Academic journal article Generations

The Public Health Perspective on Aging

Academic journal article Generations

The Public Health Perspective on Aging

Article excerpt

Unique and complementary.

The number of older people in the United States will double in the next thirty years. The public discussion about this growing number of elders often focuses on the increased demand they will create for retirement income as well as for health and social services. Health issues play a particularly important role in these discussions because healthcare is a major cost in governmental budgets and because good health is a priority for everyone.

The discipline of public health contributes to this discussion from a unique perspective. Public health is dedicated to promoting the conditions under which people can be healthy (Institute of Medicine, 2002). Three key elements characterize public health efforts: an emphasis on health rather than disease, a proactive rather than reactive approach, and a focus on the population rather than the individual. Each of these elements contributes to the unique approach of public health to the issue of health and aging. In addition, the "public" aspect of public health means that its programs and policies are designed to address the collective good, whether or not they contribute to the private gains of any particular individual person or entity.

A HEALTH EMPHASIS

In January 2000, the U.S. Department of Health and Human Services established updated national guidelines for health promotion and disease prevention. One of the guidelines' two goals is "extending the years of healthy life," a concept that embodies both physical and mental health within a physical and social context (U.S. Department of Health and Human Services, 2000, p.10). For over fifty years the World Health Organization has defined health as more than the absence of disease, but rather encompassing the physical, mental, and social well-being of populations. For older people in particular, the issue of health includes the element of physical function, but also encompasses social and psychological issues (see Damron-Rodriguez et al., this issue).

The philosophy that underlies most public health activities is that all people have a right to health and that everyone in a society benefits when its members are healthy. As a public good, the health of the public is the collective responsibility of our public institutions, especially government. Many public health measures require collaboration among various sectors of the society (see Lang et al., this issue), and many have requirements that are not adequately met by the marketplace.

For example, a large social benefit in the form of improved health and function comes from promoting exercise among older people, but no private company profits if older adults walk around their neighborhood every morning. Drug companies have well-funded marketing machines to promote the latest medications for diabetes, but no company runs ads or hosts phracian conferences at resorts to teach about the research that shows that diet and exercisecan be more effective than medications in preventing diabetes (Knowler et al., 2002). The approach to public health as a social good also underlies the field's characteristic concern with equitable access to healthcare and the conditions necessary for health, as well as the interest in promoting the quality of services that people of all ages receive.

A PROACTIVE APPROACH

Public health takes a proactive rather than a reactive stance. It fosters good health and anticipates challenges to health, rather than waiting for a problem to occur and then working to fix or cure it. As part of this proactive approach, public health distinguishes three different levels of health promotion and disease prevention-primary, secondary, and tertiary.

Primary prevention refers to efforts to prevent health problems from occurring in healthy people. Public health's roots are in the so-called sanitary movements of the nineteenth century, which included efforts to create safe sewage disposal, reduce overcrowded housing, pasteurize milk, and otherwise keep disease from spreading. …

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