Community Public Health: A Perspective to Achieve Health for All


Community Health (think it again)

Public Health recognizes the community as an important component in the prevention and control of diseases in the population. However, the current focus of the public health curriculum and practice is more towards the supply side of intervention rather on community engagement and demand generation. Thus, there is a need to emphasize the role of community in public health and define and develop a specific branch or sub-branch as ‘community public health’ within ‘public health’ which clearly defines its aim, goals, and scope. This would not only help in developing a community public health (CPH) approach within public health, but also assist in realizing the importance of people’s participation at the grassroots level. It is envisaged that the CPH approach will fill this gap to achieve ‘Health for All’. (Image: http://www.fundacionfocus.com)

Introduction

The community is subsumed within public health and it is often assumed that ‘public health’ includes ‘community public health’. Nevertheless, it is pertinent to understand and define these terms and their intended meanings. Available literature defines public health as “the science and art of preventing disease, prolonging life, and promoting physical health and efficiency through organized community efforts that will ensure to every individual in the community a standard of living adequate for the maintenance of health” (Winslow, 1920). The Institute of Medicine (1988) defined Public health as “an organized community effort to address the public interest in health by applying scientific and technical Knowledge to prevent disease and promote health”.


The definition highlights that public health is a discipline, which covers everything related to health of an individual, community and population groups [including the animals]. The contemporary public health emphasizes a community-based approach to health promotion and disease prevention. The evidence shows that despite the emphasis, community involvement, partnership, and ownership is lacking in public health programmes and are leading cause behind the modest impact. Interestingly, the focus of public health has always been on population groups, subgroups, and communities. However, there exists no specific branch or sub-branch as community public health which clearly defines its aim, goals, and scope. Thus, it is important to understand and define the term ‘community public health’ and its meaning and scope and how it is different from public health being a sub-discipline of public health.

Definition of Community Public Health

Community Public Health (CPH) can be defined as “a sub-discipline of public health which primarily focuses on community actions in health promotion and disease prevention for common good”. This definition proposed by the authors emphasizes that the core of CPH should be on community involvement and action. The definition subsumes and emphasizes to respect community's understanding of health, particularly their understanding of social, structural, physical environmental determinants and inequities. Community active participation, involvement, and ownership in designing the public health programmes at the local level, its implementation, and actions is the only path to ensure the success of sustainable public health action and better public health outcomes. Thus, empowering the communities for community health action is must which is currently missing in public health discourse and education. One can argue that public health [service/action/program] focus is on empowering the community through the community health workers (CHWs) programs. And to fulfill this role, many times, CHWs were selected from the communities to which they are serving, with a hope that the community will be empowered through them. But we often miss that these CHWs after their induction become a part of the health delivery system or a program and start looking at themselves as a health service provider and community as a receiver.