Public Health is defined as “the art and science of

preventing disease, prolonging life and promoting health through

the organized efforts of society” (Acheson, 1988; WHO).
Activities to strengthen public health capacities and service aim to
provide conditions under which people can maintain to be
healthy, improve their health and wellbeing, or prevent the
deterioration of their health. Public health focuses on the entire
spectrum of health and wellbeing, not only the eradication of
particular diseases. Many activities are targeted at populations
such as health campaigns. Public health services also include the
provision of personal services to individual persons, such as
vaccinations, behavioural counselling, or health advice.
 Community health is a field of public health that focuses on
studying, protecting, or improving health within a community. It
does not focus on a group of people with the same shared
characteristics, like age or diagnosis, but on all people within a
geographical location or involved in specific activity.

Community health covers a wide range of healthcare

interventions, including health promotion, disease prevention,
and treatment. It also involves management and administration
of care. Community health workers (CHWs) are often frontline
health professionals with knowledge of specific characteristics and
developments of the community. They are often members of the
community themselves and play an important role in the
functioning of community care.
 Public Health Nursing as, "the practice of promoting and
protecting the health of populations using knowledge from
nursing, social, and public health sciences".

As individuals, nurses directly influence the health and

wellbeing of patients every day. Through frequent contact, nurses
are best placed to encourage lifestyle changes in communities
and offer education on healthy living – particularly to the most
vulnerable in society.
 Community health nursing, also called public health nursing
or community nursing, combines primary healthcare and nursing
practice in a community setting. Community health (CH) nurses
provide health services, preventive care, intervention and health
education to communities or populations.

In the past, public health nurses worked for the government

or the public health department. Their role has since expanded.
In fact, some may not work directly with patients. According to
“The Definition and Practice of Public Health Nursing”
from American Public Health Association, “Public health nursing
is the practice of promoting and protecting the health of
populations using knowledge from nursing, social, and public
health sciences.”
PUBLIC HEALTH 1.0

This is Public Health 1.0, and despite popular

perception, these achievements explain more of the dramatic
improvement in health and life expectancy in the United States
during the 20th century than the simultaneous remarkable
advancements in medical care and technology.
In this web exclusive series of The Actuary, Geoffrey Sandler, FSA,
MAAA; Kari D. Berglund, MSc; and Sara C. Teppema, FSA, MAAA,
explore two of these achievements: vaccination and family
planning. Geoffrey discusses the challenges we face encouraging
reluctant members of society to be vaccinated. Kari and Sara
outline the history of long-acting reversible contraception
methods and offer a simple actuarial model that could be used to
derive estimates of the cost savings that might be realized if
greater use was made of these methods. They suggest potential
opportunities for extending the model so that long-term benefits
to society might be incorporated.
By the late 20th century, these interventions had largely been
integrated into the fabric of society. For example, with limited
exceptions, vaccinations are required to enter public school.
Federal and state laws establish minimum standards for motor
vehicle, food and workplace safety, as well as clean water and air.
The outrage with which the Flint water crisis was greeted only
highlights how successfully we normally manage our water
supply, but how devastating the effects are when we do not.
During the 1980s, public health professionals recognized that,
despite these extraordinary successes, vulnerable populations
remained and new threats to public health—for example,
HIV/AIDS and chronic diseases—were emerging. To address
these concerns, public health professionals began to re-
conceptualize public health as not merely a series of targeted
 interventions that could be scaled up to protect or improve
conditions for many, but as a complex, integrated system
involving “all public, private and voluntary entities that
contribute to the delivery of essential public health services within
a jurisdiction.” As an integrated system, they concluded, the
public health system delivers 10 essential services:

1. Monitor health status to identify and solve community health

problems.

2. Diagnose and investigate health problems and health hazards in

the community.

3. Inform, educate and empower people about health issues.

4. Mobilize community partnerships and take action to identify and

solve health problems.

5. Develop policies and plans that support individual and

community health efforts.

6. Enforce laws and regulations that protect health and ensure

safety.

7. Link people to needed personal health services and assure the

provision of health care when otherwise unavailable.
8. Assure a competent public and personal health care workforce.

9. Evaluate effectiveness, accessibility and quality of personal and

population-based health services.

10. Conduct research for new insights and innovative solutions

to health problems.

PUBLIC HEALTH 2.0

This is Public Health 2.0. Two other authors in this web-

exclusive series, Shereen Sayre, ASA, MAAA, and Jason McKinley,
FSA, discuss how the insurance industry might contribute to a
more fully integrated system. Shereen suggests that, due to the
historical accident that medical and dental insurance are separate
products, health professionals often fail to treat the “whole
person.” This failure sometimes leads to vicious cycles in which
chronic medical conditions lead to dental infections that, in turn,
exacerbate other chronic medical conditions. In a potentially
innovative solution, Jason suggests that insurers offering fully
underwritten medical policies should not just price
for suicide exposure, but manage it. With the information at their
disposal, insurers could identify and undertake interventions in
respect to individuals who may have the potential to commit
suicide.

A third author, Rebecca Owen, FSA, MAAA, describes

the opioid crisis and its grisly consequences. As with many public
health crises, it will require an “all hands on deck” approach,
including actuaries, to address both its near- and longer-term
consequences.

Lisa Macon Harrison, MPH, and Marjorie Rosenberg, FSA,

Ph.D., consider the public health system as a whole. Marjorie
describes an initiative by the Robert Wood Johnson Foundation
to promote a broader “culture of health” in the United States.
She acknowledges the divergent views about the role of
government in promoting health both within society-at-large
and, more specifically, among actuaries. She suggests possible
approaches to developing workable solutions despite these
differences. Lisa describes the fragmented way in which public
health is financed in the United States, rendering a vulnerable
system evermore fragile. She asks actuaries to bring their deep
knowledge of health care financing and analytical skills to bear in
building a more sustainable and resilient system.
 Public health professionals today recognize that Public
Health 2.0—with its focus on assessment, assurance and policy
development—is not meeting the challenges we expect to face
as the 21st century approaches its third decade. A next generation
framework—one that recognizes the determinants of health— is
needed. In his 2007 article, “We Can Do Better—Improving the
Health of the American People,” Steven A. Schroeder, M.D.
shows that only 10 percent of early deaths in the United States are
explained by inadequate medical care. Our genes and behavior
and our social and environmental living conditions explain the
remaining 90 percent. The last two are the “social
determinants” of health, and addressing these is the next great
challenge in public health.

PUBLIC HEALTH 3.0

This is Public Health 3.0. Four authors of this web-exclusive

series discuss elements of Public Health 3.0. When you hear the
phrase “climate change,” you probably think about effects on
our physical environment. Mona Sarfaty, M.D., MPH, FAAFP,
points out that such change has downstream consequences that
affect all our health. In a sidebar, Jeff Beckley, FSA, MAAA, chair
of the Society of Actuaries’ (SOA’s) Climate and Environmental
Sustainability Research Committee, offers thoughts on how
actuaries can contribute to managing these risks. Finally, Sudha
Shenoy, FSA, MAAA, CERA; and Michelle Mickey Rork, MPA, MPP,
describe the evolution of Oregon’s Medicaid system from fee-
for-service through managed care to its current form, community
care organizations (CCOs). They explain how actuaries helped in
the development of CCOs and suggest other potential areas for
actuarial analysis and improvement.

The fact that public health professionals today are building

Public Health 3.0 doesn’t mean that issues addressed by Public
Health 1.0 and 2.0 are resolved. They are not. For example,
outbreaks of infectious disease illustrate the need to continue
delivering Public Health 1.0 solutions. Another example: “Linking
people to needed personal health services …” a Public Health
2.0 service, remains a challenge9 today despite the reduction in
the uninsured population over the last several years.