Public health: Under-recognized but equally important
On Sept. 21-22, we members of the Philippine Society of Public Health Physicians (PSPHP) will be holding our fifth annual national convention with the theme “Succession: For the Future of Public Health.” We are medical doctors who work not in the clinical setting but instead tackle population health and health system issues—simply put, our patients are not individuals, but communities, nations, and even the world. To help secure the future of public health in our country, I want to use this occasion to remind the public about its vital importance. After all, they are the “public” in public health—it does not pertain to government, as in “public sector.”
The term “public health” has several definitions, but the one that is enduring is the one made by Charles-Edward Amory Winslow, one of the pioneers of American public health: “The science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities, and individuals.” Julio Frenk, the former secretary of health of Mexico and former dean of the Harvard T.H. Chan School of Public Health, where I received my public health doctoral training, shortened it to the “organized social response to health conditions.” Indeed, public health is everything we collectively do in society to improve everybody’s health.
We do many kinds of things in public health. For example, I specialize in protecting health from climate change—perhaps the greatest existential threat of our time—but as a public health “pracademic” and “deep generalist,” I also work on many other public health arenas such as universal health care and promoting the health of our overseas Filipino workers (OFWs). But my comrades in public health represent a wider range of roles and functions—Department of Health officials, municipal and provincial health officers, specialists in the prevention and control of different infectious diseases like tuberculosis and HIV-AIDS, mental health advocates, laboratory scientists, statisticians, communication experts, university educators, digital health innovators, and more.
Both public health and clinical practice are equally important and must be viewed as complementary to each other. However, our society continues to give more value to clinical practice and less value to public health—for obvious and understandable reasons. The effect of a 15-minute visit to the clinic is immediate, palpable, and memorable, especially if one has serious illness—while 15-year efforts to clean the environment or reform the health system may be less visible and therefore taken for granted, even if an entire nation’s health is dramatically improved. Even during the COVID-19 pandemic, the image that people remember is that of a health worker in the hospital ward wearing personal protective equipment and not of an epidemiologist doing calculations to identify hotspots of infection in the community. Clinicians are also generally paid much higher than public health workers.
Nonetheless, while we public health professionals may continue to operate behind the scenes and work in thankless jobs, our commitment to achieving the highest possible level of health for all people will not waver. We will strive to complete the unfinished business of universal health care, create the societal and environmental conditions to advance our collective physical health and mental well-being, and prepare for future pandemics and the health effects of climate change.
To address the under-recognition that public health receives, we at PSPHP are working hard to professionalize the field, by developing competency frameworks and standards, designing training programs to prepare the next generation, and communicating the powerful message of public health to the wider public. We hope to see the day when expertise in public health is not questioned, and that the efforts of real public health workers are truly valued.