As the term ‘health’ progresses to even more dynamic and ambiguous territories in the world today, health promotion and public health organisations have become increasingly important and prevalent in our society. As the World Health Organisation has tried to define health as ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’, it is obvious that health is viewed from many perspectives today and this can help explain the trends and shifts in public health as it tries to address a more modern and relevant set of determinates of health.
The determinates of health are the circumstances under which people live that can contribute to their health or ill health and can cause drastic inequity between communities and people. As public health strives to shift towards this more holistic view of health among the public, we see focus on prevention, education, accessibility, promotion and policy, thus contributing to the health of the community through large-scale community efforts, rather than focusing on the individual. This can be referred to as the population strategy, which forms the framework of the ‘new’ public health paradigm.
According to findings in the The Lalonde Report, the new public health systems started to develop in the 1970s. The population strategy deals with the complexity of health by addressing social, behavioural and environmental determinants of health such as education, employment, socioeconomic status, environment and accessibility in the hope that these inequalities and inequities in health can be balanced. This is in contrast to the ‘old’ public health paradigm, which focuses on the biological determinants of health. This includes clinical treatment and more direct, clear-cut methods in treatment of communicable disease.
Although the new public health understanding is a more modern concept, advantages and disadvantages exist in each model of public health. In considering the key determinates of public health, examples of old and new public health beliefs and practices and their strengths and weaknesses can be taken from society today. This paper will discuss relevant organisations and campaigns and how they relate and respond to the different determinants of health. These include: the role of the local council in society, schools and government, specifically primary school education and the national ‘Sun Smart’ campaigns.
Firstly, it will look at the role the local council plays in society as a representation of ‘old’ public health model. Local councils are a clear representation of old public health ideals, specifically in areas such as sanitation and waste management programs that have historical roots yet are just as important in health management today. Sanitation is the process of preventing human, animal, and insect contact with human waste, which is imperative in avoiding the spread of diseases (Global Education, 2010). The importance of sanitation dates back to the discoveries of John Snow amongst the London cholera epidemic of 1854 (Johnson, 2006).
Where Snow, a doctor, was able to establish geographical distributions of cholera deaths and chemically assess the water and patterns of the disease, he simply did not have the authority to interfere with the public water supply. Yet, the local government body, or local council could act on powers given to them by the 1848 health act (Judith Raferty, 2009), and so the importance of the local council in public health and epidemiology became a bigger focus. The Australian Government through local council has long recognised the importance of clean water and sanitation.
Although programs through local council target our large areas and populations and the implementation of infrastructures, sanitation deals with biological causes of disease as a method of prevention rather than considering a more environmental and social approach to health and therefore represents the ‘old’ perception of public health. The importance of Waste management can be viewed in the same light as sanitation. Waste that is not properly managed can create serious health or social problems in a community- the spread of diseases, pests and poisons needs to be controlled by the minimisation of waste.
Each organisation and council follows structured plans and frameworks to ensure the safety of the community-yet it is still only addressing the treatment of communicable disease. Although these public health systems are necessary in maintaining the health of the community, the fact that they only target communicable disease requires shift to a newer, broader outlook of public health, which is “distinguished by its basis in a comprehensive understanding of the ways in which lifestyles and living conditions determine health status” (WHO, Heath Promotion Glossary, p3).
We see this shift clearly in policies and campaigns implemented in primary education and schools. With influences from many other public health organisations such as the ‘Go for your life’ campaign and the Healthy Kids Association, increasing amounts of healthy canteen policy action plans are being fully endorsed by the school community (Healthy Kids Association, 2010). These policies go hand in hand with initiatives put in place by Vic Health like the ‘Walking School Bus Initiative’.
The Walking School Bus not only provides a safe environment and transport to school for children, it aims to educate in nutrition and the importance of a healthy active lifestyle, creating knowledge and powerful behavioural foundations for adulthood and future generations. By implementing these plans, the long-term goal of reducing obesity and diabetes in communities is targeted, but through a lifestyle and behavioural change. This proactive, preventative system of change is a more effective way in treating obesity, rather than the old public health framework being reactive in a more case by case manner and usually in retrospect.
This therefore showcases the new public health in action. Not only evident in the action of primary schools, state and nation wide campaigns like the ‘Sun Smart’ campaign are being promoted throughout our population. Here we witness a collaboration of funding and ideas from the Cancer Council Victoria and Vic Health, aiming to promote a balance between the benefits and harms of ultraviolet radiation (Sun Smart Victoria, 2011). Exposure and education through the Sun Smart initiative have seen drastic results since their introduction in 1988.
The comparison between people who have and have not grown up in a ‘sun smart’ environment is evident in the reduced cases of skin cancer in the under 40s age group. The program is estimated to have averted 28,000 disability-adjusted life-years (DALYs), equivalent to 22,000 life-years saved (Sun Smart Victoria, 2011). Vital new public health tools like communication, promotion and social and behavioural theory have successfully created a shift towards an environment that supports health by reducing the incidents of skin cancer in Victoria.
In terms of health promotion this natural progression to the new public health framework is not without its downfalls. Large amounts of funding and resources are needed to run these large and widespread public awareness campaigns. Not only do they expend a large amount of resources, the overall aim to reduce inequality and inequity in health status in not always met. We see these strategies effective in middle and upper social economic populations, however can lead us to think that the more vulnerable social groups such as indigenous, rural habitants and low income earners are not being successfully reached.
Reaching the hard to Reach” (Rachel Hinton, 2010 p10) however has become another focus in the new public health framework- Strategies such as the ‘Close the Gap’ campaign aim to address these problems of trying to target such large populations. As Richard A. Epstein (2002) argues it can be seen that new public health strategies can lack focus and definition, therefore being wasteful and even targeting areas they may not even ought to take place. Yet in contrast, the old public way of thinking seems only to be concerned with this treatment of communicable disease.
It lacks focus on prevention and the importance of reaching equity and equality in communities as a whole, which can be primarily addressed through lifestyle and behavioural changes. These causal determinates of health like education are the absolute root and solutionof a healthy future. Effective population health requires community, inter-sectoral and government engagement and collaboration to address the broad range of determinants that shape health and wellbeing of the whole population today (Victorian Health Care Association, 2009).