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PART I. THE DRUG/CRIME EPIDEMIC |
Introduction to the Public Health Perspective
Public health practitioners have a story they tell to explain to outsiders the difference between the roles of medicine and public health. In this story, a medical doctor treats, one after another, victims who have fallen in a river and drowned to unconsciousness. The public health practitioner responds to the drowning epidemic by going upstream to discover why so many people are falling in the river. On finding the bridge out, he puts up a warning sign, and the drownings come to a halt.
This story is not to belittle the medical role: certainly the
doctor is crucial to the health need of the drowning victims.
Rather, the story illustrates the point that disease has environmental
factors, and the interest of health can sometimes be served by
focusing on those environmental factors, as the public health
practitioner does.
The medical approach is remedial, while the public health approach
is preventive. As we shall see in Part II of this booklet, interposition
employs both remedial and preventive approaches to control the
drug/crime epidemic. Because the preventive approach to disease
control may be less familiar to the general reader, the following
few paragraphs are offered to define key terms that will aid understanding
of the public health perspective and methodology.
Epidemiologyis the scientific method for study of disease as a phenomenon
of human populations, rather than of individuals. The focus of
attention in this science is not simply on the causeof disease, but on its etiology--a considerably larger concept. The etiologyof a disease includes the agent or cause of the disease, but it
also embraces what may be a complex process by which the agent
(cause) and host (victim) are brought together, plus the factors
that may enhance or diminish the host's vulnerability to the disease,
plus the potential resources for disease control. Not all people
who come in contact with a disease contract it. This observation
highlights the multi-factorialaspect of disease transmission.
To illustrate how the above epidemiological concepts apply, let
us return briefly to the drowning story. A thorough field investigation
might discover more factors than the downed bridge. By reason
of his epidemiological training, our public health practitioner
is likely to be alert to multi-factorial influences. A sharp turn
in the road leading to the bridge might prove significant in explaining
why slow drivers avoid a dunking while speeders do not. The nearsightedness
of some drivers might also be found to be a personal factor contributing
to individual susceptibility to drowning in the story situation.
Both of those discoveries might influence placement and design
of the warning sign.
The causal webis all of "the predisposing factors of disease and their complex
relations with each other and with the disease." (Friedman, 1980,
p. 3-4.) The item that proves important in the causal web is the
item that offers the public health practitioner an effective intervention
for interrupting the process of disease.
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