17 June 2019
As explained in one of my previous blogposts – ‘What Public Health means and what you can do with it’, Public Health is the art and science surrounding disease prevention, health promotion, prolonging life within a population through the organised efforts of the population, as well as, healthcare services and health professionals. Essentially, Public Health measures are pretty much preventative measures to help promote and prolong life within a population.
Despite the crucial role that Public Health plays in healthcare systems especially in high-income countries and even in developing countries, budgets are reducing year by year. In some developing countries, budgets are sometimes non-existent. This is probably because of the austerity procedures of the Public sector or perhaps a difference in priorities in healthcare systems.
The benefits of Public Health are usually long term which could also be a reason in the reduction of Public Health budgets, but it should, on the contrary, be seen as an advantage for healthcare systems. In the words of Benjamin Franklin – “an ounce of prevention is worth a pound of cure”.
Research which evaluated the return on the investment of Public Health interventions through economic analysis found that most Public Health interventions are essentially cost-saving. 1 Thus, one the costs of poor Public Health is the high expenditure on control interventions for health issues which perhaps could have been prevented through an investment in good Public Health interventions. In other words, having poor Public Health is expensive.
Another cost of having a poor Public Health system is the increased burden on clinical health professionals. This is because another role of Public Health is to look at and deal with health issues involving various determinants which can affect the health of an individual. Such as: housing, education, social environment etc. For example, during my Community Experience module, working as a Service Support Worker meant that I had to also work alongside a Community Agent on some days. A Community Agent deals with referrals from hospitals, social care, family or friend of individuals and signposts them to the relevant services depending on the need of the service user. Most of these referrals I had the opportunity of also working on had to do with issues with Housing or the need for social inclusion which affected the health of the individual. In the absence of key workers like the Community Agents to get those issues addressed early on, there is potentially an increased burden on Clinical Health professionals.
Dealing with health emergencies and crisis in a population is also another role of Public Health. Interventions such as: community engagement, raising awareness of risk factors, case management, surveillance, contact tracing etc. are ways health professionals deal with crisis on a larger scale. Having poor Public Health, would result in the inability to do this. Thus, this could result in a higher fatality rate.
Take, the ‘Black Death’ in the Middle ages for example. It was an infamous plague which affected millions of people and caused an estimated number of 20 million deaths. During that time, health professionals were unable to cure or prevent this plague. It could perhaps be argued that one of the reasons why this plague was very fatal was because of the poor public health measures used to control it. During the medieval times, there wasn’t much advancement in health. Therefore, instead of having good hygiene people resulted in very traditional ways of controlling the plague such as: drinking portions laced with mercury, strapping live chickens around patients etc which did not help control the epidemic and led to more deaths.
The cost of poor Public Health is detrimental for all the above reasons. There’s a need for governments to invest in both public health practitioners and health professionals.