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What is a public health approach?

Katina D'Onise

Updated: Apr 29, 2024



What is a public health approach?

Taking a “public health approach” is a phrase being more commonly used in health and social services. This is with the view that public health offers insights into a way of working that can move thinking away from a focus on services for ill health (or other problem) in an individual to a view of the whole population and thinking about prevention. This is a positive development, however it is also important that we develop a collective understanding for what that means, so that a real shift in paradigm actually occurs with its consequent benefits to the community.


There are standard definitions for a public health approach, with one such definition offered by the World Health Organization and the US Centers for Disease Control and Prevention as applied to violence prevention: The four steps are to define and monitor the problem (using data from different sources); identify risk and protective factors; develop and test prevention strategies; and assure widespread adoption (1). The expansion of public health thinking outside of health can often refer to parts of the approach, such as universal (primary), secondary services for those at risk and tertiary services to reduce harm (for example, 2). They may also value the more detailed application of data to understand a problem, but they often do not cover the full suite of what I would consider to be a public health approach.


While I think the WHO definition covers the core facets of public health approach, it is not as descriptive as it could be for a non-public health audience. I find that it can be helpful to use an analogy in describing what I consider to be a public health approach, picking up the key elements. Here I compare public health to clinical medicine, that is an individual going to see a doctor for a health issue. I have deliberately polarized the two approaches here to illustrate the differences but acknowledge that in the real world the two approaches can converge at times.


A public health approach

The principal difference between public health and clinical medicine is that public health focuses on the whole population whereas clinical medicine focuses on an individual. Further, public health as a principle takes an explicit equity approach which is not necessarily the case with clinical medicine.


The “presenting complaint”

The main focus in clinical medicine is finding the right treatment for a disease to better manage or cure the disease. That is, people are already sick. Public health tends to focus on people who are well with the aim of keeping them well, hence the focus on prevention as a pillar of public health. An arm of public health takes the prevention approach one step further down the disease pathway, to look to make diagnoses of disease early and before any symptoms develop where early treatment can lead to significantly better outcomes for individuals, so called secondary prevention or screening.


The “diagnosis”

In clinical medicine diagnoses are made from gathering information about the patient from a history, physical examination and tests; in public health information is gathered through epidemiology. Epidemiology includes quantitative and qualitative data, and these are supplemented by information from affected communities. The focus in this data collection is understanding the causal origin of a health issue, including both risk and protective factors and to think about and explicitly test what might work as an intervention.


The focus of “treatment”

Clinical treatment tends to focus on proximal causes to the illness; public health on distal causes. These distal causes are often the real drivers of ill health at the population level, such as employment conditions, educational attainment, living conditions, poverty and discrimination.

Treatment aims to create a large shift within an individual, whereas in public health small shifts in many individuals can bring about large shifts in population health as a collective. Further, public health focuses on shifts in the environment (physical, social, cultural), making it easier for people to make healthy choices. These changes are achieved through changes to legislation, regulation, policy, media/communications and sometimes programs, creating a health supporting environment rather than focusing on the behaviour of individuals.


The “cure”

In clinical medicine it can be readily apparent that the disease has been cured or well managed through the clinical presentation, and sometimes further tests are required to understand how well treatment has gone. In public health, there needs to be an explicit process of evaluative thinking, thinking through the logic of how the proposed intervention will interact with the cause at the population level, through to the associated outcomes, and these will be measured through a formal evaluation.


The “multi-disciplinary team”

In clinical medicine many people with chronic conditions require the support of multi-disciplinary teams. In public health we can think about this as working with our partners. The levers for the causal factors for most cases of ill health are distributed across society, with a very strong influence of local, state and federal governments on the environments in which we live. There is a wealth of literature on how best to partner in public health settings which are directly relevant to the work of the social services.


The approach I have outlined here goes beyond thinking about the use of data and applying prevention at the service system level (universal, early intervention and targeted) to a broader way of thinking about health promoting environments. This focus should not be lost in our quest to treat the ever increasing number of people with ill health or other problem. Working with our partners to focus on the upstream, causal factors for ill health is more important now than ever before if we are all to have the opportunity to live well balanced, long, happy, healthy lives.


References

1. Centres for Disease Control and Prevention. The public health approach to violence prevention. US Department of Health & Human Services. Accessed 6/11/2023, The Public Health Approach to Violence Prevention |Violence Prevention|Injury Center|CDC

2. Communities and Justice. The public health model for child protection and wellbeing. NSW Government. Accessed 6/11/2023, The public health model for child protection and wellbeing - Prevention and early intervention | Family & Community Services (nsw.gov.au)

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