In Canada there is a tendency to equate health with health care, but there is a lot more to health than hospitals, clinics and medical services. There is also "public health" which works at a different level, one much wider than the "individual" as with the other sides of the health system.
Public health is defined as the organized efforts of society to keep people healthy and prevent injury, illness and premature death. Health care works with individuals who are not well; public health works to keep people from becoming sick, or sicker. Public health programs target whole groups of people, or populations instead of individuals.
Six areas are normally identified as public health activities: Health protection; health surveillance; disease and injury prevention; population health assessment; health promotion; and emergency preparedness and response.
Public health services comes to the fore when we face widespread problems like influenza epidemics, SARS or water quality issues. However, public health policies and programs have also made significant improvements in the safety of Canadians and in reducing the incidence of preventable illness.
Water and sanitation are one example. Though the link between water, sanitation and health have been known for centuries, it was not until the early 1900s that officials embraced that link and began to pursue adequate sanitation and clean water systems with an eye to improving public health.
It worked. Today standards and policies exist at all levels for sanitation and water quality. Implementation may not yet be perfect, but the goal is clear.
The success of immunization is another impressive public health success. Before mass immunizations began in Canada, we lived with the threat of deadly and debilitating diseases that frequently would sweep through a community. Polio is one example. It paralyzed or disabled many people.
In 1953, at its peak, polio killed 500 deaths in Canada. Two years later, the introduction of an injectable vaccine led to a dramatic drop-off in the incidence of polio. Measles, another contagious disease, caused illness in hundreds of thousands. By 1995 the number of cases in Canada had dropped to 2,362.
The success of public health programs to reduce or eliminate vaccine-preventable disease is largely the result of high vaccine coverage rates. However, work continues in this area as certain populations continue to resist vaccination for whatever reason.
More needs to be done to remove barriers to access, or to improve education so that all children are protected.
Seatbelts use in vehicles has also come as the result of public health efforts. Between 1975 and 2003, traffic fatalities decreased by over 50 per cent in Canada even though the number of drivers and cars on the road increased substantially. Part of this reduction can be credited to seatbelt use - 90 per cent of Canadians now buckle up.
Reduction in tobacco use is also largely attributable to public health efforts. A hundred years ago, tobacco was considered beneficial; by 1965, half of Canadians over 15 smoked. Once the true danger of tobacco was identified, efforts were established to reduce tobacco use. Today, about 19 per cent of Canadians smoke.
Public health matters to all Canadians, even if it is not the most visible of health care efforts. Safe water, vaccines, reduced tobacco use and lives saved with seatbelts all prove the value of public health, but don't begin to scratch the surface of the work of public health professionals.
Dr. Paul Martiquet is the Medical Health Officer for the Sea to Sky.
