Yes, academically - in practice the lines blur.

I have made an effort to differentiate in: Laverack, G. (2014) A to Z of Health Promotion. Basingstoke. Palgrave Macmillan.

Hi Glenn,

Good to hear from you. Yes - I noted with interest a month or two ago about your new book release. i intend to get a copy - and then I can see your spin on this. Do you have a 'snippet' from it that you could paste here to illustrate - without 'giving the whole game away' of course?

The goal of population health is to maintain and improve the health of the entire population, and to reduce inequalities in health between population groups. Public health on the other hand aims to reduce disease and maintain and promote the health of a population ............................................................................................(reference)...

Community health is concerned with the study and improvement of the health characteristics of communities. Health improvement aims to find ways of preventing ill-health, protecting good health and promoting better health. This is achieved ...........

Title: A to Z of Health Promotion

Year: 2013

Pages: 256

ISBN: 9781137350480

Website: http://www.palgrave.com/products/title.aspx?pid=684265

Hi Glenn,

Many thanks for that - and I can go with those myself. The lines will remain blurry though as take , for instance, population health and public health. Many will argue they are the same thing - just dressed a little differently i.e. they are both aimed at the total population. You wouldn't initiate a 'generic' public health strategy if it didn't target the whole population (however that population is defined). And then it can depend on the framework that drives public health. To me, if the public health initiative is driven by a socio-ecological-economic model - then it's the same as population health. If it is highly medicalised and based around screening, vaccination etc - then that is different. It targets parts of the population - not the whole.

Hi Dean, another level of questioning might be therefore why we have these distinctions - who generated them - probably academics- and is there a practical purpose- probably not- in practice I rarely see the term 'pop health' because as you point out the system is medically model dominated and who decides will also have a professional preference.

While all of those distinctions make sense on paper and perhaps for generating specific hypotheses for testing in specific subsamples, in reality they may all be part of public Health when faced with a new contagious health threat or severe health disparities as we have seen throughout the HIV/AIDS epidemics of the 1980s and still seeing currently. The rise of social network sampling and health disparities based on race, sexual and social networks, poverty and discrimination means that we never know the full storyor how to achieve the ultimate goals of public health efforts- the prevention of spread of the health threat despite differing social and behavioral risk and resiliency patterns- requires that we examine the risk and risk protection factors oprrating at all levels in any subpopulation that is bearing the brunt of the spread, as we have seen fir many years buy now more than ever before the increased rates of HIV spread/exposure among young Black MSM, Black single women raising children and dependent on the absent father or other at risk male for economic and housing stability, etc.

As the fouder of Chicago's AIDS Task Force in 1982, we had no idea how to prevent the causative agent, discovered in 1985, but had to still provide the public w commonsense info in order to prevent mass panic, particularly when Ryan White was refused school admission in nearby IN and it was revealed that children w AIDS were attending Chicago's public schools. When faced with such a cataclysmic and potential mass panic situation u have no other choice but to look carefully at all the epidemiologic data and provide it to the public with no guarantees but your hope that you havr not created a situation for casual spread among public school children, gay men, etc. In those situations with public fear escalating and minimal direct evidence that casual transmission was not likely to occur in school settings or drinking out of a cup after someone w AIDS used it, and be consistent, clear and closely monitor any potential new clusters of infection or disease that might forewarn a new public health risk.

David G Ostrow, MD, PhD, LFAPA

Hi Glenn,

Agreed on one hand - but not on another. To some - it may well be semantics how we define terms; or if we need to. I've always argued that it is important. The practical purpose is that we don't have divisions of community health practitioners working in different directions. That we are able to appropriately plan, resource, justify and evaluate distinct differences in practice i.e. population health, public health or health promotion and health education. Until we do - the funders may be resistance, our clients may be confused and, certainly, health professionals working in different health arenas will be competing - when they should be pulling together.

Speaking as a practitioner myself I do not see the logic in having different health workers for these different areas! They all morph in practice quite well, it is an academic pursuit to differentiate in my view - but what is the practical purpose of this?

Hi Glenn,

I don't see it as different health practitioners working in different areas - unless by different areas you mean different settings. Even then, that shouldn't matter. It's far more about, are those working in the arena all speaking the same language. It's not simply an academic exercise. Our difference Glenn is that you seem to want to separate the academic from the practical - but are they not both inter-related; otherwise we have the theory-practice divide - and that has never helped anyone.

If I am a funder wanting 'the most bang for my buck', I'm not going to accept that all health workers naturally 'morph', understand or are going to do the same thing - or that a clear understanding of terms or boundaries, academic or otherwise, is not important. If I cannot defend, differentiate, or clearly articulate my exact position to funders (as well evaluate) I would not expect funding. In that respect, surely it has a practical purpose.

Hi Dean, I am very much for the link between evidence and practice (theory is different of course). But in reality how much does this happen. Take HP as an example. We know the limited impact of many approaches but we still keep offering these as the best bang for the buck and funders/governments keep spending millions of $ on ineffective programmes. I feel that you have part answered the question by stating that you want to articulate your position better in order to be more competitive for funding. My concern is how well in PH practice we are achieving our goals of improving health, wellbeing, addressing inequality etc. Practitioners and academics speak a different language and having worked as both I do not see this changing soon-sadly.

Hi Glenn,

You and I are back on track. Fully agree - many HP bucks are wasted on fruitless and ineffective government-sponsored exercises. I also agree that we all have to speak, can clearly articulate and defend the same language - academic, practice-wise, policy-wise or whatever - even if it's a means to an end just to justify and secure resources to benefit the whole community. I'm just wondering though if you've have got me mixed up with being just an academic - and not a practitioner as well? I find, being both, that both academics and practitioners speak differently equally - when the default should be that we should all speak the same - in an ideal world that is!!

Spot on mate. I like that: speak differently equally. You work in a very vocational area and having taught nurses myself I know how realistic one has to be - at your peril. PH and HP can be a little more diffuse and I purposefully keep a foot in both the academic and practice camps to better inform my writing. I do not wish to exaggerate the issue but I constantly come across a disconnect - we need more people who are proficient in both. I know very good academics and very good practitioners but few that can bridge the gap! This applies to teaching as well as research.

Spot-on too Glenn!! Once - we've separated the 'wheat from the chaff' between us with our views - I feel more that we are kindred spirits. If the gap we speak of could be bridged by only a smallish proportion of academics/educationalist/practitioners etc - the world would be a better, healthier, more productive place. I've even argued that, if you target a very large global workforce, like nursing alone, to achieve that - then that is a big step in the right direction. Excuse all the metaphors but, on the other hand, 'you can lead a horse to water...'

You are right to focus on a very vocational area where both academics and practitioners have a vested interest to cooperate. Feel free to email me direct if you feel that there is anything that I can help with. Glenn.

Thanks Glenn - and will do!!

I empathize with the sentiments expressed here. I've encountered the same semantic conundrums myself and a couple of years ago began to substitute the phrase "health of the public" for "public health" whenever I can. At least to my mind this clarifies the issue and places all kinds of activities e.g. health promotion under the umbrella of things done to benefit "the health of the public". Not an immediate solution to the issue I know but then again, perhaps somewhere a small disturbance occurs in the status quo with this kind of drop-in-the-ocean! Thanks for the thoughtful comments everyone -

It does help Alan. Any attempt to alleviate the 'conundrum' is useful. Unfortunately, I'm not sure that the majority think like you and I or try to differentiate. We throw in population, community, socio, political, economic, ecological (even individual) health - and then many just switch off.