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WHO Who? Medicine vs. Public Health

by Emily Liu

Since the outset of the COVID-19 pandemic, the world has been waiting anxiously as researchers race to find a cure. Countless sources are constantly reporting even the slightest update on vaccine development, and we see touching stories every day about how front-line doctors and nurses are risking their lives to help patients. Workers in medicine are–rightfully–being portrayed as brilliant, noble, heroic. 

In addition to updates from the medical world, though, we’ve also been hearing safety guidelines on repeat. It’s practically etched into our minds: “Wash your hands for 20 seconds! Wear a mask! Stay 6 feet away from others!” We often get tired of hearing these phrases again and again, to the point where we start letting our guard down and subsequently allowing the virus to spread. If you’re like me, you’re curious about these health mantras and the people who came up with them. Are the guidelines really helping? Isn’t it enough just to treat sick patients and find a cure? Who is the WHO? What even is an “epidemiologist?” 

The safety guidelines against COVID-19 were determined by the Centers for Disease Control and Prevention (CDC) to help people protect themselves and others from contracting the virus. According to the CDC, the 20-second time for hand washing was implemented based on “evidence [that] suggests washing hands for about 15-30 seconds removes more germs from hands” than other time spans. Masks are recommended because they let air flow freely while blocking most of the droplets generated when we talk, cough, etc. Several NIH studies found that masks can reduce transmission of droplets, and therefore of COVID-19, by 70% or more. Finally, the distance of 6 feet is most likely the result of doubling the distance suggested for infectious diseases in the past. Large respiratory droplets expelled from a person’s mouth or nose tend to fall to the ground before they get further than 6 feet. Keeping your distance can prevent you from inhaling these potentially disease-laden large droplets. 

You may have noticed that none of these decisions involve vaccines, drugs, hospitalization, or anything that comes to mind when you think about doctors and medicine. This is because these guidelines are not made solely by the medical world–they fall into another, interdisciplinary field called public health. Public health is defined as “the art and science of preventing disease, prolonging life and promoting health through the organized efforts of society.” The definition was created by the World Health Organization (WHO), the United Nations agency responsible for protecting international public health. Arguably, “preventing disease, prolonging life, and promoting health” are the same goals the medical field pursues. However, public health accounts for other aspects of health that medicine generally does not, such as environmental preservation and accessible education. This is in accordance with the WHO’s definition of health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” 

Beyond that, there are a couple key differences in the two fields’ approaches to their shared goals. Medicine adopts a curative strategy, while public health adopts a preventative one–medicine mostly aims to treat or cure people who have already fallen sick, while public health is largely about preventing people from falling sick to begin with. Additionally, medical care usually focuses on treatment of one person at a time, and public health looks more at how to keep entire populations of people healthy. Throughout history, both medicine and public health have played integral roles in fighting disease.  

One of the first things that comes to mind when we think of medicine is vaccines. In the mid-19th century, Louis Pasteur observed that a weakened version of anthrax bacteria helped host organisms protect themselves against the “real” disease: this was the first vaccine. Later, in the 1920s, Alexander Fleming discovered that a certain type of mold was able to secrete a compound that killed surrounding bacteria. In the following years, the compound was isolated and named penicillin–the first antibiotic. From then on, scientists raced to develop more vaccines and antibiotics, and many elusive diseases suddenly became treatable. Among them were malaria, cholera, bubonic plague, tuberculosis, and smallpox, which was completely eradicated. New medicines are still being developed and making a tremendous impact; one example from relatively recent years is a drug called ivermectin(brand name Mectizan). Ivermectin is effective against river blindness, a disease native to Africa that was spread internationally during the Columbian exchange. River-dwelling black flies become infected with parasitic worms, then the infected flies bite humans and transfer the worms, causing symptoms such as blindness and itching/swelling of the skin. Merck, the manufacturer of Mectizan, donated the medicine free of charge for as long as affected countries would need it. As a result, the drug was(and still is) delivered to over 30 countries worldwide without concerns of affordability, and millions of patients have been successfully treated.  

Public health has been at play for a longer time than modern medicine, and notable examples were recorded as early as the 14th century. The bubonic plague had recently wiped out one-third of the whole European population; in the years that followed, Venice took measures to ensure that plague did not reenter the city. Any incoming trade ships were locked down for a period of 40 days, during which no people or items could enter or exit. This was the earliest recorded implementation of quarantine as a way to prevent disease – the word “quarantine” originates from the French term for the number 40 (quarante). Health professionals focused on another issue during the Industrial Revolution: sanitation. Urbanization and the spread of capitalism resulted in many people living together in cramped spaces with insufficient sewage systems, and employers forced their workers to labor for long hours in dirty and/or dangerous workplaces. If not for the subsequent sanitary reform, city residents would have been devastated by diseases like cholera. Eventually, in the early 20th century, improved methods of data collection made it possible to predict future disease transmission based on past trends and current factors; the scientists who conduct these analyses are called epidemiologists. Even within the category of disease prevention, there are various complex components at play–it’s no wonder that public health experts are greatly respected. 

So which is better, medicine or public health? Personally, I think both are equally amazing. Consider the ongoing pandemic. Without medicine, we’d be living virtual and socially distanced lives without any idea of when (or if) we could go back to normal. Without public health, we’d be waiting on a vaccine without any way of preventing the spread COVID-19 in the meantime. As a biology major, I wanted to write this article to show that health is more than just doctors and drugs. Health is curing diseases, preventing diseases, and generally, doing work that helps to improve our well-being. Only when we have all of these disciplines can we truly get the most out of… well, being.