|oclc=956710111}}</ref>
[[File:Aztec_smallpox_victims.jpg|thumb|A depiction of Aztec [[smallpox]] victims]]
Western European, [[Byzantium|Byzantine]] and [[Muslim world|Islamicate]] civilizations, which generally adopted a [[Hippocrates|Hippocratic]], [[Galen]]ic or [[Four temperaments|humoral]] medical system, fostered preventive programs as well.<ref>{{Cite book|title=Infectious ideas: contagion in premodern Islamic and Christian thought in the Western Mediterranean| vauthors = Stearns JK |date=2011|publisher=Johns Hopkins Univ. Press|isbn=978-0-8018-9873-0|oclc=729944227}}</ref><ref>{{Cite book|title=Urban Bodies - Communal Health in Late Medieval English Towns and Cities.| vauthors = Rawcliffe C |date=2019|publisher=Boydell & Brewer, Limited|isbn=978-1-78327-381-2|oclc=1121393294}}</ref><ref>{{Cite book|title=Roads to Health: Infrastructure and Urban Wellbeing in Later Medieval Italy| vauthors = Geltner G |isbn=978-0-8122-5135-7|oclc=1076422219|publisher=University of Pennsylvania Press|year=2019}}</ref><ref>{{Cite book|title=Plague and Empire in the Early Modern Mediterranean World| vauthors = Varlik M |date=2015-07-22|publisher=Cambridge University Press|isbn=978-1-139-00404-6|doi=10.1017/cbo9781139004046|s2cid=197967256 }}</ref> These were developed on the basis of evaluating the quality of local [[climate]]s, including [[topography]], wind conditions and exposure to the sun, and the properties and availability of water and food, for both [[human]]s and nonhuman [[animal]]s. Diverse authors of [[Regimen sanitatis Salernitanum|medical]], [[De architectura|architectural]], [[De re aedificatoria|engineering]] and [[Byzantine military manuals|military manuals]] explained how to apply such theories to groups of different origins and under different circumstances.<ref>{{cite journal | vauthors = McVaugh MR | title = Arnald of Villanova's ''Regimen Almarie (Regimen Castra Sequentium'') and Medieval Military Medicine | journal = Viator | volume = 23 | date = 1992 | pages = 201–214 | doi = 10.1484/J.VIATOR.2.301280 }}</ref><ref>{{Cite book|title=Les régimes de santé au Moyen Âge Naissance et diffusion d'une écriture médicale en Italie et en France (XIIIe- XVe siècle)| vauthors = Nicoud M |date=2013|publisher=Publications de l'École française de Rome|isbn=978-2-7283-1006-7|oclc=960812022}}</ref><ref>{{Cite book|title=Medieval Islamic medicine: Ibn Riḍwān's treatise "On the prevention of bodily ills in Egypt.|last=Ibn Riḍwān|first='Alī Abū al-Ḥasan al-Miṣrī|author-link=Ali ibn Ridwan|orig-date=11th century|date=1984|publisher=University of California Press|oclc=469624320|translator-first=Michael W.|translator-last=Dols| veditors = Gamal AS }}</ref> This was crucial, since under Galenism bodily constitutions were thought to be heavily shaped by their material [[Biophysical environment|environments]], so their balance required specific regimens as they traveled during different [[seasons]] and between climate zones.<ref>{{cite book | vauthors = Rather LJ | title = The ''Six Things Non-Natural'': A Note on the Origins and Fate of a Doctrine and a Phrase | series = Clio Medica | date = 1968 | volume = 3 | pages = 337–347 }}</ref><ref>{{cite conference | vauthors = García-Ballester L | title = On the Origins of ''the Six Non-Natural Things'' in Galen | veditors = Kollesch J, Nickel D | conference = ''Galen und das hellenistische Erbe:'' Verhandlungen des IV. Internationalen Galen-Symposiums veranstaltet vom Institut für Geschichte der Medizin am Bereich Medizin (Charité) der Humboldt-Universität zu Berlin 18.-20. September 1989 | location = Stuttgart | date = 1993 }}</ref><ref>{{cite journal | vauthors = Geltner G, Coomans J | title = On the Street and in the Bath-House: Medieval Galenism in Action?= | journal = Anuario de Estudios Medievales | date = 2013 | volume = 43 | pages = 53–82 }}</ref>

In [[Complex society|complex]], [[Pre-industrial society|pre-industrialized societies]], interventions designed to reduce health risks could be the initiative of different stakeholders. For instance, in [[Ancient Greece|Greek]] and [[Ancient Rome|Roman antiquity]], army generals learned to provide for soldiers' wellbeing, including off the [[battlefield]], where most combatants died prior to the twentieth century.<ref>{{cite book | vauthors = Israelovich I | chapter = Medical Care in the Roman Army during the High Empire | title = Popular Medicine in Graeco-Roman Antiquity: Explorations | veditors = Harris MV | pages= 126–146 | location = Leiden | publisher = Brill | date = 2016 }}</ref><ref>{{cite journal | vauthors = Geltner G | title = In the Camp and on the March: Military Manuals as Sources for Studying Premodern Public Health | journal = Medical History | volume = 63 | issue = 1 | pages = 44–60 | date = January 2019 | pmid = 30556517 | pmc = 8670759 | doi = 10.1017/mdh.2018.62 | doi-access = free }}</ref> In [[Christianity|Christian]] [[Monastery|monasteries]] across the [[Eastern Mediterranean]] and western Europe since at least the fifth century [[Common Era|CE]], [[monk]]s and [[nun]]s pursued strict but balanced regimens, including nutritious [[Diet (nutrition)|diets]], developed explicitly to extend their lives.<ref>{{Cite book|title=Living and dying in England, 1100–1540: the monastic experience| vauthors = Harvey BF |date=2002|publisher=Clarendon Press|isbn=0-19-820431-0|oclc=612358999}}</ref> And [[Royal court|royal]], princely and [[Papal household|papal courts]], which were often mobile as well, likewise adapted their behavior to suit environmental conditions in the sites they occupied. They could also choose sites they considered salubrious for their members and sometimes had them modified.<ref>{{cite book | vauthors = Bagliani AP | chapter = La Mobilità della Curia romana nel Secolo XIII: Riflessi locali | trans-chapter =  The Mobility of the Roman Curia in the 13th Century: Local Reflections| title = Società e Istituzioni dell'Italia comunale: l'Esempio di Perugia (Secoli XII-XIV) | series = Quaderni Storici | trans-title = Society and Institutions of Municipal Italy: the Example of Perugia (12th-14th Centuries) | publisher = Società editrice Il Mulino S.p.A. | language = it | volume = 1–2 | location = Perugia | date = 1988 | issue = 61 (1) | pages = 313–316 | jstor = 43777964 }}</ref>

In [[City|cities]], residents and rulers developed measures to benefit the general [[population]], which faced a broad array of recognized [[Risk#Health|health risks]]. These provide some of the most sustained evidence for preventive measures in earlier civilizations. In numerous sites the upkeep of [[infrastructure]]s, including roads, canals and marketplaces, as well as [[zoning]] policies, were introduced explicitly to preserve residents' health.<ref>{{Cite journal| vauthors = Coomans J |date=February 2019|title=The king of dirt: public health and sanitation in late medieval Ghent|journal=Urban History|language=en|volume=46|issue=1|pages=82–105|doi=10.1017/S096392681800024X|issn=0963-9268|doi-access=free}}</ref> Officials such as the [[muhtasib]] in the Middle East and the [[Road master]] in Italy, fought the combined threats of [[pollution]] through [[sin]], [[Visual perception#Early studies|ocular intromission]] and [[Miasma theory|miasma]].<ref>{{cite journal | vauthors = Glick TF | title = New Perspectives on the Hisba and its Hispanic Derivatives | journal = Al-Qantara | volume = 13 | issue = 2 | date = 1992 | pages = 475–489 }}</ref><ref name="pmid16540700">{{cite journal | vauthors = Kinzelbach A | title = Infection, contagion, and public health in late medieval and early modern German imperial towns | journal = Journal of the History of Medicine and Allied Sciences | volume = 61 | issue = 3 | pages = 369–89 | date = July 2006 | pmid = 16540700 | doi = 10.1093/jhmas/jrj046 }}</ref><ref name="pmid18831288">{{cite journal | vauthors = Jørgensen D | title = Cooperative sanitation: Managing streets and gutters in late Medieval England and Scandinavia | journal = Technology and Culture | volume = 49 | issue = 3 | pages = 547–567 | date = July 2008 | pmid = 18831288 | doi = 10.1353/tech.0.0047 | url = http://urn.kb.se/resolve?urn=urn:nbn:se:ltu:diva-5405 }}</ref><ref>{{cite book | vauthors = Henderson J | chapter = Public Health, Pollution and the Problem of Waste Disposal in Early Modern Tuscany | title = Le interazioni fra economia e ambiente biologico nell'Europa preindustriale. Secc. XIII-XVIII | veditors = Cavaciocchi S | pages = 373–382 | location = Florence | publisher = Firenze University Press | date = 2010 }}</ref> Craft [[guild]]s were important agents of waste disposal and promoted [[harm reduction]] through honesty and [[Occupational safety and health|labor safety]] among their members. Medical practitioners, including public physicians,<ref>{{cite book | vauthors = Nutton V | chapter = Continuity or Rediscovery? The City Physician in Classical Antiquity and Mediaeval Italy | title = The Town and State Physician in Europe | veditors = Russell AW | pages = 9–46 | location = Wolfenbüttel | publisher =  Herzog August Bibliothek | date = 1981 }}</ref> collaborated with urban governments in predicting and preparing for calamities and identifying and isolating people perceived as [[Leprosy|lepers]], a disease with strong moral connotations.<ref>{{Cite book|title=Leprosy in medieval England| vauthors = Rawcliffe C |date=2009|publisher=The Boydell Press|isbn=978-1-84383-454-0|oclc=884314023}}</ref><ref>{{Cite book|title=Leprosy in premodern medicine: a malady of the whole body| vauthors = Demaitre LE |date=2007|publisher=Johns Hopkins University Press|isbn=978-0-8018-8613-3|oclc=799983230}}</ref> [[Neighbourhood|Neighborhoods]] were also active in safeguarding local people's health, by monitoring at-risk sites near them and taking appropriate social and legal action against artisanal polluters and neglectful owners of animals. Religious institutions, individuals and charitable organizations in both [[Islam]] and Christianity likewise promoted moral and physical wellbeing by endowing urban amenities such as wells, fountains, schools and bridges, also in the service of [[pilgrim]]s.<ref>{{Cite book|title=Poverty and charity in medieval islam: mamluk egypt, 1250–1517.| vauthors = Adam S |date=2006|publisher=Cambridge University Press|isbn=0-521-03474-4|oclc=712129032}}</ref><ref>{{cite book | vauthors = Cascoigne AL | chapter = The Water Supply of Tinnīs: Public Amenities and Private Investments | title = Cities in the Pre-Modern Islamic World: The Urban Impact of Religion, State and Society | veditors = Bennison AK, Gascoigne AL | pages = 161–176 | location = London | publisher = Routledge | date =  2007 }}</ref> In western Europe and Byzantium, religious [[procession]]s commonly took place, which purported to act as both preventive and curative measures for the entire community.<ref>{{cite book | vauthors = Horden P | chapter = Ritual and Public Health in the Early Medieval City". | title = Body and City: Histories of Urban Public Health | veditors = Sheard S, Power H | pages = 17–40 | location = Aldershot, UK | publisher = Ashgate | date = 2000 }}</ref>

Urban residents and other groups also developed preventive measures in response to calamities such as [[war]], [[famine]], [[flood]]s and [[Epidemic|widespread disease]].<ref>{{cite journal | vauthors = Falcón I | title = Aprovisionamiento y sanidad en Zaragoza en el siglo XV | trans-title = Provisioning and health in Zaragoza in the 15th century | language = es | journal = Acta Historica et Archaeologica Mediaeval | volume = 19 | date = 1998 | pages = 127–144 | url = https://www.raco.cat/index.php/ActaHistorica/article/download/193939/288132 }}</ref><ref>{{cite conference | vauthors = Balestracci D | title = The Regulation of Public Health in Italian Medieval Towns | veditors = Hundsbichler H, Jaritz G, Kühtreiber T | conference = Die Vielfalt der Dinge: Neue Wege zur Analyse mittelaltericher Sachkultur | location = Vienna | date = 1998 }}</ref><ref>{{cite journal | vauthors = Ewert UC | title = Water, Public Hygiene and Fire Control in Medieval Towns: Facing Collective Goods Problems while Ensuring the Quality of Life | journal = Historical Social Research/Historische Sozialforschung | volume = 32 | date = 2007 | pages = 222–252 }}</ref><ref name="pmid21674275">{{cite journal | vauthors = Petaros A, Skrobonja A, Culina T, Bosnar A, Frkovic V, Azman J | title = Public health problems in the medieval statutes of Croatian Adriatic coastal towns: from public morality to public health | journal = Journal of Religion and Health | volume = 52 | issue = 2 | pages = 531–7 | date = June 2013 | pmid = 21674275 | doi = 10.1007/s10943-011-9503-7 }}</ref> During and after the [[Black Death]] (1346–53), for instance, inhabitants of the [[Eastern Mediterranean]] and [[Western Europe]] reacted to massive population decline in part on the basis of existing medical theories and protocols, for instance concerning meat consumption and burial, and in part by developing new ones.<ref>{{Cite book|title=Sanitation in urban Britain, 1560–1700| vauthors = Skelton LJ |isbn=978-1-317-21789-3|oclc=933433427|year=2016|publisher=Routledge }}</ref><ref name="pmid6365216">{{cite journal | vauthors = Carmichael AG | title = Plague legislation in the Italian Renaissance | journal = Bulletin of the History of Medicine | volume = 57 | issue = 4 | pages = 508–25 | date = 1983 | pmid = 6365216 | doi =  }}</ref><ref>{{Cite journal| vauthors = Geltner G |title=The Path to Pistoia: Urban Hygiene Before the Black Death|url=https://academic.oup.com/past/advance-article/doi/10.1093/pastj/gtz028/5580562|journal=Past & Present|language=en|doi=10.1093/pastj/gtz028|year=2019|issue=246|pages=3–33|doi-access=free|hdl=11245.1/3cff1e5a-78b1-4f40-a754-a28ffbb456cf|hdl-access=free}}</ref> The latter included the establishment of [[quarantine]] facilities and health boards, some of which eventually became regular urban (and later national) offices.<ref>{{Cite book|title=Expelling the plague: the health office and the implementation of quarantine in Dubrovnik, 1377–1533|isbn=978-0-7735-4539-7|oclc=937888436| vauthors = Blažina-Tomić Z, Blažina V |year=2015|publisher=McGill-Queen's University Press }}</ref><ref name="pmid27303653">{{cite journal | vauthors = Gall GE, Lautenschlager S, Bagheri HC | title = Quarantine as a public health measure against an emerging infectious disease: syphilis in Zurich at the dawn of the modern era (1496-1585) | journal = GMS Hygiene and Infection Control | volume = 11 | issue = | pages = Doc13 | date = 2016 | pmid = 27303653 | pmc = 4899769 | doi = 10.3205/dgkh000273 }}</ref> Subsequent measures for protecting cities and their regions included issuing health [[passport]]s for travelers, deploying guards to create [[Cordon sanitaire (medicine)|sanitary cordons]] for protecting local inhabitants, and gathering morbidity and mortality statistics.<ref>{{Cite book|url=https://archive.org/details/cristofanoplague0000cipo|title=Cristofano and the plague: a study in the history of public health in the age of Galileo| vauthors = Cipolla CM |date=1973|publisher=University of California Press|isbn=0-520-02341-2|oclc=802505260|url-access=registration}}</ref><ref>{{Cite book|title=Plague and the poor in Renaissance Florence| vauthors = Carmichael AG |isbn=978-1-107-63436-7|oclc=906714501|year=2014|publisher=Cambridge University Press |orig-date=1986}}</ref><ref>{{Cite book|title=Cultures of plague: medical thinking at the end of the Renaissance| vauthors = Cohn S |date=2012|publisher=Oxford University Press|isbn=978-0-19-957402-5|oclc=825731416}}</ref>  Such measures relied in turn on better transportation and communication networks, through which news on human and animal disease was efficiently spread.

===After the 18th century===
With the onset of the [[Industrial Revolution]], living standards amongst the working population began to worsen, with cramped and unsanitary urban conditions. In the first four decades of the 19th century alone, [[London]]'s population doubled and even greater growth rates were recorded in the new industrial towns, such as [[Leeds]] and [[Manchester]]. This rapid [[urbanisation|urbanization]] exacerbated the spread of disease in the large [[conurbation]]s that built up around the [[workhouse]]s and [[factory|factories]]. These settlements were cramped and primitive with no organized [[sanitation]]. Disease was inevitable and its incubation in these areas was encouraged by the poor lifestyle of the inhabitants. Unavailable housing led to the rapid growth of [[slum]]s and the [[per capita]] [[death rate]] began to rise alarmingly, almost doubling in [[Birmingham]] and [[Liverpool]]. [[Thomas Malthus]] warned of the dangers of overpopulation in 1798. His ideas, as well as those of [[Jeremy Bentham]], became very influential in government circles in the early years of the 19th century.<ref name="Britannica" /> The latter part of the century brought the establishment of the basic pattern of improvements in public health over the next two centuries: a social evil was identified, private philanthropists brought attention to it, and changing public opinion led to government action.<ref name="Britannica">{{cite web|url=http://www.britannica.com/EBchecked/topic/482384/public-health/35547/National-developments-in-the-18th-and-19th-centuries|title=Public Health | vauthors = Rhodes P, Bryant JH |date = 20 May 2019 |publisher=Encyclopædia Britannica}}</ref> The 18th century saw rapid growth in voluntary hospitals in [[England]].<ref>{{cite book| vauthors = Carruthers GB, Carruthers LA |title=A History of Britain's Hospitals |date=2005|publisher=Book Guild Publishers|isbn=978-1-85776-905-0}}</ref>

The practice of [[vaccination]] began in the 1800s, following the pioneering work of [[Edward Jenner]] in treating [[smallpox]]. [[James Lind]]'s discovery of the causes of [[scurvy]] amongst sailors and its mitigation via the introduction of [[fruit]] on lengthy voyages was published in 1754 and led to the adoption of this idea by the [[Royal Navy]].<ref>{{cite journal | vauthors = Vale B | title = The Conquest of Scurvy in the Royal Navy 1793–1800: A Challenge to Current Orthodoxy | journal = [[The Mariner's Mirror]] | volume = 94 | issue = 2 | date = May 2008 | pages = 160–175 | doi = 10.1080/00253359.2008.10657052 }}</ref> Efforts were also made to promulgate health matters to the broader public; in 1752 the British physician Sir [[John Pringle (physician)|John Pringle]] published ''Observations on the Diseases of the Army in Camp and Garrison'', in which he advocated for the importance of adequate ventilation in the [[military]] [[barracks]] and the provision of [[latrine]]s for the soldiers.<ref>{{cite journal | vauthors = Selwyn S | title = Sir John Pringle: hospital reformer, moral philosopher and pioneer of antiseptics | journal = Medical History | volume = 10 | issue = 3 | pages = 266–274 | date = July 1966 | pmid = 5330009 | pmc = 1033606 | doi = 10.1017/s0025727300011133 | publication-date = July 1966 }}</ref>

====Public health legislation in England====
[[File:SirEdwinChadwick.jpg|thumb|right|upright=0.9|Sir [[Edwin Chadwick]] was a pivotal influence on the early public health campaign.]]

The first attempts at sanitary reform and the establishment of public health institutions were made in the 1840s. [[Thomas Southwood Smith]], physician at the [[London Fever Hospital]], began to write papers on the importance of public health, and was one of the first physicians brought in to give evidence before the [[Poor Law Commission]] in the 1830s, along with [[Neil Arnott]] and [[James Phillips Kay]].<ref>{{cite book| vauthors = Thomas AJ |title=The Lambeth cholera outbreak of 1848–1849: the setting, causes, course and aftermath of an epidemic in London|url=https://books.google.com/books?id=XGLd5hQ1-8UC&pg=PA56|year=2010|publisher=McFarland|isbn=978-0-7864-3989-8|pages=55–6}}</ref> Smith advised the government on the importance of [[quarantine]] and sanitary improvement for limiting the spread of infectious diseases such as [[cholera]] and [[yellow fever]].<ref>{{cite book| vauthors = Stacey M |title=The Sociology of Health and Healing|url=https://books.google.com/books?id=5IAUjCaEtCoC&pg=PA69|date=1 June 2004|publisher=Taylor and Francis|isbn=978-0-203-38004-8|page=69}}</ref><ref>{{cite book| vauthors = Finer SE |title=The Life and Times of Sir Edwin Chadwick|url=https://books.google.com/books?id=JycOAAAAQAAJ|year=1952|publisher=Methuen|isbn=978-0-416-17350-5|pages=424–5|author-link=Samuel Edward Finer}}</ref>

The Poor Law Commission reported in 1838 that "the expenditures necessary to the adoption and maintenance of measures of prevention would ultimately amount to less than the cost of the disease now constantly engendered". It recommended the implementation of large scale government [[engineering]] projects to alleviate the conditions that allowed for the propagation of disease.<ref name=Britannica/> The [[Health of Towns Association]] was formed at Exeter Hall London on 11 December 1844, and vigorously campaigned for the development of public health in the [[United Kingdom]].<ref name=Ashton>{{cite journal | vauthors = Ashton J, Ubido J | title = The healthy city and the ecological idea | journal = Social History of Medicine | volume = 4 | issue = 1 | pages = 173–180 | date = April 1991 | pmid = 11622856 | doi = 10.1093/shm/4.1.173 | url = http://www.johnrashton.securemachines.co.uk/documentbank/the%20healthy%20city%20and%20the%20ecological%20idea.pdf | access-date = 8 July 2013 | url-status = dead | archive-url = https://web.archive.org/web/20131224102422/http://www.johnrashton.securemachines.co.uk/documentbank/the%20healthy%20city%20and%20the%20ecological%20idea.pdf | archive-date = 24 December 2013 }}</ref> Its formation followed the 1843 establishment of the Health of Towns Commission, chaired by Sir [[Edwin Chadwick]], which produced a series of reports on poor and insanitary conditions in British cities.<ref name=Ashton/>

These national and local movements led to the [[Public Health Act 1848|Public Health Act]], finally passed in 1848. It aimed to improve the sanitary condition of towns and populous places in England and Wales by placing the supply of water, sewerage, drainage, cleansing and paving under a single local body with the General Board of Health as a central authority. The Act was passed by the [[Liberal Party (UK)|Liberal]] [[First Russell ministry|government]] of [[John Russell, 1st Earl Russell|Lord John Russell]], in response to the urging of Edwin Chadwick. Chadwick's seminal report on ''The Sanitary Condition of the Labouring Population'' was published in 1842<ref>{{cite book | title=excerpt from ''Report...from the Poor Law Commissioners on an Inquiry into the Sanitary Conditions of the Labouring Population of Great Britain'' (pp. 369–372) (online source)|chapter-url=http://www.victorianweb.org/history/chadwick2.html| vauthors = Chadwick E |chapter=Chadwick's Report on Sanitary Conditions | year=1842| publisher=to The Victorian Web|location=added by Laura Del Col|access-date=8 November 2009}}</ref> and was followed up with a supplementary report a year later.<ref>{{cite book | title=Report on the Sanitary Condition of the Labouring Population of Great Britain. A Supplementary Report on the results of a Special Inquiry into The Practice of Interment in Towns|url=https://archive.org/details/reportonsanitary00chaduoft| vauthors = Chadwick E | year=1843| publisher=Printed by R. Clowes & Sons, for Her Majesty's Stationery Office| location= London}} Full text at Internet Archive (archive.org)</ref> During this time, [[James Newlands]] (appointed following the passing of the 1846 Liverpool Sanatory Act championed by the Borough of Liverpool Health of Towns Committee) designed the world's first integrated sewerage system, in Liverpool (1848–1869), with [[Joseph Bazalgette]] later creating [[London sewerage system|London's sewerage system]] (1858–1875).

The Vaccination Act 1853 introduced compulsory [[Smallpox vaccine|smallpox vaccination]] in England and Wales.<ref>{{Cite book| vauthors = Brunton D |title=The Politics of Vaccination: Practice and Policy in England, Wales, Ireland, and Scotland, 1800–1874|publisher=University Rochester Press|year=2008|isbn=9781580460361|pages=39}}</ref> By 1871 legislation required a comprehensive system of registration run by appointed vaccination officers.<ref>{{Cite web|url=http://discover.ukdataservice.ac.uk/catalogue?sn=4127 |title=Decline of Infant Mortality in England and Wales, 1871–1948: a Medical Conundrum|access-date=17 December 2012}}</ref>

Further interventions were made by a series of subsequent [[Public Health Acts]], notably the [[Public Health Act 1875|1875 Act]]. Reforms included the building of [[sanitary sewer|sewer]]s, the regular [[waste disposal|collection of garbage]] followed by [[incineration]] or disposal in a [[landfill]], the [[History of water supply|provision of clean water]] and the draining of standing water to prevent the breeding of mosquitoes.

The [[Infectious Disease (Notification) Act 1889]] ([[52 & 53 Vict.]] c. 72) mandated the reporting of infectious diseases to the local sanitary authority, which could then pursue measures such as the removal of the patient to hospital and the disinfection of homes and properties.<ref>{{Cite book|title = Intrusive Interventions: Public Health, Domestic Space, and Infectious Disease Surveillance in England, 1840–1914| vauthors = Mooney G |publisher = University of Rochester Press|year = 2015|isbn = 9781580465274|location = Rochester, NY}}</ref>

==== Public health legislation in other countries ====
[[File:Illustrated Current News-1918-Thompson, Paul.png|thumb|Example of historical public health recommendations during the [[1918 flu pandemic]] in [[New Haven, Connecticut|New Haven]], Connecticut, United States]]
In the United States, the first public health organization based on a state health department and local boards of health was founded in [[New York City]] in 1866.<ref>United States Public Health Service, ''Municipal Health Department Practice for the Year 1923'' (Public Health Bulletin # 164, July 1926), pp.  348, 357, 364</ref>

During [[The Weimar Republic]], Germany faced many public health catastrophes.<ref>{{Cite web |title=Public Health under the Third Reich |url=https://perspectives.ushmm.org/collection/public-health-under-the-third-reich |access-date=2024-08-21 |website=perspectives.ushmm.org |language=en}}</ref> The [[Nazi Party]] had a goal of modernizing health care with ''Volksgesundheit'', German for ''people's public health''; this modernization was based on the growing field of [[eugenics]] and measures prioritizing group health over any care for the health of individuals.<ref>{{Cite journal |last=Eckart |first=W. U. |date= May 1989|title=[Public health service in the Weimar Republic and in the early history of West Germany] |url=https://pubmed.ncbi.nlm.nih.gov/2525688/ |journal=Das Offentliche Gesundheitswesen |volume=51 |issue=5 |pages=213–221 |issn=0029-8573 |pmid=2525688}}</ref> The end of World War 2 led to the [[Nuremberg Code]], a set of research ethics concerning human experimentation.<ref>{{cite journal | vauthors = Bachrach S | title = In the name of public health--Nazi racial hygiene | journal = The New England Journal of Medicine | volume = 351 | issue = 5 | pages = 417–420 | date = July 2004 | pmid = 15282346 | doi = 10.1056/NEJMp048136 | url = https://www.ushmm.org/m/pdfs/07192004-nazi-racial-hygiene-bachrach.pdf | url-status = live | archive-url = https://web.archive.org/web/20240114095559/https://www.ushmm.org/m/pdfs/07192004-nazi-racial-hygiene-bachrach.pdf | archive-date = Jan 14, 2024 }}</ref>

====Epidemiology====
[[File:Snow-cholera-map-1.jpg|thumb|Early [[Epidemiology|epidemiologist]] John Snow mapped [[Cluster (epidemiology)|clusters]] of cholera cases in London.]]
The science of [[epidemiology]] was founded by [[John Snow (physician)|John Snow]]'s identification of a polluted public water well as the source of an 1854 [[cholera]] outbreak in London. Snow believed in the [[germ theory]] of disease as opposed to the prevailing [[Miasma theory of disease|miasma theory]]. By talking to local residents (with the help of [[Reverend Henry Whitehead]]), he identified the source of the outbreak as the public water pump on Broad Street (now [[Broadwick Street]]). Although Snow's chemical and microscope examination of a water sample from the [[Broad Street pump]] did not conclusively prove its danger, his studies of the pattern of the disease were convincing enough to persuade the local council to close the well pump by removing its handle.<ref>{{cite book | vauthors = Vinten-Johansen P, Brody H, Paneth N, Rachman S, Rip M, Zuck D | date = 2003 | title = Cholera, Chloroform, and the Science of Medicine: A Life of John Snow | publisher = [[Oxford University Press]] | isbn = 0-19-513544-X}}</ref>

Snow later used a [[dot distribution map|dot map]] to illustrate the cluster of cholera cases around the pump. He also used statistics to illustrate the connection between the quality of the water source and cholera cases. He showed that the [[Southwark and Vauxhall Waterworks Company]] was taking water from sewage-polluted sections of the [[Thames]] and delivering the water to homes, leading to an increased incidence of cholera. Snow's study was a major event in the history of public health and geography. It is regarded as the founding event of the science of [[epidemiology]].<ref>{{cite book | vauthors = [[Steven Berlin Johnson|Johnson S]] | date = 2006 | title = [[The Ghost Map]]: The Story of London's Most Terrifying Epidemic – and How it Changed Science, Cities and the Modern World | publisher = [[Riverhead Books]] | isbn = 1-59448-925-4}}</ref><ref>{{cite book | vauthors = Porta M |title=A Dictionary of Epidemiology |url=http://global.oup.com/academic/product/a-dictionary-of-epidemiology-9780199976737?cc=us&lang=en |edition=6th |year=2014 |location=New York |publisher=Oxford University Press |isbn=978-0-19-997673-7}}</ref>

====Control of infectious diseases====
[[File:Paul-Louis Simond injecting plague vaccine June 4th 1898 Karachi.jpg|thumb|upright=0.9|[[Paul-Louis Simond]] injecting a plague vaccine in Karachi, 1898]]

With the pioneering work in [[bacteriology]] of French chemist [[Louis Pasteur]] and German scientist [[Robert Koch]], methods for isolating the [[bacteria]] responsible for a given disease and vaccines for remedy were developed at the turn of the 20th century. British physician [[Ronald Ross]] identified the [[mosquito]] as the carrier of [[malaria]] and laid the foundations for combating the disease.<ref>{{cite web | vauthors = Chowdhury JL | location = India | publisher = Eastern Panorama |url=http://easternpanorama.in/index.php?option=com_content&task=view&id=1123&Itemid=10|title= Laboc Hospital – A Noble Prize Winner's Workplace|access-date=11 July 2013|url-status=dead|archive-url=https://web.archive.org/web/20131105175214/http://easternpanorama.in/index.php?option=com_content&task=view&id=1123&Itemid=10|archive-date=5 November 2013}}</ref> [[Joseph Lister, 1st Baron Lister|Joseph Lister]] revolutionized [[surgery]] by the introduction of [[antiseptic]] [[surgery]] to eliminate [[infection]]. French epidemiologist [[Paul-Louis Simond]] proved that [[plague (disease)|plague]] was carried by [[flea]]s on the back of [[rat]]s,<ref>{{cite book | vauthors =  Marriott E | date = 1966 | title = Plague. A Story of Science, Rivalry and the Scourge That Won't Go Away | isbn = 978-1-4223-5652-4}}</ref> and Cuban scientist [[Carlos J. Finlay]] and U.S. Americans [[Walter Reed]] and [[James Carroll (scientist)|James Carroll]] demonstrated that mosquitoes carry the virus responsible for [[yellow fever]].<ref name = "Pineo_1996">{{cite book | vauthors = Pineo RF | chapter = Public Health | title =m Encyclopedia of Latin American History and Culture | volume = 4 | location = New York | publisher = Charles Scribner's Sons | date = 1996 }}</ref>{{rp|481}}<ref>{{cite book | vauthors = Pierce JR, Writer J |title=Yellow Jack: How Yellow Fever Ravaged America and Walter Reed Discovered its Deadly Secrets |date=2005 |publisher=J. Wiley |location=Hoboken, NJ |isbn=978-0-471-47261-2}}</ref> Brazilian scientist [[Carlos Chagas]] identified a [[Chagas disease|tropical disease]] and its vector.<ref name = "Pineo_1996" />{{rp|481}}

== Society and culture ==

===Education and training===
Education and training of public health professionals is available throughout the world in Schools of Public Health, Medical Schools, Veterinary Schools, Schools of Nursing, and Schools of Public Affairs. The training typically requires a [[university degree]] with a focus on core disciplines of [[biostatistics]], [[epidemiology]], [[Health administration|health services administration]], [[health policy]], [[health education]], [[behavioral science]], gender issues, sexual and reproductive health, public health nutrition, and [[occupational health|occupational]] and [[environmental health]].<ref name="mmwr4850">{{cite magazine|date=24 December 1999|title=Achievements in Public Health, 1900–1999|url=https://www.cdc.gov/mmwr/PDF/wk/mm4850.pdf|magazine=Morbidity and Mortality Weekly Report|publisher=U.S. Department of Health & Human Services|volume=48|number=50}}</ref><ref>Public Health Agency of Canada. [http://www.phac-aspc.gc.ca/php-psp/mphpg-mhplg/mphp-mhpp04-eng.php Canadian Public Health Workforce Core Competencies], accessed 19 April 2011.</ref>

In the global context, the field of public health education has evolved enormously in recent decades, supported by institutions such as the [[World Health Organization]] and the [[World Bank]], among others. Operational structures are formulated by strategic principles, with educational and career pathways guided by competency frameworks, all requiring modulation according to local, national and global realities. Moreover, integrating technology or digital platforms to connect to low health literacy LHL groups could be a way to increase health literacy. <ref>{{cite journal | vauthors = Murugesu L, Heijmans M, Rademakers J, Fransen MP | title = Challenges and solutions in communication with patients with low health literacy: Perspectives of healthcare providers | journal = PLOS ONE | volume = 17 | issue = 5 | pages = e0267782 | date = 2022-05-04 | pmid = 35507632 | pmc = 9067671 | doi = 10.1371/journal.pone.0267782 | bibcode = 2022PLoSO..1767782M | doi-access = free | veditors = Nayyar A }}</ref>It is critically important for the health of populations that nations assess their public health human resource needs and develop their ability to deliver this capacity, and not depend on other countries to supply it.<ref>{{cite journal | vauthors = White F | title = The Imperative of Public Health Education: A Global Perspective | journal = Medical Principles and Practice | volume = 22 | issue = 6 | pages = 515–529 | year = 2013 | pmid = 23969636 | pmc = 5586806 | doi = 10.1159/000354198 }}</ref> 

====Schools of public health: a US perspective====
In the [[United States]], the Welch-Rose Report of 1915<ref>{{Cite report|title=Institute of Hygiene: Being a report by Dr. William H. Welch and Wickliffe Rose to the General Education Board, Rockefeller Foundation| vauthors = Welch WH, Rose W |pages=660–668|year=1915}} reprinted in {{Cite book| vauthors = Fee E |url=http://www.deltaomega.org/documents/WelchRose.pdf|title=The Welch-Rose Report: Blueprint for Public Health Education in America|publisher=Delta Omega Honorary Public Health Society|year=1992|location=Washington, DC|archive-url=https://web.archive.org/web/20120507022011/http://www.deltaomega.org/documents/WelchRose.pdf|archive-date=7 May 2012}}</ref> has been viewed as the basis for the critical movement in the history of the institutional schism between public health and medicine because it led to the establishment of schools of public health supported by the [[Rockefeller Foundation]].<ref name="PHP">{{cite book| vauthors = Patel K, Rushefsky ME, McFarlane DR |title=The Politics of Public Health in the United States|publisher=M.E. Sharpe|year=2005|isbn=978-0-7656-1135-2|pages=91}}</ref> The report was authored by [[William H. Welch|William Welch]], founding dean of the [[Johns Hopkins Bloomberg School of Public Health]], and [[Wickliffe Rose]] of the Rockefeller Foundation. The report focused more on research than practical education.<ref name="PHP" /><ref>{{cite journal | vauthors = Brandt AM, Gardner M | title = Antagonism and accommodation: interpreting the relationship between public health and medicine in the United States during the 20th century | journal = American Journal of Public Health | volume = 90 | issue = 5 | pages = 707–715 | date = May 2000 | pmid = 10800418 | pmc = 1446218 | doi = 10.2105/AJPH.90.5.707 }}</ref> Some have blamed the Rockefeller Foundation's 1916 decision to support the establishment of schools of public health for creating the schism between public health and medicine and legitimizing the rift between medicine's laboratory investigation of the mechanisms of disease and public health's nonclinical concern with environmental and social influences on health and wellness.<ref name="PHP" /><ref>{{cite book| vauthors = White KL |url= https://archive.org/details/healingschismepi00whit|title=Healing the schism: Epidemiology, medicine, and the public's health|publisher=Springer-Verlag|year=1991|isbn=978-0-387-97574-0|location=New York}}</ref>

Even though schools of public health had already been established in [[Canada]], [[Europe]] and [[North Africa]], the United States had still maintained the traditional system of housing faculties of public health within their medical institutions.  A $25,000 donation from businessman [[Samuel Zemurray]] instituted the [[Tulane University School of Public Health and Tropical Medicine|School of Public Health and Tropical Medicine at Tulane University]] in 1912 conferring its first doctor of public health degree in 1914.<ref>{{cite book| vauthors = Darnell R |title=Histories of anthropology annual|publisher=University of Nebraska Press|year=2008|isbn=978-0-8032-6664-3|pages=36}}</ref><ref>{{cite book| vauthors = Dyer JP |title=Tulane: the biography of a university, 1834-1965|publisher=Harper & Row|year=1966|pages=136}}</ref>  The [[Yale School of Public Health]] was founded by [[Charles-Edward Amory Winslow]] in 1915.<ref>{{Cite book | vauthors = Burrow GN |title=A history of Yale's School of Medicine: passing torches to others|date=2002|publisher=Yale University Press|isbn=9780300132885|location=New Haven|oclc=182530966|url=https://archive.org/details/yalesschoolofmed00burr}}</ref> The [[Johns Hopkins School of Hygiene and Public Health]] was founded in 1916 and became an independent, degree-granting institution for research and training in public health, and the largest public health training facility in the United States.<ref>Education of the Physician: International Dimensions. ''Education Commission for Foreign Medical Graduates''., Association of American Medical Colleges. Meeting. (1984 : Chicago, Ill), p. v.</ref><ref>{{cite book | vauthors = Terris M | chapter = The Profession of Public Health | title = Conference on Education, Training, and the Future of Public Health | date = March 1987 | location = Washington, DC | publisher = Board on Health Care Services, National Academy Press | page = 53 }}</ref><ref>{{Cite journal| vauthors = Sheps CG |year=1973|title=Schools of Public Health in Transition|journal=The Milbank Memorial Fund Quarterly. Health and Society|volume=51|issue=4|pages=462–468|doi=10.2307/3349628|jstor=3349628}}</ref> By 1922, schools of public health were established at [[Columbia University|Columbia]] and [[Harvard]] on the Hopkins model. By 1999 there were twenty nine schools of public health in the US, enrolling around fifteen thousand students.<ref name="mmwr4850" /><ref name="PHP" />

Over the years, the types of students and training provided have also changed. In the beginning, students who enrolled in public health schools typically had already obtained a medical degree; public health school training was largely a second degree for [[physician|medical professionals]]. However, in 1978, 69% of American students enrolled in public health schools had only a [[bachelor's degree]].<ref name="mmwr4850" />

====Degrees in public health====
{{Main|Professional degrees of public health}}
[[File:London_School_of_Hygiene_and_Tropical_Medicine_Library_2017-09-12_2.jpg|thumb|The [[London School of Hygiene & Tropical Medicine]] is the oldest school of public health in the [[Anglosphere]].<ref>{{Cite book| vauthors = Kar SB |url=https://books.google.com/books?id=chJbDwAAQBAJ&q=London+School+of+Hygiene+and+Public+Health+oldest|title=Empowerment of Women for Promoting Health and Quality of Life|date=2018-05-18|publisher=Oxford University Press|isbn=978-0-19-938467-9|pages=69|language=en}}</ref>]]
Schools of public health offer a variety of degrees generally fall into two categories: professional or academic.<ref>{{cite web|date=11 March 2011|title=Schools of Public Health and Public Health Programs|url=http://www.ceph.org/pdf/Master_List.pdf|url-status=dead|archive-url=https://web.archive.org/web/20120611212645/http://www.ceph.org/pdf/Master_List.pdf|archive-date=11 June 2012|access-date=30 March 2011|publisher=[[Council on Education for Public Health]]}}</ref> The two major postgraduate degrees are the [[Master of Public Health]] (MPH) or the [[Master of Science]] in Public Health (MSPH). Doctoral studies in this field include [[Doctor of Public Health]] (DrPH) and [[Doctor of Philosophy]] (PhD) in a subspecialty of greater Public Health disciplines. DrPH is regarded as a professional degree and PhD as more of an academic degree.

Professional degrees are oriented towards practice in public health settings. The [[Master of Public Health]], [[Doctor of Public Health]], [[Doctor of Health Science]] (DHSc/DHS) and the [[Master of Health Administration|Master of Health Care Administration]] are examples of degrees which are geared towards people who want careers as practitioners of public health in health departments, managed care and community-based organizations, hospitals and consulting firms, among others. Master of Public Health degrees broadly fall into two categories, those that put more emphasis on an understanding of epidemiology and statistics as the scientific basis of public health practice and those that include a more wide range of methodologies.  A Master of Science of Public Health is similar to an MPH but is considered an academic degree (as opposed to a professional degree) and places more emphasis on scientific methods and research. The same distinction can be made between the DrPH and the DHSc: The DrPH is considered a professional degree and the DHSc is an academic degree.<ref>{{Cite web |last=Communications |first=Bouvé |date=2023-06-04 |title=Doctor of Health Science vs. Medical Science: Which Is Better? |url=https://bouve.northeastern.edu/news/doctor-of-health-science-vs-medical-science-which-is-better/ |access-date=2024-08-21 |website=Bouvé College of Health Sciences |language=en-US}}</ref><ref>{{Cite web |last=Bridgeport |first=University of |date=2021-08-25 |title=Ph.D. vs. Doctor of Health Science {{!}} University of Bridgeport |url=https://www.bridgeport.edu/news/phd-vs-doctor-of-health-science/ |access-date=2024-08-21 |website=University of Bridgeport News |language=en-US}}</ref><ref>{{Cite web |date=2022-12-01 |title=DrPH vs. PhD: What's the Difference? |url=https://publichealth.tulane.edu/blog/drph-vs-phd/ |access-date=2024-08-21 |website=publichealth.tulane.edu |language=en-US}}</ref>

Academic degrees are more oriented towards those with interests in the scientific basis of public health and [[preventive medicine]] who wish to pursue careers in research, university teaching in graduate programs, policy analysis and development, and other high-level public health positions. Examples of academic degrees are the [[Master of Science]], [[Doctor of Philosophy]], [[Doctor of Science]] (ScD), and Doctor of Health Science (DHSc). The doctoral programs are distinct from the MPH and other professional programs by the addition of advanced coursework and the nature and scope of a [[dissertation]] research project.

=== Notable people ===
* [[John Graunt]] (1620–1674)  was a British citizen scientist who laid the foundations for epidemiology.<ref>{{Cite journal| vauthors = Berke O, Sobkowich K, Bernardo TM|date= November 2020 |title=Celebration day: 400th birthday of John Graunt, citizen scientist of London|journal=Environmental Health Review|volume=63|issue=3|pages=67–69|doi=10.5864/d2020-018|s2cid=228938397|issn=0319-6771|doi-access=free}}</ref>
* [[Edward Jenner]] (1749–1823) created the [[smallpox vaccine]], the first vaccine in the world. He is often known as "the father of [[immunology]]".
* [[Benjamin Waterhouse]] (1753–1846) introduced the [[smallpox vaccine]] in the United States.
* [[Lemuel Shattuck]] (1793–1859) has been described as an "architect" and "prophet" of American public health<ref>{{cite journal | vauthors = Winkelstein W | title = Lemuel Shattuck: architect of American public health | language = en-US | journal = Epidemiology | volume = 19 | issue = 4 | pages = 634 | date = July 2008 | pmid = 18552594 | doi = 10.1097/EDE.0b013e31817307f2 | doi-access = free }}</ref>
* [[John Snow]] (1813–1858) was 'the father of modern epidemiology'.<ref>{{cite journal |last1=The Commonwealth Fund |title=Snow on cholera: A reprint of two paper: John Snow, M.D |journal=The Health Officer |date=1936 |volume=1 |issue=8 |page=306}}</ref>
* [[Joseph Bazalgette|Sir Joseph William Bazalgette]] (1819–1891) created a [[London sewerage system|sewer network for central London]] in response to the [[Great Stink]] of 1858. This proved instrumental in relieving the city from [[cholera]] epidemics.<ref>{{cite book| vauthors = Halliday S |title=The Great Stink of London: Sir Joseph Bazalgette and the Cleansing of the Victorian Metropolis|publisher=The History Press|year=2013|isbn=978-0752493787}}</ref>
* [[Louis Pasteur]] (1822–1895) conducted research that laid the foundation for our understanding of the causes and preventions of diseases.
* [[Robert Koch]] (1843–1910) used his discoveries to establish that germs "could cause a specific disease"<ref>{{cite book | chapter-url=https://www.ncbi.nlm.nih.gov/books/NBK24649/#:~:text=In%20the%20final%20decades%20of,and%20suspected%20they%20caused%20anthrax | title=Science, Medicine, and Animals | chapter=A Theory of Germs | date=4 January 2024 | publisher=National Academies Press (US) }}</ref>and directly provided proofs for that [[germ theory of diseases]], therefore creating the scientific basis of public health,<ref name="Lakhtakia_2014">{{cite journal | vauthors = Lakhtakia R | title = The Legacy of Robert Koch: Surmise, search, substantiate | journal = Sultan Qaboos University Medical Journal | volume = 14 | issue = 1 | pages = e37–e41 | date = February 2014 | pmid = 24516751 | pmc = 3916274 | doi = 10.12816/0003334 }}</ref> saving millions of lives.<ref>{{cite web | title = On this day (11.12.1843): Robert Koch: The Man who Saved Millions of Lives | url = https://history.info/on-this-day/1843-robert-koch-man-saved-millions-lives/ | work = history.info }}</ref>
* [[Charles V. Chapin]] (1856–1941) public health advocate and researcher credited with planting "the roots of quality in public health" in the United States<ref name="Beitsch">{{cite journal | vauthors = Beitsch LM, Yeager VA, Moran J | title = Deciphering the imperative: translating public health quality improvement into organizational performance management gains | journal = Annual Review of Public Health | volume = 36 | issue = 1 | pages = 273–287 | date = March 2015 | pmid = 25494050 | doi = 10.1146/annurev-publhealth-031914-122810 | doi-access = free }}</ref>
* [[Sara Josephine Baker]] (1873–1945) was an "instrumental force in child and maternal health"<ref>{{cite journal | vauthors = Hansen B | title = Public careers and private sexuality: some gay and lesbian lives in the history of medicine and public health | journal = American Journal of Public Health | volume = 92 | issue = 1 | pages = 36–44 | date = January 2002 | pmc = 1470556 | doi = 10.2105/AJPH.2005.079145 | pmid = 11772756 }}</ref>
* [[Nora Wattie]] (1900–1994) led the development of public health services and sanitation, and education in improving women and child health in the poorest [[slum]]s of [[Glasgow]], for which she received the [[Order of the British Empire|OBE]].<ref>{{Cite journal| vauthors = Mackie EM, Wilson TS |date=12 November 1994|title=Obituary N.I.Wattie|journal=British Medical Journal|volume=309|pages=1297}}</ref>
* [[Jonas Salk]] (1914–1995) developed one of the first [[polio vaccine]]s and campaigned vigorously for mandatory vaccinations.
* [[Ruth Huenemann]] (1910–2005) She became a pioneer in the study of [[childhood obesity]] in the 1960s studying the diet and exercise habits of Berkeley teenagers.<ref name="Asimov">{{cite news | vauthors = Asimov N |title=Ruth Huenemann – pioneer in study of childhood obesity |url=https://www.sfgate.com/bayarea/article/Ruth-Huenemann-pioneer-in-study-of-childhood-2578534.php |access-date=7 September 2022 |agency=SF Gate |publisher=Hearts Newspapers |date=1 September 2005}}</ref>
* [[Edmond Fernandes]] ( 1990-) Demonstrated proof of concept to end the burden of [[Malnutrition]] in India and around the world.<ref>{{Cite news |date=2023-08-27 |title=Mangalurean doctor's pilot project helps bring down malnutrition in Yelburga |work=The Times of India |url=https://timesofindia.indiatimes.com/city/mangaluru/mangalurean-doctors-pilot-project-helps-bring-down-malnutrition-in-yelburga/articleshow/103103565.cms?from=mdr |access-date=2023-09-23 |issn=0971-8257}}</ref>
* [[Dilip Mahalanabis]] - Credited to have evolved and utilized [[Oral rehydration therapy|ORS]] to save thousands of lives during the [[Bangladesh Liberation War|liberation war]]. 

== Country examples ==

{{World topic|Public health in|title=Public health by country|noredlinks=yes|state=show}}

=== Canada ===
In Canada, the [[Public Health Agency of Canada]] is the national agency responsible for public health, emergency preparedness and response, and infectious and [[chronic disease]] control and prevention.<ref>{{Cite web|title=Canada: International Health Care System Profiles|url=https://international.commonwealthfund.org/countries/canada/|access-date=2020-05-25|website=international.commonwealthfund.org}}</ref>

=== Cuba ===
Since the 1959 [[Cuban Revolution]], the [[Cuban government]] has devoted extensive resources to the improvement of [[Healthcare in Cuba|health conditions]] for its entire population via universal access to health care. Infant mortality has plummeted.<ref name = "Pineo_1996" />{{rp|483}} [[Cuban medical internationalism]] as a policy has seen the Cuban government sent doctors as a form of aid and export to countries in need in Latin America, especially [[Mission Barrio Adentro|Venezuela]], as well as Oceania and Africa countries.

===Colombia and Bolivia===
Public health was important elsewhere in Latin America in consolidating state power and integrating marginalized populations into the nation-state.  In Colombia, public health was a means for creating and implementing ideas of citizenship.<ref>{{cite thesis | vauthors = Jalil H | title = Curing a Sick Nation: Public Health and Citizenship in Colombia, 1930–1940 | degree = PhD | publisher = University of California, Santa Barbara | date = 2015 | url = https://www.proquest.com/openview/8857409366fdb10eb0deed2d240e299d/1?pq-origsite=gscholar&cbl=18750&diss=y }}</ref> In Bolivia, a similar push came after their 1952 revolution.<ref>{{cite thesis | vauthors = Pacino N | title = Prescription for a Nation: Public Health in Post-Revolutionary Bolivia, 1952–1964 | degree= PhD dissertation | publisher = University of California, Santa Barbara | date = 2013 | url = https://www.proquest.com/openview/1ecc715c16bd995ff30d8b8dc73ecb0c/1?pq-origsite=gscholar&cbl=18750 }}</ref>

=== Ghana ===
[[File:Children_received_ITNs_during_a_school_distribution_in_Ghana_(14011793910).jpg|thumb|Ghanaian children receive insecticide-treated bed nets to prevent exposure to [[malaria]] transmitting mosquitos. ]]
Though curable and preventive, malaria remains a major public health issue and is the third leading cause of death in Ghana.<ref>{{Cite web|title= Ghana|url=https://www.cdc.gov/globalhealth/countries/ghana/|access-date=9 April 2018|website=CDC Global Health }}</ref> In the absence of a vaccine, mosquito control, or access to anti-malaria medication, public health methods become the main strategy for reducing the prevalence and severity of malaria.<ref name="Agyepong_1999">{{cite journal | vauthors = Agyepong IA, Manderson L | title = Mosquito avoidance and bed net use in the Greater Accra Region, Ghana | journal = Journal of Biosocial Science | volume = 31 | issue = 1 | pages = 79–92 | date = January 1999 | pmid = 10081239 | doi = 10.1017/S0021932099000796 | s2cid = 42129995 }}</ref> These methods include reducing breeding sites, screening doors and windows, insecticide sprays, prompt treatment following infection, and usage of insecticide treated mosquito nets.<ref name="Agyepong_1999" /> Distribution and sale of insecticide-treated mosquito nets is a common, cost-effective anti-malaria public health intervention; however, barriers to use exist including cost, household and family organization, access to resources, and social and behavioral determinants which have not only been shown to affect malaria prevalence rates but also mosquito net use.<ref>{{Cite web|title=Ghana Demographic and Health Survey 2014|url=https://dhsprogram.com/pubs/pdf/fr307/fr307.pdf|access-date=18 May 2020}}</ref><ref name="Agyepong_1999" />

=== France ===
{{excerpt|Health care in France#Public health initiatives (1871–1914)|paragraphs=1,2}}

===Mexico===
{{excerpt|Healthcare in Mexico#Public health|paragraphs=1,2|file=no}}

=== United States ===

{{excerpt|United States Public Health Service|paragraphs=1,2|file=no}}

The United States lacks a coherent system for the governmental funding of public health, relying on a variety of agencies and programs at the federal, state and local levels.<ref name="Leider">{{cite journal | vauthors = Leider JP, Resnick B, Bishai D, Scutchfield FD | title = How Much Do We Spend? Creating Historical Estimates of Public Health Expenditures in the United States at the Federal, State, and Local Levels | journal = Annual Review of Public Health | volume = 39 | issue = 1 | pages = 471–487 | date = April 2018 | pmid = 29346058 | doi = 10.1146/annurev-publhealth-040617-013455 | doi-access = free }}</ref>
Between 1960 and 2001, public health spending in the United States tended to grow,
based on increasing expenditures by state and local government, which made up 80–90% of
total public health spending.  Spending in support of public health in the United States peaked in 2002 and declined in the following decade.<ref name="Himmelstein">{{cite journal | vauthors = Himmelstein DU, Woolhandler S | title = Public Health's Falling Share of US Health Spending | journal = American Journal of Public Health | volume = 106 | issue = 1 | pages = 56–57 | date = January 2016 | pmid = 26562115 | pmc = 4695931 | doi = 10.2105/AJPH.2015.302908 }}</ref> State cuts to public health funding during the [[Great Recession]] of 2007–2008 were not restored in subsequent years.<ref name="Alfonso">{{cite journal | vauthors = Alfonso YN, Leider JP, Resnick B, McCullough JM, Bishai D | title = US Public Health Neglected: Flat Or Declining Spending Left States Ill Equipped To Respond To COVID-19 | journal = Health Affairs | volume = 40 | issue = 4 | pages = 664–671 | date = April 2021 | pmid = 33764801 | pmc = 9890672 | doi = 10.1377/hlthaff.2020.01084 | s2cid = 232367227 }}</ref>
As of 2012, a panel for the  [[U.S. Institute of Medicine]] panel warned that the United States spends disproportionately far more on clinical care than it does on public health, neglecting "population-based activities that offer efficient and effective approaches to improving the nation's health."<ref name="IOM2012">{{cite book |last1=Institute of Medicine |title=For the Public's Health: Investing in a Healthier Future |date=2012 |publisher=The National Academies Press |location=Washington, DC |isbn=978-0-309-22107-8 |page=2 |doi=10.17226/13268 |pmid=24830052 |language=en}}</ref><ref name="Himmelstein"/>  {{as of|2018}}, about 3% of government health spending was directed to public health and prevention.<ref name="Butcher"/><ref name="California">{{cite web |title=Health Care Costs Accounted for 17.7 Percent of GDP in 2018 |url=https://www.chcf.org/blog/health-care-costs-accounted-17-7-percent-gdp-2018/#related-links-and-downloads |website=California Health Care Foundation |access-date=2 March 2022 |date=2 June 2020}}</ref><ref name="Nunn">{{cite web | vauthors = Nunn R, Parsons J, Shambaugh J |title=A dozen facts about the economics of the US health-care system |url=https://www.brookings.edu/research/a-dozen-facts-about-the-economics-of-the-u-s-health-care-system/ |website=Brookings Institution |access-date=2 March 2022 |date=10 March 2020}}</ref> This situation has been described as an "uneven patchwork"<ref name="Wallace">{{cite journal | vauthors = Wallace M, Sharfstein JM | title = The Patchwork U.S. Public Health System | journal = The New England Journal of Medicine | volume = 386 | issue = 1 | pages = 1–4 | date = January 2022 | pmid = 34979071 | doi = 10.1056/NEJMp2104881 | s2cid = 245640052 }}</ref> and "chronic underfunding".<ref>{{cite web |title=Explore Public Health Funding in the United States {{!}} 2021 Annual Report |url=https://www.americashealthrankings.org/explore/annual/measure/PH_funding/state/ALL |website=America's Health Rankings |access-date=2 March 2022 |language=en}}</ref><ref name="Yale">{{cite news |title=GHJP Report Calls for Reinvestment to Revive Public Health in the U.S. |url=https://law.yale.edu/yls-today/news/ghjp-report-calls-reinvestment-revive-public-health-us |access-date=2 March 2022 |work=Yale Law School |date=June 7, 2021 |language=en}}</ref><ref name="Eager">{{cite book | vauthors = Eager W, Herman D, House M, Robinson L, Williams C |title=Confronting a legacy of scarcity: a plan for America's reinvestment in U.S. public health |date=2021 |publisher=Yale School of Public Health |url=https://law.yale.edu/sites/default/files/area/center/ghjp/documents/publichealthfunding_final_6.7.21.pdf}}</ref><ref name="tfah">{{cite web |title=The Impact of Chronic Underfunding on America's Public Health System: Trends, Risks, and Recommendations, 2021 |url=https://www.tfah.org/report-details/pandemic-proved-underinvesting-in-public-health-lives-livelihoods-risk/ |website=Trust for America's Health |date=May 7, 2021 |access-date=2 March 2022}}</ref>
The [[COVID-19 pandemic]] has been seen as drawing attention to problems in the public health system in the United States and to a lack of understanding of public health and its important role as a [[common good]].<ref name="Butcher"/>

== See also ==
{{Div col|colwidth=25em|content=* [[Global health]]
* [[Harm reduction]]
* [[Health care]]
* [[Health equity]]
* [[Health policy]]
* [[Health system]]
* [[Health law]]
* [[Effects of climate change on human health]]
* [[European Public Health Association]]
* [[Post-assault treatment of sexual assault victims]]
* [[List of national public health agencies]]
* [[Universal health care]]}}

== References ==
{{Reflist}}

{{offline|med}}
{{subject bar|portal1=Medicine||portal2=Society|portal3=Psychiatry|portal4=Psychology|portal5=Human sexuality|portal6=Cannabis|portal7=COVID-19|wikt=yes|commons=yes|commons-search=Category:Public health|q=yes|v=yes|v-search=Public health|s=yes|s-search=Portal:Public health|b=yes|d=yes|d-search=Q189603}}
{{Public health}}
{{Occupational safety and health}}
{{Social sciences}}
{{Concepts in infectious disease}}
{{Authority control}}

{{DEFAULTSORT:Public Health}}
[[Category:Public health| ]]
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[[Category:Health economics]]
[[Category:Health policy]]
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