Chapter 5: The Boundaries of Public Health

a. I was surprised to learn that the golden age of public health at the turn of the century was followed by relegation to secondary status to clinical medicine, with less financing. This seems counter-intuitive; with so many achievements in such a short amount of time, such as the development of state health departments, and the advancement of dispensaries. However, this shift is perhaps understandable, considering the ambivalence of private physicians towards public health and private dispensaries, as described throughout the chapter.

b. I agree that the maintenance of the public's health allows or even demands concern with almost every aspect of life. For example, public health involves people's diet, sleep, family life, habits, weight, mood, community, and environment.

c. I disagree  with Charles V. Chapin's view that poor housing does not contribute to poor health. For examples, roaches can have implications for people with asthma, mold can cause illness, and vermin can carry diseases. Clean and safe housing has important implications for health. Further, location of housing towards trails, parks, and farmer's markets also contributes to health, as well.

d. One thing mentioned in this chapter that I have experienced is that timely medical assistance often keeps people out of poverty. Social worker Mary Richmond remarked upon this fact in Chaper 5, noting that timely medical assistance did not result in a "downward tendency." It is true that when people are able to receive treatment quickly, they can maintain their health, return to work faster, and thus stay out of poverty.

e. One aspect of the Starr book that I was interested in learning about is that of primary prevention and the role of external factors in public health, such as community and environment. In this chapter, Starr mentions that latent tuberculosis was widespread among people in the late 1800s and early 1900s, but that many were not sick. This prompted efforts at improving resistance via nutrition, housing, and working conditions. Starr notes that these interventions may be as important as preventing infection itself. This is one example of primary prevention, in that improvements in general health can help prevent specific diseases from causing illness. It is also interesting to note that the individual was not held chiefly accountable, but that aspects of the individual's environment, such as the workplace and housing, were also mentioned. Starr later notes that attention shifted from the environment to the individual, which is seen today. Currently, our country's medical system focuses on tertiary or secondary prevention. There is also an emphasis on personal responsibility. It is interesting to note that just 100 years ago, important aspects of primary prevention and external forces on health, such as workplaces and housing and communities were seen as important.