In order to determine whether infertility should be considered a public health issue, it is important to briefly examine the field of public health and the criteria used for defining a public health issue. Understanding public health begins with the concept of health itself. The World Health Organisation (WHO) describes health as “A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”.
Health should be seen as having value to the extent that it makes possible a satisfactory total living experience, considering both the quality and quantity of life as important. Assurance of health is seen as a government responsibility to some degree in almost every country and the human rights framework has successfully been used as a tool to protect and promote health.
Definitions of public health tend to be broad and inclusive in scope. The International Institute of Medical Education (IIME) defines public health as the “Organised efforts of society to protect, promote, and restore people’s health.” The IIME maintains that while public health activities change with variations in technology and social values, the goals remain the same: to reduce the amount of disease, premature death, and disease-produced discomfort and disability in the population. This population focus may leave some individual needs unaddressed. In general, public health is concerned with four broad areas: (1) lifestyle and behaviour, (2) environment, (3) human biology and (4) organization of health programs and systems. The field of public health, however, is not just a medical, sociological, and environmental enterprise; Public health must really be regarded as an ethical enterprise, an agent of social change, not just for the sake of change but to make possible the achievement of other social goals.
Historically, public health has been a progressive discipline; it developed through concern for sanitation issues, then turned to questions of communicable disease; prevention of physical and mental ailments in the individual was added next, then promotive social and behavioural aspects of health and recently, public health has turned its attentions to dilemma of distribution, quality, and assurance of comprehensive health care for all. The current public health paradigm emphasizes an individual’s relationship with their complex social and physical environment. The gradual extension of the horizons of public health is in conformance with advances in medical and scientific knowledge as well as social and political progress.
The progressive nature of public health makes any restriction of the functions and responsibilities of health… difficult. To tie public health to the concept that answered our need 50 years ago, or even a decade ago, can only hamstring our contribution to society in the future.
The cost of public health programs relative to produce benefits is the subject of much attention and public discussion. Financial policy must balance program costs as well as humanitarian and social gains, economic advantages, and the value of lives made possible or continued by public endeavours. Cost/benefit considerations are valuable in obtaining public understanding and support for budget decisions concerning health programs. The government-public health partnership often grapples with the difficulty of attaching value to a health outcome which is prevented and struggles to justify expenses for lessening suffering which may not be easily visible to the individuals who make the budgetary allocations.
