What is public health?

You probably don’t spend much of your day thinking about what public health is and why it matters, but you contribute to the health of your community and society at large every day! Washing your hands after using the bathroom, sneezing into the crook of your elbow, and utilizing biking and walking paths in your neighborhood are all examples of public health initiatives to protect not only yourself but those around you.

The CDC Foundation defines public health as “the science of protecting and improving the health of people and their communities. . . . Achieved by promoting healthy lifestyles, researching disease and injury prevention, and detecting, preventing and responding to infectious diseases.” The keyword here is communities – public health focuses on improving individual behavior that collectively informs the community’s well-being.

Recently, we’ve experienced an acute upheaval to our public health system: COVID-19, an infectious disease unlike any other we’ve seen in the last 100 years. Epidemiologists around the world are working to find a way to eradicate this disease for good, but we’ve been dealing with another pandemic for far longer – chronic lifestyle diseases, which have crushed our public health system slowly but steadily. What’s worse is that having a chronic disease increases your risk for severe illness from COVID-19, which brings us to the height of this crisis. We have the power to reimagine what public health means and how it can benefit every single person in every single community – and it all starts with you.

Public health has shifted its focus from acute to chronic disease.

Historically, public health was solely focused on minimizing the spread of infectious diseases, such as smallpox and polio, through efforts like providing communities with clean sources of water and air, teaching proper hygiene, and reducing overcrowding in homes and factories. These diseases were eventually eradicated through immunization, but these simple measures have remained the foundation for keeping communities safe and healthy.

In modern times, public health systems are mostly focused on preventing chronic lifestyle diseases in addition to infectious diseases. This shift is significant because while infectious disease can be severe, it’s acute. Chronic disease can also be severe, but it develops over lifetimes and costs the healthcare system billions of dollars every year. In an article published in the Journal of Medical Ethics, researchers explain that of the leading factors contributing to the burden of disease around the world, obesity is one of the most expensive, and “it is far better—economically, medically and ethically—to prevent obesity than to try to treat it once it occurs.”

The prevention of chronic disease requires a robust public health system that must be equipped to provide preventive health resources that are accessible in addition to individualized health services. 

Public health and determinants of health

Unlike acute diseases, chronic health issues are complex and multifaceted. In order to create the public health infrastructure needed to properly address these complex diseases, improve health, and prevent further disease, local, state, and federal governments must work together to focus on determinants of health, or the aspects of a community that impact individual health and behavior. These include public policy, social factors, and health services.

Public policy

Public policy focuses on nutrition, housing, and the environment. Ideally, policies enacted should focus on a collective and preventive approach to health. Examples of such policies include taxing tobacco products, requiring food labels detailing macro- and micronutrients, adding fluoride to water, and labeling and separating toxic waste, as well as housing policies, such as affordable housing, rent stabilization, and home safety regulations (protection from childhood lead poisoning).

Social factors

These are the conditions in which people are born, live, grow, learn, work, and age and can be directly responsible for health outcomes. Examples include:

• Accessibility and availability to resources to meet daily needs, such as food and jobs
• Exposure to crime and violence
• Social support and relationships
• Access to schools
• Access to transportation
• Exposure to racism or discrimination
• Quality of physical environment, which can include pollution, worksite conditions, toxin exposure, and barriers to quality of life if someone has a disability, as well as structure of the environment, such as presence of walking paths, bike paths, and green spaces (parks)

Health services

These services include preventive doctor’s visits for disease screenings, annual checkups, and dental cleanings. If someone needs care, it’s important to consider how far they’d have to travel, how much services cost with and without insurance, and if language assistance is needed. This determinant of health is about more than just having access to healthcare services but also the barriers to such care.

According to the CDC, these are the 10 most essential public health services that can address the determinants of health described above. The combination of these determinants plays a defining role in how a community functions and their health outcomes. During the COVID-19 pandemic, we’ve seen devastating disparities in community health in the United States, due in part to public health policy failing to provide crucial preventive health resources, making certain communities more susceptible to severe illness and death from COVID-19.

Where individual behavior meets community health outcomes

During this pandemic, local, state, and federal governments have advised the public to do three things consistently to prevent the spread of COVID-19: wear a mask, social distance, and wash your hands. These agencies are depending on public health initiatives – signs on mass transit, social media ads, setting regulatory policies for businesses – to compel individuals to comply with these new public health rules because they benefit not only them (the individual) but also everyone around them (their community).

However, it is up to each individual to make their own decisions, and their compliance (or noncompliance) with these rules will directly impact their own health and the health of those around them. This is still true during non-pandemic circumstances as each individual has a responsibility to contribute to the greater health of their community by following public health guidelines, including practicing proper hygiene and staying home when sick, which helps prevent acute illness.

When it comes to the prevention of chronic disease, individual behavior still matters – in the sense that it can empower and inspire others to behave in a healthier way. A great example of this is quitting smoking. This is beneficial not only for the individual who is no longer smoking but also for their family or even their neighbors, who may be inhaling secondhand smoke. This act of quitting might inspire a family member to also quit, holding each other accountable and working toward living a healthier lifestyle together. This ripple effect is so powerful, and many successes of public health initiatives can be attributed to individual behaviors that ripple out to every individual within a community.

Why Health Coaches are imperative to public health initiatives

We’ve known for far too long that our healthcare system is focused on treating disease once it happens, not preventing the disease from developing at all. For those who have the means and access, preventive health can be a given – eating nutritious food, staying physically active, taking care of mental health, and practicing self-care, including adequate sleep and hydration. Furthermore, these preventive health choices are just that – individual choice. For those who don’t have the means or the access, preventive health might feel out of reach and not a choice they can easily make – their neighborhood experiences food apartheid, public transportation is limited, they work more than one job or long hours, or they don’t have health insurance.

When preventive health can't be an individual choice because of a lack of access, the development of chronic disease is hard to avoid for the entire community. Health Coaches can and should be part of bridging this gap of access because everyone deserves to be able to take care of themselves and their families.

Health Coaches have the ability to work with people one on one, meeting them where they are. Health Coaches can seek opportunities at urban farms, soup kitchens, food pantries, schools, pharmacies, urgent care clinics, and neighborhood grocery stores to bring crucial holistic health knowledge to underserved communities who need it most.

Health Coaches can also meet and work with public health officials, providing resources for new public health initiatives and even executing them in the community themselves. This could look like setting up a booth at the local farmers’ market to provide health consultations, running a workshop at the local VA on the benefits of self-care for mental health, or organizing an after-school program to teach kids how to incorporate more healthy foods into their lifestyle.

To achieve IIN’s mission of improving health and happiness around the globe, Health Coaches have a great responsibility: to share what they’ve learned about how to transform health. Our global community needs Health Coaches – they need you – now more than ever.