PUBLIC HEALTH PROBLEM

Public Health Problem

Public Health Problem

Introduction

In public health, the goal is to prevent disease or injury in a whole population—a city, state or country, for example. That's different from the goal of health care, which is to care for individuals.

An example may make the distinction sharper: A public health approach to cancer could involve a statewide public awareness campaign about the risk factors for cancer such as smoking or sun exposure, while a health care approach would focus on educating individuals about such risk factors. 

Discussion

Schizophrenia meets the four criteria for a problem requiring public health action:

1. The problem occurs frequently and widely.

2. The problem causes severe disability and suffering.

3. There are effective methods of dealing with the problem.

4. Treatments are acceptable to patients, their families, and society.

Schizophrenia occurs frequently and widely / A World Health Organization (WHO) study detected very little variation in the incidence of the illness in countries around the world. Using a precise definition of schizophrenia, it has been found that the incidence of schizophrenia is not significantly different between countries (7-14/100,000 in the sites investigated). When a less rigid definition is used, incidence figures are considerably higher, and when other psychotic conditions related to schizophrenia are included, the incidence rates are higher still and show significant variation across countries (Jablensky et al. 1992).

Schizophrenia causes severe disability and suffering / The discrimination because of schizophrenia increases the suffering associated with the disease for the patient. Those close to the patient suffer because they are also marked by the stigma of the disease (Axelrod 2002). It has been estimated that in 1991, schizophrenia cost the United States $19 billion in direct expenditures and $46 billion in lost productivity (indirect costs), a total of almost $65 billion. When the indirect costs, which make up 71% of the total, are added to the direct costs, it is possible to obtain a more comprehensive estimate of the financial burden of this illness, which devastates the lives of millions of individuals and their families (Wyatt et al. 1995). Recent studies estimating the burden of schizophrenia indicate that the disease causes distress, loss of productivity, lower quality of life, and secondary mental health problems for patients and their families (Thornicroft and Tansella 1996).

Schizophrenia is treatable / A recent review found that, in approximately 20%-25% of people with schizophrenia all symptoms disappear, and that return to self-sufficiency and good social functioning occurs in a further 20% (Warner 1994). Reports from developing countries indicate much higher rates of recovery. Even if treatment does not remove all symptoms, effective treatment can increase an individual's quality of life and ability to function. Since the introduction of chlorpromazine in the 1950s, an increasing number of medications and psychosocial treatments have been developed that can effectively alleviate the symptoms of schizophrenia (Cullitor 2000). These medications are particularly valuable in reducing or eliminating positive symptoms such as delusions, hallucinations, and agitation that occur in acute episodes of the ...