PART I

INTRODUCTION TO PUBLIC HEALTH

Discussed issues: definition of health and disease; classification of

health definitions, definition of public health, Essential Public Health
Operations (EPHO)

1. DEFINITION OF HEALTH
Health is commonly defined by reference to various negative terms. When asked “What
does it mean to be healthy?”, many of us would probably reply that “a healthy person is
someone who is not ill”, “health stands for the lack of diseases, pathologies or ailments”. What
is more, many of us would find it easier to list factors that are detrimental to health rather than
those improving health. Having analyzed the concept in more detail, we come to a conclusion
that the concept of health is ambiguous and extremely difficult to define. Therefore we should
introduce a general division of health definitions into1:
• popular definitions, known as amateur definitions of health, and
• Professional definitions, which are usually developed in discussions held by
representatives of various fields of science. Currently we can find approximately
130 definitions of health used in the world. Professional definitions evolve in
time – this is due to, inter alia, cultural and social transformations taking place.
Thus a question arises which definition should be used in health science or in medical
science”? The development of science is the driving force of the development of civilization.
Definitions of health and illness which appeared in different periods of history were determined
by research methods and techniques available then. Of vital importance is also knowledge and
experience of a defining person, as well as values and cultural beliefs concerning desirable and
undesirable states. The development of nursing was initially focused on the biological
understanding of human health, whereas currently is incorporates knowledge coming from
interdisciplinary concepts – clearly concentrated more on building health (supporting good
points and resources of individuals and whole communities, such as, for example, pro-health
behavior or building social support).

The subject literature offers various classifications of definitions of health and disease.
Scientific discussion on these terms is of key importance for clinical practice, medicine
organization and the society.

2. TYPES OF DEFINITIONS OF HEALTH AND DISEASE

1
Domaradzki J. O definicjach zdrowia i choroby. Folia Medica Lodziensia, 2013, 40/1:5-29
 It should be noticed that there are around 130 definitions of health. They are based on
various, often different spheres (biological, mental or social). That is why we can distinguish
the following definitions of health: biological, functional and biological-functional ones2:

BIOLOGICAL DEFINITIONS
Biological definitions treat health and disease as certain somatic states, which can be
experienced with our senses and empirically measured by means of objective medical
parameters. In this scope, health is defined as a biological and physiological state of the body,
whereas disease usually has one cause (genes, bacteria, virus, parasite). Medicine,
epidemiology and etiology are mainly based on definitions of such nature. Examples of
biological definitions:
• Galen’s definition: “a state of ideal balance and harmony of the organism and
absence of pain”
• Brzeziński and Korczak’s definition: “proper or normal state of the organism”.

FUNCTIONAL DEFINITIONS
Functional definitions are typically used by sociologists and psychiatrists, who treat health
as sine qua non condition of an individual’s efficient and effective participation in social life
and their ability to perform valued tasks, while defining disease as “harmful dysfunction”
(disease hinders or makes it impossible for individuals to function in society). Examples of
functional definitions of health:
• Talcott Parsons - health means an individual’s ability to play the assigned
social roles and to perform resulting tasks. (Disease is a state which makes it
difficult or impossible for individuals to function in society).3
• Rene Dubois – health is subjective experience and cannot be classified within
any theoretical framework.4
• Aaron Antonovski – defines health as the feeling of cohesion, coherence, which
acts as an internal system of coping with adversities.5
• Alma-Ata (1978) – At the conference devoted to health promotion held in
Alma-Ata, the following definition of health was adopted: an ability to lead
productive, meaningful and creative life in social and economic spheres.6

BIOLOGICAL-FUNCTIONAL DEFINITIONS

2
Domaradzki J. O definicjach zdrowia i choroby. Folia Medica Lodziensia, 2013, 40/1:5-29O definicjach
zdrowia i choroby.
3
Ibidem
4
Dubos R., Miraże zdrowia. Utopia, postęp i zmiany biologiczne. PZWL, Warszawa 1952.
5
Domaradzki J. O definicjach zdrowia i choroby. Folia Medica Lodziensia, 2013, 40/1:5-29O definicjach
zdrowia i choroby
6
Ibidem
 Definition of health according to WHO (1948): “Health is a state of complete physical,
mental and social wellbeing, and not merely the absence of – objectively existing – disease
or infirmity”.7
In the context of the WHO definition – reaching the so-called complete health might seem
a rather utopian goal, a difficult or even unattainable state. On the other hand, the above
definition clearly marks directions to be adopted if we want to strengthen and improve health.
These actions may be aimed at maintaining physical, mental and social health. Therefore, if we
want to effectively build the health of the society, we need to conduct activities devoted to
health promotion and disease prophylaxis.
Complete, holistic health, as specified in the definition of the World Health Organization,
allows humans to:
• overcome obstacles,
• make mental and physical effort,
• enjoy life.

The concept of health defined by WHO allows us also to indicate a variety of meanings
that health has:
• Health as value – which allows us to pursue our aspirations and fulfill
need for satisfaction and to actively change environments,
• Health as a resource (wealth) which guarantees development of society /
achieving proper quality of life,
• Health as a means – not a goal in everyday life,
• Health as a concept – presenting advantages of being healthy instead of
showing negative consequences of disease.

DIMENSIONS OF HOLISTIC HEALTH (the so-called holistic model of health):

✓ physical health – when the organism functions properly,
✓ sanity:
• emotional health: ability to recognize emotions, express them in a proper way,
ability to cope with stress, tension, fear, depression, aggression,
• mental health: ability to think logically and clearly,
✓ social health – ability to initiate, maintain and develop proper relations with other
people,
✓ spirituals health – related to religious beliefs and practices, a collection of principles and
ways of achieving internal peace and balance.

HEALTH - SUMMARY
Health is a subjective, individual, and even intimate state. Health in holistic sense – can be
built, shaped, created, moved to a higher level. Difficulties with defining health stem from the
fact that is has no material designatum, it is more of an idea than something tangible. Health is
also a relative concept. The goals of medicine are increasingly becoming derivatives of the

7
Strona WHO
social understanding of the concepts of health and disease. Here, the words of Bjørn Hofmann
may sound interesting : Doing good is more important than finding the truth.

3. DEFINITION OF PUBLIC HEALTH

There are many historical and contemporary definitions of public health. They differ as to
tasks, functions of public health and as to the scope of analyzed health conditions8. Below we
can find selected definitions of public health.
CHARLES EDWARD AMORY WINSLOW’S DEFINITION
In the most developed version it is as follows9: “Public health is the science and art of
preventing disease, prolonging life and promoting physical and mental health and efficiency
through organized community efforts aimed at sanitation of the environment, controlling
infectious diseases, educating individuals in personal hygiene issues, organizing medical and
care services which help early diagnosis and preventive treatment of diseases, and developing
social machinery to provide each individual with standard of life needed to maintain health, that
is the organization of the benefits which will allow each citizen to execute their inborn rights to
health and longevity”.
Winslow’s definition was not the first one, but it is acknowledged as the so-called classic
definition. In this version it was adopted by WHO Expert Committee on Public-Health
Administration in 1951. Nevertheless, WHO/EURO today still uses Acheson’s definition.
WHO DEFINITION
Public health is the science and art of preventing disease, prolonging life and promoting
health through organized community efforts.10
DEFINITION ACCORDING TO DONALD ACHESON
In 1988 Donald Acheson transformed Winslow’s definition, describing public health as: the
science and art of preventing disease, prolonging life and promoting health through organized
efforts of the society11.
DEFINITION OF THE AMERICAN ACADEMY OF ARTS AND SCIENCES
Public health is everything we as the society do together to ensure conditions in which
people can be healthy.12
NEW PUBLIC HEALTH
New public health was announced in the papers and program documents of WHO in 1986,
along with the proclamation of the Ottawa Charter for Health Promotion. It was defined as
professional and social care for the effects brought to our health by our environment. New

8
Cianciara D. Nie ma zdrowia bez badań w dziedzinie zdrowia publicznego. NIZP-PZH. Warszawa 2014.
9
Turnock BJ. What is public health. [in:] Essentials of public health. Turnock BJ. Sudbury, Jones & Bartlett
2001: 1-19.
10
https://www.euro.who.int/en/health-topics/Health-systems/public-health-services (dn. 10.07.2020)
11
Rechel, B., McKee, M. Facets of Public Health in Europe. European Observatory on Health Systems and
Policies Series; Open University Press: Maidenhead, UK, 2014.
12
Kowalska I., Mokrzycka A. Międzynarodowe koncepcje podstawowych funkcji/świadczeń zdrowia
publicznego ze szczególnym uwzględnieniem funkcji środowiskowych i ich wpływ na identyfikację priorytetów
zdrowia publicznego w Polsce. Zdrowie Publiczne i Zarządzanie, 2012; 10(1): 31–44
Public Health (NPH) is a science and a complex approach to preserving and strengthening the
health of population in macro-social and local dimensions.13 This approach is based on the
scientific identification of health and health-related needs of communities and initiating and
organizing coordinated efforts of government, self-government and non-governmental
institutions in order to achieve desired health standards. In 2012 the European area of WHO
adopted the European Action Plan for Strengthening Public Health Capacities and Services. In
this plan promotion of health, along with health care and disease prevention was listed as the
core public health operation.14 15
PUBLIC HEALTH - SUMMARY
Public health is both science and practice – a combination of knowledge and action.
Public health aims at preventing diseases and prolonging life of the whole population. Public
health in principle Deal with the health of groups of people, communities or whole populations,
but never loses sight of individuals.16
The subject literature and program documents of numerous organizations operating on a
national and international level bring several descriptions and definitions of public health.
Moreover, the following concepts of public health have been developed17:
• New,
• New Era,
• Global,
• International,
• Ecological,
• Planetary,
• Evidence-Based.

4. PUBLIC HEALTH OPERATIONS

Public health aims at preventing disease and prolonging life of the whole population. This
goal may be accomplished through all actions aimed at ensuring health safety of the population,
actions aimed at preventing, counteracting and minimizing various threats, as well as by
shaping health conditions (socio-economic, environmental, cultural), which enable us to
maintain and improve health of the population18.
Selected functions of public health:
• estimating and monitoring health of communities and endangered populations
in order to identify health problems and determine priorities,
• formulating, implementing and evaluating actions aimed at solving health
problems of the population,

13
Wysocki MJ., Miller M. Paradygmat Lalonde’a, Światowa Organizacja Zdrowia i Nowe Zdrowie Publiczne.
PRZEGL EPIDEMIOL 2003;57:505–12.
14
WHO, (2012).European Action Plan for Strengthening Public Health Capacities and Services.
https://www.euro.who.int/__data/assets/pdf_file/0005/171770/RC62wd12rev1-Eng.pdf (10.06.2020r.)
15
Kulik.T.B. Pacian A. Zdrowie publiczne. PZWL. Warszawa 2014
16
https://www.pzh.gov.pl/podstawowe-funkcje-zdrowia-publicznego-essential-public-health-operations-
ephos-cz-1/ (dn. 10.06.2020)
17
https://www.pzh.gov.pl/zdrowie-publiczne/ (dn. 22.06.2020).
18
Czupryna A., Poździoch S., Ryś A., Włodarczyk WC. Zdrowie publiczne, Kraków 2001, Uniwersyteckie
Wydawnictwo Medyczne Vesalius
 • ensuring the society has equal and fair access to appropriate health services,
organized in an efficient and effective way, taking particularly into consideration
health promotion and disease prevention,
• evaluating the efficiency and effectiveness of the health care system,
• controlling ecological factors and creating socio-economic conditions favorable
to health.
In 1997 the World Health Organization started research on essential operations
(tasks/actions) of public health (EPHO – Essential Public Health Operations). EPHO constitute
a list of fundamental operations performed in order to protect the health of the population and
to treat diseases through actions focusing on the environment and the society.
The European Region of the World Health Organization (WHO) acknowledges the
following Essential Public Health Operations (OPHS)19:
• Surveillance of population health and wellbeing (protective vaccinations, disease
control, disease surveillance, preventing injuries)
• Monitoring and response to health hazards and emergencies (monitoring prevalence and
mortality rate, monitoring determinants of the health state, assessing effectiveness of
promotion, prevention and services, assessing effectiveness of public health operations,
assessing health needs and threats of population groups which should be offered
services).
• Health protection including environmental occupation, food safety and others.
• Health promotion including action to address social determinants and health inequality
(encouraging members of the community to take pro-health actions, providing
information in the school environment, at work and in place of living on health and
skills needed for this, as well as educating in this area).
• Disease prevention, including early detection of illness.
• Assuring governance for health and wellbeing.
• Assuring a sufficient and competent health workforce.
• Assuring sustainable organizational structures and financing of Public Health.
• Advocacy communications and social mobilization for health.
• Advancing public health research to inform policy and practice.
Essential public health operations are divided into two groups:
• focused on collective health needs (of the whole population),
• focused on individual health needs.

5. HISTORY OF PUBLIC HEALTH – SELECTED FACTS

• Hippocrates (400-377 BC) – treatise “On Airs, Waters and Places” – father of
medicine.
• Bernardino Ramazzini (1653-1714) –treatise ‘De morbisartificiumdiatriba’ –
precursor of occupational medicine.

19
https://www.euro.who.int/en/health-topics/Health-systems/public-health-services/policy/the-10-
essential-public-health-operations (5.06.2020)
 • Antony Leeuwenhoek (1632-1723) – grinder, inventor of the microscope, described
blood cells, sperm cells, structure of bones and muscles.
• Gotfried Wilhelm Leibnitz (1646-1716) – philosopher, mathematician and lawyer,
called for establishment of a public health care system.
• John Graunt (1620-1674) – precursor of epidemiology and demography, analyzed the
changes to the health of the Brits based on reports on births and deaths.
• William Farr (1807-1883) – organized and developed the system of medical statistics,
determined the main principles valid in epidemiology.
• Johan Peter Frank (1745 – 1821) – professor of medicine in Gőttingen, Pavia, Vienna
and Petersburg, author of the foundations of public health ‘System einer
vollständingmedizinischen Polizei’ His postulates to the state concerning the health of
the whole population:
• introducing the obligation to have health certificates before one could marry,
• taking care of maternity,
• providing assistance to the sick,
• organizing schools and education in line with health requirements,
• fighting alcoholism and prostitution,
• supplying the population with water and removing waste.
• work of 19th century scientists on prevention of infectious diseases – the golden age
of public health -Jenner (vaccine against smallpox); Semmelweis (aseptic); Pasteur
(vaccine against anthrax and rabies); Koch (discovered Bacillus anthracis, tubercle
bacillus, Vibrio cholera); Pettenkofer (experimental hygiene) ; Lister (creator of
antiseptics) ; Snow (curbing cholera epidemic).
• Laws limiting youth work in England < 18 years old up to 12 hours per day and
banning labor of children < 9 years old (1883).
• ‘Public Health Act’ 1848 and 1875 guaranteeing establishment of self-government
health organs in England.
• Bismarck’s system of social insurance (1883-9).
• Józef Polak (1857-1928) –Public Health journal
• Alice Hamilton (1869-1970) – mother of public health in the United States.
• Marc Lalonde’s report, Canada 1974 – determinants of Canada inhabitants’ health.
• World Health Organization, Conference in Alma-Ata 1978: Strategy “Health for All
by 2000” –HFA 2000 – eliminating inequality in health on a global scale.
• Ottawa Charter 1986 – determined action for health promotion.20
• National Health Program for 2007-2015, Poland
• Health for All in 21st century. WHO, Copenhagen 1999 (Health Policy for All in the
WHO European Region)21:
o Two main goals:
▪ 1. To promote and protect people’s health throughout their lives
▪ 2. To reduce the incidence of the main disease and injuries
o Four major strategies:
▪ Multi-sector strategies in the process of assessing health (health
determinants and their assessment using HIA procedures).

20
https://www.who.int/teams/health-promotion/enhanced-wellbeing/first-global-conference (dn.
11.06.2020)
21
Wysocki MJ., Miller M. Paradygmat Lalonde’a, Światowa Organizacja Zdrowia i Nowe Zdrowie Publiczne.
Przegl Epidemiol 2003;57:505–12.
 ▪ Health-outcome-driven programs and investment for health
development and clinical care.
▪ Integrated family- and community-oriented primary health care.
▪ Participation in health development of partners from various
environments (home, school, work, local community or country)

Infographics to Part I:
1. What is health?
2. Interdisciplinary nature of public health.
3. Definitions and operations of public health.
4. The history of developing a vaccine.
5. Public health research on the emergence and control of nutrient deficiency diseases.