Understanding Public Health Informatics in Context of Health in Low and Middle-Income Countries
Public Health Informatics in the Context of Health in Low and Middle-Income Countries
This chapter builds upon the first one. Chapter 1 situated public health informatics (PHI) in a historical perspective to understand how computers, and technical and medical biases have shaped the trajectory of PHI, leading to the neglect of focus on public health issues, especially in the context of LMICs.
This chapter attempts to situate PHI in the context of public health in LMICs, which will lead to the articulation of an integrated PHI perspective that combines understandings from the informatics and public health domains.
Defining Public Health
‘Public Health is the science and the art of preventing disease, prolonging life, and promoting physical health and efficiency through organised community efforts for the sanitation of the environment, the control of community infections, the education of the individual in principles of personal hygiene, the organisation of medical and nursing services for the early diagnosis and preventive treatment of disease, and the development of the social machinery which will ensure to every individual in the community a standard of living adequate for the maintenance of health’
The distinction of public health from medical care is important to grasp. Medical care is often used interchangeably with healthcare, and relates largely to the prevention, diagnosis, and management of disease in an individual patient, typically within a clinical establishment like a hospital. In contrast, public health is concerned with the health of populations. The mission statement of John Hopkins Bloomberg School of Public Health expresses this quite lucidly as ‘Protecting Health, Saving Lives—Millions at a Time’ (http://www. jhsph.edu/about/).
Sometimes public health refers only to preventive and promotive aspects of health, and excludes clinical care. Preventive and promotive care can take the form of action of other non-health sectors, like the impact of air pollution on health, the provision of safe drinking water, or of preventive health services like immunization or vector control. While promotive and preventive care are undoubtedly important components, the scope of public health is not limited to these. Public health also includes the organization of curative or clinical healthcare services to ensure access, equity, affordability, and quality of medical care services.
Another important statement of the goals of public health is the historic Declaration of Alma-Ata of 1978. This declaration, one of the most important public health documents of all times, defines health ‘as a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity’. It further elaborates that health is a fundamental right and that the attainment of this is a most important world-wide social goal. Alma-Ata established primary healthcare as the key strategy to the achievement of health for all.
An important unifying theme in all these definitions is that the object is not the single individual or family, but a population; and information on healthcare of many individuals is translated to issues of health status, equity, access, and the quality of care enjoyed by all. This has important implications for PHI, as we will go on to argue in this chapter. First, we discuss the primary healthcare component in more detail.