1.4: Public Health and Medicine
- Page ID
- 116078
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\(\newcommand{\avec}{\mathbf a}\) \(\newcommand{\bvec}{\mathbf b}\) \(\newcommand{\cvec}{\mathbf c}\) \(\newcommand{\dvec}{\mathbf d}\) \(\newcommand{\dtil}{\widetilde{\mathbf d}}\) \(\newcommand{\evec}{\mathbf e}\) \(\newcommand{\fvec}{\mathbf f}\) \(\newcommand{\nvec}{\mathbf n}\) \(\newcommand{\pvec}{\mathbf p}\) \(\newcommand{\qvec}{\mathbf q}\) \(\newcommand{\svec}{\mathbf s}\) \(\newcommand{\tvec}{\mathbf t}\) \(\newcommand{\uvec}{\mathbf u}\) \(\newcommand{\vvec}{\mathbf v}\) \(\newcommand{\wvec}{\mathbf w}\) \(\newcommand{\xvec}{\mathbf x}\) \(\newcommand{\yvec}{\mathbf y}\) \(\newcommand{\zvec}{\mathbf z}\) \(\newcommand{\rvec}{\mathbf r}\) \(\newcommand{\mvec}{\mathbf m}\) \(\newcommand{\zerovec}{\mathbf 0}\) \(\newcommand{\onevec}{\mathbf 1}\) \(\newcommand{\real}{\mathbb R}\) \(\newcommand{\twovec}[2]{\left[\begin{array}{r}#1 \\ #2 \end{array}\right]}\) \(\newcommand{\ctwovec}[2]{\left[\begin{array}{c}#1 \\ #2 \end{array}\right]}\) \(\newcommand{\threevec}[3]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \end{array}\right]}\) \(\newcommand{\cthreevec}[3]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \end{array}\right]}\) \(\newcommand{\fourvec}[4]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \\ #4 \end{array}\right]}\) \(\newcommand{\cfourvec}[4]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \\ #4 \end{array}\right]}\) \(\newcommand{\fivevec}[5]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \\ #4 \\ #5 \\ \end{array}\right]}\) \(\newcommand{\cfivevec}[5]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \\ #4 \\ #5 \\ \end{array}\right]}\) \(\newcommand{\mattwo}[4]{\left[\begin{array}{rr}#1 \amp #2 \\ #3 \amp #4 \\ \end{array}\right]}\) \(\newcommand{\laspan}[1]{\text{Span}\{#1\}}\) \(\newcommand{\bcal}{\cal B}\) \(\newcommand{\ccal}{\cal C}\) \(\newcommand{\scal}{\cal S}\) \(\newcommand{\wcal}{\cal W}\) \(\newcommand{\ecal}{\cal E}\) \(\newcommand{\coords}[2]{\left\{#1\right\}_{#2}}\) \(\newcommand{\gray}[1]{\color{gray}{#1}}\) \(\newcommand{\lgray}[1]{\color{lightgray}{#1}}\) \(\newcommand{\rank}{\operatorname{rank}}\) \(\newcommand{\row}{\text{Row}}\) \(\newcommand{\col}{\text{Col}}\) \(\renewcommand{\row}{\text{Row}}\) \(\newcommand{\nul}{\text{Nul}}\) \(\newcommand{\var}{\text{Var}}\) \(\newcommand{\corr}{\text{corr}}\) \(\newcommand{\len}[1]{\left|#1\right|}\) \(\newcommand{\bbar}{\overline{\bvec}}\) \(\newcommand{\bhat}{\widehat{\bvec}}\) \(\newcommand{\bperp}{\bvec^\perp}\) \(\newcommand{\xhat}{\widehat{\xvec}}\) \(\newcommand{\vhat}{\widehat{\vvec}}\) \(\newcommand{\uhat}{\widehat{\uvec}}\) \(\newcommand{\what}{\widehat{\wvec}}\) \(\newcommand{\Sighat}{\widehat{\Sigma}}\) \(\newcommand{\lt}{<}\) \(\newcommand{\gt}{>}\) \(\newcommand{\amp}{&}\) \(\definecolor{fillinmathshade}{gray}{0.9}\)Public health and clinical medicine are both important to health. They work together for greater impact. However, they each have a distinct focus and set of tools. Most of us are familiar with medicine, having spent time in a clinic or hospital at some point. Far fewer people have ever visited a public health agency. Let's explore some of the differences and similarities between public health and medicine.
There is a parallel between the distinction "upstream" / "downstream" and the distinction "public health" / "medicine."
This is also talked about sometimes as the difference between the bio-medical approach, and the systems-approach. In general, public health is focused on systems and prevention (upstream) and medicine is focused on individual bodies and treatment (downstream).
The following chart compares the two disciplines:
| Public Health | Medicine |
|---|---|
|
Primary focus is prevention |
Primary focus is treatment and cure Focuses on individual patients Well-defined profession, well-known Care for the whole patient is primary |
Both disciplines are essential to health, of course.
- In the middle of a heart attack, I want a doctor, not a public health worker!
- To prevent a heart attack, I'm happy that public health workers have reduced my exposure to second-hand smoke and unhealthy ingredients in food, and continue to remind me to get more exercise.
- In many areas, public health and medicine work together -- for example, in ensuring that the population receives needed vaccines.
- Some individuals work in BOTH fields at once. There are doctors and nurses employed in public health agencies, and there are community health workers and other public health advocates who work in clinics.
- In addition, preventative medicine is a growing focus for doctors and other healthcare providers who use medicine to prevent disease, not just treat it. They still focus on treatment of the individual -- not on population health -- yet share with public health a focus on prevention.
Two Models: Biomedical and Social Ecological
Later in this chapter, you will see a contrast of two models or ways of thinking about health problems. One is more aligned with medicine and its strengths -- the biomedical model. The other is more aligned with public health and its strengths -- the social ecological model. Both models rely heavily on evidence drawn from science, both share a focus on prevention, yet the biomedical model also incorporates treatment and a stronger focus on individual health outcomes, rather than population health.
Costa Rica: Full integration of Public Health and Medicine
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Costa Rica, a relatively poor country, can boast of a life expectancy greater than the US life expectancy. They have lower rates of many diseases than their neighboring countries. One key to this success is the full integration of public health with their system for delivering primary care (the first level of medical care) to all their residents. The same team of doctor, nurse, and community health workers who treat a person's diabetes also survey the community for health risks like bad water and follow up with all residents needing vaccines. Even at the national level, the system that oversees hospitals and clinics is merged with the national public health agency (their CDC). This deep integration of prevention and treatment has produced remarkable results!
If you want to learn more about this, the following brief video summarizes one study of Costa Rica's success in integration of prevention and treatment through their primary care system, resulting in longer and healthier lives:
In the United States, most state and federal dollars spent on health go toward medical care, not public health, yet public health often provides a greater impact for the money -- as they say, an ounce of prevention is worth a pound of cure. That's just one reason why it's important for more people to understand the work of public health!
Try out this activity to check your understanding:
Are these examples of public health or medicine? (Or could some of them be both?)
Screening for high blood pressure
Treating cancer
Installing speed bumps in a neighborhood to slow traffic
Building affordable housing
Promoting the eating of more fruits and vegetables
Vaccination
Teaching kindergarten students about brushing and flossing their teeth
Setting a broken leg in a cast
Providing condoms for free
References
Citation: article from the New Yorker (fix format)
(Image of a stream courtesy of http://www.flickr.com/photos/nov03/ - with a Creative Commons license allowing use with attribution. CORRECT CITATION FORMAT)