Is public health a science, meticulously grounded in evidence, or is it an art, relying on creativity and human connection to inspire change? Medical science provides knowledge about diseases, vaccines, and preventive medicine; engineering science ensures infrastructure such as clean water, sanitation, and pollution control; while social science addresses human behaviour, health policies, and societal inequalities. In the realm of art, there is the component of creating effective messages to reach the public. Thus, we must recognise that public health is interdisciplinary and multidisciplinary, harmoniously combining various sciences, artful communication, and social advocacy. It defies simple definitions, working at the intersection of multiple fields to improve the health and well-being of entire populations.
What is public health?
Public health is the science of keeping communities healthy and disease-free. It is a field that encompasses experts from medicine, engineering, social sciences, information technology, communication, law, economics, and even politics. Public health involves preventive healthcare, environmental sanitation, disease control, health education, and policymaking, addressing health determinants beyond individual medical care. It encompasses community health, occupational safety, behavioural health, and health policy.
Ancient civilizations understood the need for sanitation to prevent disease. The Indus Valley civilisation had elaborate drainage systems, demonstrating early public health awareness. The Roman Empire constructed sophisticated aqueducts, baths, and drainage systems, showing their understanding of public sanitation. However, modern public health truly began in the late 18th century with industrialisation. As cities grew overcrowded and unsanitary, diseases such as cholera and tuberculosis spread widely, forcing authorities to act. Britain’s landmark Public Health Act of 1848 marked the first organised effort to control disease through governmental policy. It set the stage for future developments in sanitation and preventive care worldwide.
Initially, public health revolved around sanitation, hygiene, and infection control—reflecting concerns dominant during the Great Sanitary Awakening of the 1800s. Over time, however, public health has expanded dramatically. Currently, public health covers diverse areas, including food safety, nutrition, occupational health, control of non-communicable diseases such as diabetes and hypertension, as well as sexually transmitted infections, gender equality, poverty alleviation, health disparities, strengthening health systems, and even the latest challenge: the commercial determinants of health. These determinants include the aggressive marketing of harmful products like tobacco, alcohol, and unhealthy food, which influence health at a population level.
Public health vs. primary care
Though sharing similar goals, public health and primary care differ significantly. Primary care predominantly involves curative treatment at an individual level, addressing diverse health issues—ranging from minor infections and chronic diseases to mental health—typically managed by a general physician. It also incorporates preventive and promotive services like routine health check-ups and lifestyle counselling. Public health, conversely, emphasises community-level strategies aimed primarily at disease prevention, health education, and population-wide interventions. It broadly focuses on implementing vaccinations, sanitation improvements, maternal and child health programmes, and disease surveillance systems.
Across the globe, the responsibility for public health varies considerably, shaped by historical and administrative structures unique to each country. India, influenced heavily by its British colonial past, delegates public health responsibilities primarily to the States, with Central support through funding, planning, and guidelines.
Historically, countries influenced by British practices—including India, Pakistan, and Sri Lanka—view public health primarily as a medical discipline managed by medical doctors trained in preventive and social medicine. In contrast, nations like the United States historically approached public health through an engineering lens, emphasising sanitation, infrastructure development, and environmental health interventions managed largely by engineers and sanitation specialists. However, it is widely accepted today that public health is inherently multidisciplinaryand thereby, demands collaborative efforts from diverse professionals to address complex health challenges in society effectively.
India’s public health structure
India’s public health system, deeply influenced by British colonial practices, operates under the Ministry of Health and Family Welfare. The Constitution divides public health responsibilities across different governmental levels: Public health and sanitation appear in the State List, making State governments primarily responsible. Yet, certain areas like family welfare are listed under the Concurrent List, shared between State and Central governments, while issues such as international health regulations, port health authorities, and quarantine fall under the Union List. Within States, public health and preventive health departments conduct essential activities such as immunisation programmes, vector-borne disease control (dengue, malaria, and chikungunya etc), entomological surveillance (monitoring insect vectors), maternal and child health services, nutrition programmes, and health education campaigns. Local municipal bodies manage sanitation, waste disposal, street cleaning, and sewage management, whereas engineering departments and water boards oversee water supply and infrastructure.
Public health today is deeply interconnected, evolving from its early sanitary origins into an expansive field that addresses comprehensive determinants of health. Public health often faces ethical challenges, balancing individual rights against community interests. Mandatory vaccinations, quarantine during outbreaks, and restrictions during pandemics illustrate how public health must sometimes prioritise collective good over personal freedoms. Such conflicts underscore the complexity of public health decision-making.
As we look ahead, understanding that public health is a collective responsibility—shared by governments, professionals, and citizens alike—is crucial. In short, public health is not just about medicine or engineering—it is about harnessing diverse expertise to create a healthier world, ensuring equitable health opportunities for all.
Published – March 11, 2025 03:49 pm IST
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