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Public health intervention

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A public health intervention is any effort, policy, or program intended to improve mental and physical health at the population level. Interventions involve social movements that strive to support public health at different levels of society.[1] Public health interventions may be run by a variety of organizations, including governmental health departments and non-governmental organizations (NGOs). Interventions can be personal, community-level, national, and global.[1] Common types of interventions include screening programs,[2] vaccination,[3] food and water supplementation, and health promotion. Common issues that are the subject of public health interventions include obesity,[4] drug, tobacco, and alcohol use,[5] and the spread of infectious disease, e.g. HIV.[6] Public health interventions are distinct from healthcare interventions in terms of their scope, methods, and objectives.[1] Though, both are highly interconnected and necessarily complementary.

A policy may meet the criteria of a public health intervention if it prevents disease on both the individual and community level and has a positive impact on public health.[7]

History

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The origins of public health interventions originated with early efforts in disease surveillance, quantification of illness, and intervention implementation.[8] These interventions further expanded to analyze the efficacy of various approaches. As urbanization and community life increased, the need for organized health protection grew.[8] Over time, public health strategies have evolved to involve both public and private sectors, often working together to intervene in human rights issues related to health.[8] Despite advances in healthcare access and coverage, social inequalities continue to impact equitable health. Inequality, war, and infectious diseases contribute to the need for public health interventions.[8]

Types

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Health interventions may be run by a variety of organizations, including health departments and private organizations. Such interventions can operate at various scales, but these interventions do not reach individuals simultaneously or to equal extent.[1] The whole population can be reached via websites, audio/video messages and other mass media, or specific groups can be affected by administrative action, such as increasing the provision of healthy food at schools.[citation needed]

Screening

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Main article: Screening (medicine)

Screening refers to the practice of testing a set of individuals who meet a certain criteria (such as age, sex, or sexual activity) for a disease or disorder. Many forms of screening are public health interventions. For example, mothers are routinely screened for HIV and Hepatitis B during pregnancy. Detection during pregnancy can prevent maternal transmission of the disease during childbirth.[9]

Vaccination

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Main article: Vaccination schedule

Vaccination programs are one of the most effective and common types of public health interventions. Typically programs may be in the form of recommendations or run by governmental health departments or nationalised health care systems. For instance, in the U.S., the Center for Disease Control decides on a vaccination schedule,[10] and most private health insurers cover these vaccinations. In the UK, the NHS both decides and implements vaccination protocols. NGOs also may be involved in funding or implementing vaccination programs; for instance Bill and Melinda Gates Foundation assists governments in Pakistan, Nigeria and Afghanistan with the administration of polio vaccination.[11]

Supplementation

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Supplementation of food or water of nutrients can reduce vitamin deficiency and other diseases. Supplementation may be required by law or voluntary. Some examples of interventions include:

Behavioural

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Main article: Behavior change (public health)

Interventions intended to change the behaviour of individuals can be especially challenging. One such form is health promotion, where education and media may be used to promote healthy behaviours, such as eating healthy foods (to prevent obesity), using condoms (to prevent the transmission of STDs), or stopping open defecation in developing countries (see for example in India the campaign Swachh Bharat Mission).[citation needed]

The use of laws to criminalise certain behaviours can also be considered a public health intervention, such as mandatory vaccination programs[16][17] and criminalisation of HIV transmission.[18][19][20] However, such measures are typically controversial, particularly in the case of HIV criminalisation where there is evidence it may be counter productive.[18][19][20] Laws which tax certain unhealthy products may also be effective, although also not without controversy, and are sometimes called a "sin tax". Examples include the taxation of tobacco products in the U.S. and New Zealand,[21] and sugared drinks in the UK.[22]

Structural

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Structural interventions address underlying social, political, and economic determinants of health.[23] These efforts often account for the influence of culture and societal values on health outcomes. Structural interventions promote public health by altering systemic conditions and social norms. Such efforts may involve institutional reforms, the redistribution of resources, and the expansion of healthcare accessibility.[23] A key focus is reducing disparities resulting from unequal distributions of resources and power, with particular attention to improving health outcomes among marginalized populations.[23]

Impact

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Health impacts can be sorted and displayed as a pyramid with five levels of intervention; the interventions at the base of the pyramid have the greatest population impact and require less individual effort; the higher tier interventions have the least population impact and require the most individual effort to prevent negative health outcomes and promote positive health outcomes:[14]

  • Level 5 Counselling and education
  • Level 4 Clinical interventions
  • Level 3 Long-lasting protective interventions
  • Level 2 Changing the context to make individuals’ default decisions healthy
  • Level 1 Socioeconomic factors: (poverty reduction, improved education

Global public health

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Global public health experienced significant transformation in the early 20th century, particularly with the involvement of institutions such as the Rockefeller Foundation (RF). The RF established new frameworks that transcended narrow political and economic self interest.[24] The RF shaped other health organizations and spearheaded the establishment of public health schools and disease campaigns. It contributed to the creation of national public health departments around the world and institutionalized international health.[24]

In 1946, the World Health Organization (WHO) founded to serve as a permanent international health agency.[24] Its creation supported the professionalization of the global health field and facilitated the coordination of international health interventions. The WHO's early efforts supported the development of global health interventions through mandates focused on data collection, epidemiological surveillance, training, research, and greater resource mobilization.[24]

Evaluating efficacy

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Evaluating and predicting the efficacy of a public health intervention, as well as calculating cost effectiveness, is essential. An intervention should ideally lower morbidity and mortality. Several systematic protocols exist to assist developing such interventions, such as Intervention Mapping.[25] The effectiveness of public health interventions can be assessed through measurable outcomes, particularly in disease-specific interventions.[26] For example, interventions addressing sexually transmitted infections are commonly evaluated using indicators such as transmission dynamics, disease severity, and treatment and prevention likelihood.[26] Evaluation methodologies vary depending on the specific public health issue. To assess the overall performance of an intervention, health departments often both population-level outcomes and the mediating processes in between. These middle processes may include evaluation of patient interviews and contact tracing for infectious diseases.[26]    

Defining and measuring success in global health is a complex and contentious issue. Some frameworks define success in terms of disease control or the eradication of disease.[24] However, the presence of various actors can complicate objective evaluation. Historically, certain funders and policymakers have selectively invoked historical episodes to push particular agendas about misperceived success.[24] Although there is increasing awareness about the methodological challenges in producing evidence-based global health assessments, critiques of global health interventions remain politically sensitive due to the imperative for global health action, donor influence, and the potential for backlash.[24]

See also

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References

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  1. ^ a b c d Doval, Hernán C. (2015). "Building Bridges between Healthcare and Public Health. From Efficacy Trials in Patients to Those Effective in Populations". Revista Argentina de Cardiología. 83 (6): 566–571. ISSN 0034-7000.
  2. ^ Kim, Hyuncheol Bryant; Lee, Sun-Mi (2017-03-06). "When public health intervention is not successful: Cost sharing, crowd-out, and selection in Korea's National Cancer Screening Program". Journal of Health Economics. 53: 100–116. doi:10.1016/J.JHEALECO.2017.02.006. PMID 28340393.
  3. ^ Kürüm, Esra; Warren, Joshua L.; Schuck-Paim, Cynthia; Lustig, Roger; Lewnard, Joseph A.; Fuentes, Rodrigo; Bruhn, Christian A. W.; Taylor, Robert J.; Simonsen, Lone (2017-07-31). "Bayesian model averaging with change points to assess the impact of vaccination and public health interventions". Epidemiology. 28 (6): 889–897. doi:10.1097/EDE.0000000000000719. PMC 5617796. PMID 28767518.
  4. ^ Bhuyan, Soumitra S.; Chandak, Aastha; Smith, Patti; Carlton, Erik L.; Duncan, Kenric; Gentry, Daniel (2015-08-07). "Integration of public health and primary care: A systematic review of the current literature in primary care physician mediated childhood obesity interventions". Obesity Research and Clinical Practice. 9 (6): 539–552. doi:10.1016/J.ORCP.2015.07.005. PMID 26259684.
  5. ^ Todd, Adam; Moore, Helen J.; Husband, Andrew K.; Bambra, Clare; Kasim, Adetayo; Sniehotta, Falko F.; Steed, Liz; Summerbell, Carolyn D. (2014-08-22). "Community pharmacy interventions for public health priorities: protocol for a systematic review of community pharmacy-delivered smoking, alcohol and weight management interventions". Systematic Reviews. 3: 93. doi:10.1186/2046-4053-3-93. PMC 4145162. PMID 25145710.
  6. ^ M, Schrappe; K, Lauterbach (1998-01-01). "Systematic review on the cost-effectiveness of public health interventions for HIV prevention in industrialized countries". AIDS. 12 Suppl A: S231–8. PMID 9633007.
  7. ^ Patil, Rajan R. (2013-11-01). "Application of PHEL - 'Public Health Epidemiological Logic' of Public Health Intervention and Public Health Impact". International Journal of Preventive Medicine. 4 (11): 1331–1336. PMC 3883261. PMID 24404371.
  8. ^ a b c d Tulchinsky, Theodore H.; Varavikova, Elena A. (2014), "A History of Public Health", The New Public Health, Elsevier, pp. 1–42, doi:10.1016/B978-0-12-415766-8.00001-X, ISBN 978-0-12-415766-8, PMC 7170188, retrieved 2025-05-04
  9. ^ "Screening for hepatitis B, HIV and syphilis". www.nhs.uk. 2018-01-10. Retrieved 2018-06-09.
  10. ^ "Vaccines". medlineplus.gov. Retrieved 2021-11-19.
  11. ^ "Polio". Bill & Melinda Gates Foundation. Retrieved 2018-06-09.
  12. ^ Hetzel, B. (1983-11-12). "Iodine Deficiency Disorders (Idd) and Their Eradication". The Lancet. 322 (8359): 1126–1129. doi:10.1016/S0140-6736(83)90636-0. ISSN 0140-6736. PMID 6138653. S2CID 6190461.
  13. ^ Honein, Margaret A. (2001-06-20). "Impact of Folic Acid Fortification of the US Food Supply on the Occurrence of Neural Tube Defects". JAMA. 285 (23): 2981–6. doi:10.1001/jama.285.23.2981. ISSN 0098-7484. PMID 11410096.
  14. ^ a b Frieden, Thomas R. (April 2010). "A Framework for Public Health Action: The Health Impact Pyramid". American Journal of Public Health. 100 (4): 590–595. doi:10.2105/ajph.2009.185652. ISSN 0090-0036. PMC 2836340. PMID 20167880.
  15. ^ Hiligsmann, Mickael; Neuprez, Audrey; Buckinx, Fanny; Locquet, Médéa; Reginster, Jean-Yves (December 2017). "A scoping review of the public health impact of vitamin D-fortified dairy products for fracture prevention". Archives of Osteoporosis. 12 (1): 57. doi:10.1007/s11657-017-0352-1. ISSN 1862-3514. PMC 5486688. PMID 28634891.
  16. ^ Haverkate, M; D'Ancona, F; Giambi, C; Johansen, K; Lopalco, P L; Cozza, V; Appelgren, E; on behalf of the VENICE project gat, collective (2012-05-31). "Mandatory and recommended vaccination in the EU, Iceland and Norway: results of the VENICE 2010 survey on the ways of implementing national vaccination programmes" (PDF). Eurosurveillance. 17 (22). doi:10.2807/ese.17.22.20183-en. ISSN 1560-7917. PMID 22687916.
  17. ^ Vamos, Cheryl A.; McDermott, Robert J.; Daley, Ellen M. (June 2008). "The HPV Vaccine: Framing the Arguments FOR and AGAINST Mandatory Vaccination of All Middle School Girls". Journal of School Health. 78 (6): 302–309. doi:10.1111/j.1746-1561.2008.00306.x. ISSN 0022-4391. PMID 18489462.
  18. ^ a b Burris, Scott (2008-08-06). "The Case Against Criminalization of HIV Transmission". JAMA. 300 (5): 578–81. doi:10.1001/jama.300.5.578. ISSN 0098-7484. PMID 18677032.
  19. ^ a b Cameron, E (December 2009). "Criminalization of HIV transmission: poor public health policy". HIV/AIDS Policy & Law Review. 14 (2): 1, 63–75. ISSN 1712-624X. PMID 20225503.
  20. ^ a b Mykhalovskiy, Eric (2011-09-01). "The problem of "significant risk": Exploring the public health impact of criminalizing HIV non-disclosure". Social Science & Medicine. 73 (5): 668–675. doi:10.1016/j.socscimed.2011.06.051. ISSN 0277-9536. PMID 21835524.
  21. ^ Wilson, Nick; Blakely, Tony; Tobias, Martin (2006-11-02). "What potential has tobacco control for reducing health inequalities? The New Zealand situation". International Journal for Equity in Health. 5 (1): 14. doi:10.1186/1475-9276-5-14. PMC 1654162. PMID 17081299.
  22. ^ Briggs, Adam D. M.; Mytton, Oliver T.; Kehlbacher, Ariane; Tiffin, Richard; Rayner, Mike; Scarborough, Peter (2013-10-31). "Overall and income specific effect on prevalence of overweight and obesity of 20% sugar sweetened drink tax in UK: econometric and comparative risk assessment modelling study". BMJ. 347: f6189. doi:10.1136/bmj.f6189. ISSN 1756-1833. PMC 3814405. PMID 24179043.
  23. ^ a b c "Structural interventions in public health : AIDS". LWW. Archived from the original on 2025-03-19. Retrieved 2025-05-04.
  24. ^ a b c d e f g Birn, Anne-Emanuelle (2009-01-01). "The stages of international (global) health: Histories of success or successes of history?". Global Public Health. 4 (1): 50–68. doi:10.1080/17441690802017797. ISSN 1744-1692. PMID 19153930.
  25. ^ Bartholomew, L. K., Parcel, G. S., Kok, G., Gottlieb, N. H., & Fernández, M.E., 2011. Planning health promotion programs; an Intervention Mapping approach, 3rd Ed. San Francisco, CA: Jossey-Bass.
  26. ^ a b c Cope, Anna Barry; Mobley, Victoria L.; Samoff, Erika (2023-08-01). "Measuring Success: Disease Intervention Specialists Performance Metrics and Outcome Assessments". Sexually Transmitted Diseases. 50 (8S Suppl 1): S18 – S22. doi:10.1097/OLQ.0000000000001740. ISSN 1537-4521. PMC 10348621. PMID 36730526.
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