Understanding Community Health

In our Community Health Program, HumanaNatura uses the phrases “public health” and “community health” somewhat interchangeably, since in principle both terms refer to the same essential social function or process: the systematic and progressive creation of improved health conditions in human communities and the interdependent global society they now form in the modern age.

With either terminology, this essential modern social enterprise is accomplished through the complementary use of applied health and well-being science, social advocacy techniques, and coordinated public or social investments. Usually, the state of public or community health is measured, and thus sometimes implicitly defined, in terms of objective health-related metrics in at least five areas:

Longevity – expected length of life
Morbidity – risk of disabling illness or injury
Autonomy – ability to complete activities of daily life
Fitness – aerobic capacity, strength, coordination, and range of motion
Wellness – reported levels of personal satisfaction and life engagement, and measured stress and antisocial behavior

These objective measures are of course essential to assessing general health conditions in a community, and also to testing the effects over time of specific public health interventions aimed at improving community and societal health. At the same time, we would also point out that undue focus on these and other metrics, or preoccupation with institutional programs aimed at their selective advancement, can obscure the full breadth and holistic quality of the natural phenomenon that is our health.

Metrics in themselves do not ensure sufficient exploration of health science and available health promotion techniques, or the use of science and techniques in efficient or creative strategies for individual and community health advancement. Importantly, metrics alone do not lead to progress in (and instead generally reflect) our current health understanding and can keep us from new health insights and considerations. In our time, this notably includes the critical but still poorly-appreciated HumanaNatura insight that we possess a natural potential for ever-higher states of well-being and quality of life.

For these reasons, it is essential to appreciate that a conscious or unconscious approach to or conception of health enhancement inevitably guides all health promotion efforts (and informs all selection and use of public health metrics). As we will discuss, this underlying conception or framing our health potential proves as important to our ability to advance our health and quality of life as data measurement.

The nature of community health
From the introductory discussions of this program, it should be reasonably clear that HumanaNatura believes a new and more naturalized paradigm for public health promotion is needed to better advance modern health levels. This paradigm is intended to address existing public health system limitations and to mobilize public health officials and the populations they serve in new, more informed, and more impactful ways.

In this section of the program, we will outline the rationale for and needed scope of this new public health paradigm, amid a review of existing public health practices. In later sections, we will provide detailed instructions for implementation of the resulting HumanaNatura community health model. In this review and later guidance, you will see that our approach includes both more robust scientific and social advocacy components. Let’s clarify the needed scientific scope of our new community health paradigm before continuing.

When we consider potential uses of science in individual and public health promotion efforts, there really is only one position we can logically take: that health promotion efforts should make use of all available and credible health-related science. We might temper this statement by noting that our use of science is justifiably subject to resource and implementation considerations (to feasibility and cost-benefit analysis) and to ethical considerations. Other than these caveats, we will propose that there is no other rational limitation of the use of science to promote public health – notably personal or organizational unease with findings or misalignment with sectional interests.

In practice, these rational constraints on health-related scientific inquiry and application usually involve considerations of time, place, and manner (of sources of enabling sponsorship, and the availability of practical and ethical methods), rather than frequent grappling with fundamental limits on our use of new scientific knowledge. New genetic science, for example, today waits for translation into therapeutic uses, but most ask when and how, and not if, this will occur. This is entirely understandable, given our now growing history of scientific progress.

To be true to this important principle, an optimal paradigm for health promotion in our time requires that health efforts be grounded not only in familiar science, but in essentially all health-related science available to us. In this regard, public health efforts must now specifically incorporate critical elements from the emerging science of evolutionary theory. As we have suggested, this last step is critical in ensuring an important and even fundamental new understanding of the natural emergence and development of health, whether human health or that of other species, as well as the health-impacting functioning of the complex evolved systems that are our communities, technology, and global society.

In our time, many public health practitioners and our overall international public health system – local, regional, national, and global organizations tasked with large-scale application of advancing health science in our communities and overall society – can be seen as engaged in a more limited use of science than is possible or desirable. Public health efforts today are of course normally closely allied with key fields of health-related science, and have made powerful use of empirical methods to advance general health conditions (if within traditionally-defined life patterns). As we will discuss, improvements in sanitation, infectious disease control, and environmental pollution levels are among the most important examples of this application of contemporary science.

But added work remains to improve our public health system’s use of available science, and significant barriers to new public health progress resulting from this system limitation are now clearly evident in our communities and global society. As will become clear in this section of the program, there is now an urgent opportunity first to make practitioners at all levels of our public health system much broader and more interdisciplinary consumers of available health-related science. And equally, there is an added and substantial health-impacting opportunity waiting in the full assimilation of evolutionary science by our public health system, including its many essential and integrative lessons for the promotion of human health and quality of life.

Though HumanaNatura’s science and evolutionary-based system for natural health promotion is relatively new, already it has proven a potent and transformative approach to the challenge of modern health enhancement, suggesting the waiting effect in a wider adoption of our natural health paradigm. HumanaNatura’s approach has immediately led to essential new health principles and unusually productive natural health enhancement practices. Today, our evolutionary-based health system offers a fundamentally new conceptual framework for public health scientists, our international public health system, and community health advocates seeking to advance general health conditions.

Without a new foundation for our self-understanding and health promotion efforts in evolutionary theory, and without our use and thoughtful application of the totality of health and well-being science now available, the prioritization and advancement of human health and quality of life by health scientists and public health officials promises to remain poorly-grounded, imprecise, and overly-narrow in scope. Absent change, work at public and community health promotion will likely remain subject to the conceptual and practical barriers and rapidly-diminishing returns we will discuss, rather than achieve the internal synergies and compounding and open-ended progression that is the mark of healthy natural life and robust evolving systems.

Once our health is re-framed scientifically as a natural phenomenon, and its promotion is informed by the full breadth of contemporary health science and advocacy methods available, HumanaNatura’s programs and models demonstrate the way in which formerly diverse fields of natural and health science quickly converge into a new, highly integrated, and remarkably powerful general paradigm for health promotion. This new human health promotion model links all modern-day health issues in individuals, communities, and even our global society to our long natural history and basic design as a species. It promises nothing less than to guide both research and public policy efforts in far more effective and optimal ways.

The full result of this change – grounding the overall practice of public health in nature and natural systems, rather than the immediate and evolved biases of society in any epoch – promises to be nothing less than a revolutionary step forward in both the effectiveness of our public health efforts and the general quality of life in communities around the world.

The modern rise and dilemma of our public health system
Today’s scientifically-driven discipline of public health began in earnest in the 1800s with the industrial revolution. Unprecedented urban migration and growing pre-modern cities spawned rapid increases in levels of illness and death – notably from inadequate sanitation, infectious diseases, workplace hazards, and social upheaval. Concurrently, the scientific advances that enabled industrialization provided the means to curtail these newly exacerbated but longstanding characteristics of urban life.

As you may know or suspect, the formal practice of public health is much older than the industrial revolution, with evidence of earlier, pre-scientific efforts extending back to the oldest Asian and Mesoamerican city-states. These pre-industrial public health measures were arrived at by quasi-scientific observation, trial and error, and natural intuition.

In most cases, earlier public health measures evolved to similar and predictable natural limits, since they proceeded with only a superficial understanding of the sources of our health and the mechanisms of disease. As we have suggested, though limits on public health efforts have been appreciably lifted in our time through the scientific revolution, the efficacy of public health actions are still closely linked to available science and its integrated use. Thus, even today, limitations in our public health efforts are inevitable whenever the discipline lacks progressive uptake or the capacity to organize and apply new health science.

Pre-modern public health practices included the separation of human and animal waste from human living and gathering areas, provision of pure natural drinking water, nutritional recommendations, segregation of people with serious infections, safety practices in trades and guilds, ensuring adequate light and ventilation in urban buildings, and providing designated areas for recreation and encouraging exercise. With industrialization, these earlier efforts were able to borrow from new scientific and technological advances, allowing public health efforts to greatly extend their impact and reach. The result was to mitigate and ultimately overwhelm many of the increased risks to community health that came with the rise of modern population centers. The most notable of these risks related to poor sanitation, infectious diseases, and inadequate food safety. Their modern mitigation has now produced an unprecedented level of human health for most people in the industrialized world.

Based on the health metrics introduced before, the most successful public health programs in the last 100 years include vaccination programs, motor-vehicle safety, workplace safety, infectious disease control, health promotion programs targeting heart disease and stroke, food safety, maternal and infant health programs, family planning, water supply safety, and anti-tobacco efforts. These programs have combined to greatly extend longevity and improve quality of life in all developed nations and many developing countries. Although not typically included in traditional conceptions of public health, we would add that other progressive social measures in the last century have proven at least as effect. These include measures to reduce the threat of world war, the rise of modern law enforcement methods and the extension of criminal justice systems to more of the world’s population, the greatly expanded education and nurturing of children, measures to ensure the equality of women, and the gradual automation of hazardous work.

As suggested before, the modern discipline of public health has been described as a form of social or public enterprise that seeks to extend expansions in science to optimally impact human health. This particular and critical form of social enterprise involves identifying health-related opportunities and problems amenable to scientific understanding and collective action, and the making of public investments to protect, promote, and improve our overall state of health and well-being. As a social enterprise involving collective action, the discipline of public health is thus always in part a political procedure, requiring not just credible and actionable science, but also adept public leadership. By the term public leadership, we mean the ability to build public awareness and consensus for change, and then to achieve the active or tacit agreement of people to act or structure life in new ways.

In following the progression of public health, before and during the industrial era, there has been an important change in the state of the discipline in the last fifty years that bears special note and consideration for those of us interested in promoting new public and community health. Throughout much of our civilized past, public health efforts were principally limited by inadequate science – by misunderstanding or ignorance of the nature of the health opportunities and threats we faced as people. But with the remarkable expansion of science in modern times, the practice of public health has been largely freed from the constraint of inadequate understanding and made into a powerful and potentially open-ended public enterprise.

As a consequence of the scientific revolution, and the profound and still accelerating pace of scientific discovery, the discipline of public health today faces a new, quite different, and still generally underappreciated principal constraint and modern dilemma. This new state of our public health efforts is in fact one of abundant science, to the point that available health science now increasingly eclipses the discipline’s traditional need or capacity for conceptual, political, and social leadership. Our inherited public health system is, in other words, now inundated with new and highly actionable health science, but is steadily proving unable to assimilate and act on this science in society today.

Because of the vast expansion of available science, our public health system is now principally limited by its conceptual, organizational, and political dimensions, rather than its traditional constraint of available scientific understanding. As we will discuss, these limitations include but extended well beyond its ability to assimilate emerging health-related findings from increasingly diverse fields of science. They include the discipline’s seeming incapacity to formulate a positive health-based vision for society, to marshal support for new progressive change that is reflective of our full scientific understanding, or to move beyond past successes at threat mitigation and related modes of practice.

For this reason, HumanaNatura believes that limitations in the robustness of public and organizational leadership. and heath advocacy models – including the poor uptake of unfamiliar fields of science and natural models of human health – are now the principal constraint on new advances in public and community health in our time. As evidence of this idea, we would point to important new non-scientific constraints on community health advancement that are already strongly extant in society, reflecting our public health system’s state of art.

These common constraints can be seen in a number of health-related areas in society today:

Evidence of Non-scientific Limits on our Public Health System

An insufficient, piecemeal, and disorganized paradigm for health promotion, with no clear unifying goal or vision – especially in the developed world
Continued principal emphasis on health threats over than well-being opportunities, marked by over-resourcing and over-management of established programs
Inadequate cultivation of public expectations for continual progress in health and quality of life – for contrast, as advocates have created for technological progress
Inattention to and lack of facility with clearly-understood and remarkably urgent new health issues (e.g. the deadly and now ubiquitous triad of sugar, salt and fat-rich foods)
Insufficient and far from optimal public investments in various areas shown to reliably promote greater health and quality of life (ones we will discuss)
Continued excessive funding of medical care and inadequate investment in to reduce preventable diseases and premature health-impairment

This new central dilemma of public health in the twenty-first century – principally involving conceptual, organizational, and political limitations – has its roots in the discipline’s history of working within and only selectively challenging community living patterns and social outlooks. Public health officials in the past, lacking the scope of science now available to us and facing formidable urgent threats to public safety, sought primarily to improve life as it was generally led. Then, they had little opportunity or need to lead consideration of altogether new modes of life and health in order to further quality of life.

This earlier trend or model for public health promotion is of course understandable, when one considers that before the 1800s, the tenor of community life and preoccupations of people were closely linked to long-established and closely-held religious ideals, and before the 1700s, that human life was only slowly evolving and approaches other than feudalism and an agrarian-based economic order were not yet understood. Pre-modern life, as it was lived, was thus often seen as an essential and only gradually alterable human condition by earlier public health practitioners, just as it still is by many lay people and health practitioners today. But now, this intuitive view of life persists in the face of sweeping, profound, and ongoing changes in our society in the last century, and new and abundant data suggesting that greatly improved social systems and public health approaches are now possible.

Lacking credible science to suggest improved forms of community organization or models for daily life, public health advocates in the past used emerging scientific knowledge primarily to make inherited patterns of life less conspicuously and immediately hazardous. Unfortunately, this threat-reduction approach to public health is now fast reaching its own internal limits, just as pre-scientific efforts once did, as selected large-scale health threats amenable to earlier methods have become well-mitigated. Now, our contemporary public health efforts increasingly can be seen as operating far below their full potential, in our more scientifically-advanced and health opportunity-rich digital age.

For HumanaNatura, our past general approach to public health is one that now requires significant re-thinking and change, and calls on us to again bring new science and improved advocacy practices – this time post-industrial era ones – to the longstanding human endeavor that is public health promotion.

Macro-view: Our public health enterprise by the numbers
Before considering specific new programs for our public health system and introducing our alternative community-based operating model for the general practice of public health, let’s first describe in greater detail our public health system as it is today in much of the world, to ensure you are grounded in its essential facts and current “as is” state.

The social enterprise that is our international public health system is an enormous effort spanning the developed world and most developing nations. To get a sense of the scale of public health efforts today, consider health-related expenditures in the case of the United States, which admittedly represents the high end of public health investment spectrum among the nations of the world today. But this level of investment, as well as specific idiosyncrasies in the U.S. system, are likely an important indicator of the trajectory and eventual outcome of current public health approach in all nations, developed and developing alike, without substantive change in orientation, focus, and methods.

The U.S. National Center of Health Statistics reported recently that roughly 12 million people were employed in the nation’s health system, representing almost five percent of the U.S. population, and that annual health-related expenditures in the U.S. totaled approximately $2 trillion, or about 15 percent of its gross domestic product. These amounts include the costs of medical and health care services, for reasons that will become clear in a moment. But they do not include the administrative and social costs of governmental safety, industrial regulation, and environmental protection agencies, all of which contribute to the promotion of public health (but our often viewed as lying beyond the field’s domain). These figures also do not include billions of dollars in health investments made at an individual and family level.

Comparable health-related expenditures in other developed countries, though lower than the U.S., are still quite large and in most cases increasing rapidly as a percent of gross domestic product. A recent analysis of health-related spending by the United Nations’ Organization for Economic Cooperation and Development, measured as percentage of gross domestic product, included the following findings: Australia (9.2%), France (10.4%), Germany (10.5%), Japan (8.0%), and the United Kingdom (7.8%).

Health investments across the developed world are thus substantial and even are understated in these statistics. In the world-leading case of the U.S., health-related expenditures are the subject of intense and ongoing scrutiny by both professional analysts and political leaders. Such scrutiny is a development that can be expected to emerge in other developed nations, and then in developing ones – as national health-related expenditures steadily increase in proportion to national income, and especially where increasing expenditure levels fail to reliably advance key public health measures and objectives in an equal or greater proportion.

On this important point, it might be tempting to take increasing health-related expenditures as a positive trend, reasoning that increasing and sensibly-managed health expenditures will lead to increasing states of health and quality of life for the people of a nation. But emerging data suggests this is not the case today and will not be the case in the future, even when great efforts are made to wring efficiencies from health systems as they are now generally constituted. In the developed world, substantial diminishing returns in health expenditures have already begun to set in – with stalling progress on key health measures and galloping expenditures for costly treatment of unmitigated sources of illness and compromised well-being. Together, these trends risk circularly driving further disinvestment in programs to promote future health levels, and underscore the need for progressive change in our approach to public health.

Another tempting and common explanation for the trend of increasing health costs is the idea that they are a consequence of aging populations in the developed world. Unfortunately, this explanation fails to account for a majority of the data, since health costs are rising disproportionately to aging effects in many nations. This idea does not consider the effects of new modern trends toward diminished health earlier in life, ones that are now substantially impacting public health levels and driving new health expenditures in younger adults. These trends include increasing obesity and related diseases, unmitigated cardiovascular and cancer risks, debilitating stress and disaffection and their related health consequences, and widely divergent health outcomes for different social groups within nations. For us, all are predictable outcomes of materially abundant, consumption-based, and inadequately health-focused social systems and public policies.

Ultimately, HumanaNatura believes that increasing health-related expenditures and declining health-related returns across the developed world are systemic. From our perspective, they are rooted in a vicious cycle of insufficient public understanding and investment in key health promoting social conditions, and exacerbated by insufficient public leadership and an inadequate paradigm for public or community health promotion. A principal result of this uncontrolled health cycle is our growing need for increased medical expenditures, or the rationing of costly medical care, amidst increased and multiplying health and wellness reductions in adults of all ages (reductions which are further magnified by aging effects).

Aggregate data from our public health system thus suggests an urgent need to reconsider our goals for and approaches to public health promotion. With change in specific areas we will discuss, we have the ability to counter the key drivers of this vicious cycle of health disinvestment amidst rising technology, prosperity, and scientific understanding, and break through current systematic limits to achieve new states of public health and quality of life. Instead of these limitations, we would ask you to begin to imagine an alternative path of consistently increasing health and quality of life in our communities – at constant or even diminishing levels of public health expenditures – through synergies and network effects available through more informed, coordinated, and participatory public health promotion strategies.

Micro-view: Focus of public health officials today
In our time, the work of public health promotion is principally conducted by scientists, governmental professionals, and non-governmental advocacy groups working at the local, state or provincial, national, and international levels.

This multi-leveled public health system has intended and unintended overlap, and is subject to normal organizational biases to overweight resources in established competencies and at its top and middle levels. Both trends are due to well-understood organizational and human dynamics, including the force of careerism and excessive and often unconscious resourcing of roles proximate to key decision-makers and their immediate staff. Keeping in mind these natural tendencies toward lowered organizational and system effectiveness, our public health system is intended to work as an integrated, complementary, and health-promoting set of operations – one, as we have suggested, that is distinct from and antecedent to the practice of medicine and the delivery of health care services.

While there is considerable variability in roles and training within our public health organizations, in different nations and especially at the community level, many practitioners have training in health science, public policy, or a combination of the two (via dedicated undergraduate or graduate-level training programs in public health). In general, our most highly-trained public health professionals today are consolidated at the national and international levels of our public health system. Many are technically-oriented and have limited experience in political advocacy, and often only early-career experience in the execution of public health programs at the community level. Even fewer have experience in integrated health promotion efforts and instead normally concentrate on specific health programs and in functional or specialist areas.

For all these reasons, much of our public health system today is functionally and programmatically, rather than locally and holistically, oriented. By its own nature, this distinct form of organization often leads to diffuse accountability for outcomes at a regional or local level, and is generally subject to lower levels of self-integration, progressivity, and client involvement than is possible or desirable. The result is less public health advancement than is possible, notably in a time of proliferating health science and new tools and methods for both organizational transparency and social advocacy.

At this point in our discussion, we would encourage you to spend some time doing an online search to learn more about public health service delivery in your community, including identifying the local, state or provincial, national, and international public health organizations that have jurisdiction for or an impact on your community’s health promotion efforts. We will set expectations in advance that this task can be daunting, since there are often a surprising number of governmental and non-governmental agencies, at various levels and with varying responsibilities, involved in the enterprise of public health. But together, these agencies ultimately promote, or fail to promote, progressive health and quality of life in your community.

Understanding the scale and diversity of actors within today’s public health system – and the often unclear accountability for community-level health outcomes within this system – can be real work but is also deeply revealing and informative. It underscores the enormous public health effort already underway in the world today. It equally highlights the generally top-down, often single-issue orientation of many elements in our existing public health system, and the generally low integration of these elements. A review of our health system from a community level underscores the great distance and often only limited connection that now occurs between our public health system and the life and concerns of local communities. And it reveals the principal – and for HumanaNatura generally far too limited – conceptions of our health and quality of life advancement potential.

As you begin to investigate the specific governmental agencies and public health organizations with responsibility for your community’s health (your local public health agency may have a list or publish one online), you are likely to find responsibility and focus in one or more of the following areas:

Common Public Health Focus Areas Today

Drinking water regulation
Waste & waste water regulation
Food safety
Vital statistics
Tobacco prevention & control
Women, infants & children
Health profession licensing
Health facility regulation
Medical & crime examination
Laboratory research
Mental health
Drug & alcohol abuse prevention
Environmental regulation
Environmental health
Toxic substance control
Health care services
Emergency response
Health risk screening
Communicable disease control
Occupational safety
Home safety
Transportation safety

Each of these public health efforts is of course an aspect of promoting greater public health in our time. But as you may find in your investigation of public health programs in your community, existing programs often lack sufficient integration and cohesiveness, many are ineffective or over-resourced relative to more compelling community health investment alternatives, and almost all are inadequately integrated into a larger general effort to advance societal health and quality of life or to leverage resources by engaging local communities in the work of progressive health self-promotion.

As we have suggested, after many years of focus on control and standardization in traditional public health domains, natural organizational biases toward specialization and orthodoxy, and over-reliance on traditional methods and sources of political legitimacy, have created a slowing pace and imprecision in new public health efforts. We believe these trends have developed to the point of creating important barriers to the field’s continued advancement in the developed world. These limitations include conceptual constraints on the potential scope of public health endeavor and permissible domains of science, a failure to look beyond public health’s earlier mandate to prevent immediate threats to life and health, and the lack of an integrated and sufficiently compelling contemporary mission for public health.

As a result, our global public health system is now insufficiently progressive and self-challenging in its underlying models and approaches, far too focused on risk mitigation and past modes of practice, and unable or unwilling to forge new public consensus for reliable new health promotion investments (ones often extending beyond its earlier scope of practice and requiring new health promotion methods). These important trends are worth taking a moment to put into perspective, by again considering that medical and health care delivery systems across the developed world generally continue to find increasing funding (evidenced by their growing share of world gross domestic product).

For us, this trend of increasing medical expenditures amidst declining efficacy in public health promotion efforts represents more than the expanding treatment of people and disease, it is also a reflection of continued poor health amidst greater affluence and health expectations – and thus of inadequate public health leadership and social investments to ensure health and quality of life amidst these conditions. This trend is of course decades in the making and, if unchecked, will require eventual action from either within the public health system or outside of it. In either case, rapidly rising medical costs are strongly suggestive of an inadequate current approach to public health promotion. They are a development that has been allowed to go significantly unchallenged by public health leaders, despite their understanding of the generally poor ability of medical care to impact community health and quality of life outcomes.

Though often counterintuitive to people and significantly at odds with our dominant pattern of health-related expenditures in much of the world, current data suggests that of the roughly 30-year improvement in life expectancy in the developed world from 1900 to 2000, approximately 25 of these added years of life came from public health efforts and only five from improved medical care, despite social investments that favored costly medical care expenditures over public health promotion investments by a factor of roughly 30:1. This astounding pattern of facts must call to task our current public health system and its leadership, and begins for us a clear case to explore systemic change.

The full result of these trends, in the developed world at least, is a public health system in unmistakable, but still largely unrecognized, crisis. From the HumanaNatura perspective, it is a system too narrowly focused, built upon on and wedded to inadequate models of human health and public health promotion, and failing to keep pace with dramatic expansions in health and well-being science and social advocacy techniques in our time. It is also a system frequently eclipsed in the political sphere by our medical community and many other sectional groups, in spite of its fundamental criticality to advancing human welfare and impressive earlier record of social activism and benefit.

As we have discussed, our public health system faces and inevitably must find ways to overcome our natural human under-appreciation of the importance and power of cooperative action, and the effects of sustained and compounding social investments in our future. Admittedly, this insight has been growing within our public health system for some time, but thus far has not caused sufficient change to suggest clear alignment with this critical health principle.

Calls for new health leadership
As mentioned before, modern public health efforts have traditionally been defined and organized around solving and preventing severe and widely-recognized social health threats – given the dominant pattern of life in any given time – especially where political mandates for action are largely given and the legitimacy and coercive power of national and regional government is available to public health practitioners.

While these efforts are important, plainly essential conditions to a healthy global society, and even foundational to advancing natural human health amid fixed life, they hardly exhaust the potential for health-promoting public investments we might make as communities and an interconnected global society. Traditional descriptions of public health highlight this general scope of practice, dividing the discipline into two fundamental areas of concern:

General environmental controls – especially of water and sewage
Specific disease controls – including vaccination and hygienic standards

This broadly-accepted framing of our public health system’s mission underscores the discipline’s long focus on the prevention of disease, death, and disability, and suggests why many public health organizations face considerable difficulty when asked to make the needed transition to public health’s next frontier – the identification and promotion of deeper and generally unrecognized health and quality of life opportunities. Implicit in this new work is the cultivation of public awareness and political support for progressive health-promoting social investments.

In fairness to many within the public health system, attempts to better define and broaden conceptions of the practice of public health have occurred before and are ongoing, and successful health promotion programs have been implemented beyond the conceptual limits of environmental and disease controls (as familiar items in the list of public health accomplishments above suggests). In fact, as early as 1920, the American health advocate and public health pioneer C.E.A Winslow actively promoted a recasting of public health as “the science and art of preventing disease, prolonging life, and promoting health,” suggesting a new balance between prevention and promotion efforts.

A generation later, in 1958, the British industrialist and health advocate Geoffrey Vickers provocatively suggested that advances in public health and human quality of life were made through the “successive re-definings of the unacceptable,” underscoring the idea that progress in and the process of public health is as much conceptual, political, and activistic as scientific. Vickers correctly recognized that a key limitation on social health levels and the permissible scope of public health efforts in modern times is our current attainment, and thus conception, of health and quality of life itself – what today’s public health discipline calls (and often too passively accepts) the “macro environment” in which it operates and we all live.

More recently, and perhaps aptly reflecting the risk-aversion and orthodoxy that now increasingly limit our public health establishment, in 1988 the U.S. Institute of Medicine feebly suggested, in a seminal assessment of the state of public health, that the discipline’s correct focus was on “assuring conditions in which people can be healthy.” This decidedly accommodating recommendation effectively places the locus of responsibility for health promotion on individuals and thus limits our total health potential – by downplaying the critical role that social systems and public investments play in determining general health and quality of life levels, as well as our expectations for future health states.

As you might expect, this proposal hardly captured the attention of political leaders of the time, and was perhaps not intended or expected to, and failed to inspire a new generation of waiting public activists to take up important public opportunities, then and now, for greatly increased focus public health and quality of life promotion.

Despite regular calls for change from within the discipline, most public health efforts today remain organized as they were fifty years ago, around six major functions:

Public health’s major functions today

Preventing epidemics & the spread of disease
Protecting against environmental hazards
Preventing injuries & disability
Promoting & encouraging healthy behaviors
Disaster response & recovery
Assuring health service quality & access

As you can see from this list of widely-accepted public health system accountabilities, the task health promotion is included, but is also masked and largely overwhelmed by a public health agenda organized and dominated by focus on large-scale threats to habitual activities of daily life.

This total approach is of course far less than alternatives we can imagine, ones where public health leaders might perhaps visibly seek to challenge and improve the content of daily life and regularly foster progressive “re-definings of the unacceptable.” With a larger view of the ultimate mission of our public health system – indeed of all government in a modern and interdependent age – we might even expect our leaders to champion ongoing initiatives to pursue our new potential for unprecedented health and well-being amidst the progressing science and technology around us.

HumanaNatura’s four-part agenda for change
Given these many considerations, we believe there is a new and urgent opportunity in our time to make our public health system far more adept in its political domain, and to move the discipline beyond its historical moorings and earlier focus on mitigating the severest and most immediate health risks inherent in communities as they are constructed.

To break the organizational and conceptual impasse that now keeps our public health system from progressive leadership in the face of rapidly advancing health science and advocacy methods, we believe that the discipline of public health must now be greatly democratized and far more deeply integrated into society itself, and not allowed to remain as a relatively passive and bureaucratic function of central governments. As in other new social endeavors in this pattern in our time – including the promotion of industrial competition, the opening of borders between nations, and the rise of open information systems – we expect that the bringing of new transparency and decentralization to the essential social endeavor of public health promotion will be disruptive but also will infuse health promotion efforts with substantial innovation and new progressiveness, and provide important long-term benefits.

The new opportunity for the discipline of public health today, enabled by startling advances in health-related science in recent decades, is to re-draw its underlying paradigm and operating models, to see and pursue our modern and natural potential for much greater health and quality of life, and to foster new and stronger health-based agendas voices in the political life of our communities, nations, and global society. For health practitioners and community advocates around the world seeking opportunities for progressive change, the potential for positive and transformative impact through new health promotion methods is now waiting, potent, and far-reaching.

As suggested in our discussion, HumanaNatura believes that our public health system must now re-focus in its efforts in four key areas. In our view, these changes are essential if our public health system it is to continue to advance health and quality of life beyond current limits, redirect vast and often ineffective medical care expenditures to far more health-impacting uses, and help our increasingly post-industrialized world better see its changed health landscape and seize its new open-ended health potential.

HumanaNatura’s four part proposal for change is as follows:

Broader use of science – a key opportunity for change in our public health system involves broadening the ways it defines and considers public or community health. This change includes assimilation of more diverse health-related scientific disciplines, ones that are new and still expanding in our time, including critical fields exploring evolutionary health dynamics. This broader set of findings and models offers both expanded and more fundamental ideas of our essential health contributors, and suggests both more ambitious and more holistic public health efforts. The expected result of this change will be to the enable far richer and more natural conceptions of our human health and quality of life needs, more essential and systematic programs for health promotion, and improved priorities and more impactful future health-related expenditures.
New emphasis on public leadership – a second opportunity for new public health system progress entails more express recognition of the inherently political nature of public health promotion. This change includes the now urgent need to view active and astute political leadership as an essential part of the work of health promotion in a new century, particularly as this work moves from mitigation of obvious health threats toward investment in more subtle quality and fabric of life domains for the future. Across many areas of our public health system, societal health would be well-served by a new and ongoing focus on the politics of our health and active and effective engagement in contemporary health science advocacy. Importantly, this change must include encouraging candidates for elective office with health-based and quality of life political platforms.
Community-based health promotion – a third critical opportunity for change involves re-focusing and better integrating health promotion efforts at the community level, where social health landscapes principally occur and where their essential influences on individual health are most directly realized. This change includes better enlisting and supporting local communities in the planning and work of health promotion investments. It also includes infusing the public health system with an overriding focus on making health promotion measurable and accountable at the community level, and ultimately a locally-directed and self-advancing community process and mission, whenever this is feasible. This altered model for public health promotion suggests a strong matrix organizational structure for our public health system overall, one that: 1) puts community health leaders and community-based advocacy groups on equal footing with functional scientists and specialist professionals, 2) views both sets of actors as essential components of well-targeted and progressive public health action, and 3) substantially reduces middle levels throughout today’s public health system.
Commitment to progressivity – as suggested already, a fourth and in some ways most fundamental component of needed change to our public health system – one that aims to set our societal public health efforts on a continually self-correcting and self-renewing path over time – is a new system-wide commitment to progressive health and quality of life improvement as the foundation of all public health organizations and promotion efforts. This change represents a sharp break from the public health system’s past, and its earlier principal focus on functional mandates and mitigating urgent threats of death and disability. The change even suggests a new and far more desirable central mission or ethos for all civil governments and communities in the post-industrial world – that of progressively promoting health and human quality of life.

HumanaNatura’s proposal for a new four-part program of change for our public health system seeks to resolve and move public health promotion beyond the dilemma it now faces in the developed world – of increasingly costly health-related expenditures but diminishing overall quality of life improvements resulting from these expenses. It envisions a more diverse and vigorous uptake of health-related science, far more activist and skilled involvement by health advocates in political life, a redefined operating model directed principally at participatory and self-advancing health promotion at the community level, and sustained commitment to progressivity as a system-wide public health ethos.

For HumanaNatura, the case for these changes is already clear and becomes more compelling with each passing year, as rapidly health and well-being science advances suggest important and compelling new opportunities for far greater post-industrial health and quality of life than presently exists or is being pursued today. These opportunities are still poorly understood in our time, by the general public and many public health practitioners, and thus require an essential new, science-based natural health paradigm in communities and nations around the world.

Re-defining public health today
For the important reasons we have discussed, and despite good intentions and work of public health practitioners with the current system, we believe our global public health approach is in need of substantial and basic change in its methods, models, goals, and approaches.

In our view, the natural human imperative of public and community health is simply too fundamental to our well-being and quality of life to be left to a status quo that is less than our full potential. In our time, this includes permitting the lagging orthodoxies, relenting application of science, self-referential orientation, and top-heaviness of our existing public health establishment to persist. As we have suggested, all are regular shortcomings of the traditional bureaucratic structures and “command and control” functioning that our public health system still regularly employs.

As we seek change and new public health system responsiveness, our understanding of the discipline that is public health can be greatly simplified and demystified, with productive and insight-yielding results. Despite the enormous and complex public health structure we have inherited, all public or community health-promotion efforts in their essence involve the pragmatic, and ideally progressive, removal of health limiters and creation of new health enablers in our communities and broader society:

Public health’s essential attributes

Grounded in multidisciplinary science (medical, psycho-social, quantitative)
Frequently requires governmental action
Involves social justice and fairness considerations
Political in nature – allocation of costs and benefits
High focus on prevention (HN: needed shift to promotion)
Open-ended agenda (new health measures always possible)

With these essential attributes in mind, you can perhaps see that the basic social function that is public health potentially can be fulfilled in many ways and with any number of organizational formats. The discipline’s principal constraints thus do not involve a complexity of purpose or method, but rather just two key operating requirements: 1) the availability of accurate and actionable health science, and 2) sufficient political, financial, and managerial resources to act on this science.

For this reason, we might now begin to focus our public health efforts entirely on these two tasks – the surfacing of actionable science and the effective application of this science in society – and encourage experimentation with a variety of operational expressions of these efforts in the coming decades and beyond. In this way, the discipline of public health can be expected to evolve and improve, and find its most effective approaches and best practices in different social settings, especially as technology and living conditions continue to change and our level of scientific understanding improves. In all cases, the success of any public health structure or system should be measured by its ability to progressively advance the health landscapes of the communities, families, and individuals it touches. Today, of course, we largely have one approach to public health.

The critical function of advancing public health must naturally begin with action on clear and present threats to the life and health of a community. These include security issues, infectious diseases, hazardous materials, and other risks that are the traditional domain of modern public health efforts. But as these more pointed and palpable risks to community health are mitigated, our public health efforts cannot be held hostage to them. If public health efforts are to function progressively, the task of health promotion must naturally shift to less urgent but still substantial health limitations and opportunities, and be permitted and encouraged to employ new and altered methods to address them.

Needed new areas of public and community health focus include public policies and social investments in many essential dimensions of modern community life. Most are well beyond the scope of traditional public health practices and include:

New opportunities for community health advocacy

Community planning and design
Land use and zoning
Transportation systems
Energy and the environment
Nutrition and exercise
Lifestyle and personal incentives
Family integrity
Stress and disaffection
Educational curricula
Community & individual norms
Employment & work-life balance
Taxation & economic policy
Community sustainability

As you may have discovered in researching the agencies responsible for health promotion efforts in your community, most traditional public health organizations have limited experience in and perhaps little appetite for these new health promotion challenges and opportunities in our twenty-first century world. For this reason, these important and still scarcely explored domains for new and progressive health promotion wait for new health activism today, and for a new scope and organizational competencies within the discipline of public health, to build on past public health successes and advance community health and quality of life in a new century.

To begin to bridge this gap between past public health successes and needed new areas of community health focus, we would like to again underscore that all health and quality of life promotion efforts, old and new, can productively be seen as forms of social investment. This term comes from the field of economics and refers to cooperative work of all kinds – work that provides a net benefit to all or most individuals in a social group, but is impossible or very difficult without an organized effort and contributions involving all or at least substantial portions of the group.

As social investments, both existing and future community health initiatives can be subject to the same types of analysis, advocacy considerations, and management controls as other endeavors in the public sphere. All public health efforts can and should compete for public funding, and public health advocates must refine their methods until they achieve consistent success in securing new funding for critical health advancement measures.

Conceptual and organizational barriers
Describing organized community actions and health-promoting social investments by the term “public health” promotion may be more familiar and widely-used than referring to this work as “community health” efforts, but HumanaNatura believes the more common term suffers in critical ways that make a strong case for change today – for a change in the name of these efforts to match a change of our approach to them.

One way the term and traditional discipline of public health suffers is the manner in which it is so often poorly understood, and seen as a practice apart from, the public that public health organizations seek to serve. In practice, public health organizations today are often a distant, mysterious, and technocratic part of regional and national governments, rather than the highly visible, deeply integrated, and leading function of community life that health promotion efforts might be.

As you may have surmised in your analysis of health organizations impacting your community, public health today is often done to the public – not by or with it – limiting civic engagement and long-term support, failing to mobilize local resources for assistance with health-promotion efforts, and missing important opportunities to multiply and leverage public health investments through the cultivation of more health-aware and actively health-advancing communities. A new, more holistic, and far more community-engaged public health approach thus deserves and even requires the new description of “community health,” rather than risk confusion with or continued ambivalence toward our public health legacy.

A second way the term public health suffers is related to the first. Specifically, this is the frequent isolation or sidelining of public health agencies in supporting and generally unobtrusive roles within government. This is in considerable contrast to the publicized, politicized, and leading roles we have suggested are now needed to advance higher-order health initiatives in a new century and increasingly post-industrial society. With little traditional requirement to garner public attention and community engagement in the work of mitigating urgent threats of death and disease, public health organizations seeking change to more activist operating models are likely to encounter not just issues of functional fixedness, but also of organizational perception and identity, and the inertia of public health’s long history of political risk aversion and subordination in government and politics. Here again, new terminology, to match and promote new approaches and agendas, is likely to help in renewing public health promotion efforts within government and political life.

In the early work of scientific public health promotion – for example as infectious disease threats were newly understood through emerging biological science – only moderate community involvement was needed or sought to begin remedial measures. Seeking to address these and other urgent threats in the early stages of industrialization, improved sanitation systems were proposed and built, immunization programs were created, and food safety measures were instituted, all with large and near immediate impacts and a generally passive role for the public.

As we have discussed it is precisely because of this institutional legacy that public health organizations often now struggle to envision and lead change amidst the new and more subtle, but still quite important, opportunities for public health promotion we have discussed. Public health issues such as drug use, obesity, irrational and addictive behaviors, mental illnesses, and social isolation have thus far proven intractable public health problems, with the root causes of these seemingly disparate conditions – community dissolution and unnatural general life conditions – misunderstood, overlooked, or seen as lying beyond the permissible sphere of endeavor by our public health system.

Ironically, while these and other new community health issues have persisted and even increased, traditional public health organizations often simultaneously struggle for adequate resources and visibility, despite widespread opportunities for new and impactful health-related social investments. Communities today often urgently seek or require assistance with pressing health threats and latent quality of life opportunities, but often ones not properly seen within the traditional sphere of our public health system. Without change, this disconnect between our community health issues and public health system is likely only to increase, as communities present health landscapes that are increasingly diverse and more complex, requiring new sets and synchronization of responses and investments, and new leadership to realize these changes.

As you consider these important ideas, we would encourage you to investigate your community’s local public health organization for yourself. By this, we mean taking time to meet its working staff and leadership, and to learn about its operating model and key areas of focus. If you take up this challenge, we would encourage you to inquire about the most pressing health issues and waiting quality of life opportunities present in the community, what new health promotion projects are planned or envisioned, and the organization’s current versus desired resource levels.

If you want, you might then introduce and ask for feedback on HumanaNatura’s proposal for a four-part program of change for our public health system: 1) a more diverse and activist uptake of health-related science, 2) more active and sustained involvement in political life, 3) a redefined and flatter operating model organized principally at the community level, 4) a sustained commitment to ongoing progressivity as a system-wide public health ethos.

In your community’s health organization, you are apt to find well-intention people and even some progressive and engaged health advocates. But you may also discover and confront firsthand signs of the larger systemic and organizational limitations in our public health system that we have introduced to you:

Public health practitioners unaware or dismissive of new and unfamiliar science or opportunities for community health promotion outside traditional areas
Caution toward calls for a commitment to sustained and progressive health improvement and greater community involvement in selecting and implementing public health programs
Unease or unpreparedness regarding notions of more robust political leadership and new levels and forms of health advocacy in our communities

Based on discussions in your community, you may well conclude, as we have, that many local and regional public health organizations are unready for the task of progressive health promotion- greatly limiting our current quality of life potential – and that our public health efforts face a fundamental need for systemic change and redefinition. At a local level, we believe that the needed shift to a new community health system is, in fact, remarkably analogous to the far-reaching shift now underway in similarly-scaled public law enforcement agencies. Here, local security organizations have been tasked to move from traditional and functional law enforcement to the far more effective and holistic crime-prevention model of community policing.

From public health to community health
Even with HumanaNatura’s criticisms of current practices within the field of public health, please have no doubt that the essential mission of our public health system – to advance the health of the public – is an essential human function and vital to healthy communities and our global society.

As we have suggested, public health investments in the last century or more have included some of the wisest use of our collective resources in the modern age. Our past public health successes underscore and make us eager to explore – pragmatically, scientifically, and progressively – the enormous potential for new public and community health measures to further and perhaps dramatically improve the health landscape of our communities and broader society, in our time and for future generations.

Still, the results of past narrowness of focus, vicarious institutional and political legitimacy, and missed opportunities for more robust public health leadership and social investments are with us today. They notably take the form of low public awareness of emerging health science and limited expectations positive change in health and quality of life in our communities. This current state of our collective health reflects our health system’s inability, up to now, to captivate the public’s imagination and lead a true health-based agenda in public life. It includes the system’s failure to marshal increasing resources and a commitment to act in new areas where it can impactfully advance health, longevity, and quality of life. As suggested before, current system limitations are aptly surmised by the lack of public expectations for ongoing health and quality of life advancement, akin to expectations for and interest in ongoing technological development.

If health organizations must work to become more progressive and robust in a new century, after remarkable earlier successes in a narrower range of domains, we can take heart in the knowledge that many public health practitioners are conscious of this fact. Most remember the essential progressive mission of their profession and are likely to embrace and support new health agendas that better utilize and advance the impact of their discipline. Many will prove eager to foster community health advocacy and assist new voices calling for health-based change.

We hope this discussion of our public health system has provided you with an adequate grounding and critical framework for understanding and demystifying this enormous but entirely understandable modern public enterprise. We also hope it has given you confidence to begin to act on health matters in your community – exploring and increasing your community’s current health promotion efforts, and eventually working to make health and quality of life promotion your community’s central mission. If you would like more information on the history and current practice of public health, a list of materials for further reading is provided at the end of this program.

Building on our discussion of the current state of public health efforts, and the many important opportunities to broaden, integrate, and make more progressive the work of health promotion affecting the communities in which we live, we turn next to the actual practice of promoting increasing health and quality of life in local and regional communities.

As discussed already, the practice of public and community health is in part scientific and conceptual, requiring a comprehensive health paradigm and knowledge of available health science, and in part political and organizational, requiring astute public advocacy to mobilize community members and catalyze progressive health-related learning and action. The remainder of our Community Health Program will help with political and organization process in community health promotion, while our companion Community Assessment Form will lay out key scientific and conceptual considerations in the work of advancing community health.

Together, these two essential public health techniques – the surfacing of actionable science and the effective application of this science in society – have the potential to create powerful and lasting change in our shared and inevitable state of community life and health. They promise equally to flow over and upward to influence established public health institutions and our global society, encouraging each to recognize our modern opportunity to re-center life itself in the science and task progressive health-based change.

Key Community Links

Most-Used Resources

Understanding Community Health