Diseases, Problems or Needs: A Framework for Public Health

Public health can play a pivotal role between the health care system and the whole of society when it comes to designing—and also to implement them—health care policies and, above all, general public policies with impact on health. Policies which require the involvement of many other sectors besides the health sector, since many of the determinants of health, beyond the absence of disease, are unrelated to the health sector. Prioritization often involves competition between the more traditional perspectives of health that are based on a pathogenic approach and aim to cure and prevent disease and the salutogenic approach that aims to detect and promote the causes of good health or at least of resilience. The absence of one satisfactory theory of health is a limitation of the salutogenic perspective but we don’t have either a true theory of the disease, beyond the description of pathological entities. Public health, understood as what we do as a society—not just as a health system—to guarantee the health of people has the responsibility and the opportunity to combine both perspectives in a balanced way.