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by Jenny Smith
Table of Contents
Health care is vital to all of us some of the time but public health is vital to all of us all of the time.
—C. Everett Koop, MD, former U.S. Surgeon General (Association of Schools of Public Health, 2003)
Public health is a social institution many of us have heard of but would find difficult to describe. We'd likely either group public health with the medical profession or define it as the local health department. Because most of us rarely come in direct contact with public health professionals, we lack firsthand experience with this field. Yet our health is as dependent on public health as it is on medicine.
Medical personnel provide us with health care when we need it. We go to them for annual checkups and shots or to be treated for a specific illness or disease. In contrast, public health care professionals work on ways to prevent health problems that affect large segments of the population. For example, with epidemics like AIDS or severe acute respiratory syndrome (SARS), the public health profession educates society about these diseases in order to minimize occurrences.
Medical professionals work with individual patients, and public health professionals focus on the community as a whole. Medical professionals concentrate on diagnosing and treating specific ailments of individual patients; public health professionals emphasize prevention and health promotion using a variety of interventions that target the environment, public policy, and human behavior. Both medicine and public health are necessary complements in the overall health of our society.
Focus on population
Focus on individual
Emphasis on prevention, health promotion for the whole community
Emphasis on diagnosis and treatment, care for the whole patient
Biological sciences central, stimulated by major threats to health of populations
Biological sciences central, stimulated by need of patients
Varied interventions targeting the environment, human behavior/lifestyle and medical care
Predominant intervention is medical care
Public service ethic, tempered by concerns for the individual
Personal service ethic, conditioned by awareness of social responsibilities
Variable certification of specialists beyond professional public health degree
Uniform certification of specialists beyond professional medical degree
Public health uses a population-based approach to health. Here are some examples of how this approach works:
(Association of Schools of Public Health, 2001)
A dynamic public health curriculum in schools matters because it can accomplish several important educational goals. It teaches students about health and how to access information and health care services. It strengthens students' connection to their school and communities. It exposes students to potential careers in the public health sector. And it is also an effective vehicle for learning because public health can be integrated into the curriculum across disciplines.
The benefits of public health in education
Public health is a real and concrete way for middle and high school students to learn about health issues. Effective public health education includes opportunities for students to become actively involved in solving current school or community health problems. Through public health, students learn about an issue, develop a plan to address the issue, and implement interventions. For instance, in the public health approach to obesity as a school health concern, students would review data about the issue, learn about the impact of nutrition and physical activity on weight, and identify changes that can be made in the school to address obesity. A potential solution might be to replace soda machines with bottled-water machines. Students learn about good health through their effort to improve the health of others. They apply their knowledge and skills in the classroom and community, under the guidance of the instructor. Feedback is immediate and correction or reinforcement takes place in an ongoing way.
The teenage years are normally a time of self-absorption and self-centeredness. Public health education shifts teens' focus by encouraging students to develop a sense of responsibility for others. Concentrating on the health of others strengthens students' connection to their school and community. A strong attachment to the school community and a commitment to education are critical in reducing a student's risk of drug use and delinquent behavior (Hawkins & Catalano, 1990; Resnick et al., 1997). A feeling of connectedness to school consistently leads to better health among children (Battistich & Hom, 1997; Blum & Rinehart, 1998).
An important component of any public health curriculum is service learning. ASCD's Health in Education Initiative projects used public health as the focus for a wide range of service learning opportunities across different disciplines. Service learning helps build a bond between students and their school or community and lays the foundation for becoming responsible, contributing citizens (Billig, 2000). Broadly speaking, service learning engages students in structured activities based on the needs of the school or community. It integrates the curriculum into these activities, enabling students to apply their skills and knowledge. Through service learning students develop a deeper caring for others (Billig, 2000).
Service learning, as a teaching strategy, is also a powerful way to motivate youth and build self-esteem. Studies indicate that in many cases, students who participate in high-quality service learning programs are more likely to attend class punctually, initiate questions, and complete assignments. They care more about doing their best and show greater concern toward others. Because service learning boosts self-esteem and self-efficacy, students are less likely to engage in risky behaviors (Billig, 2000).
Service learning is not
(National Commission on Service-Learning, 2002)
Public health is an excellent vehicle for the learning process because it can easily be integrated into curricula. English classes, for example, can explore literature with health themes, math classes can analyze and plot data relating to health epidemics, and social studies classes can examine health epidemics among various cultures. Incorporating public health into these subjects facilitates the learning process and provides a variety of service learning activities.
Examples of Service Learning Activities
Mentored and taught 10 lessons to 3rd graders about substance abuse.
Organized and held a one-day summit on drugs, alcohol, nutrition, and sexuality for 6th graders.
Designed research and presented findings on post-9/11 hate crimes and depression among teens in a public forum with local health and city officials.
Educated 30 high school classes about the environmental impact of a local coal-burning power plant.
Created a play for middle school students on tobacco, targeting Latino teens, as part of the advocacy efforts of the National Cancer Institute.
Created a public service announcement on carbon monoxide poisoning for local television.
Created and distributed to classes, preschools, and parent support groups a nutrition guide and cook-book for combating effects of lead poisoning.
Developed and submitted recommendations for Internet articles on ethnic concerns about health care access, gangs, police, and school system issues.
Created a health-oriented newsletter distributed to the student body and faculty.
* This list of schools, identified by the state where they reside, received Health in Education Initiative grants through ASCD to form partnerships with public health organizations in order to promote awareness of public health among middle, junior, and high school students.
Students can gain exposure to public health careers through mentoring and internship opportunities, guest speakers, field trips, and by developing public health interventions for the school or community. Through modeling, students learn about potential career opportunities. Students of all races and ethnicities benefit from exposure to careers in public health, particularly if guest speakers and mentors have a similar ethnic background. Attracting ethnic students to careers in the health care field is also important because each ethnicity has its own nuances that are better understood by a professional with the same ethnic background.
A public health professional is involved in one or more of the following 10 essential public health services.
Ten essential public health services
(Public Health Functions Steering Committee, 1994)
Both public health and education strive to improve the well-being of our society. The mission of education is to create an actively engaged citizenry. The mission of public health is to create a healthy population. The education system educates individuals to improve the community. Public health promotes environmental and social change to improve the lives of individuals. Together they are natural partners in learning for life.
A high-quality public health education class should teach students key skills and information in three main categories: (1) general public health skills, (2) issues relating to culture with a focus on access to care, and (3) environmental change. The class must involve a well-planned service learning component if it is to be maximally effective. Instruction should also center on real and current school and community health issues.
General public health education starts with fundamental theories and models of public health in which the community is viewed as the patient. Students learn to interpret health data for their school or community to accurately understand the prevalence of disease in populations and subpopulations. Analyzing health issues helps students develop critical thinking and problem-solving skills. Interventions, developed and implemented by the students, cultivate leadership skills. Students also gain an understanding about the impact of legal and family systems on public health.
Understanding cultural issues and access-to-care issues is critical for comprehending health problems of the larger community. Family conditions and cultural values may, for example, prohibit or prevent the use of certain traditional medical practices. Language barriers may limit access to care for non-English-speaking people unable to explain their ailments or understand the medical system. Students learn about these issues through exploring their own family and cultural beliefs and that of subpopulations within the school and community.
Advocacy is also an essential component of the public health profession and an important skill for cultivating an active citizenry. A curriculum that focuses on public health issues and skills gives students opportunities to get involved in policy development or change at the school or community level. Concentrating the project's efforts in policy areas where students can be successful builds their competency and esteem. Students learn that they do have a voice and can initiate change that positively affects the lives of others.
When planning the public health curriculum, it is important to help students assess key public health skills they already have. The curriculum should include activities that
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