As the field of medicine expands, so too does the field of public health. Public health is the marriage of health and community. It studies how the community and environment influence the quality of life or the people who live there.
Public health is an incredibly broad field, ranging from considerations of poverty, urban planning, safety measures and preventative care. While the traditional healthcare field tends to treat symptoms and illnesses after they happen, public health seeks to root out the risk factors and determinants of those illnesses and find a way to reduce or even prevent them from arising in the first place.
Patrick Remington, the Associate Dean of Public Health at the UW School of Medicine and Public Health (UWSMPH), is an expert in public health, having dedicated most of his career to it. At UWSMPH, they have weaved public health into the research and service missions at the school.
His area of expertise is public health surveillance. He researches and investigates determinants of public health issues, meaning that he and similar researchers are the ones who call attention to and provide evidence for issues that need fixing.
“It’s important to have good healthcare, it’s important to be educated and have healthy behaviors, but these are all influenced a lot by the conditions in which we live, the built environment, the physical environment, policies, rules and laws. Public health tries to shape our environments and our communities so that people can live long and healthy lives.”
In the past, public health has focused on improving living environments and healthy behaviors, but in recent years, more and more evidence indicates that the root causes of many health problems are fundamental factors like poverty, lack of education and unemployment.
“We’ve been adding the concept of health equity, so not just having long and healthy lives, but long and healthy lives for all,” Remington said.
“We really see that today, that having no hope because of being born in [poverty] or ending up in this situation by your circumstance, that with hopelessness, comes poor health,” Remington added.
“Fundamentally, people have pain … often coming from social circumstance.”
In Wisconsin, a model for measuring population health has been developed, called Health Outcomes. It measure how long and how well people live by monitoring four factors: Health behaviors, healthcare access, social determinants, and built and physical environments.
Social determinants include factors like education, job availability, living wages and supportive communities. These social determinants are particularly important, as they are heavily related to poverty rates, which in turn influence the quality of life for the population.
Built and physical environments look at whether the community has qualities like access to safe places to exercise or access to healthy and affordable food.
Here in Madison, public health is also a matter of great importance. Madison and Dane County as a whole have interesting mixtures of rural, suburban and urban populations. In particular, Remington said, the urban areas of Madison are challenged with high rates of obesity, poverty, challenges in finishing school and finding jobs.
“The report on the Race to Equity that was published a number of years ago showed that right here in Dane County, we have some of the biggest disparities between whites and blacks for educational outcomes, of jobs and income and also health outcomes, right here in our own county.”
A public health debate recently arose with a specific provision in the newly proposed Wisconsin state budget. Part of the budget proposes to remove the right of the government to use condemnation to construct new pedestrian and bike paths. Condemnation allows the government to legally take private property for public use, provided that compensation is given to the private party.
Without this power, the cost of constructing new sidewalks and bike paths could rise, as well as possibly causing new projects to be cancelled.
”[Bike paths and sidewalks] are absolutely proven to improve health and safety… It’s not good public policy, it should’ve been debated, and we should’ve been able to compare the cost and benefits of such a policy,” Remington said.
“Childhood obesity rates, adult obesity rates, cannot be confronted without making the hard decisions in some communities that it takes to put in a sidewalk or a bike path.”
While there are many issues still to be addressed in public health, the advances and progress that public health investment has brought cannot be ignored.
The massive anti-smoking campaign started several decades ago has been a huge triumph for public health. Smoking rates have gone down dramatically since it was implemented, as the public became more educated.
“I think the gains from reducing smoking have been tremendous,” Remington said.
Remington also mentioned an exemplary public health in the small town of Algoma, Wis. It’s certainly not a town that would be featured on any travel brochure, but the close community ties and overall population health have marked this small Wisconsin town as an excellent example of proper implementation of public health policy, despite the challenges that face small rural towns like Algoma.
“This little community has figured it out. From their schools, to their employers, to their religious and civil organizations, they have threaded health throughout all their doings.”
While every city faces different challenges, this success story is an indication that public health policy can and does work when done right.
“We want to make the easy choice, the healthy choice, so that people who are trying to live a healthy lifestyle don’t find obstacles … so that we achieve the public health aim of building societies so that all people can live long and healthy lives.”