Judging from recent articles which have appeared in the mass
media and medical literature on topics as diverse as bullying
and hoarding, it appears that seeing social phenomena through
the lens of public health offers benefits that many advocates
seek. This raises questions about what the benefits of earning
the "public health issue" label are, and what criteria must be
fulfilled by a social phenomenon to be legitimately classified
as a "public health issue".
Quick quiz:
As
readers of The Epidemiology Monitor and public health
scientists, which of the following phenomena do you think are a
public health issue? You may wish to revisit your answers after
reading this article.
Racism Yes or No
Computer
Security Yes or No
Bullying Yes or No
Harmful Alcohol Use
Yes or No
Online Pornography
Yes or No
Adolescence Yes or No
Child
Obesity Yes or
No
Infertility
Yes or No
The
Size of Soda Servings Yes or
No
Injury Yes or No
Violence Yes or No
Marijuana Use Yes or No
Hoarding Yes or No
|
HIV in
Fishing Towns Yes
or No
Trauma
Yes or No
Depression Yes or No
Teen
age Pregnancy Yes or No
Child
Labor Yes or No
Adult
Obesity Yes or No
All
Season Tires Yes or No
Active, non-motorized
transportation Yes or No
Guns Yes or No
Gang
Violence Yes or No
Climate Change Yes or No
Achieving a "Good" Death
Yes or No |
A
case has been made in various publications for all of these
phenomena to be considered public health issues. Among the
recent cited reasons for positing a phenomenon as a public
health issue are those listed below. Read these reasons and
consider whether or not to change your view about what is or is
not a public health issue.
Issue |
Reasons Cited |
Racism |
-
Psychological toll on black Americans causes stress
related health issues causing them to die younger
than white Americans.
-
Black Americans receive poorer health care
-
Research on Black Americans is underfunded.
-
People of color are underrepresented in clinical
trials.
-
Poor
Black Americans are being hit hardest by political
resistance to implement the Affordable Care Act
|
Computer security |
-
Individual action to protect yourself only gets you
so far. You need a group response.
|
Bullying |
-
It
is widespread in the US
-
It
is a multifaceted form of maltreatment
-
It
is linked to a wide range of health issues and can
result in injury, distress, or death.
-
There are risk factors for bullying or being a
victim of bullying
-
It
may be preventable.
|
Alcohol Use |
-
It
is a causal factor in more than 200 diseases and
injuries.
-
It
causes deaths.
-
It
is harmful for others besides the drinker
|
Adolescence |
-
We
pay little attention to the health of 10-19 year
olds.
-
Almost all adolescent deaths are preventable
-
Mental health challenges are the overwhelming
problem for adolescents
-
Teenagers need adequate consideration and a voice in
public policy
|
Injury |
-
They
are preventable
-
We
want to approach problems in the community as a
whole and not focus on individuals
-
Want
to focus on prevention not treatment
-
Want
to use many solutions
|
Size of Soda Servings |
-
Sodas are bad for health. If you are ill, your
illness has consequences for others.
-
Public health measures make life healthier and safer
for everyone.
-
Makes the default choice the healthier choice.
-
The
intervention is broadly inclusive and democratic.
|
Infertility |
-
Unwanted childlessness causes significant sometimes
life threatening consequences.
-
Prevalence is significant.
-
Often linked to preventable infections.
-
Recognition and treatment are neglected now.
-
Discipline of public health could contribute
significantly to policy and programs
|
Violence |
-
It
is transmitted like a disease.
|
Gun Violence |
-
The
US has one of the highest rates of homicides in the
developed world.
-
The
US has an average of 88 gun deaths per day.
-
Every time a gun is used in self-defense, there are
4 accidental shootings, 7 criminal assaults or
homicides, and 11 attempted or completed suicides.
-
The
National Rifle Association specifically targets the
public health approach.
-
Promoting reasonable gun policies does not make
public health professionals anti-gun
|
Marijuana Use Legalization |
-
It
produces second hand smoke
-
It
leads to schizophrenia, especially in teen boys
-
Driving while high should be discouraged.
|
Achieving a “Good” Death |
-
Public health addresses the distribution of limited
resources.
-
We
can achieve better care with lower costs by avoiding
unwanted aggressive care.
|
Trauma |
-
It
is the number one health public health issue of our
time.
-
Unrelenting stress is linked to obesity, diabetes,
depression, and suicide.
-
Teaching resilience can transform trauma.
|
HIV/AIDS in Fishing Communities |
-
AIDS
related illness and mortality are devastatingly high
in some fishing communities.
|
Hoarding |
-
A
growing problem.
-
Epi
studies suggest prevalence is 2-5 percent of the
population.
-
It
spreads pests and possible health dangers to the
community.
-
Social service or other agencies have to use
resources to clean houses people cannot afford to
clean.
|
All Season Tires |
-
Cold
hardens the rubber in all season tires
-
They
are unsafe in cold weather and dangerous in snow.
-
People are dying because of these tires.
-
Manufacturers are allowed to market tires as all
season knowing they are unsuitable in cold weather
|
Childhood Obesity |
-
It
has a significant long term health impact
-
We
do not have universally accepted definitions
|
Adult Obesity |
-
We
need to prevent it before it happens.
-
We
need to create lasting change by making the healthy
choices the easiest choices.
|
Child Labor |
-
It
is a global practice
-
It
has many negative outcomes
|
Active (non-motorized) transportation |
-
Everyone travels.
-
Transportation systems impact health.
-
Health should be considered in transportation and
land use planning and decision making
-
It
can produce health benefits and curb health care
spending
|
Online Pornography |
-
It
is harmful in many ways—preventing healthy
sexuality, disempowering women, leading to sexual
violence and non-consensual sex.
-
It
is so widespread as to be considered a crisis
-
If
CDC got interested, we could have success in the way
we had success with cigarette smoking
|
Climate
Change |
-
Rebranding this issue as a health issue rather than
an environmental or national security issue might
have more resonance for the average citizen.
-
It
fosters a more emotionally compelling response since
it focuses on the immediate implications a warmer
climate could have on people's lives.
-
It
provides a sense of hope that problems can be
addressed and avoided.
-
Invoking health helps to bypass the political
quagmire.
-
Doctors can have a potential impact scientists may
not have because they can transcend political
differences and we really care about what they say.
-
It
can change the type of dialogue people have about
climate change.
|
Gang
Violence |
-
It
has a distressing impact on individuals, families,
and communities.
-
The
wider social-economic costs can be equally damaging.
-
It
provides communities with the opportunity to rethink
how services for young people are delivered and how
public health funding can be used in a more flexible
way.
|
A question posted on Researchgate last year resulted in the
following criteria being offered for what makes an issue a
"public health issue". Read these criteria and see if they
change your view about what is or is not a public health issue.
1. The
concept of preventability—there are conceivable ways to prevent
the phenomenon.
2. High
prevalence of a risk factor or disease.
3. A rapid
increase in incidence and prevalence.
4. Cost of
the disease
5. Burden
of disease
6. Has the
capability of affecting the population as a whole
7. Will
require group action to solve.
8. Ability
to recognize the problem unhindered by obstacles posed by
culture, politics, lack of resources, or lack of effective
measures. This set of criteria effectively requires that a
phenomenon must be seen as culturally appropriate, politically
acceptable, technically feasible, and financially possible in
order to be or become a true “public health issue”. ■
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