19 May 2020

This blog is an excerpt from my new article, Public Health Priorities: the importance of public health. You can also see my presentation for European Public Health Week 2020 on this subject.

COVID-19 has focused attention on global public health organizations such as the World Health Organization (WHO). What exactly is public health? What do public health organizations usually focus on? What are their capabilities during an infectious disease emergency?

Part 1 of this series focuses on why public health is important. Part 2 looks at the funding for disease control organizations such as the WHO and the European Center for Disease Prevention and Control (ECDC) as well as how to make policy decisions about health programs. Part 3 goes more in depth into the budget of the US Centers for Disease Control and Prevention (US CDC) as an example of historical and current budget priorities.

What is Public Health?

Public health is the concept of improving infrastructure for a common good. Infrastructure may be regulatory (seatbelts, occupational health agencies) or physical (sewer systems, health clinics, bed nets).

Public health is also about equity. Everyone benefits from health-oriented rules (no smoking in workplaces), infrastructure (clean water; emerging disease identification and warning systems), and discoveries (vaccines).

Public health discoveries

Tu Youyou identified the ancient traditional Chinese use of a plant called sweet wormwood to fight fevers, a symptom of malaria; she and her team extracted a substance, artemisinin, which is used today to fight malaria. She and colleagues won the Nobel Prize in the category “Physiology or Medicine” in 2015.

Public health initiative: The WHO recommends artemisinin-based combination therapy for malaria.

Yet: The WHO estimates there were 228 million cases of malaria and 405,000 deaths in 2018, due to lack of insecticide-treated nets and sufficient medical care.

Life without Public Health

What would the costs be, both for health care as well as societal costs to businesses, trade, and families due to death and injuries, without public health initiatives?

Three health issues provide good illumination into the importance of public health efforts: life expectancy, maternal mortality and smallpox.

Life expectancy

Until the 1900s, the average life expectancy in Europe was around 40 years. A major driver of the low life expectancy was high infant mortality. In Switzerland in 1876, 27% of deaths were of children under one and another 8% were in children 5 and under; each age group over five represented only about 1% of deaths for the year.[1]

Figure 3:   Swiss Life Expectancy
Year Total
1876 40.19
1880 42.47
1885 43.92
1890 45.01
1895 46.93
1899 49.31
Source: https://www.mortality.org/Country/Country?cntr=CHE

Infectious diseases were historically the main drivers of infant mortality, including pneumonia, influenza, and diarrheal diseases. In France, approximately one-third of babies died before age one in the 1700s, until improvements in birthing techniques and smallpox vaccinations reduced the infant mortality rate to one in six infants by 1850; however urban crowding and the spread of epidemics like cholera increased infant mortality again (as did the custom of giving babies to wet nurses in the countryside who nursed and cared for them).[2]

To learn more about maternal mortality, smallpox and disease control, download my article.

Stay tuned for parts 2 and 3, which will be available in the upcoming weeks.

The public health advertisements in the slideshow were collected by the World Health Organization.

[1] The Human Mortality Database. https://www.mortality.org/Country/Country?cntr=CHE (accessed April 2020)

[2] Institut national d’études démographiques (INED). “Infant mortality in France”. https://www.ined.fr/en/everything_about_population/demographic-facts-sheets/focus-on/infant_mortality_france/