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April 3, 2006
What is public health?

darren mays is an mph candidate in the rollins school of public health

As public health students, my peers and I agree that, more often than not, what we study is misunderstood. When we tell people—family, friends, complete strangers—we’re working toward a public health degree, the most frequent response is: “So, you’re going to be a doctor?”

While it is true that many public health students do go on to become doctors (not only the medical kind but many varieties), it’s also safe to say these are the minority of students who pass through the Rollins School of Public Health.

Former U.S. Surgeon General C. Everett Koop said, “Health care matters to some of us all of the time; public health matters to all of us all of the time.” Dr. Koop’s statement may in a paradoxical way explain why public health is so often misinterpreted.

Incorporating biological, political and social sciences, public health is a diverse field that provides services that are essential to the collective well-being of populations. These services include monitoring and evaluating the health status of communities; providing those communities with health information and education to enable them to make informed decisions; conducting research and development of cutting-edge health interventions; and providing outreach to ensure individuals receive the appropriate health services. These things often can fly under the radar of the average man or woman, but on a population level, they are indispensable.

Ultimately, every student of public health will put his or her studies to practice in a very different way, but they all share a common goal: Whether studying health behavior and education, global or environmental health, health policy and management, biostatistics or epidemiology, the aim is to ensure that the healthiest of lives is lived by individuals locally, nationally and globally.

To some, this may sound idealistic and lofty. The best way to illustrate how public health professionals work is through a few examples.

Historically, public health achievements—such as improved public sanitation systems, pasteurization of milk and vaccine development—yielded direct, quantifiable successes such as increased life expectancy and decreased infant mortality. However, contemporary public health issues present us with new complexities that require innovative and interdisciplinary approaches and solutions. Consider perhaps our most salient population, one affected by numerous, multifarious pubic health concerns: our children.
Some may recall the April 2003 headline in The New York Times indicating that 25 percent of children in Harlem suffer from asthma. Or, consider the ubiquitous reports of an “obesity epidemic” among U.S. children; current figures indicate that approximately 9 million American children are considered obese, putting themselves at risk to develop chronic conditions such as diabetes and heart disease. These are just two of the growing battles that public health professionals fight today.

Recent research indicates that trends in childhood obesity may be linked to patterns in urbanization and the built environments (the communities where we live, including schools, shopping malls, residential and recreational areas) that surround today’s children, who tend to exercise less, eat less healthy foods and watch more television than earlier generations. All these trends are associated with kids’ growing waistlines and an increase in urban sprawl and reliance on automobiles for transportation.

Indeed, the theme of this year’s National Public Health Week is helping communities improve the built environment and children’s health (see story, page 4), which we at Emory are helping celebrate. Public health professionals have developed numerous programs to combat obesity among children in relation to the built environment. For example, International Walk to School (www.iwalktoschool.org) is a program that seeks to increase physical fitness through a basic form of exercise: walking to school. And the CDC developed its “Guide to Community Preventive Services” to help promote physical activity, as well as review and evaluate interventions, such as changes to physical education curricula to increase the time kids spend physically active at school.

Moreover, research indicates the built environment can affect children’s respiratory health. Recent studies have concluded that children living in urban areas with high air pollution suffer from asthma at much higher rates than the national average. For example, last year’s New York Times headline was quite correct: Children in Harlem suffer from asthma at rates of about 25 percent, compared to the national average of about 7 percent.

While little is known about what causes asthma, it is clear that air pollutants and airway irritants, both of which are more abundant in urban areas, can cause asthma attacks and may worsen matters for children who reside in cities. Most Atlanta commuters who have traveled on the city’s interstates during the summer months have seen the electronic signs above the highway advertising smog-alert days.

Public health professionals are working to intervene at both the individual and population levels to reduce the adverse health effects of pollution on children in urban areas. For example, the Harlem Children’s Zone Asthma Initiative seeks to screen children living in a 60-block area of Central-Harlem for asthma, and has implemented an intensive community-based intervention, including home visits to families of asthmatic children. The home visits assess health care and medication needs and provide a range of environmental, educational, social and medical services based on family needs.

Locally, the Atlanta BeltLine project uses an environmental approach to addressing childhood asthma at the population level, rather than with individual. The BeltLine project (www.BeltLine.org) seeks to connect Atlanta’s communities using a 22-mile loop of abandoned railway that encircles Intown Atlanta. The proposed beltline is two-and-a-half miles from the city’s center, connecting 45 different Atlanta communities and providing access to MARTA stations, schools and local attractions. By redeveloping areas around the BeltLine, including parks and existing green space, the project simultaneously looks to reduce Atlantans’ reliance on automobiles, improve environmental conditions and create a healthier environment in which to raise our children.

While these examples by no means define our field, they do provide a snapshot of public health in action, especially concerning children’s health and the built environment. However, that snapshot does give a glimpse of how all our lives are affected by public health concerns.

We may not carry stethoscopes, but people working toward careers in public health can help write the prescription for a healthy community.

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