588027 research-article2015

RSH0010.1177/1757913915588027Letters to the editorLetters to the editor

Letters to the editor

RESPONSE TO GRIFFITHS PAPER - PUBLIC HEALTH SPECIALIST WORKFORCE TRAINING It is interesting to see Sian Griffiths1 quoting the adage ‘public health is everybody’s business’. Along with a number of other articles in the same issue of the journal, the suggested approach to addressing current challenges facing public health is to examine itself from other people’s perspectives. Those with good memories will recall the quality profession had a similar problem, which can become the equivalent of ‘public health is somebody else’s business’. The quality profession identified that they needed to change from being seen as a performance monitoring agent to one that provided change management, adding value to those agencies it worked with. In essence, let the people who are being monitored own their performance metrics and not expect another agency to spend time chasing them. Public health, like quality, needs to show corporate and value-adding credentials. In particular, providing an understanding of risk and contingency planning, along with root cause analysis, will provide organisations with a better understanding of their issues of concern and, most importantly, solutions to their solutions. In these times of constrained financial resources, it is also worth stressing the longer term vision required before the return on investment is seen. As David Hemenway2 highlights, politicians are all too

The definition of public health – where to shift the focus: prevention or population? In 1920, the American microbiologist and public health pioneer Charles-Edward Amory Winslow1 famously described public health as ‘the science and art of preventing disease’. Influenced by those words, public health is today commonly defined as the science of preventing diseases, as opposed to medicine, defined as the science of curing diseases. But public health is also frequently defined as the science of improving the health of populations, as opposed to medicine, defined as the science of improving the health of individuals. Unfortunately, these two criteria are not identical and using them as though they are as only serves to create confusion and inaccuracy. According to the individual-versus-population criterion, the relationship between a physician and her patient, with the former aiming at maximising the health of the latter, is the quintessential representation of medicine. However, according to the cure-versus-prevention criterion, the same relationship would not be suitable to represent medicine since a good physician aspiring to optimise patient health will also need to call into play preventive strategies. The foregoing is only one of the many cases of ambiguity. For instance, according to the individual-versus-population criterion, the study of the drug development process would be part of public health; yet, according to the cure-versus-prevention criterion, it would

aware of the election cycle; investments made by politicians of their political persuasion today may give rise to benefits for another of a different political persuasion. A further complicating factor for public health lies in its now weak link to the National Health Service, with its adoption of market-based solutions in the pursuit of efficiencies. Is public health seen as yet another external organisation chasing them with performance measures of dubious utility? Perhaps the future lies with the need for a public health function within provider organisations as historically was the case. Looking at population health should be an essential part of a provider organisation’s risk and contingency planning. For example, the policy emphasis to improve diagnosis rates for dementia could have major implications for provider organisations. How many have any understanding of the risks for their organisation, or indeed have taken contingency measures to address them? Sid Beauchant Information Adviser, Berkshire Healthcare NHS Foundation Trust, Bracknell, UK

References 1. 2.

Griffiths S. Public health specialist workforce training. Perspectives in Public Health 2014; 124(5): 243–4. Hemenway D. Why we don’t spend enough on public health. New England Journal of Medicine 2010; 362: 1657–8.

be part of medicine. Besides, according to the cure-versusprevention principle, all non-preventable diseases would lie outside the boundaries of public health. As the cases above well illustrate, the two criteria cannot be used interchangeably. To rigorously define public health, the scientific community would instead be better served by choosing and promoting just one of them. I believe that, as the examples above show, Winslow’s words have been slightly over-interpreted over the past century; in reality, although prevention is obviously key for good societal health, it is neither a prerequisite nor an exclusive condition for a population health approach. By contrast, the individualversus-population principle is more logical and intuitive, and it is this principle that should be used to distinguish public health from medicine. The use of rigorous and reasonable representations and definitions is important not only in itself but also as a means to improve the acquisition and transmission of knowledge. Andrea Ballabeni Harvard T.H. Chan School of Public Health, Boston, MA, USA

Reference 1.

Winslow CE. The untilled fields of public health. Science 1920; 51: 23–33.

166  Perspectives in Public Health l July 2015 Vol 135 No 4 Downloaded from rsh.sagepub.com at UNIV OF WISCONSIN OSHKOSH on November 14, 2015

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