The Health Promotion Argument: NCDs and Public Health

Abstract

Concern with health and disease at the population level has historically been the primary focus of public health. While epidemiology as a primary subject area of public health concentrated on the etiological origins of disease and their distribution, the rest of the public health enterprise had broader interests. This was particularly true in what Rosen aptly called the “industrialism and the sanitary movement from 1830 to 1875” (1958). This was the period of the politicization of public health by such champions as Rudolph Virchow, Louis-René Villermé, and Edwin Chadwick. Regrettably, from a health promotion perspective, after such a population focus much of public health thinking and practice that followed into and including most of the twentieth century focused more on the individual. This was partly as a result of the rise of a bacteriological theory of disease etiology (cf. Chapters VII and VIII in Rosen), but can also be viewed as a political inheritance from the European colonialism concerns with hygiene and tropical medicine. From time to time, particularly from the mid twentieth century onwards, there was also a modest interest in community and social medicine, notably in Britain. Towards the end of the twentieth century and in recent decades there has been increasing interest in noninfectious etiologies and chronic diseases in public health. An American manifesto of this broader interest was the creation at the public health agency CDC in 1988 of a National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).