Core Functions, Training, Skills and Expertise of P.H. Professionals

Core Functions, Training, and Expertise of Public Health Professionals

At the start of the twenty-first century, environmental health is positioned at a significant watershed moment, comparable to the advent of the initial public health ideas. The concept of public health, which was predominantly developed in the nineteenth century as a manageable and urban-focused discipline, has been replaced by an expansive global biosphere concept. Environmental health, having established itself as a discipline in the nineteenth century, is now required to reinvent itself for the modern era. While many emerging threats are now global in scale, the specific problems and the necessary responses are frequently regional, local, or even individual in nature.

The impact of the environment on human health is considered an inevitable by-product of human activity, specifically influenced by the nature of that activity and the associated attitudes. Contemporary reviews of National Health Service expenditure have emphasized the economic benefits of upstream investment, noting that public health measures can significantly reduce the overall burden of disease. Finding answers to modern environmental problems is difficult, requiring vision, ambition, leadership, debate, consensus, and agreement. To address these complexities, a new kind of environmental health practitioner is necessary.

Environmental Health and Human Rights

The World Health Organization (WHO) has contextualized environmental health within the framework of human rights. According to Klaus Toepfer (2001), human rights cannot be fully secured in an environment that is degraded or polluted. Environmental conditions are a primary determinant of the extent to which individuals can enjoy basic rights, including the right to life, health, adequate food, housing, and traditional culture and livelihood. Toepfer asserted that those who pollute or destroy the natural environment are not merely committing crimes against nature but are also violating fundamental human rights.

To fulfill their future roles, environmental health practitioners must possess a deep understanding of four key areas: the definitions and principles of environmental health, the specific agenda with which they must engage, the skills and expertise required for professional practice, and the ultimate objectives of their environmental health activities.

Definitions and Principles of Environmental Health

The term "environmental health" is unique due to its "catch-all" nature. When the dimensions of "environment" and "health" are separated, they illustrate the all-encompassing scope of the combined term. Several formal definitions exist. In 1989, the WHO defined environmental health as comprising those aspects of human health and disease determined by factors in the environment. It also refers to the theory and practice of assessing and controlling factors in the environment that can potentially affect health.

In 1993, the WHO European member states expanded this, stating environmental health includes aspects of human health—including quality of life—that are determined by physical, biological, social, and psycho-social factors in the environment. It also entails the theory and practice of assessing, correcting, and preventing environmental factors that could adversely affect the health of present and future generations. Fundamentally, these definitions show that environmental health is two things: specific aspects of human health and the means (the practice) by which those issues are addressed.

Environmental health adopts a holistic view of human health and the environments where people live. As a concept and a practical delivery mechanism, it provides a foundation for decision-makers to work toward sustainable development. This wide-ranging discipline relies on inter-sectoral co-operation and action. It is often a far larger concept than the traditional roles played by Environmental Health Officers (EHOs), involving professionals outside the mainstream environmental health sector.

The Six Core Principles of Environmental Health

The environmental health approach has grown organically rather than by specific design. Because the field is subject to constant and turbulent change, it is vital to maintain core values and principles. Environmental health works across three time phases: repairing past damage, controlling present risks, and preventing future problems. The emphasis on each phase depends on available resources and specific risk factors.

Principle 1 centers on the human condition, stating that the maintenance and improvement of human well-being is the primary target of environmental action. Principle 2 focuses on Equity. Disadvantaged groups often live in the worst housing, work in dangerous occupations, and lack access to wholesome food. Because the poor bear a disproportionate share of the global burden of suffering, equity is a primary element that must underpin all environmental health actions.

Principle 3 involves Governance and civic engagement. Environmental health protection requires a model of democracy where people are not just represented but are active participants. Principle 4 emphasizes Co-operation and Partnership. An intersectoral approach is required because isolated decisions cannot solve complex problems. This involves stable co-operative mechanisms where governmental agencies, the public sector, and private organizations share a stake in common problems and collaborate throughout the entire problem-solving process.

Principle 5 addresses Sustainable Development (Sustainability) through three components: Policy Integration (integrating health considerations into all levels of government policy), Partnership (consulting with all society groups in planning), and Appropriate Scale (handling policy at the level where the issue occurs, following the subsidiarity principle). Principle 6 acknowledges the International Character of environmental issues. Since health issues cross borders, international co-operation and collaboration remain key principles despite local distractions.

Core Functions and the 10 Essential Public Health Services

The 1994 framework identifies three core functions of public health: Assessment, Policy Development, and Assurance. These functions relate directly to the 10 Essential Public Health Services (EPHS).

Assessment involves monitoring environmental and health status to identify and solve community problems, as well as diagnosing and investigating health hazards. Policy Development focuses on informing, educating, and empowering people; mobilizing community partnerships to solve problems; and developing plans that support health efforts. Assurance includes enforcing laws that protect health, linking people to needed services, assuring a competent workforce, evaluating the quality and effectiveness of services, and researching innovative solutions.

The 10 Essential Public Health Services provide the framework to protect and promote health for all communities. Achieving equity is central to this framework, requiring the removal of systemic barriers such as poverty, racism, gender discrimination, and ableism, so that everyone has a fair opportunity for optimal health.

Detailed Service Breakdown:

  1. Maintain an understanding of health and its influences through data collection, identifying root causes of inequities, and engaging community members as experts.

  2. Anticipate and mitigate emerging threats through epidemiology, using real-time data for outbreaks and high-volume laboratory testing.

  3. Develop and disseminate accessible, culturally, and linguistically appropriate health information using communication principles like risk communication and health literacy.

  4. Convene multi-sector partnerships (e.g., housing, education, transportation) to develop solutions.

  5. Champion and improve policies and laws to correct historical injustices and ensure a fair opportunity for health.

  6. Equitably apply and enforce laws, including sanitary codes for food and protection of drinking water.

  7. Connect populations to health and social services that support the whole person, addressing barriers to care.

  8. Build and train a competent, culturally humble public health workforce while promoting lifelong learning.

  9. Link research with practice, evaluating services to ensure they do not create harm and using lived experience as data.

  10. Ensure ethical leadership, manage financial resources effectively, and maintain robust, secure information technology systems.

Prevention: The Cornerstone of Public Health

The defining strategy of public health, which distinguishes it from clinical professions, is the prevention of poor health by assuring conditions in which people can be healthy. While clinical professions focus on treating individuals, public health is proactive and uses the language of epidemiology and ecology. Prevention is categorized into three types:

Primary Prevention is concerned with eliminating risk factors for a disease. It intends to prevent the development of disease or the occurrence of injury, thereby reducing the incidence in a population.

Secondary Prevention focuses on early detection and treatment of disease in subclinical or clinical stages. The goal is to treat the disease after it has developed but before there are permanent adverse consequences. Public health professionals ensure access to this care rather than providing it directly.

Tertiary Prevention attempts to eliminate or moderate disability associated with advanced disease. It focuses on the optimum treatment of identified disease to reduce complications and limit disability. Public health is interested in this to prevent long-term health consequences and progression of illness.

Environmental Health Practice and Stressors

Environmental health practice involves assessing, correcting, and preventing the impact of stressors on the living environment. Humans operate in three primary environments: home, work, and recreational environments. The field addresses activities related to food, water, air, land, and buildings. Stressors are features of the environment that induce harm in living systems or organisms and are categorized into five types.

Biological stressors include natural or man-made elements that present health risks through ingestion, inhalation, inoculation, or physical contact. Chemical stressors are chemical entities or intermediates that expose humans to risk via absorption or ingestion and interfere with biological systems. Physical stressors are measurable physical manifestations (natural or human-induced) that damage cells, tissues, organs, or homeostatic systems, affecting mental and social well-being.

Social stressors are behaviors associated with human community life and habitation that impact well-being. Psychosocial stressors are attitudes of mind and mental processes that can have an adverse impact on the health of an individual or a community.

Skills and Expertise of Practitioners

The Strategic Vision for Environmental Health (2012) captured ideas from stakeholders to address the wider determinants of health, including housing standards, food, and occupational safety. Practitioners are expected to lead local government health strategies, act as key partners in reducing health inequalities, and tackle current and future risks.

The operational skills of environmental health practitioners include eight key competencies:

  1. Assess: Utilizing analytical skills to form professional judgments.

  2. Consult: Practicing a full range of techniques for giving and receiving information.

  3. Advise: Communicating technically correct information to guide colleagues and clients.

  4. Enforce: Using mechanisms to secure compliance with laws and standards based on risk.

  5. Train/Educate: Using skills to acquire knowledge, raise awareness, and modify behavior.

  6. Advocate: Supporting and campaigning for critical health issues.

  7. Evaluate: Considering all aspects of an issue and defending the values assigned to them.

  8. Research: Identifying information sources, critically assessing options, and undertaking planned research exercises.

Questions & Discussion

The following questions were posed for class brainstorming and self-study:

  • What is Environmental health? (Brainstorming session)

  • What is the role of public health practitioners in secondary and tertiary prevention?

  • What is the difference between a risk factor and the etiology of a disease?

  • What are some examples of each of the five stressors (biological, chemical, physical, social, psychosocial)?

  • What is the agenda for environmental health and the agendas for environmental health change in recent times?

  • What are the approaches identified or recommended for changes?