Public health is the science and art of preventing disease, prolonging life, and promoting healthy communities. It includes everything from ensuring clean water and air to developing effective vaccination programs. There are many ways to achieve the objectives of public health, but some key tools and methods include research, education, community engagement, policy development, environmental analysis, and leadership.
The first modern public health initiatives emerged in Britain in the 18th century out of necessity as the population grew and people began to live in large cities. Great Britain led the world in addressing issues related to urbanization including providing safe drinking water, constructing sewer systems, and establishing vaccination and quarantine programs.
As the understanding of infectious diseases grew and as social reforms like the New Deal and the Great Society were implemented, federal responsibilities, oversight, and funding for public health expanded significantly in the U.S. In 2021 (the last year for which data is available prior to the COVID-19 pandemic) ASTHO reported that federal sources accounted for the largest percentage of state health department budgets (53%).
State and local governments also play important roles in public health, with some states and communities having a more centralized approach to governance where most or all services are delivered through a single public health agency. Other states have a more decentralized structure where most or all services are provided through independently run local health departments. In either case, the boundaries between federal, state and local levels of public health authorities can become blurred and may shift over time depending on specific circumstances.
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