epublishing store: Intro

Sexual Health eBook Volume3
Chapter 1

Public Health Perspectives in Sexual Health, Bernardo Useche and Michael W. Ross

The current public health approach to health-related issues differs from a classic medical approach in several important aspects (Schneider, 2000). First, the focus is on the health of populations rather than on the individual (Emmons, 2000; Institute of Medicine, 1998, 2002; Krieger, 2001; Rose, 1992, 2001) because, as Berkman and Kawachi (2000) have explained, “We now understand that most behaviors are not randomly distributed in the population. Rather, they are socially patterned and often cluster with one another” (p. 7). Thus, the social aspects of the community that may predispose it to health or illness, and the physical aspects of the environment that may lead to health or illness, are emphasized.  

Second, the emphasis is on prevention. This may be primary prevention, where illness is prevented from occurring; secondary prevention, where early screening and intervention may prevent the illness from developing further; and tertiary prevention, the classic medical treatment of an existing illness.

Third, there is the recognition, along with the emphasis on populations rather than on individuals, that a relatively small shift in the behavior of a population—for example, in reduced smoking—may lead to a significant reduction in the burden of disease, for example, lung disease.

Fourth, public health tends to problematize outcomes rather than behaviors. For example, driving motor vehicles is not seen as a problem, but unsafe driving is. In the present case, sexual behavior itself is not seen as the problem, but rather the outcomes that may result from irresponsible behavior, such as unwanted pregnancies, sexually transmitted infections (STIs) sexual violence, and sexual dysfunctions, are.

Fifth, public health has always balanced prevention and promotion, thus preventing health problems by promoting healthier options. Positive approaches are preferred, particularly when the associated behavior—as in human sexuality—is relatively health neutral and can be associated not only with health problems but also with enhanced mental health and meaning in, and quality of, life.
Finally, public health is concerned with the distribution of health and illness—and of access to health services, including preventive programs—across the population.

Thus, inequalities in health and access to care also fall within the mandate of public health (Krieger, 2000).

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