We who are in the practice of public health often struggle with how to describe what "public health" is to our citizens and those who make decisions about our funding. It is not obvious to most people just what public health means. Public health departments are often vaguely thought of as some kind of extension of Medicaid or other public programs involved with providing healthcare to those with limited income.
In the second issue of "From the Director," published in October 2005, I described more precisely what public health actually is. You can find that more detailed description here: http://www.scchealth.org/docs/doche/director/1005_director.html. If you haven't read it, or have forgotten it, I urge you to take a look at it.
The reason I am bringing the topic up again was an interesting experience I had earlier this month when I needed to look up some information on the life cycle of mosquitoes to answer an e–mail question from a citizen. To research this I turned to a tried and true source of information, Municipal and Rural Sanitation by Ehlers and Steel, sixth (and last) edition. This reference was first published in 1958 and the sixth and final edition was published in 1965. It was probably the book most used by both municipal and rural sanitarians for many years and continuing several decades after the last edition.
Sanitarians are now commonly called Environmental Public Health Specialists. No matter the name, they continue a tradition of being masters of multiple disciplines and areas of expertise. Although the ongoing trend towards specialization has split off parts of the generalist practice of Environmental Public Health, these dedicated and well-trained professionals still continue to be responsible for a broad array of public health and safety programs. When I turned to the table of contents of Municipal and Rural Sanitation, I was reminded of this diversity. To illustrate this point I am going to list the chapter titles with a few comments on content.
Chapter 1 – Communicable Diseases – What does an Environmental Public Health Specialist have to do with communicable disease? Some of the chapter sub-topics include typhoid fever, dysentery and polio (all water related), diseases of animals transmissible to man and arthropod-borne disease (insects such as ticks, flies, and mosquitoes). While the diagnosis, treatment, and reporting of communicable disease is a part of the medical side of public health, the control of the factors conducive to the spread of the diseases is sometimes a function of environmental public health.
Chapter 2 – Water: General Characteristics, Treatment and Protection – Traditionally sanitarians provided expertise and practical guidance when a drinking water source was a well, cistern, or spring. This included and still includes the ability to assess the microbiological (and sometimes chemical) safety of such a water source. In some cases it was and remains important for the sanitarian to be familiar and trained in how drinking water treatment and distribution systems work. Safe drinking water sources and vaccination-immunization have had the greatest impact in the last century in reducing death and illness world–wide.
Chapter 3 – Air Pollution and Its Control – This subject is now often a part of a separate environmental protection program but occasionally is still part of the public health department. In either case, it is a public health concern.
Chapter 4 – Treatment and Disposal of Human Wastes – Sewage has the potential to contaminate water supplies. Onsite sewage (septic tank) has historically posed risks to well–water supplies. Proper construction of septic tanks and treatment and disposal of sewage goes hand in hand with the water protection issues in Chapter 2.
Chapter 5 – Refuse–Sanitation – Our 21st century methods of disposing of garbage and solid waste have greatly reduced health threats due to refuse. Ash pits, which used to be a prime breeding area for rats in urban areas, are a thing of the past with restrictions on open burning due to clean air laws. Modern pest resistant containers for garbage and trash and the widespread use of garbage disposals have also resulted in a dramatic reduction in problems associated with refuse.
Chapter 6 – Milk Sanitation – Today, milk and other dairy products constitute one of the most highly regulated (and as a result one of the safest) segments of the food industry. Sanitarians still are the mainstay of milk inspection programs. Their mission is to inspect and enforce standards from the dairy barn to the final stage of packaging. Since milk is one of the most potentially hazardous foods, as well as one of the most nutritious, this level of protection will always be needed.
Chapter 7 – Food Sanitation – Food is a necessity of life, and environmental public health workers inspect food from its source on the farm to the restaurant in which it is served and the grocery store in which it is sold. Even with this oversight, food recalls occur with alarming regularity. Still, the record of working to ensure a safe food supply in the United States is very good and has been improving for many decades.
Next month I will look at the remaining 13 chapters of Municipal and Rural Sanitation. I hope that it is already becoming apparent just how important the practice of Environmental Public Health is to the well–being of our communities.