Public health and arthritis: A growing imperative

The Merriam-Webster Dictionary defines public health as the art and science dealing with the protection and improvement of community health by organized community effort and including preventive medicine and sanitary and social science. Until the mid-20th century, the field of public health was primarily concerned with the prevention and control of infectious diseases. More recently, public health scientists and practitioners have also been engaged in the prevention and control of chronic diseases. In the mid-19th century, when the therapeutic armamentarium of physicians was limited, the relationship between the fields of public health and medicine was very close. Indeed, most public health professionals were physicians. However, as biomedical science led to more and more diagnostic and therapeutic strategies for physicians in the 20th century, and as separate schools of medicine and public health were established in American universities, the fields have developed different approaches to solving health problems. Medicine has been primarily concerned with the diagnosis and the palliative and curative treatments of disease and the health of the individual patient. Public health has been primarily concerned with the prevention and control of disease and the health of the population. The goal of this chapter is to illustrate the magnitude of the arthritis public health problem in the United States and to describe potential public health approaches to mitigate this problem. In order to more clearly describe public health perspective, science, and intervention, contrasts will be made with the medical approach, but this should not be interpreted to mean that one approach is superior to the other. In fact, it is likely that arthritis patient-physician encounters will be more effective when arthritis public health efforts are successful and vice versa. It is this synergy for which both fields should be striving.