The Public Health Primer, by Jo Fairbanks and William H Wiese
The great German statesman Otto von Bismarck once famously said that a people should not know how their laws and sausages were made. When it comes to matters of public health, this is especially true. Where this book succeeds and serves as a worthwhile work in its subject matter is the honesty of the authors in discussing the question of economic scarcity and trade-offs as well as the lack of constitutional warrant for the public health measures and institutions that exist in the United States. The authors are by no means hostile to efforts at public health, but they are aware of the problematic nature of many interventions and the way that such interventions frequently fail to help solve the problems that bureaucrats set out to ameliorate and solve. The authors are far more prone to blame confounding effects and the human tendency to confuse correlation with causation, and celebratory of movements to view health as a process rather than as a ideal that has moral and spiritual as well as physical components, but if there is a fair amount of disagreement that the reader may have with the authors, the authors’ honesty demonstrates that they are people of integrity even if one may disagree with what they have to say.
This book’s main content is less than 150 pages, making this an efficient book, and it contains eleven chapters divided into three parts. After a preface, the book begins with a discussion of the history, development, and organization of public health (I) with chapters on the history of public health efforts (1) starting from the ancient Middle East and Greece, the current US public health system (2), and the practice of public health in the United States (3). After that the authors discuss basic concepts and analytical tools in public health (II), including epidemiology and the determinants of disease (4), basic measurements and statistics (5), inferential reasoning (6), and the surveillance and monitoring of the health of populations (7). Finally, the authors discuss public health interventions and applications (III), including health promotion and protection (8), personal health care services (9), health program planning (10), and global health (11), with a discussion of the far more modest state of public health in many foreign countries. The book then ends with various supplementary material, such as a glossary of terms, list of acronyms, references, index, and information about the authors.
This book really does serve as a public health primer, discussing the desire that public officials have for power and control, their limited ability in managing even the sort of chronic conditions that public health measures are known for. The authors discuss the history of public health and if they are more dismissive of spiritual causes than is right, they surely are right to note that basic aspects of public health are extremely ancient in nature and that public health has frequently failed to successfully deal with the sort of epidemics that make it important. Given the honesty that the authors have about the difficulties of changing behavior, the limited success of public health institutions in improving health beyond the level that we currently enjoy, and the absent constitutional warrant for public health endeavors in general, as well as the economic realities that public health institutions have to work with, this is a book that can be appreciated regardless of one’s view about specific interventions and problems that fall under the rubric of public health. Given that public health itself exists as a way of attempting to counteract the negative effects of people living together, there appears to be some nature of contradiction inherent in the field itself.