It seems that in attempting to map out, define, and understand the field of public health, we have only revealed more of its complexities and difficulties. This weeks readings traced the evolution of public health from 19th century “environmental and ecological approaches” and biased, simplistic miasma theories (17) to the current integration of public health into educational, political, psychological, and social systems. It began as a reaction to cholera epidemics in London, which established the ruling theory that environmental factors and social status affected health. The poor, the immigrants, the minorities, the laborers were all blamed for creating the dirty environments that were said to have caused these outbreaks of disease and malaise. While environmental factors are extremely important influences on overall health, they are certainly not the only pieces in the public health puzzle. As the readings discuss, as public health has evolved over the years to adapt parallel to cultural shifts, more and more factors that affect well-being and health are being discovered. Some of these include income levels, spending and support for public health aid programs, education levels, gender, genetics, ethnicity, geography, and workplace conditions. I wonder what the miasma theorists would think if someone explained to them that there are a lot more contributors to health than merely air quality and so-called sinful lifestyles. There are obvious drawbacks to placing too much emphasis on the impact of social factors on health, as we have seen with the treatment of HIV/AIDS patients and the bias against the poor when dealing with cholera. However, viewing public health issues through a purely scientific biomedical lens or “to explain disease without any of the disruptive implications of class analysis” can be equally problematic as it opens up the possibility of ignoring important social factors, as these very elements of class and status are directly linked to health (22-23, 29).
But which is a better and more important predictor of levels of health, social status or biological and environmental factors? What do you think?
JE
