What is health? What is public health?

The World Health Organization (WHO) defines health as:

"...a state of complete physical, mental, and social well-being; not merely the absence of disease or infirmity."

The Institute of Medicine (IOM) defines public health as:

"...what we, as a society do collectively to assure the conditions for people to be healthy."

As you learn about the role and goals of public health from the recordings in this training, think about how these definitions can assist and guide you in your work of being health and wellness leaders in your community.

As discussed in the video, depression and obesity are pressing public health concerns.

• What is being done in your community to address depression?
• Is your community connected to Mass in Motion, working to address obesity?

Refer to the last page of this training to access these and other public health resources:

1. MA Department of Mental Health, with many resources for mental health on their website
2. Mass in Motion, a statewide movement that promotes opportunities for healthy eating and active living in the places people live, learn, work and play

Remember, the core role of public health is to create a healthy world. Always be mindful of ways in which you can get more involved in combating important public health challenges in your community.

How do you define health equity? How do you address health equity in your daily public health work?

For some best practices and practice-based strategies to incorporate equity into foundational skills of public health and to advance health equity in your community, review the CDC publication A Practitioner's Guide for Advancing Health Equity: Community Strategies for Preventing Chronic Disease.

According to the Guide, health equity means that every person has an opportunity to achieve optimal health regardless of:

• The color of their skin
• The level of education they've received
• Their gender identity
• Their sexual orientation
• The job they have
• The neighborhood they live in
• Whether or not they have a disability

Are there health issues or certain populations in your community that require collaboration in order to shift the prevalence vs. risk factor curve "to the left" as described in the recording?

Using students as your population of interest, consider how you could collaborate with your school department.

• You could reach out to the school nurses in your district to understand health concerns that they may have already identified in the student population
• Remember, school nurses are public health nurses who happen to work in a school setting

Of course, there are many other potential collaborators who are concerned about youth. Getting to know your community will help you identify them.

We need many partners to achieve our mission of creating healthier communities and a healthier world.

How much of your daily public health work is informed by data? Do you know the difference between quantitative and qualitative data?

Data provides evidence to support programs and policies that are designed to improve individual and population health. There are two kinds of data:

• Quantitative data is information in numeric form (i.e., things that can be counted, measured, or compared on a numerical scale)
• Qualitative data is descriptive (i.e., things that can be observed, but not measured)

Both types of data are important to public health work.

What health data sources are available to you? What data points do you contribute to local or state data collection systems?

Review the data resources listed on the last page of this training. Consider bookmarking them on your computer.

We often want to compare estimates of prevalence or incidence between groups (e.g., those who follow a healthy diet versus those that follow an unhealthy diet).  Remember, there are two types of comparisons:

1. Absolute comparisons look at differences (e.g., differences in prevalence or differences in cumulative incidence)
2. Relative comparisons look at ratios (e.g., ratios of prevalence or ratios of risk)

Once we have these measures, we then need to determine if they suggest a difference in prevalence or incidence between groups, and there are statistical approaches to these assessments.

• The null value (or the "no difference" value) of an absolute measure is zero (i.e., if the 2 risks are equal, the difference will be zero)
• The null value (or the "no difference" value) of a relative measure is one (i.e., if the 2 risks are equal, the ratio will be one)

Which is best to use when determining risk for students in a school setting? It depends on the question you ask.

Use absolute measures for questions like:

• How much impact would a prevention program have?
• How many students would benefit?

Use relative measures for questions like:

• How much more likely are students with the risk factor/exposure to develop a disease compared to those without the risk factor/exposure?

How often do you advocate for your public health agency and its programs? Are you familiar with the elements of effective advocacy and coalition building?

Before moving on, read this policy brief on the power of advocacy released by the American Public Health Association.

Advocacy extends beyond interacting with lawmakers. Some additional advocacy efforts include:

1. Amplifying your message and building greater public support by educating the public about the important role public health plays in improving their lives.
2. Having conversations with family, friends, and colleagues about public health issues and the importance of advocacy.
3. Using your social media platforms, and submitting op-eds and letters to the editor to your local newspapers to highlight key public health issues and priorities.

Think of a health policy you would like to change in your school, district, or community.

1. Who are the advocates that would support the change?
2. Who are the decision-makers that could assist you in implementing the change?

It is important to know the answer to both of these questions before you advocate for any change in health policy. 

Think back to a time you were part of a coalition.

Consider the following questions:

1. What worked?
2. What didn't?
3. What was your role in the coalition?
4. How did your coalition conclude its work?

Do you know the difference between a law and policy? How have laws and policies impacted your daily work?

Federal laws and policies, as well as state and local ones, will shape much of your work.

Laws and policies, however, are not the same thing, so be sure you understand the difference. Periodically review any local board of health regulations in your community, and update your work as necessary.

You should also be familiar with the municipal by-laws that impact public health - things like zoning restrictions, wetland protection measures, and building setbacks can all impact your public health programs.

Print, save, or bookmark the Massachusetts Department of Public Health's Manual of Laws and Regulations Relating to Boards of Health. Review this manual to familiarize yourself with the large scope of responsibilities that local boards of health in Massachusetts have.

• Local boards of health oversee a wide range of public health control and prevention activities (disease surveillance and investigation, environmental and sanitary code enforcement, food protection, nuisance abatement, and many more)
• The Manual supports the concept that oftentimes critical health problems are best handled by local officials who are familiar with the community and the conditions

Take a moment to think about the consequences you see in your community as a result of changes in policies or laws related to health care access.

Specifically, consider these questions:

1. Has hospital consolidation occurred in your community?
2. If so, has that consolidation led to an increase or a decrease in access to care?

How would you define health and public health?

Re-read the definitions of health and public health that were provided at the beginning of this training:

The World Health Organization (WHO) defines health as:

"...a state of complete physical, mental, and social well-being; not merely the absence of disease or infirmity."

The Institute of Medicine (IOM) defines public health as:

"...what we, as a society do collectively to assure the conditions for people to be healthy."

After having learned about the role and goals of public health from all of the recordings in this training, would you agree with these definitions? How you would change or build upon them?

Using one of the two examples Professor Godley listed on the Let's Practice slide, answer these questions:

1. What is the actual health risk?

2. At which level(s) of the social ecological model do you feel interventions are needed?

3. What are your suggested interventions?

4. Which intervention do you think would have the best chance of success? Why?

Do you remember the difference between quantitative and qualitative data?

Take a moment to review the difference between quantitative and qualitative data:

• Quantitative data is information in numeric form (i.e., things that can be counted, measured, or compared on a numerical scale)
• Qualitative data is descriptive (i.e., things that can be observed, but not measured)

Both types of data provide evidence to support programs and policies that can improve individual and population health.