Better Health For All

A public health department could be introduced in hospitals all over the world. 

Doctors and public health specialists working together under the umbrella of hospitals can lift a huge burden of diseases off our society and our health budget. Public health specialists could counsel people in the surrounding community (including patients and their caregivers) about preventive measures for maintaining good health. This effort would help people understand the importance of prevention and how it can save them from major diseases. 

During visits for a regular checkup or a simple fever, patients and their caregivers at high risk could be advised by public health specialists about preventive measures. For example, most cases of cardiac disease develop due to a poor diet and sedentary lifestyle. Too often people ignore the symptoms and avoid visiting a doctor. If such cases are detected early on during, say, a routine hospital visit, public health specialists could help people from developing serious conditions. Instead of encouraging people to eat better and exercise after a cardiac disease diagnosis, why not help people when they are still relatively healthy? 

Having public health departments embedded in hospitals could also provide better epidemic prevention and response, resulting in fewer casualties and less panic.  

Public health department in hospitals could comprise of  two sections; 

Section 1: Epidemic Training Cell  

A system could be created so that at times of natural disasters/catastrophes all public health specialists can unite at one platform and use all their abilities to save the affected people from further physical and mental pain. 

This cell is for quick response when epidemic occurs to avoid panic and minimise casualties. In epidemic days it can hold counseling sessions for all patients visiting hospital along with healthy attendants to minimise the spread of epidemic. 

It can also conduct on-the-job training of staff. An example of this is the implementation of the latest program that has been introduced by WHO called IMCI (Integrated Management of Childhood Illness) which has distance learning modules for health workers for better health care delivery. 

Section 2: Disease Prevention Cell  

The aim of this would be to provide health education to prevent people getting sick and/or contracting diseases. An example of this would be educating people on the importance of drinking safe water by using chlorine tablets as a replacement for boiling water.  

This department could work in collaboration with other units such as cardiology, gastroenterology, psychiatry, dermatology, cancer surgery, ophthalmology, gynecology and pediatrics. 

Here are some examples of how this could work in practice; 

Cardiology 

• Patient arrives in Cardiology Emergency Department with chest pain or tachycardia and is sent back after ECG shows no signs of pathology. In the presence of a public health department this patient could be consulted about their weight, habits, physical activity and mental health to avoid development of a major cardiac pathology in future 

Gastroenterology 

• Patient arrives in Gastroenterology Department with epigastric pain and is sent home after being prescribed regular treatment. 
• In the presence of a public health department this patient could be consulted about the importance of boiled/safe water and safe food intake as a preventive measure against Hepatitis and other gastric diseases. 

Cancer surgery 

There is a real life case of a young woman who developed breast cancer. She had a single mastectomy but 10 years later, she developed breast cancer on the other breast and is currently undergoing chemotherapy after surgery. She wasn’t consulted about follow up/looking for warning signs after her first diagnosis but in the presence of a public health department, this patient could have been consulted to avoid future pathology by regular follow ups and looking out for warning signs as early as possible. 

Gynecology and Pediatrics 

• A public health department could educate pregnant women about warning signs to look for during pregnancy, and in their babies to prevent the occurrence of a serious disease. 

• For example, pregnant mothers could be given instructions on how to fulfill the nutritional requirements of themselves during pregnancy and beyond. 

For all of the above departments, infographics and health education posters could be displayed to educate patients and staff as well. 

What would the aims and requirements of a public health department be? 

The staff required for setting up of this department should be qualified in public health or community medicine. 

The main aim of introducing public health departments in hospitals is to prevent development of diseases or their serious forms and give health education to people who are not receiving it at the moment. The focus of hospitals lies on curative treatment but a formal way of giving people health education is missing in our health system. If properly implemented, this could make us a healthy and productive nation and world. 

Written by Dr Sarah Tanvir, MBBS, MPH, Diploma in Best evidence Medical Education, Pakistan.