Introduction to Public Health and Infectious

Diseases

R. Erol Sezer

Yeditepe Üniversitesi Tıp Fakültesi Halk Sağlığı Anabilim Dalı

In 1920, Yale professor of public health and respected public health figure C.E.A. Winslow defined public health as

“...the science and art of preventing disease, prolonging life and promoting health and efficiency through organized community effort for the sanitation of the environment, the control of communicable infections, the education of the individual in personal hygiene,

the organization of medical and nursing services for the early diagnosis and preventive treatment of disease, and for the development of the social machinery to insure everyone a standard of living adequate for the maintenance of health, so organizing these benefits as to enable every citizen to realize his birthright of health and longevity.”

Life expectancy at birth in Turkey

males females

1945-50 36.7 39.6

1955-60 46.5 49.7

1965-70 53.9 57.4

1975-80 60.3 64.0Nusret Fişek. Nusret Fişek. Halk Sağlığına Giriş. Çağ Matbaası, Ankara 1983

Bebek Ölüm Hızının Uluslararası Karşılaştırması (1.000 Canlı Doğumda), 2012

Sağlık Bakanlığı İstatistik Yıllığı 2012

Infant mortality rate estimate in Turkey in 1963

% 190-270 per thousand live birthsGales KE. The report of an inquiry into birth and death rates in Turkey. Hıfzıssıhha Okulu, 1964, Yayınlanmamış Rapor.

According to the Institute of Medicine «Broad mission of public health is to fulfill society’s interest in assuring conditions in which people can be healthy.»

This statement’s main assumptions and implications:

«…First, the idea of assuring health for all people—the entire population— is embedded in the mission statement. We are obligated to ensure health-producing conditions for all people— not just the poor, not just the rich, but people of all incomes, but people of all races and ethnicities..»

«…Second, the work of public health is a societal effort with a societal benefit. Public health takes the view held by many professions and societies throughout human history that healthy people are more productive and creative, and these attributes create a strong society.» It is easier for the individual to be healthy and stay healthy in healty populations.

..Third, the public health mission acknowledges that health is not guaranteed. The mission states that “people can (not will) be healthy.” Health is a possibility, although we intend through our actions to make it highly probable. However, not everyone will be healthy even if each one exists in health-producing conditions. Public health efforts will not result in every person being healthy—although we certainly would not object to that kind of success…»

The fourth and fifth assumptions embedded in the public health mission are that prevention is the preferred strategy and to be successful, prevention must address the “conditions,” that is, physical and social environment, in which people live.

…This choice of a prevention and environment-based strategy clearly distinguishes public health from the clinical professions, which focus on diagnosing individuals and treating them when they have health problems detectable by clinical methods—history, physical examinations, laboratory tests, imaging, and so forth.

There are three types of prevention: primary, secondary, and tertiary:

Primary prevention is concerned with eliminating risk factors for a disease. Intervening in an asymptomatic person to prevent the onset of the disease.

Primordial prevention is defined as prevention of risk factors themselves.

Secondary prevention focuses on early detection and treatment of a disease by using screening tests to identify pre-clinical disease in an asymptomatic person.

Tertiary prevention attempts to eliminate or moderate disability associated with advanced disease.»

In the Spring of 1994 a working group on the core functions of public health took on the task of developing a consensus list of “essential services of public health” that would provide one voice for public health professionals and simultaneously clearly articulate to the public and policy makers the important role of public health in health care. 

The 10 Essential Services of Public Health are:

1. Monitor health status to identify and solve community health problems

2. Diagnose and investigate health problems and health hazards in the community

3. Inform, educate, and empower people about health issues

4. Mobilize community partnerships and action to identify and solve health problems

5. Develop policies and plans that support individual and community health efforts

6. Enforce laws and regulations that protect health and ensure safety

7. Link people to needed personal health services and assure the provision of health care when otherwise unavailable

8. Assure a competent public and personal health care workforce

9. Evaluate effectiveness, accessibility, and quality of personal and population-based health services

10.Research for new insights and innovative solutions to health problems

Spirit of Public Health :A quatation from “Krieger, N., & Birn, A. E. (1998). A vision of social justice as the foundation of public health: Commemorating 150 years of the spirit of 1848. AJPH, 88(11), 1603–1606.”

“To declare that social justice is the foundation of public health is to call upon and nurture that invincible human spirit that led so many of us to enter the field of public health in the first place: a spirit that has a compelling desire to make the world a better place, free of misery, inequity, and preventable suffering, a world in which we all can live, love, work, play, ail and die with our dignity intact and our humanity cherished.”

Time Population million

No of Malaria cases

Morbidity rate (Per thousand)

1945 18,9 2.542.000 134,50

1950 20,8 1.888.000 90,80

1955 23,9 485.000 20,30

1960 27,5 3.092 0,10

1965 31.1 4.587 0,15

1970 35,3 1.263 0,04

Malaria in Turkey (1945-1970)

Nusret Fişek. Halk Sağlığına Giriş. Çağ Matbaası, Ankara 1983