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Background
Public health is the science of protecting and improving the health of people and their communities through the promotion of healthy lifestyles. It also includes research into disease and injury prevention, as well as detection, prevention, and response to infectious diseases. Overall, public health is concerned with protecting the health of entire populations.
Public health professionals work to prevent population-wide health problems, including those that disproportionately harm certain groups. Functions of public health professionals include:
- Monitoring a community’s health status to identify potential issues and hazards.
- Conducting research to find solutions to long-standing and emerging health challenges.
- Enforcing laws and regulations that promote public health and protect health and safety.
- Educating the public, including underserved communities, about how they can improve their health status. This includes risk factors for common health problems, behaviors (such as exercise and good nutrition) to reduce these risks, and the importance of preventive care (such as routine screenings and immunizations).
- Offering and funding community programs that offer health screenings, preventive services, and health-promotion programs. These include nutritional screening and counseling, exercise and weight-control programs, and addiction treatment programs.
- Tracking and educating the public about infectious disease outbreaks and preventable injuries. This includes the impact of gun violence and its ramifications on public health.
Public health challenges are on the rise. Preparation and planning at the federal, state, and local levels are essential for protecting populations during all types of public health emergencies. This can include natural disasters, outbreaks of infectious diseases, and other catastrophic events. The effects of a public health emergency can be felt across all aspects of an individual’s life, including their health and financial resilience.
The COVID-19 pandemic has underscored the importance of fully funding public health programs and infrastructure (see also Public Health and COVID-19). A 2020 Trust for America’s Health report found that less than 3 percent of overall health care spending goes to public health. State spending, for the most part, has declined as well. While the Affordable Care Act established the Prevention and Public Health Fund to provide investments in prevention and public health, it has been underfunded. Chronic underfunding limits the nation’s ability to promote the health of all people and communities. It also inhibits timely response to emergencies. It can result in a lack of essential public health infrastructure. In turn, that can harm all public health services and programs.
For example, inadequate public health funding hampered the response to the COVID-19 pandemic. Moreover, some communities lack adequate numbers of health professionals to respond to disease outbreaks. They may also lack systems to monitor outbreaks and share information. Communities without sufficient public health resources also struggle to promote positive health outcomes.
The private sector can also play a role in promoting public health and disseminating accurate information. For example, well-designed, evidence-based, nondiscriminatory workplace wellness programs can improve employees’ health and well-being. This is beneficial not only to workers but also to private-sector companies. Workplace wellness programs may reduce health care spending, absenteeism, and accidents, as well as lead to better work performance. Smaller employers, however, may face challenges in developing and implementing such programs.
PUBLIC HEALTH: Policy
PUBLIC HEALTH: Policy
Public health promotion
Federal, state, and local policymakers should engage in robust, fully funded public health activities and programs. They should foster positive health outcomes for all members of a community by:
- promoting healthy behaviors, such as by financing preventive health services and educating the full range of community members on healthy behaviors and risk-reducing behaviors;
- preventing and responding to potential public health problems, including infectious disease outbreaks and preventable injuries;
- funding and supporting community-based strategies to address the social determinants of health.
All levels of government should conduct activities designed to protect, improve, and maintain public health. Policymakers should fully fund public health research, programs, and infrastructure. This includes ensuring that providers develop infrastructures such as laboratories and surveillance capacity and offering education about how to promote public health and identify public health threats.
All levels of government should be prepared to respond to public health crises adequately.
Policymakers should also strengthen state and local capacity to deliver public health services.
Adequate funding
All levels of government should provide adequate federal funding to support and maintain a robust public health care infrastructure. They should foster health promotion, disease prevention, and individual and family engagement activities. Funding should focus on:
- research (including community-based participatory research where feasible),
- population-based disease prevention,
- health-promotion and education programs,
- data systems and research,
- promoting health equity and equality,
- emergency preparedness and response,
- environmental and safety standards, and
- public and professional health education.
The federal government should adequately fund the Prevention and Public Health Fund.
Federal, state, and local strategies to improve public health should focus on broad-based community interventions that promote health and reduce health disparities.
All levels of government should direct sufficient financial and technological resources toward:
- solving environmental problems and working cooperatively with the private sector to address environmental concerns;
- the timely development and manufacture of safe, effective vaccines;
- research into effective strategies to protect the public from biological attacks; and
- ensuring key public- and private-sector health care personnel are adequately prepared to respond to public health crises relevant to their areas of practice.
Public health data collection
Federal and state health agencies should expand and improve standardized data collection, sharing, and reporting to identify and address disparities in service. At the same time, the privacy and security of health information held by private and public entities should be ensured and best practices followed (see also Privacy, Confidentiality, and Security of Health Information in this chapter). Data gathered should be sufficient to answer questions about disparities and support strategies to address them. Data should include identity, zip code, spoken language, and other data points that allow users of the data to better understand inequities and design targeted interventions.
Federal and state agencies should conduct studies and demonstrations that identify the causes of disparities and effective solutions and publish the results. Successful programs should be brought to scale, and performance related to disparities should be publicly reported and continually updated to ensure that measures are current and reflect the evolving science on addressing health disparities. Health agencies should collaborate across agencies and share data to address social determinants of health.
When requesting data that may be sensitive to individuals, policymakers should follow best practices, including posting clear nondiscrimination policies and emphasizing that disclosure is voluntary and individuals have the right not to respond.
Equitable outcomes
All levels of government and the private sector should take sustained actions to address the drivers of disparities in health and health outcomes.
Research
Federal and state governments should support research that identifies the effects of health-promoting behaviors on public health. For example, they should study the effects of exercise on cardiovascular and cognitive health. They should also fund cost-benefit research on health-promoting behaviors in both the public and private sectors. An example would be exploring the cost to employers of workers’ inactivity.
Scientific knowledge should undergird public health policymaking. Comprehensive public health data should be collected, analyzed, interpreted, and disseminated to monitor and improve public health. This includes specific demographic data to understand and reduce health disparities including race, ethnicity, spoken language, and geographic location.
Research should include health-promotion behaviors.
Sound public health strategies for health promotion, disease prevention, and intervention should be evidence-based on evidence and should have proven efficacy. Costs and benefits should be considered but should not be determinative.
Personal responsibility
Officials at all levels of government should help people fulfill their personal responsibility to protect their health by taking advantage of health-education opportunities and affordable and appropriate preventive health measures.
Policymakers at all levels of government should collaborate to develop, fund, implement, and evaluate strategies to protect and improve public health. They should support policies and implement programs that promote healthy behaviors. Federal, state, and local governments and the private sector should provide incentives for people to engage in behaviors proven to improve health and strengthen the physical infrastructure supporting such health-promoting behaviors. Policymakers should identify ways to support the implementation of workplace wellness programs by small employers. These programs should be evidence-based and nondiscriminatory.
Public health workforce
All levels of government should fund public health workforce development, including strategies to ensure workforce diversity.