The original inception of the public health discipline/field was to control infectious and contagious diseases within the population. Starting with Dr. John Snow in the late 1800s and moving forward, the control and/or eradication of disease has been a chief concern using primary, secondary, and tertiary prevention (UCLA, 2013). Large-scale projects such as widespread water fluoridation and the eradication of smallpox are chapters in the history of public health. Recently however, there has been a significant shift from the scope of contagious disease to lifestyle or behavioral (including mental) diseases.
Lifestyle/behavioral diseases such as COPD, heart disease, cancer, mental illness, etc. have become more prevalent in the wake of decreases in contagious diseases (McKenzie & Pinger, 2012). While some aspects have been present (i.e. violence, cancer, etc.) for some time, the limited resources of public health programs once geared towards communicable disease are now able to address them as prior disease are controlled through technology. In addition to a resource shift, there has been a larger swath of lifestyle diseases tied to environmental issues such as air quality, water quality, and exposure to various pathogens/carcinogens (Moeller, 2011).
Medical as well as public health resources become scarcer and more limited as the population grows and ages. This means that widespread education and prevention of lifestyle/behavioral disease in the individual has become a significant public health issue. This is doubly so as these lifestyle diseases enter what the World Health Organization (WHO) has called epidemic proportions (World Health Organization [WHO], 2014). Public health officials and professionals, once using vaccinations and quarantines are now using education, advocacy, and community organizing to treat obesity (both childhood and adult), smoking, drinking, domestic violence, and other factors of these lifestyle diseases.
There has been some question, especially in the light of personal responsibility and behavioral disease, on whether the government should involve itself in this aspect of public health. Regarding the widespread and infections nature of diseases such as polio, smallpox, etc. there was always the understanding that the government (at all levels) was acting in the best interests of society to control and prevent disease (McKenzie & Pinger, 2012). With lifestyle/behavioral diseases, there is a question on how much the individual affects the community and how much their individual health choices such as diet or exercise affect the overall health of the community. Looking at the evidence, especially in the post Affordable Care Act (ACA) United States, that public cost control as well as access and delivery to limited health care resources have long been center to the discussion. This concern for distributing finite (Center for Bioethics, 1997) within the population is further evidence that public health...