Africa Topicality

ENDI 1
Topicality
ENDI TOPICALITY FILE
endi topicality file...........................................................................................................................................................1

topicality explanation......................................................................................................................................................2
public health assistance is limited to disease prevention and supporting existing public health infrastructures............3
public health assistance includes military disaster relief................................................................................................6
public health assistance means government-provided services......................................................................................7
public health means government-provided services.......................................................................................................8
public health must be provided by the government and must be prevention..................................................................9
public health excludes treatment...................................................................................................................................10
public heath excludes subgroups...................................................................................................................................13
public health is limited to proximate health risks.........................................................................................................14
broad definitions of public health are bad.....................................................................................................................15
at: 10 essential public health services definition...........................................................................................................19
at: public health is population health generally.............................................................................................................20
public health includes non-governmental organizations...............................................................................................21
at: rothstein definition of public health.........................................................................................................................22
public health includes medical treatment......................................................................................................................23
public health allows targeting subgroups......................................................................................................................24
broad definitions of public health.................................................................................................................................25
public health definitions – laundry list..........................................................................................................................26
public health is disease prevention and community health promotion.........................................................................27
aids assistance is public health assistance.....................................................................................................................28
bioterrorism is a public health problem........................................................................................................................29
public health includes environmental health.................................................................................................................30
public health includes environmental health.................................................................................................................31
public health includes crime prevention.......................................................................................................................33
violence prevention is a public health issue..................................................................................................................34
public health assistance can be multilateral..................................................................................................................35
increase means to make greater.....................................................................................................................................36
Assistance is the transfer of goods or services..............................................................................................................37
ENDI 2
Topicality
TOPICALITY EXPLANATION
Resolved: The United States federal government should substantially increase its public health assistance to Sub-
Saharan Africa.
There are not prewritten violations but there is enough evidence included to write at least 5 pretty good topicality
violations that will probably be at the core of most topicality debates next year:
1. Public health assistance is limited to disease prevention and public health infrastructure support. This includes
probably the best / only cards that define “public health assistance” as a term of art and should allow you to handily
beat affirmatives that do things unrelated to medical or other traditional public health issues. Affirmatives that do
things like peacekeeping, debt relief, or economic support are very likely to lose to this. Those teams will have to
rely on definitions of “public health” instead of “public health assistance” and are therefore likely to have an inferior
interpretation.
2. Public health can only be provided by governments. While there are good affirmative answers, this is a good
violation to write against cases that fund NGOs. A lot of the best “aid bad” ground assumes direct funding to
governments and this can help you set up a counterplan to fund NGOs instead of African governments.
3. Public health excludes treatment. There are good cards both ways, but you are likely to use this violation against
cases that boost disease treatment programs, like providing doctors or drugs.
4. Public health excludes focusing on population subgroups. This is useful for affirmatives that target a particular
segment of a population, such as African militaries. The argument is that all assistance must be open to the public at
large instead of a specific segment.
5. Public health requires a focus on proximate environmental threats to health. In my opinion, this is maybe the
best violation; proximate means “most direct or immediate”. You would say that public health is limited to
prevention but not all prevention cases are topical. Only those that focus on the direct cause of illness are topical; a
focus on root causes is not. For example, a proximate cause of poor health might be unprotected sex that results in
HIV transmission or drinking dirty water that results in cholera. So a topical affirmative would be to provide
condoms or clean water technology. Now, the root cause of these problems might be poverty or government
corruption, but those are clearly indirect.
ENDI 3
Topicality
PUBLIC HEALTH ASSISTANCE IS LIMITED TO DISEASE PREVENTION

AND SUPPORTING EXISTING PUBLIC HEALTH
INFRASTRUCTURES
Public health assistance can be one of three things: disease monitoring, assistance to public health authorities
or restoring public health infrastructures. (It is distinct from the other types of assistance listed here)
Olson, 99 (Robert, Research Director of the Institute for Alternative Futures. He was the primary author of the US
Department of Defense report on which this article is based, “The US military’s future in operations other than
war”, foresight: the journal of futures studies, strategic thinking and policy, / vol.01,no.01, feb.99, ingenta)
Examples of Plausible Mission Types

Assistance with the Y2K computer problem - Provision of electric power, emergency communications, water,
food, and medical services; and maintenance of law and order in the event of widespread and prolonged
failures; participation in international efforts to assist nations facing the greatest difficulties..
Counter-drug operations - International cooperative efforts targeted at growing, harvesting, and producing
drugs; monitoring international transit points for narcotics trafficking; and sea, land, air interception of drug
smuggling operations.
Counter-terrorism operations - Domestic and international preventive activities, training programmes,
hostage rescue missions, and emergency responses including medical capabilities for treating and
transporting victims.
Biologic and chemical threats - Advance preparation and rapid response to chemical or biologic
emergencies in the USA and participation in international efforts to prevent weapons proliferation.
Peace operations – Peacekeeping to separate combatants and to promote an environment suitable for
conflict resolution; peace-enforcement to compel compliance with international resolutions or sanctions;
and peacebuildingto rebuild governments and other institutions in order to avoid relapse into conflict.
Development failure rescue missions - Creation of a safe environment for NGOs to function; assistance with
training, equipment repair, food distribution; `adopt a community’ programmes; refugee care; and
restoration of law and order.
Arms control - Inspection of military facilities, supervision of troop withdrawals, and treaty verification
activities; finding and seizing weapons of mass destruction; and dismantling, destroying, or disposing of
weapons and hazardous material.
International humanitarian assistance - Transportation and distribution of food and medical supplies to an
unstable area during a civil war or other major upheaval.
Disaster relief - The transportation and distribution of food, provision of medical care, and rebuilding of
infrastructure following natural disasters.
Nation building - Restoration of law and order in the absence of government authority (ie, failed states),
infrastructure reconstruction, and assistance in re-establishing self-rule mechanisms and institutions.
Public health assistance - Assistance in global disease monitoring; assistance to public health authorities in
preventing epidemics, meeting emergency health needs and chronic problems, and restoring failing public
health infrastructures.
Environmental interventions - Assessment of environmental damage and health threats; environmental
recovery operations; and participation in long-term environmental restoration projects
Support for preventive diplomacy - Any other mission designed to head off conflict such as collecting
information about protagonists, mediating disputes, monitoring military movements, and initiating deterrent
deployments.
ENDI 4
Topicality

INFRASTRUCTURES
Most literature supports our interpretation of international public health assistance
Brown, 1987 (Peter, professor of anthropology at Emory, Cultural Anthropology, February 1987, “Microparasites
and Macroparasites”, JSTOR)
This raises the question: who consumes more, macroparasites or microparasites? Such a
question would appear trivial were it not for the fact that a large literature in the field of
international public health argues that endemic diseases like malaria are the root cause of
economic underdevelopment. Moreover, such a question has policy implications, since
international public health assistance has traditionally been oriented toward the control and
eradication of microparasites.
Public health assistance is distinct from debt relief and development assistance—it is disease prevention and
assisting existing public health services
White House National Security Strategy, 2000 (“A NATIONAL SECURITY STRATEGY FOR A GLOBAL
AGE”, http://www.au.af.mil/au/awc/awcgate/nss/nss_dec2000_part2.htm)
Efforts by the United States to foster sustainable development include:

• Promoting sound development policies that help build the economic and social framework needed to encourage
economic growth and poverty reduction and facilitate the effective use of external assistance.
• Debt relief to free up developing countries' resources for meeting the basic needs of their people. The United States
led the G-7 in adopting the Cologne Debt Initiative for reducing debts owed them by those of the world's poorest
countries committed to sound policies that promote economic growth and poverty reduction. The resulting plan is
embodied in the HIPC Initiative.
• Public health assistance consisting of grants, loans, and tax incentives for the prevention and treatment of
epidemics such as AIDS, malaria, and tuberculosis, as well as the training of individuals to continue providing
public health services.
• Human capacity development assistance for basic education and literacy programs, job skills training, and other
programs specifically designed to protect women's health, provide educational opportunity, and promote women's
empowerment.
• Leadership in the G-8 and OECD to raise environmental standards for export credit agencies and international
financial institutions.
ENDI 5
Topicality

INFRASTRUCTURES
Public health assistance requires assistance from public health authorities; it is distinct from infrastructure
development or skill development
National Academy of Sciences, 97 (Commission on Behavioral and Social Sciences and Education, Enhancing
Organizational Performance,
http://books.nap.edu/openbook.php?
chapselect=yo&page=158&record_id=5128&Jump+to+Specified+Page.x=0&Jump+to+Specified+Page.y=0)
Aid to domestic, civilian populations consists of the use of military forces in their native country for enhancing the
well-being of the population in several areas (Nunn, 1993):
Human capital development is assistance in the improvement of educational, personal, and vocational skills among
different segments of society. The U.S. Civilian Conservation Corps' program during the 1930s is an example. The
proposed National Guard Youth Corps and the YESS program in Michigan are other examples.
Public health assistance is the assistance of public health authorities in meeting emergency needs and chronic
problems associated with the health of the population. The Military Assistance to Safety and Traffic Program
already incorporates some of this mission and is available in several states.
Rehabilitation of infrastructure is the restoration and construction of public facilities (e.g., roads, schools, housing).
Although a foreign example, Operation Provide Comfort in Iraq provided road and housing construction similar to
what might be done domestically.
Firefighting consists of the use of military troops to support civilian efforts in controlling forest fires and wildfires.
The 1994 deployment of U.S. troops to fight fires in the Pacific Northwest is an example.
Public health assistance involves direct medical and sanitation assistance missions
Olson, 99 (Robert, Research Director of the Institute for Alternative Futures. He was the primary author of the US
Department of Defense report on which this article is based, “The US military’s future in operations other than
war”, foresight: the journal of futures studies, strategic thinking and policy, / vol.01,no.01, feb.99, ingenta)
Fourth,humanitarian assistance missions have a strong public health component which may include ensuring the
quality of the water supply to prevent spread of disease, establishing basic sanitation conditions in a refugee camp,
or improving sanitation techniques in host nation medical facilities. In such cases, US medical forces may find
themselves providing medical supplies, community health services, public health education,training,and even basic
equipment to augment the local medical infrastructure.
ENDI 6
Topicality
PUBLIC HEALTH ASSISTANCE INCLUDES MILITARY DISASTER

RELIEF
Public health assistance is a role of the military
National Academy of Sciences, 97 (Commission on Behavioral and Social Sciences and Education, Enhancing
Organizational Performance,
http://books.nap.edu/openbook.php?
chapselect=yo&page=158&record_id=5128&Jump+to+Specified+Page.x=0&Jump+to+Specified+Page.y=0)
Aid to domestic, civilian populations consists of the use of military forces in their native country for enhancing the
well-being of the population in several areas (Nunn, 1993):
Human capital development is assistance in the improvement of educational, personal, and vocational skills among
different segments of society. The U.S. Civilian Conservation Corps' program during the 1930s is an example. The
proposed National Guard Youth Corps and the YESS program in Michigan are other examples.
Public health assistance is the assistance of public health authorities in meeting emergency needs and chronic
problems associated with the health of the population. The Military Assistance to Safety and Traffic Program
already incorporates some of this mission and is available in several states.
Rehabilitation of infrastructure is the restoration and construction of public facilities (e.g., roads, schools, housing).
Although a foreign example, Operation Provide Comfort in Iraq provided road and housing construction similar to
what might be done domestically.
Firefighting consists of the use of military troops to support civilian efforts in controlling forest fires and wildfires.
The 1994 deployment of U.S. troops to fight fires in the Pacific Northwest is an example.
Using military medical personnel is a form of public health outreach

Nunn, 93 (Sam, US Senator, Domestic Missions for the Armed Forces. Fourth Annual Conference of Strategy, U.S.
Army War College, http://www.strategicstudiesinstitute.army.mil/pubs/display.cfm?pubID=347)
Public Health Outreach.

In a similar vein, there are many citizens in both urban and rural areas who lack the very basics of health and
medical services. There may be opportunities in specific locations to use DoD medical capabilities to assist civilian
authorities in providing public health outreach to these urban areas. The Center for Disease Control (CDC) in
Atlanta estimates that fewer than half of all American children are fully immunized against diseases such as polio,
diphtheria, tetanus, measles, and rubella. Infant vaccination and basic medical treatment are services that the
military provides routinely in humanitarian missions abroad. Why not use these resources at home?
ENDI 7
Topicality
PUBLIC HEALTH ASSISTANCE MEANS GOVERNMENT-PROVIDED

SERVICES
Public health assistance means the provision of government health services generally available
Code of Federal Regulations, 06 (Title 45, Volume 2, 45CFR402.2, 10/1,
http://a257.g.akamaitech.net/7/257/2422/13nov20061500/edocket.access.gpo.gov/cfr_2006/octqtr/45cfr402.2.htm)
Public health assistance means health services (1) that are generally available to needy individuals residing in a
State; (2) that receive funding from units of State or local government; and, (3) that are provided for the primary
purpose of protecting the health of the general public, including, but not limited to, immunizations for
immunizable diseases, testing and treatment for tuberculosis and sexually-transmitted diseases, and family
planning services.
Public health assistance is the provision of public health services, is generally available to all individuals, and
receives government funding
Hyde, 95 (Henry, US Senator, text of a bill introduced in the Senate, 3/22,
http://www.eff.org/Legislation/Bills_by_number/hr1292_95.bill)
(3) `program of public health assistance' means a program in a State or political subdivision that--
(A) provides public health services, including immunizations for immunizable diseases, testing and
treatment for tuberculosis and sexually-transmitted diseases, and family planning services;
(B) is available generally to needy individuals residing in the State or political subdivision; and
(C) receives financing from the State government or political subdivision.
Public health are activities carried out by governmental health agencies—it’s not everything that effects “the
public’s health” or “population health”
Gray, 04 (Bradford, Editor of the Milbank Quarterly, The Milbank Quarterly, v. 82, n.1, editor’s introduction,
http://www.milbank.org/820100.html)
Readers may notice a change on the masthead of the Quarterly, which for many years has carried the subtitle “A
Journal of Public Health and Health Care Policy.” With this first issue of Volume 82, that subtitle now reads “A
Multidisciplinary Journal of Population Health and Health Policy.” This modification in the description of the
Quarterly’s content is not intended to signal a change of purpose but to convey more clearly and accurately the
Quarterly’s focus. The term public health has increasingly come to connote a relatively narrow, though vitally
important, set of activities that are carried out by agencies with official functions. The Milbank Quarterly is
concerned with a very broad range of topics affecting health, as this current issue well illustrates. The term public
health has increasingly seemed too confining. (It is noteworthy that the title of a recent Institute of Medicine report
[2002] about assuring the future health of the American people contains the term the public’s health rather than
public health.) The term population health has been increasingly used in recent years, probably because it suggests a
broad set of concerns—a particular perspective—rather than a specific set of activities, actors, or approaches. Thus,
population health is more descriptive of the content to which the Quarterly aspires than public health is.
ENDI 8
Topicality
PUBLIC HEALTH MEANS GOVERNMENT-PROVIDED SERVICES

Public health is provided by the government and involves population-based services
Gostin, 2000 (Lawrence, Professor of Law at Georgetown University and Professor of Public Health at the Johns
Hopkins University, “Conceptual Foundations of Public Health Law”, http://www.milbank.org/gostin001210.pdf)
In this chapter, I construct a definition of public health law, borrowing from ideas in constitutional law, theories of
democracy and community, and public health history and practice. My definition of public health law follows, and
the remainder of this chapter offers a justification for each component of the definition.
Public health law is the study of the legal powers and duties of the state to assure the conditions for people to be
healthy (e.g., to identify, prevent, and ameliorate risks to health in the population) and the limitations on the power
of the state to constrain the autonomy, privacy, liberty, proprietary, or other legally protected interests of individuals
for the protection or promotion of community health .
Through this definition, I suggest five essential characteristics of public health law (see Figure2):
Government: Public health activities are a special responsibility of the government.
Populations: Public health focuses on the health of populations.
Relationships: Public health addresses the relationship between the state and the population (or between the state
and individuals who place themselves or the community at risk).
Services: Public health deals with the provision of population-based services grounded on the scientific
methodologies of public health (e.g., biostatistics and epidemiology).
Coercion:Public health authorities possess the power to coerce individuals and businesses for the protection of the
community, rather than relying on a near universal ethic of voluntarism.
Public health involves governmental efforts to promote the health of populations instead of individuals
The crux of public health, as I have sought to demonstrate, is a public, or governmental, entity that harbors the
power and responsibility to assure community well-being. Public health, however, also focuses on persons or
groups that stake a claim to health protection or promotion. Most scholars who have compared public health with
medicine have noted that, generally, public health focuses on the health of populations, while medicine focuses
on the health of individuals.4 1Elizabeth Fee observes that medicine and public health have contradictory interests.
“Public health is oriented toward the analysis of the determinants of health and disease on a population basis,
while medicine is oriented toward individual patients.”42 Public health is organized to provide an aggregate benefit
to the mental and physical health of all the people in a given community. Classic definitions of public health
emphasize this population-based perspective: “As one of the objects of the police power of the state, the ‘public
health’ means the prevailingly healthful or sanitary condition of the general body of people or the community in
mass, and the absence of any general or widespread disease or cause of mortality. The wholesome sanitary condi-
tion of the community at large.”43 Consequently, while the art or science of medicine seeks to identify and
ameliorate ill health in the individual patient, public health seeks to improve the health of the population.
ENDI 9
Topicality
PUBLIC HEALTH MUST BE PROVIDED BY THE GOVERNMENT AND

MUST BE PREVENTION
The defining characteristic of public health is that it requires coercive government intervention for the
prevention theats to the population—it excludes the provision of publicly-funded health care
Rothstein, 02 (Mark, Chair in Health Law and Policy, at Bradeis University School of Law and School of
Medicine, Journal of Law, Medicine, and Ethics, Summer, “Rethinking the Meaning of Public Health”, ebsco)
Government intervention as public health

The third conception of public health, and the one I advocate, is more limited in scope. "Government intervention as
public health" involves public officials taking appropriate measures pursuant to specific legal authority, after
balancing private rights and public interests, to protect the health of the public. These measures may be coercive. The
existence of a public threat demands a public response, and in a representative political system it is the government that is authorized to act on
behalf of the public.' -^ The police power is the constitutional authority on which public health measures are based. According to the U.S.
Supreme Court: According to settled principles, the police power of a state must be held to embrace, at least, such reasonable regulations
established directly by leg- islative enactment as will protect the public health and the public safety.... There are manifold restraints to which
every person is necessarily subject for the common good. On any other basis organized society could not exist with safety to its members."
The moral and political authority (and duty) of the government to mandate public health actions, including
quarantine, isolation, immunization, contact tracing, property seizures, and environmental regulation, derives from
one of the following three conditions. First, the health of the population is threatened. The paradigmatic public
health threat is an infectious disease, where the threat to the public is through the horizontal transmission of infection. Other health
threats may have a public health effect because they involve common resources and because the failure to control the problem at the source will
lead to adverse health consequences to many people. Thus, person-to-person transmission is not necessary to have a public health threat.
Food safety, sanitation, water fluoridation, insect and vermin control, and pollution control are examples of public
health measures to address health threats to the public.
The second type of condition to justify a public health intervention occurs when the government has unique pow-
ers and expertise related to an essential aspect of public health. Disease reporting and surveillance illustrates this
category. Legally mandated reporting of certain types of health conditions, such as some infectious diseases, occupational diseases, cancers,
sexually transmitted diseases, gunshot wounds, child fatalities, and suspected cases of domestic violence, are all important to the collective
health of the community. Reporting allows for data aggregation and analysis as well as more direct intervention to prevent additional cases.
Without mandatory reporting, important cases would be lost, and only the government has the authority to mandate reporting. Moreover,
government public health agencies have access to the trained professionals needed to interpret the data.
The third type of condition to justify a public health intervention occurs when government action is more efficient
or more likely to produce an effective intervention. An example would be newborn screening programs, which are
mandated by law in every state. Public health programs to identify inborn errors of metabolism and other heritable disorders offer uniformity in
standards and reporting. In addition, screening programs are often tied to publicly financed follow-up and treatment.
The key element of public health is the role of the government — its power and obligation to invoke mandatory or
coercive measures to eliminate a threat to the public's health. Without a threat to the public, it is much more difficult to make a
case for the use of coercive powers; in the absence of such legal authority, the participation of individuals in health- enhancing activities
ordinarily must be voluntary. Applying these principles to the three sources of moral and political authority for governmental public health
activity, the justification for activity goes in descending order from (1) population-wide health threat; to (2) unique governmental powers and
expertise about an essential aspect of public health; to (3) the need for more efficient and effective governmental action in ensuring public health.
Public health activities in this third category may overlap with population health measures. Consequently, newborn screening for
phenylketonuria (PKU), congenital hypothyroidism, and other disorders; school-based medical screening for scoliosis, tuberculosis, vision and
hearing problems, dental caries, and other conditions; and broad health promotion activities may be considered in varying degrees by different
jurisdictions to lack the urgency and public health effects necessary to require universal participation.
Under this narrower definition of public health, a "public health clinic" providing primary care is not engaged in
public health; it is a public entity providing individual health care. In the United States, because there is no guaranteed access to
health care, the responsibility for providing health care to uninsured individuals often falls to public health agencies. One effect of this
allocation of responsibility is that providing primary care services tends to be commingled with, and to crowd out, other public health functions.
As a result, many health departments lack the resources to engage in core public health functions, such as epidemiology, disease surveillance,
and environmental regulation.
ENDI 10
Topicality
PUBLIC HEALTH EXCLUDES TREATMENT

Public health is distinct from treatment and health care—it involves efforts at abating the root cause, not
treating a symptom
Taylor, 03 (Roscoe, director of the Department of Public Health for Tasmania, State of Public Health Report 2003,
http://www.dhhs.tas.gov.au/agency/publications/documents/StateofPublicHealthReport2003.pdf)
Public health has been defined as

“The science and art of preventing disease, prolonging life, and promoting health through the organised efforts of
society” (Acheson 1988).
It is important not to confuse the term “public health” with the “health care system”, although the two are
interrelated. The fundamental influences shaping the overall health of our population are generally much more
dependent on factors arising outside the health care system than they are upon access to high-quality medical
treatment services. Therefore this is not a report on the quality of our health care system.
Public health excludes publicly funded health care

Moody, 01 (Terrence, director of policy of the Christchuch community services committee, CHRISTCHURCH
PUBLIC HEALTH STRATEGY
http://archived.ccc.govt.nz/Council/Agendas/2001/June/RiccartonWigram/ChristchurchPublicHealthStrategy.pdf)
The term public health is used in the context of the “health of the public” and not “publicly-funded health care”. It
therefore relates to the health of whole populations, or population groups such as children or older people, rather
than individuals. 3
Public health is the sum total of all factors effecting the population’s health—it excludes a narrow focus on
individual health care or access to doctors
Benjamin, 02 (Phil, health editor for Political Affairs.net, People’s Weekly World newspaper online, 5/11,
“Housing: Key component in public health”, http://www.pww.org/index.php/article/view/1176/1/82/)
The May issue of the American Journal of Public Health (AJPH) carries an excellent discussion on the origins of
efforts to improve the health for people in the U.S., which stemmed in part from the popularity of the term “public
health.” For example, drug and insurance companies often advertise their products as a means of improving a
person’s health. While true as far as it goes, prescription drugs should address an individual’s diagnosed disease and
illness. But, that is not public health. Nor is access to a physician, hospital and ancillary medical and nursing
professional. The same can be said of hospitals. While all of these – pharmaceuticals, health care professionals and
hospitals – are necessary in providing health care they, neither alone nor in combination, do not and cannot –
guarantee public health. By definition, public health is the sum total of all social, economic and political events that
impact on the health of a country: jobs, income, education, housing and peace – these are the major determinants of
the public’s health. I have included “peace” in my definition of public health because war results in tens of thousands of deaths and disabling
injuries directly, and the dislocation of millions of people who are forced to alter their way of even staying alive in such a manner as to affect the
lives of everyone. And there are the waves of immigration and emigration caused by the rampages of transnational corporation that result in
massive changes in employment and unemployment. Housing – adequate, affordable housing – is a major component of public health. The
British magazine, The Economist, reports skyrocketing costs of housing in the United Kingdom. In Ireland, Dublin reports the highest increase in
apartment rental costs throughout Europe. War is destroying housing stocks in those countries suffering. But poor housing and homelessness are
not someone else’s problem. Listen to Mary E. Northridge of the AJPH: “In New York City alone, about 29,400 homeless people, including
12,500 children, spend their nights in shelters or hot-plate hotel rooms. Discrimination in the location of housing for people of color, the poor and
the disabled contributes to egregious disparities in the health among population groups.” The picture would be even more damning if Northridge
had included the tens of thousands of new immigrants from Mexico, Latin America, Southwest Asia and other parts of the world. Poor housing
conditions are directly associated with major health problems: respiratory infections, asthma, mental health, severe injuries and lead poisoning.
Issues such as sanitary conditions, overcrowding and poor ventilation, once thought of as a distant problem, are once again on the front burner in
the cities of industrialized countries, just as they continue to grow in developing countries. “Broad societal support is needed to solve the current
housing crisis ... In the final analysis, while safe and affordable housing alone cannot ensure sound population health, it is undoubtedly a
necessary condition,” Northridge’s editorial concludes.
ENDI 11
Topicality

Public health excludes individual treatment services—the only topical treatment cases are those that deal
directly with prevention, such as immunizations
Texas Department of Health, 98 (HCR 44 Report: Executive Summary,
http://www.tdh.state.tx.us/phimprovement/execsumm.htm)
Public health is commonly confused with publicly funded health care, or indigent care, but these are actually distinct
and different activities. Health care, both public and private, can be thought of as direct medical care provided to
individuals, while public health is population-based services that are geared toward protecting the health of the
public as a whole. Public health and medical care are on opposite ends of a health care continuum that overlaps in
the middle, with treatment of individuals for the good of the public (such as giving immunizations or tracking
sexually transmitted diseases). Public health efforts are not health services for the needy or other select groups of
people--they serve everyone. Most public health activities do not and cannot differentiate as to poverty level or
citizenship status. Population-based efforts such as controlling pollution or contagious diseases by definition benefit
the whole population.
Public health involves governmental efforts to promote the health of populations instead of individuals
The crux of public health, as I have sought to demonstrate, is a public, or governmental, entity that harbors the
power and responsibility to assure community well-being. Public health, however, also focuses on persons or
groups that stake a claim to health protection or promotion. Most scholars who have compared public health with
medicine have noted that, generally, public health focuses on the health of populations, while medicine focuses
on the health of individuals.4 1Elizabeth Fee observes that medicine and public health have contradictory interests.
“Public health is oriented toward the analysis of the determinants of health and disease on a population basis,
while medicine is oriented toward individual patients.”42 Public health is organized to provide an aggregate benefit
to the mental and physical health of all the people in a given community. Classic definitions of public health
emphasize this population-based perspective: “As one of the objects of the police power of the state, the ‘public
health’ means the prevailingly healthful or sanitary condition of the general body of people or the community in
mass, and the absence of any general or widespread disease or cause of mortality. The wholesome sanitary condi-
tion of the community at large.”43 Consequently, while the art or science of medicine seeks to identify and
ameliorate ill health in the individual patient, public health seeks to improve the health of the population.
A public health approach requires looking at the root cause instead of at individual treatment
The foundational article by Michael McGinnis and William Foege examines the leading causes of death in the
United States, revealing different forms of thinking in medicine and public health. Medical expla-nations of death
point to discrete pathophysiological conditions, such as cancer, heart disease, cerebrovascular disease, and
pulmonary disease. Public health explanations, on the other hand, examine the root causes of disease. From this
perspective, the leading causes of death are environmental, social, and behavioral factors, such as smoking, alcohol
and drug use, diet and activity patterns, sexual behavior, toxic agents, firearms, and motor vehicles. McGinnis and
Foege observe that the vast preponderance of government expenditures is devoted to medical treatment of diseases
ultimately recorded on death certificates as the nation’s leading killers. Only a small fraction is directed to control
the root determinants of death and disability.52
ENDI 12
Topicality

Public health excludes clinical interventions—consensus view of definitions
Hopkins University, “Public Health, Ethics, and Human Rights: A Tribute to the Late Jonathan Mann”, Journal of
Law, Medicine & Ethics, Summer, ebsco)
Most definitions share the premise that the subject of public health is the health of populations -- rather than the
health of individuals --and that this goal is reached by a generally high level of health throughout society, rather than
the best possible health for a few. The field of public health is concerned with health promotion and disease
prevention throughout society. Consequently, public health is less interested in clinical interactions between health-
care professionals and patients, and more interested in devising broad strategies to prevent, or ameliorate, injury and
disease.
Public health excludes treatment; it’s limited to prevention activities

Goldstein, 1989 (Arnold, professor of health care administration and law at Northwestern, The Aspen Dictionary of
Health Care Admininistration, p. 222)
The science dealing with the protection and improvement of community health by organized community effort.
Public health activities are generally those less amendable to being undertaken individually, or less effective when
undertaken on an individual basis. They do not typically include direct personal health services. Immunization,
sanitation, preventive medicine, quarantine or other disease control activities, occupational health and safety
programs, assurance of healthfulness of air, water and food, health education and epidemiology are examples of
recognized public health activities.
ENDI 13
Topicality
PUBLIC HEATH EXCLUDES SUBGROUPS

Public means it has to be open to all—it can’t target a particular sub-group even if it effects a small number
of people
Dawson and Verweij, 07 (Angus, Centre for Professional Ethics, Keele University, and Marcel, Ethics Institute,
Utrecht University, “The Meaning of ‘Public’ in ‘Public Health’”, Ethics, Prevention, and Public Health,
http://fds.oup.com/www.oup.co.uk/pdf/0-19-929069-5.pdf)
This last dimension of 'public health' has a strong connection with our basic understanding of the concept of 'the
public', in the sense of the difference between talking about the public (or the public interest) as being different from
a well-defined group of specified individuals (and their individual aggregated interests). As we saw above, there is a
sense in which 'the public' refers to an indefinite number of non-assignable individuals, as Jeremy Bentham amongst
others has suggested (Barry 1965: 229; Bentham 1996). The 'public' in this sense might refer to all members of a
given community or state, but it need not, as a 'public' can also involve a smaller group of persons, as long as the
persons are not specified. For example, in the context of a public health response to prostitution, all actual clients
(and all persons who would consider visiting a prostitute) are members of the relevant 'public'. Improving the
underlying social and environmental conditions of health will affect the health of persons, and that is an important
reason for action, even though it will often be impossible to determine who exactly benefited from it. That the
'public' in public health refers to an indefinite number of individuals does not mean that any improvement in relation
to public health necessarily implies improvement of the health of many persons. The number cannot be specified.
For example, improving protection against a bioterrorist attack might save millions of people, or it might save 'only'
a few. But the important thing is that it might be anyone of us, who is saved. Any individual member of the relevant
community has a share in the benefit from the improvement in public health. Similarly, in economic and political
theory, public goods are goods that are open to all: it is not specified in advance which particular individuals will
benefit from those goods. However, whilst such goods are 'open to all', this does not necessarily imply that every
person will indeed benefit. On the other hand, just because any individual benefits are 'merely' statistical does not
mean that the intervention is unethical. However, it does mean that we should think clearly about whether or not it is
justifiable, preferably, before it is introduced. To conclude, talking about public health in the sense of 'the health of
the public' has several dimensions. First, it may refer to the sum of the health of all individuals in the relevant group
or population. Second it might also refer to the way that health is 'distributed' in a population. And finally, an
important sense of public health refers to underlying social and environmental conditions that might affect the health
of each member of the public.
Public health excludes population sub-groups

Minnesota Department of Health, no date (CHS Planning Guidelines, “Population-Based Public Health”
http://www.health.state.mn.us/divs/chs/pdf/gdlinebkgrd2.pdf)
Population-based public health programs are founded on community need, which is determined through a
systematic assessment of the health status of the whole population. In this respect, the term “public health” refers to
governmental public health programs and services where community is defined in geopolitical terms. It is not
effective to assess only selected groupings. The entire county population, or city population, or multi-county
population must be assessed to identify needs that should be addressed. Government is responsible for promoting
and protecting the health of the entire population. Public health carries out that responsibility of government and, is
ultimately accountable for the health status of the entire population. It is not just the poor, elderly, very young, or
groups with other characteristics that make them vulnerable who are public health’s clients. Population health is
greater than the sum total of every individual’s health status.
ENDI 14
Topicality
PUBLIC HEALTH IS LIMITED TO PROXIMATE HEALTH RISKS

Public health should be limited to the proximal risk factors for injury and disease—it requires a prevention
focused on the direct cause, rather than the root cause. Broadening the term makes it meaningless and
limitless
Hopkins University, “Public Health, Ethics, and Human Rights: A Tribute to the Late Jonathan Mann”, Journal of
Law, Medicine & Ethics, Summer, ebsco)
Scholars and practitioners have long been conflicted about the "reach" or domain of public health.[ 11] Some prefer
a narrow focus on the proximal risk factors for injury and disease. Under this perspective, public health should
identify risks or harms and intervene to prevent or ameliorate them. This has been the traditional role of public
health, exercising discrete powers such as surveillance, infectious disease controls (e.g., screening, vaccination,
partner notification, and quarantine), and sanitary measures (e.g., safe food and drinking water).
Others prefer a broad focus on the societal, cultural, and economic foundations of health. Under this perspective,
public health should be more concerned with the underlying conditions that are associated with poor health.[ 12] For
instance, the field of public health is ultimately interested in the equitable distribution of social and economic
resources because social status, race, and wealth are important determinants of health.[ 13] This inclusive direction
for public health is gaining popularity; consider how many of the federal government's health objectives for 2010
seek a reduction in health disparities.[ 14] Public health researchers are also venturing into areas far from their
traditional expertise, including violence, war, homelessness, and discrimination.[ 15]
The problem with an expansive view is that public health -- as a field, as a mandate -- becomes limitless, as almost
everything human beings undertake affects public health. By this account, public and private activities across a
wide spectrum are the work of public health. To many, this all-inclusive notion of public health is
counterproductive. First, by defining itself so widely, the field lacks precision. Public health becomes an all-
embracing enterprise bonded only by the common value of societal well-being. Second, by adopting such a broad
array of behavioral, social, physical, and environmental interventions, it lacks a discrete expertise. The public health
professions consequently incorporate a wide variety of disciplines (e.g., occupational health, health education,
epidemiology, and nursing) with different skills and functions. Finally, by espousing controversial issues of
economic redistribution and social restructuring, the field becomes highly political. While public health practitioners
like to conceive of their field as a positivistic discipline that stresses the importance of science and technique, the
field is, in reality, imbued with values and influenced by interest-group politics.
Proximal means nearest to

American Heritage, 2000 (dictionary.com)
Proximal
adj. Nearest; proximate.
And this means it has to be the closest cause in a chain of events

Merriam-Webster's Dictionary of Law, 1996 (Dictionary.com)
proximate
Function: adjective1 : next immediately preceding or following (as in a chain of causation, events, or effects) :
being or leading to a particular esp. foreseeable result without intervention
ENDI 15
Topicality
BROAD DEFINITIONS OF PUBLIC HEALTH ARE BAD

A narrower definition is normatively desireable to bring coherence to the public health literature and to
create limits on government power
In support of a narrower definition

There are five reasons I believe it is desirable to embrace a narrower definition of public health. First, health-related
activities that trigger the coercive power of government raise the most serious and complex legal and ethical issues;
only activities falling within a narrow definition of public health can justify the use of this power. Second, the
narrow and more specific classification of public health activities indicates the outer limits of coercion for
government programs. Third, the classification scheme helps in allocating responsibilities for public, population,
and individual health among the private, public, and not-for-profit sectors. Fourth, classifying possible government
activities according to public health roles helps in setting priorities. Fifth, because public health has been the
justification for some overreaching or even reprehensible prior government activities, ranging from eugenics to
unethical research on human subjects, a narrow definition of public health will help steer public health officials
away from activities that are inappropriate for the government.
Broad definitions of public health are bad—they prevent any coherent study of the actual public health
services provided by government
CONCLUSION
In common parlance, "public health" is now a general, descriptive term and not a term of art. It is incongruous to
embrace the broadest meaning of public health at the same time that our legal system and public health
infrastructure are based on a narrow definition of public health jurisdiction, authority, and remedies. Moreover, the
boundless conception of public health now gaining in popularity not only may fail to achieve its goal of alleviating
the economic and social roots of ill health, but it may actually impede the ability of public health officials to
provide traditional public health services. The moral and political power of governments to act in the realm of
public health devolves from the existence of a serious threat to the public. Coercive public health measures are
justified by the natural law principle of self-preservation applied on a societal basis. Indeed, modern public health
traces its philosophical roots to nineteenth century utilitarianism.^^ The broad power of government to protect
public health includes the authority to supersede individual liberty and property interests in the name of preserving
the greater public good. It is an awesome responsibility, and therefore it cannot and must not be used
indiscriminately. According to the definition I support, only public health officials can undertake public health
actions because their coercive powers are firmly grounded in constitutional provisions and enabling legislation. In
my view, public health does not include providing basic health services or population health measures, such as
health promotion, and it does not include private actors undertaking similar individual or population health
measures. The distinctions among the definitions of public health and their various applications are more than
semantic. A clearer understanding of the role of public health helps to allocate responsibilities, set priorities, and
avoid inappropriate government activities.
ENDI 16
Topicality

Broad definitions of public health are limitless—any action to stop nuclear conflict or war would be topical
and it makes it impossible to provide an educational curriculum
There is a growing trend to include within the sphere of public health all the societal factors that affect health. This
is a very long list, including war, violence, poverty, economic development, income distribution, natural resources,
diet and lifestyle, health-care infrastructure, overpopulation, and civil rights.^ There is much to recommend
viewing the sources of health broadly — in other words, considering health as more than the absence of illness and
disease. Yet the conceptual value of considering the health of a population in light of a wide array of factors does
not necessarily translate into a practical framework for implementing policy. The term "public health" is a legal
term of art, and it refers to specifically delineated powers, duties, rights, and responsibilities. Even beyond its legal
usage, public health applies to specific institutions and individuals, such as public health departments and public
health officials. The "human rights as public health" definition has been applied both internationally and
domestically. According to Morris Schaefer: "The health of most people in the world depends less on access to
medical seryices than on efficient farming, distributive justice, ensuring 'domestic tranquility,' and broad-based,
sustainable development of natural and built environments."2 Similarly, on a national level, William R. Breakey has
written: "We should be as much concerned about the thousands of people who are homeless in American cities and
the thousands of children in residentially unstable families as we are when there is an epidemic of an infectious
disease affecting a few hundred people, and we should respond with the same urgency."3 Schaefer and Breakey are
certainly right in their assessments. Nevertheless, just because war, crime, hunger, poverty, illiteracy,
homelessness, and human rights abuses interfere with the health of individuals and populations does not mean that
eliminating these conditions is part of the mission of public health. It is understandable why knowledgeable and
caring health professionals would want to improve the health of individuals and communities by focusing on the
root causes of illness and disease. Analyzing political, economic, and social issues in a scientific manner is
appealing by providing essential data and more rigorous methodology. It also seems to help make the concerns
more objective and their remediation more achievable. Unfortunately, labeling so many activities as pub- lie health
does little if anything to eliminate the problem of poor health. "Even if we claimed that poverty is the root cause of
all disease, which it surely is not, we would hardly be closer to solving the problem—just as we were no closer to
eliminating the threat of nuclear war after pointing out that Armageddon would interfere with physicians' treatment
of their patients."4 Ilan H. Meyer and Sharon Schwartz refer to the trans- formation of social issues into health
issues as the "public healthification" of social problems, which they consider analogous to the medicalization of
individual social problems.5 In their view, public health provides too narrow a perspective to be effective. "In the
case of many social problems, public health research questions as currently conceptualized are less complex than
the social and political issues (conflicting interest groups, conflicting value systems, power relationships) that need
to be resolved for interventions to be successfully applied."7 In a recent article, Larry Gostin describes three main
reasons the all-inclusive notion of public health is not only ineffective but counterproductive.8 First, the field of
public health lacks precision if it includes such disparate areas of concern that have as their only commonality
causing adverse effects on health. Second, as the field of public health expands well beyond its core area of
expertise, it can claim no special abilities to end wars, modernize agriculture, or re- structure economies. Third, by
becoming involved with economic redistribution and social restructuring, the field becomes highly politicized. The
human rights definition of public health also raises practical problems. What curriculum could possibly train public
health professionals on all the various root causes of poor health? What political system or public health budget
will support far-ranging interventions by those charged with protecting public health? What effect will such
seemingly quixotic activities have on the ability of public health professionals to combat traditional public health
problems, such as infectious diseases and poor sanitation, as well as new threats, such as bioterrorism ?
ENDI 17
Topicality

Broad definitions of “public health” render the term meaningless
Okma, 99 (Kieke, senior policy adviser to the Dutch Minister of Health, Welfare, and Sport, book review of
European Health Care Reform: Analysis of Current Strategies, Journal of Health Politics, Policy and Law 24.4
(1999) 835-840, project muse)
The book also uses concepts and categories that are overly broad and ill-defined. In discussing public health, for
example, the authors emphasize that health care reforms should aim to improve the health of the population, and
they underline the importance of public health in the design and implementation of health care reforms. They
conclude that the definitions of the term "public health" by the World Health Organization (WHO) and the
American Institute of Medicine ("organized community efforts aimed at the prevention of disease and promoting of
health") need widening in order to redirect the organization of the health care system. Such widening is central to the
"new public health movement," which seeks to strengthen community involvement and professional accountabilities
and expand the scope of health care to encompass medical services as well as a wide range of other measures to
promote, protect, and improve the health of a given population (67). This is a normative view, with far-reaching
implications for health policy design. In fact, such widening not only eliminates the borderline between health
policy and public health policy, but also the one between health policy and other social policies. As Joe White
(1995: 21) states in his book Competing Solutions, "If health care policy includes everything, then it means
nothing."
The term “public health” is limitless

Sullum, 2000 (Jacob, senior editor of Reason Magazine, “Public Health vs. The Nanny State?”, The Independent
Institute, 10/26, http://www.independent.org/events/transcript.asp?eventID=25)
Given that expectation, it may seem rude to ask why exactly smoking is a matter of public health. It’s certainly a
matter of private health since it tends to shorten one’s life. But lung cancer, heart disease and emphysema are not
contagious, and smoking itself is a pattern of behavior, not an illness. It is something that people choose to do, not
something that happens to them against their will.If smoking is a matter of public health, and therefore subject to
government control, then so is any behavior that might lead to disease or injury. And in fact, public health officials
nowadays target a wide range of risky habits, including not just smoking, but drinking, overeating, failing to
exercise, owning a gun, and riding a bicycle without a helmet. Even gambling, which has no obvious connection to
morbidity and mortality, is a matter of interest to public health researchers. In short, there is no end to the
interventions that could be justified in the name of public health as that concept is currently understood.
ENDI 18
Topicality
Broad definitions of public health are totally meaningless

By contrast the broad accounts do not just focus public health attention on the 'traditional' elements of prevention,
but expand their concern to pick out all factors that may influence health such as the socio-economic conditions of a
society including issues like homelessness, violence, war, race, education, and wealth. All of these factors are held
to be legitimate concerns for public health activity because they all impact upon people's health (in the broadest
sense). Indeed, the aim of such an approach might be seen as the promotion of general societal well-being rather
than the mere reduction or removal of specified threats to health in a narrow sense (such as direct risks to physiolo-
gical functioning). In principle such a conception of public health could be limitless, as almost all human
activities (and many inactivities) may affect health. Indeed, such 'broad' accounts end up being reminiscent of the
WHO definition of health as: 'a state of complete physical, mental and social well- being' (WHO 1946). Whilst the
influence of the WHO definition of health can perhaps be seen as a theoretical stimulus to such an approach, a more
practical one is the fact that many public health practitioners explicitly see their role as advocates for the public's
health as explicitly being a form of political activity. However, such 'broad' definitions have a significant problem in
that they are so inclusive, so packed with content, that they cease to have any clear focus or meaning (Griffiths and
Hunter 1999:1). If we employ such an approach, any intervention aiming at improving well-being is likely to count
as a matter relevant to public health. The concept of 'public health', essentially, just collapses into that of generating
well-being or welfare: as a result such a concept, arguably, loses any useful purpose. In other words, supporters of
such broad accounts are likely to be caught by a dilemma. On the one hand, by calling something a public health
problem underlines its importance, but, on the other hand, such a broad definition of public health seems to be
almost without limits. Whilst, it might be impossible to avoid fuzzy edges to the concept of 'public health', any
useful concept of 'public health' is going to have to be limited in some way.
ENDI 19
Topicality
AT: 10 ESSENTIAL PUBLIC HEALTH SERVICES DEFINITION

The 10 essential public health services definition was politically motivated and too broad to rationally assess
public policy
Turnock and Handler, 1995 (Bernard and Arden, Division of Community Health Sciences at the University of
Illinois at Chicago School of Public Health, American Journal of Public Health, September, p. 1295-1296, ebsco)
The essential public health services were developed for an entirely different application, namely, to describe public
health activities more understandably for external audiences and constituencies. This has been widely perceived to
be necessary to secure or even maintain public resources for population-based, community-oriented prevention
efforts, but especially to serve as a basis for the funding of core public health functions once this opportunity
materialized in the national health reform debate, A list of core functions was deemed necessary in view of the
conflicting language between health reform's version of core functions and that promoted by the IOM report. As a
result, health reform's core functions were recast by the US Public Health Service as essential public health
services. They actually represent a mixed bag of inputs, processes, and outputs that serve a useful purpose, but that
may not provide the most rational basis for assessing and enhancing local public health practice.
ENDI 20
Topicality
AT: PUBLIC HEALTH IS POPULATION HEALTH GENERALLY

Defining public health as population health is too vague and limitless; it means that public health isn’t a
distinguishable term and could be provided by private corporations or NGOs
A somewhat less expansive, but still broad definition is the one traditionally used in public health. Under the
traditional conception, public health focuses on the health of entire populations rather than individual patients.
According to Dan Beauchamp and Bonnie Steinbock: "Whereas in medicine, the patient is an individual person, in public health, the 'patient' is the whole community or population. The goal
One of the most commonly cited definitions of public health in this vein
of public health is to reduce disease and early death in populations."*
comes from the Institute of Medicine (IOM) report The Euture of Public Health: "Public health is what we, as a
society, do collectively to assure the conditions for people to be healthy"' Although I would place this definition in the traditional category, it
is a vague definition that fails to indicate the primary objective or scope of public health. Unlike most other definitions of public
health, it does not explicitly state that public health is concerned with the health of the population rather than individuals. The IOM report also makes public health the responsibility of
everyone, although it gives primacy to government efforts: "The mission of public health is addressed by private organizations and individuals as well as by public agencies. But the
governmental public health agency has a unique function: to see to it that vital elements are in place and that the mission is adequately addressed."'" In contrast to this government-centered
approach, a more expansive definition of public health cited in, but not necessarily endorsed by the IOM report is the following: "It's anything that affects the health of the community on a
Under such a view, efforts to improve access to health care as well as more general measures to prevent
mass basis.""
injury and illness and reduce morbidity and mortality, such as advice to use sunscreen and eat healthy foods, would
be considered public health. I term this conception of public health the "population health as public health" model. There are three
important characteristics of the "population health as public health" model. Each characteristic, however, raises concerns. First, this version
of public health is the province of both the public and private sectors. Thus, public health would include the efforts
of nonprofit organizations, commercial entities, and private citizens to promote healthy lifestyles. A beer company's
"drink with moderation" campaign, a cigarette company's program to discourage underage smoking, and a religious
organization's promotion of abstinence to reduce teen pregnancy would all be considered public health efforts. With
such a broad approach, there is a risk that the urgency of public health will become diluted, and the public will have
an increasingly difficult time in distinguishing public health from public relations. Second, "population health as
public health" fails to establish any meaningful lines of demarcation between individual health and public health.
Under the "population health as public health" approach, when individual health measures are performed on or
addressed to an unspecified but sufficient number of individuals, then this becomes public health. For example, when primary
care physicians adopt as the standard of care a new type of screening test or treatment modality, the result may be to improve the health of numer- ous individuals. But it is unclear at what point
cumulative individual health measures become population health. It is also unclear when responsibility for such a health measure shifts from the individual health-care provider to a public
unlike traditional public health measures, such as infectious disease control, the failure to undertake
health official. Third,
population health measures, such as a treatment or preventive measure for a person who is sick or at risk, does not
place the health of other individuals in jeopardy. Consequently, when population health is based on multiple individual health actions, it may not justify
coercive measures on the part of the government. Responsibility for these interventions would lie with individual health providers, non-governmental organizations, and government agencies
The "population health as public health" approach is thus ill-defined, with diverse
acting in their non-coercive, population health role.
actors pursuing widely divergent strategies to deal with the same health problems, tackling health problems of
varying severity, and often pursuing their own agendas with little coordination or accountability. Furthermore, it is
ill-advised to adopt a definition of public health that mixes government with non-government initiatives, coercive
with non-coercive measures, and harms that affect individual health with those that affect the health of the public.
Definitions that define public health as anything promoting general health are too vague and are ineffective
as a call to action
Parascandola, 2000 (Mark, graduate student in public health at Johns Hopkins, In These Times, “Plague Spring,”
10/30, http://www.inthesetimes.com/issue/24/24/parascandola2424.html_
But some of the blame must go to public health practitioners themselves. Nagged with self-doubt, they can't seem to
agree on what their own obligations are. In its 1988 report on "The Future of Public Health," a National Academy of
Sciences committee provided only a hopelessly vague definition: "The committee defines the mission of public
health as fulfilling society's interest in assuring conditions in which people can be healthy." In other words, public
health is anything that helps people to be healthy. As a call to action, that definition leaves something to be desired.
ENDI 21
Topicality
PUBLIC HEALTH INCLUDES NON-GOVERNMENTAL ORGANIZATIONS
Assistance can be channeled through NGOs

Merrill, 02 (Susan, head of a US AID task for on foreign aid, Foreign Aid in the National Interest,
http://www.usaid.gov/fani/ch01/conditions.htm)
The United States should use its voice, vote, and full influence within the World Bank and other multilateral
development banks to terminate development assistance to bad governments and to focus on countries with
reasonably good governance. The United States should extend the principles of its foreign policy into international
development, persuading the international financial institutions to stop financing grossly corrupt, wasteful, and
oppressive governments. Much progress has been made on this front over the past decade, and the United States
should continue to press for greater accountability and logic in international lending. Where there is no demonstrated
commitment to reform, development assistance should go to nongovernmental actors. Beyond humanitarian and
public health assistance, the aid should be aimed mainly at empowering civil society to change the regime or
improve governance in other ways. Otherwise, even if aid funds are spent directly by aid agencies or through NGOs,
they will simply substitute for what corrupt officials are stealing from the national budget and so will do little to
reduce poverty.
Public health can involve NGOs

In its second role in public health, the term 'public' refers to a specific sort of practice, intervention, or policy that is
aiming at population health through collective means. Again, the basic idea is that public health interventions are not
primarily actions of individual persons, but they involve some form of collective action. One straightforward
understanding of this is to say that these interventions are al ways (or perhaps, normally) government interventions.
After all, government is the ultimate public body, and normally we assume that public institutions are in some way
linked to government. As we have seen some authors, such as Rothstein, and perhaps less strictly, Gostin, restrict
the field of public health to policies or interventions by government. However, it is also possible that programmes
that aim to improve the public's health are developed by private (or at least non-governmental) institutions. For
example, originally, vaccination programmes in the Netherlands were carried out by societies of which anyone could
become a member, some of the sanitary improvements of the nineteenth century in the UK were carried out by
private water companies, and a great deal of international public health work is carried out by inter-governmental
organisations such as the World Health Organization. Vaccination or screening can also be offered by individual
physicians or within the context of employment. In all such cases this can still be considered a collective action if
such activities fit within an overall programme in which many people cooperate in order to realise objectives that go
beyond improving the health of assignable individuals. Arguably, most objectives with respect to improving the
public's health (in any of the senses discussed above) cannot be realised by one person, acting on his or her own. To
improve average health, to reduce health inequalities, or to improve those conditions that are relevant for the health
of anyone, will normally require joint and coordinated action by many people and institutions. Governments will
often play an important role in facilitating or coordinating these efforts, although this might not always be necessary.
ENDI 22
Topicality
AT: ROTHSTEIN DEFINITION OF PUBLIC HEALTH

Rothstein’s definition of public health is normative
There is also another way that a broad and narrow view of public health can be distinguished. In his paper,
'Rethinking the Nature of Public Health', Mark Rothstein (2002) argues against the broad view that public health is
'anything that affects the health of the community on [a] mass basis'. In contrast, Rothstein argues for what he
characterises as a narrow account focused on government interventions as the defining characteristic of public
health. He suggests that the use of such authority is only justified if three conditions are met: firstly, where the
health of the population is threatened by something (this will include environmental factors not just diseases);
secondly, where the government has powers or expertise to meet that threat; and, thirdly, where the action of
government will be more efficient or more likely to be beneficial than the actions of individuals. Rothstein's view
might be criticised on the basis that he is not so much defining public health as seeking to establish the legitimate
boundaries of (sometimes coercive) government intervention in people's lives for the purpose of promoting public
health. Such concerns are clearly normative-so let's turn to our second distinction.
ENDI 23
Topicality
PUBLIC HEALTH INCLUDES MEDICAL TREATMENT

Public health includes medical treatment
Gilks, 2006 (Charles, Director, Co-ordinator of the Treatment and Prevention Scale-up team in the HIV Department
in WHO Headquarters, Geneva, “A PATIENT-ORIENTED VERSUS A SYSTEM-ORIENTED APPROACH:
CONTRADICTORY OR COMPLEMENTARY?”,
http://www.msf.ch/fileadmin/user_upload/uploads/ureph/dvd/pdf/charles_gilks.pdf)
From the WHO’s viewpoint, prevention has always been very important; we believe that health sectors should
focus on prevention. When ARVs became available, we thought they were a new component of comprehensive
response, and we needed to pay special attention to them. As a result, we developed what we call a public health
approach to treatment. Many people think that since we take a public health approach we focus only on disease
prevention, but for us the term “public health” includes the idea of access to treatment. We defined our approach in
a document published in 2003 and revised in 2006 to facilitate the commitment to universal access to treatment by
2010 made by the G8 and endorsed by the UN system. Many partners have implemented the approach in the field
with great success.
There’s no brightline between individual medical care and public health

Admittedly, it is not easy to separate individual and population-based health interventions. A direct relationship
exists between the health of each individual and the health of the community at large. After all, the well-being of
the whole may be accomplished by little more than assuring the health of each individual. This is not to suggest,
however, that the public health system is, or should be, solely responsible for population- level approaches and the
health care system responsible for individual- level approaches. Sometimes the dividing line between health care
and public health is exceedingly difficult to draw. The medical treatment of an infectious disease, for example,
benefits both the individual and the wider population. The boundaries between medicine and public health become
obfuscated in such cases, and it is not unusual to see both the health care and public health systems accept
responsibility for patient care, health education, and follow-up for infectious diseases.
Public health includes treatment

Public Health Foundation, 96 (“MEASURING EXPENDITURES FORESSENTIAL PUBLIC HEALTH
SERVICES”, http://www.phf.org/Reports/Expend1/exec_summ.htm)
In 1995, the Public Health Foundation, under contract to the U.S. Public Health Service (PHS), worked with state
and local public health, mental health, substance abuse, and environmental agencies in nine states—Arizona,
Illinois, Iowa, Louisiana, New York, Oregon, Rhode Island, Texas, and Washington—and with federal PHS
agencies to develop and test a methodology for estimating investments in the ten essential public health services
outlined below. These services include both personal health services (direct care services provided to individuals)
and population-based health services (interventions that prevent disease and promote health among entire
populations). Expenditures for personal health services (the second part of essential service #6, “assure the provision
of health care when otherwise unavailable”) were analyzed apart from all other essential public health services.
ENDI 24
Topicality
PUBLIC HEALTH ALLOWS TARGETING SUBGROUPS

Public health allows targeting subgroups of the population
The starting point for identifying public health issues, problems and priorities, and for designing and implementing
interventions, is the population as a whole, and also population subgroups that are ‘at risk’.
ENDI 25
Topicality
BROAD DEFINITIONS OF PUBLIC HEALTH
Public health includes 10 essential services

Association of Schools of Public Health, 06 (“What is Public Health?”, http://www.asph.org/document.cfm?
page=300)
The Ten Essential Public Health Services*
•Monitor health status to identify community health problems

•Diagnose and investigate health problems and health hazards in the community
•Inform, educate, and empower people about health issues
•Mobilize community partnerships to identify and solve health problems
•Develop policies and plans that support individual and community health efforts
•Enforce laws and regulations that protect health and ensure safety
•Link people to needed personal health services and assure the provision of health care when otherwise unavailable
•Assure a competent public health and personal health care workforce
•Evaluate effectiveness, accessibility, and quality of personal and population-based health services
•Research for new insights and innovative solutions to health problems
The Institute of Medicine defines public health as community efforts to promote population health
The concentration on aggregate health effects in populations helps Construct a thoughtful definition of public health
that I incorporate into my broader definition of public health law. Definitions of public health vary widely, ranging
from the utopian conception of the World Health Organization of an ideal state of physical and mental health4 9to a
more concrete listing of public health practices.50 The Institute of Medicine has proposed one of the most
influential contemporary definitions of public health: 51
Public health is what we, as a society, do collectively to assure the conditions for people to be healthy. This requires
that continuing and emerging threats to the health of the public be successfully countered. These threats include
immediate crises, such as the AIDS epidemic; enduring problems, such as injuries and chronic illness; and growing
challenges, such as the aging of our population and the toxic by-products of a modern economy, transmitted
through air, water, soil, or food. These and many other problems raise in common the need to protect the nation’s
health through effective, organized, and sustained efforts led by the public sector.
ENDI 26
Topicality
PUBLIC HEALTH DEFINITIONS – LAUNDRY LIST

Laundry list of public health definitions
2.2. Definitions of 'Public Health'

In this section we outline a number of the most influential or interesting definitions or accounts of 'public health'
available in the public health literature. This review is not supposed to be systematic or complete, but these accounts
are chosen to enable us to pick out a number of different relevant features of public health to provide the basis for
further discussion.
Public health is the science and the art of preventing disease, prolonging life and promoting physical health and
efficiency through organised community efforts for the sanitation of the environment, the control of community
infections, the education of the individual in principles of personal hygiene, the organisation of medical and nursing
service for the early diagnosis and preventative treatment of disease, and the development of social machinery which
will ensure to every individual in the community a standard of living adequate for the maintenance of health.
(Winslow 1920)
what we, as a society, do collectively to assure the conditions in which people can be healthy (Institute of Medicine
1988)
the science and art of preventing disease, prolonging life and promoting health through organised efforts of society
(Acheson 1988)
'Government intervention as public health' involves public officials taking appropriate measures pursuant to specific
legal authority. . . to protect the health of the public. . . The key element in public health is the role of the
government-its power and obligation to invoke mandatory or coercive measures to eliminate a threat to the public's
health. (Rothstein 2002)
Society's obligation to assure the conditions for people's health (Gostin 2001)
Childress et al. (2002) prefer to list 'features' or aspects of public health: Public health is primarily concerned with
the health of the entire population, rather the health of individuals. Its features include an emphasis on the promotion
of health and the prevention of disease and disability; the collection and use of epidemiological data, population
surveillance, and other forms of empirical quantative assessment; a recognition of the multidimensional nature of the
determinants of health; and a focus on the complex interactions of many factors-biological, behavioral, social and
environmental-in developing effective interventions.
ENDI 27
Topicality
PUBLIC HEALTH IS DISEASE PREVENTION AND COMMUNITY

HEALTH PROMOTION
Public health is disease prevention and community health promotion
Department of State, 05 (Publication from the U.S. Consulate General’s Office in Mumbai, India, “FOCUS
SECTION PUBLIC HEALTH”, July/August,
http://mumbai.usconsulate.gov/uploads/images/3S0uDPfrOACiEFbPdYV6Jg/awa050708.pdf)
The term ‘public health’ is defined as “The science and art of preventing disease, prolonging life and promoting
health and efficiency through organized community effort.” This definition by Professor C.E.A. Winslow, a pioneer
in public health advocacy in early 1920s, appeared in his article The Untilled Fields of Public Health in Science
Magazine (1920). The mission of public health, "the fulfillment of society's interest in assuring the conditions in
which people can be healthy," is explained in another work, The Future of Public Health (1988). Since the
beginning of the 20th century, the health and life expectancy of people in many countries of the world have
improved dramatically. Control of epidemic diseases, safe food and water, and maternal and child health services
are only a few of the public health achievements that have prevented countless deaths and improved the quality of
life. The average lifespan has increased substantially and this gain is attributed to advances in public health.
Public health is broad and includes almost all prevention services

If government has the primary responsibility to assure the conditions of health for populations, then what public
health activities best assure health, and what organizational arrangements are necessary to provide these services?
The answers to these questions inform not only traditional methods for population-based health improvement but,
more important, the critical differences between medical and public health services. The literature is replete with
attempts to identify the mission of public health, classify “core” functions, and set national and international 54
standards for “essential” services.55 The mission of public health is broad, en- compassing systematic efforts to
promote physical and mental health and to prevent disease, injury, and disability.5 6 The core functions of public
health agencies are to prevent epidemics, protect against environmental hazards, promote healthy behaviors, respond
to disasters and assist communities in recovery, and assure the quality and accessibility of health services.57
The “essential services” of public health are to monitor community health status; diagnose and investigate health
problems; inform and educate people about health; mobilize community partnerships; develop and enforce health
and safety protection; link people to needed personal health services; assure a competent health workforce; foster
health-enhancing public policies; evaluate the quality and effectiveness of services; and research for new insights
and innovations.5 8
ENDI 28
Topicality
AIDS ASSISTANCE IS PUBLIC HEALTH ASSISTANCE

Contextually, AIDS assistance is a form of public health assistance
Morrison, 06 (Stephen, chair of the CSIS Africa Program, “Sustaining U.S. Global Leadership on HIV/AIDS”,
CSIS Conference of the CSIS Task Force on HIV/AIDS, 7/16,
http://www.kaisernetwork.org/health_cast/uploaded_files/0171306_csis_future_transcript.pdf)
Our purpose today is to look to the future. Our purpose today is to take a count of what we’ve been able to achieve
through U.S. leadership on HIV/AIDS in the last several years, and what lies ahead as we look beyond the first
phase of PEPFAR, and the critical challenges that will have to be met, and some of those challenges are quite
formidable. We have tried to put a special focus today on three issues, this is not comprehensive, but there are three
very important ones. They are meeting the steep rising demands for financing for HIV/AIDS programs and related
infectious disease public health programs, its reinvigorating and elevating the prevention agenda and making it
more effective, and its addressing the workforce deficits, the critical workforce deficits that we see in many parts of
the world that face the most acute challenges. We are hoping in the next phase of this task force to carry forward in
this mode and to begin to use our efforts to try and build a pragmatic bipartisan consensus around what the next
administration should be thinking about on HIV/AIDS. We are very grateful to the Bill and Melinda Gates
Foundation for supporting us over this last five year period.
PEPFAR is a public health assistance program

Lime, 04 (Helen, US Ambassador to Mozambique, speech entitled “The American Experience with Peace,
Democracy, and Development.”, http://maputo.usembassy.gov/sp_11012004.html)
President Bush’s Emergency Program for AIDS Relief – the largest public health assistance program in history for
one disease – aims to save lives, and improve the lives of those suffering. The United States is committed to
spending 15 billion dollars to fight HIV/AIDS in fifteen countries where it is needed most, including Mozambique.
ENDI 29
Topicality
BIOTERRORISM IS A PUBLIC HEALTH PROBLEM

Bioterrorism prevention is a public health problem
Department of State, 05 (Publication from the U.S. Consulate General’s Office in Mumbai, India, “FOCUS
SECTION PUBLIC HEALTH”, July/August,
http://mumbai.usconsulate.gov/uploads/images/3S0uDPfrOACiEFbPdYV6Jg/awa050708.pdf)
While the public health initiatives of the 20th century – from sanitation and immunization to tobacco control – have
been remarkably successful in enhancing the quantity and quality of lives, at the dawn of a new century, public
health threats loom as large as ever – from HIV/AIDS, Ebola, West Nile virus, SARS, and avian influenza to the
epidemic of obesity and the threat of bioterrorism. Also with the frequent and rapid transportation of people and
disease vectors by air there has been a growing need for the monitoring of public health on a global level.
ENDI 30
Topicality
PUBLIC HEALTH INCLUDES ENVIRONMENTAL HEALTH

Public health is broad and allows addressing all environmental issues
The “organised efforts of society” that lead to disease prevention and the promotion of public health may be very
broad. For example, the Ottawa Charter for Health Promotion (WHO 1986) identified the following prerequisites
for health: peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice, and
equity. Beyond these basics are a range of protective and risk factors that are also very much determined by social
structures and forces. Recognition of the interrelationship between health on the one hand and social, economic and
environmental factors on the other is giving rise to what may be called an “ecological” view of health. Human
activities are intimately embedded in, and dependent on the natural environment, which in turn is influenced by
human activities. Ultimately, human health is dependent on the health of ecosystems and the carrying capacity of
the natural environment. Physical, chemical and biological factors affect the quality and safety of air, water, soil
and food. Larger scale environmental disruptions, such as global climate change and depletion of resources such as
fresh water, can have major health implications. The impact of the environment on human health is a legitimate
public health concern.
Public health includes environmental health threats

Texas Department of Health, 98 (HCR 44 Report: Executive Summary,
http://www.tdh.state.tx.us/phimprovement/execsumm.htm)
Environmental problems also have the potential to threaten public health. For example, in July 1997 the Texas
Department of Health lifted a consumption advisory against eating fish taken from the lower Brazos River that had
been in effect since 1990. Fish in this part of the river along the coast in Brazoria County had been found to contain
elevated levels of dioxins, which are suspected of causing cancer, liver abnormalities, and reproductive problems
when consumed regularly over a period of time. A Dow Chemical plant in Freeport was identified as a source of the
dioxin compounds in the fish, and the company cooperated with officials to correct the dioxin release and reimburse
TDH for retesting fish. In April 1996, fishing was banned from Mountain Creek Lake in Dallas County until further
notice due to polychlorinated biphenyls (PCBs) found in fish from the lake that were tested by the Navy. The use of
PCBs has been banned due to possible effects such as cancer, skin irritations, and reproductive disorders, but the
compounds are very long-lasting and continue to contaminate the environment. At the time that this warning was
issued, it was one of 14 active advisories or closures to fishing in Texas waters, most of which were in urban and
industrial areas.
In 1998, oyster harvesting in Galveston Bay was banned from June to October due to the linking of oysters from the
bay to an illness caused by the bacteria Vibrio parahaemolyticus. The Texas Department of Health counted 416
cases of the illness from 13 states, including 296 cases in Texas. Cooking destroys the bacteria, and cooler
temperatures and water are expected to help control the bacteria, which are more abundant in warm weather in
coastal waters worldwide. Another periodic health threat concerning shellfish is "red tide," an algae that releases
toxins that kill fish and contaminate shellfish such as oysters. Consumption of the shellfish can cause neurotoxic
shellfish poisoning, and cooking does not destroy the toxin. Harvesting of oysters, clams, and mussels from
Matagorda Bay to the Rio Grande was banned in fall 1996 and again in fall 1997 extending into the first few months
of 1998.
There are several important lessons to be drawn from these examples. Public health, or the lack of it, has the
potential to affect every person in Texas. Prevention activities, including environmental monitoring and public
health education, are crucial in communities to reduce the incidence of preventable disease and death. These
activities must be ongoing, not initiated only during times of crisis. When there is a crisis, time is critical in
addressing public health threats. The faster resources can be targeted to isolating the threat and educating the public,
the more lives can be saved and suffering can be prevented. When there is a severely underfunded local public
health presence or none at all in a community, there is not a functional infrastructure in place, and valuable time is
lost in recognizing the threat and mobilizing already stretched state resources.
ENDI 31
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PUBLIC HEALTH INCLUDES ENVIRONMENTAL HEALTH

Environmental health is a subset of public health
Moody, 01 (Terrence, director of policy of the Christchuch community services committee, CHRISTCHURCH
PUBLIC HEALTH STRATEGY
http://archived.ccc.govt.nz/Council/Agendas/2001/June/RiccartonWigram/ChristchurchPublicHealthStrategy.pdf)
It has long been understood that there are a number of social, economic and environmental determinants of health
as they relate to whole populations. These have recently been addressed in publications such as that of the National
Health Committee 4 and that of the Ministry of Health 5 In the case of environmental determinants these are often
clear and are usually well accepted. These come under the concept of environmental health, which is seen as a
subset of public health. This focuses on environmental conditions and hazards that affect, or have the potential to
affect, human health by direct or indirect means but can also include factors that can reduce psychosocial hazards
such as crowding and lack of amenities.6 These are covered under the Health Act and the Local Government Act
and other legislation such as the Resource Management Act, the Building Act, and parts of the Hazardous
Substances and New Organisms Act administered by local authorities. These include matters to do with water
supply, solid and liquid waste management, housing, road safety, and control of environmental hazards.
Ozone depletion is a public health problem

Last, 93 (John, Department of Epidemiology and Community Medicine, University of Ottawa, Annual Review of
Public Health, “ GLOBAL CHANGE: Ozone Depletion, Greenhouse Warming, and Public Health’, May, online)
PUBLIC HEALTH ACTION Strategic and tactical public health responses are required (66, 67).
Weather advisory messages warning about safe exposure levels have been routinely used
on Australian radio and television for some years, and started in Canada in early 1992; such
advisories are not part of routine weather reports in the US. Advisories should include
messages about avoiding severe sunburn, especially for children, and recommendations
about clothing, sun glasses, and sunscreen ointments and creams that may protect against
excessive exposure to UV radiation. Suncreams and lotions are assessed for toxicity and
potential carcinogenicity by government agencies, such as the Bureau of Chemical Hazards
in Canada. There are no Occupational Safety and Health Act standards for protection
against UV radiation, and permissable exposure limits only for short-term, high-intensity
exposure. Health education might help to change attitudes back to those that prevailed in
western societies from late Victorian times through the end of World War I, when a pale
complexion, rather than a "healthy tan," was considered attractive. Should we try to
convert persons with fair skins to this view and away from the notion that suntan is
desirable? If so, research is needed to identify and evaluate ways to do this. An Institute of
Medicine workshop in 1990 offered some ideas (68).
PUBLIC POLICY
The goal is to reduce, as rapidly as possible, the contamina- tion of the atmosphere by
ozone-destroying chemicals, notably CFCs. This requires political action. Most of the
industrial nations in which CFCs are produced and used have signed the Montreal protocol
(69), thus agreeing eliminate the production and use of CFCs as soon as possible. In early
1992, the Bush administration undertook to phase out CFCs by 1995; however, even if
production and use of CFCs ceases worldwide, they will continue to accumulate in the
atmosphere for up to 100 years (70). Many developing nations have just begun to use CFCs;
their economies will suffer more than those of industrial countries if eliminating CFCs leaves
them with no alternative to these useful solvents and refrigerants (71). Moreover, CFC
substitutes (hydrochlorofluorocarbons) may have deleterious effects on the ozone layer that
are almost as bad as CFCs (72).
CONCLUSION
There is convincing evidence that the stratospheric ozone layer has been damaged by
human action, that the damage is progressive, and that this poses serious threats to
ENDI 32
Topicality
biological systems and human health. Action to limit the damage has begun and must
continue. In addition, public health action to mitigate risks to human health is needed.
ENDI 33
Topicality
PUBLIC HEALTH INCLUDES CRIME PREVENTION

Public health includes crime prevention
McManus, 03 (Jim, scholar at Nacro, a UK-based think tank aimed at reducing crime, “Primary Care Trusts as
responsible authorities”, May, http://www.crimereduction.gov.uk/partnerships49.htm)
The NHS has a responsibility, with other statutory agencies, for health in its widest sense: public health. The term
'public health' essentially refers to the general state of the population's health, both mental and physical. This is
where there is a clear crossover with crime. The poorest communities are likely to have the worst public health as
well as high crime. And crime and fear of crime are significant contributory factors to poor public health. This
provides a natural set of policy links and opportunities for action between public health and community safety.
Reducing physical disorder in an area will have a health impact as well as a crime and disorder impact. There are,
similarly, a number of parallels between the process of determining local needs and responding to them. This
framework provides a number of opportunities for action. Reducing crime can help the health services: fewer violent
crimes mean fewer resources have to be used on treating the victims and the long-term psychological and physical
consequences of crime on health can be reduced.
ENDI 34
Topicality
VIOLENCE PREVENTION IS A PUBLIC HEALTH ISSUE

Violence against women is a public health issue
Chrisler and Ferguson, 06 (Joan, professor of psychology at Connecticut College, and Sheila, “Violence against
Women as a Public Health Issue”, Annals of the New York Academy of Sciences 1087 (1), 235–249, November,
Synergy)
Violence can be considered "infectious" in rape-prone cultures that celebrate violence and domination. The number
of annual injuries and deaths due to violence against women and girls is high enough to demand the type of active
interventions and public policies that have been targeted at infectious diseases by public health agencies. In this
article, we review data on the physical and mental health effects that violence has on victims of domestic violence,
rape, stalking, and sexual harassment. We also focus on the economic costs to the health care system, business and
industry, families, and the broader society that accrue as a result of the widespread violence against women and
girls. Victims' suffering can never be accounted for by economic data, but those data may be helpful in pushing
governments to allocate funds and agencies to take preventive actions.
Violence prevention is a public health issue

Chrisler and Ferguson, 06 (Joan, professor of psychology at Connecticut College, and Sheila, “Violence against
Women as a Public Health Issue”, Annals of the New York Academy of Sciences 1087 (1), 235–249, November,
Synergy)
The term "public health" probably calls to mind programs aimed at preventing the spread of infectious diseases such
as polio, syphilis, or avian flu. However, violence is also "infectious" in a culture that seems to encourage, or at least
to tolerate, it. The United States has been classified as a rape-prone culture (Rozee, 1993) that celebrates aggression
and domination. Violence is a frequent theme in our films, television shows, video games, comic books, and popular
songs. The number of annual injuries and deaths in the United States that are due to criminal violence is high
enough to demand the type of active interventions and public policies that traditionally have been targeted at
infectious diseases. In fact, in 1985 U.S. Surgeon General C. Everett Koop declared domestic violence the biggest
health crisis of the decade. We do not mean to imply that no progress has been made since then, but a lot more needs
to be accomplished.
Feminists typically consider violence against women and girls to be an abuse of power in the course of the
domination, intimidation, and victimization of one person by another, often, but not always, in the context of a
relationship. Violence against women by intimate partners includes domestic or courtship violence, stalking, and
rape. Violence against women and girls by family members includes child or elder abuse, incest, and incidental
injuries in the course of domestic partner violence. Violence against women by coworkers, casual acquaintances, or
strangers includes sexual harassment, stalking, rape, and violence in the course of the commission of another crime
(e.g., mugging). It would be a mistake to assume that all such violence is committed by men and boys against
women and girls. We know, for example, that intimate partner violence is a problem in lesbians' and gay men's
relationships (Island, & Letellier, 1991; Renzetti, 1992; Stahly & Lie, 1995), and researchers have begun to
document and study instances of violence against men by women (e.g., Anderson, 2005; Brush, 2005; McHugh,
2005). However, because most men are bigger and stronger than most women (hence, able to inflict more serious
damage), there appear to be many more instances of violence by men than by women, and more data are available
on women's injuries at the hands of men, we focus our attention here on the public health effects of violence against
women that was most likely committed by men.
ENDI 35
Topicality
PUBLIC HEALTH ASSISTANCE CAN BE MULTILATERAL

Public health assistance can be multinational and administered by in-country residents
Wilensky, 01 (Robert, Military Medicine, “Medical Civic Action Program in Vietnam: Success or failure?,”
September, http://findarticles.com/p/articles/mi_qa3912/is_200109/ai_n8962195/pg_3)
The Provincial Health Assistance Program had been a U.S. Agency for International Development program of
public health assistance to the Vietnamese Ministry of Health, Social Welfare, and Refugees. It was a multinational
program, and the aid was to be administered by Vietnamese nationals. It was designed to be of short-term duration,
being phased out of existence as soon as possible. It could not fill the needs of rural areas. A telegram from the State
Department to the Military Assistance Advisory Group in April 1962 indicated the need for improved rural medical
care in Vietnam.
ENDI 36
Topicality
INCREASE MEANS TO MAKE GREATER
Increase means to make greater

Random House Dictionary, 1987
Increase –v.t. 1. To make greater, as in number, size, strength, or quality; augment; add to: to increase taxes. –v.t.
2. To become greater, as in number, size, strength, or quality: Sales of automobiles increased last year.
Increase means to become larger in quantity

Encarta College Dictionary, 01 p.730
Increase
MAKE OR BECOME LARGER OR GREATER to make something larger in number, quantity, or degree, or
become larger in number, quantity, or degree
Increase must be a net increase

Rogers, 05 (Judge, STATE OF NEW YORK, ET AL., PETITIONERS v. U.S. ENVIRONMENTAL
PROTECTION AGENCY, RESPONDENT, NSR MANUFACTURERS ROUNDTABLE, ET AL.,
INTERVENORS, 2005 U.S. App. LEXIS 12378, **; 60 ERC (BNA) 1791, 6/24, lexis)
[**48] Statutory Interpretation. HN16While the CAA defines a "modification" as any physical or operational
change that "increases" emissions, it is silent on how to calculate such "increases" in emissions. 42 U.S.C. § 7411(a)
(4). According to government petitioners, the lack of a statutory definition does not render the term "increases"
ambiguous, but merely compels the court to give the term its "ordinary meaning." See Engine Mfrs.Ass'nv.S.Coast
AirQualityMgmt.Dist., 541 U.S. 246, 124 S. Ct. 1756, 1761, 158 L. Ed. 2d 529(2004); Bluewater Network, 370
F.3d at 13; Am. Fed'n of Gov't Employees v. Glickman, 342 U.S. App. D.C. 7, 215 F.3d 7, 10 [*23] (D.C. Cir.
2000). Relying on two "real world" analogies, government petitioners contend that the ordinary meaning of
"increases" requires the baseline to be calculated from a period immediately preceding the change. They maintain,
for example, that in determining whether a high-pressure weather system "increases" the local temperature, the
relevant baseline is the temperature immediately preceding the arrival of the weather system, not the temperature
five or ten years ago. Similarly, [**49] in determining whether a new engine "increases" the value of a car, the
relevant baseline is the value of the car immediately preceding the replacement of the engine, not the value of the car
five or ten years ago when the engine was in perfect condition.
ENDI 37
Topicality
ASSISTANCE IS THE TRANSFER OF GOODS OR SERVICES

Assistance is the transfer of money, goods, or services
DEPARTMENT OF ENERGY, 2005 (“GUIDE TO FINANCIAL ASSISTANCE”,
http://professionals.pr.doe.gov/ma5/MA-
5Web.nsf/WebAttachments/financialassistanceguide2005/$File/financialassistanceguide2005.doc)
Assistance. Money, property, services, or anything of value transferred to a recipient to

accomplish a public purpose of support or stimulation authorized by Federal statute.

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ENDI 1

ENDI TOPICALITY FILE

endi topicality file...........................................................................................................................................................1

PUBLIC HEALTH ASSISTANCE IS LIMITED TO DISEASE PREVENTION

Examples of Plausible Mission Types

PUBLIC HEALTH ASSISTANCE IS LIMITED TO DISEASE PREVENTION

Efforts by the United States to foster sustainable development include:

PUBLIC HEALTH ASSISTANCE IS LIMITED TO DISEASE PREVENTION

PUBLIC HEALTH ASSISTANCE INCLUDES MILITARY DISASTER

Using military medical personnel is a form of public health outreach

Public Health Outreach.

PUBLIC HEALTH ASSISTANCE MEANS GOVERNMENT-PROVIDED

PUBLIC HEALTH MEANS GOVERNMENT-PROVIDED SERVICES

PUBLIC HEALTH MUST BE PROVIDED BY THE GOVERNMENT AND

Government intervention as public health

PUBLIC HEALTH EXCLUDES TREATMENT

Public health has been defined as

Public health excludes publicly funded health care

PUBLIC HEALTH EXCLUDES TREATMENT

PUBLIC HEALTH EXCLUDES TREATMENT

Public health excludes treatment; it’s limited to prevention activities

PUBLIC HEATH EXCLUDES SUBGROUPS

Public health excludes population sub-groups

PUBLIC HEALTH IS LIMITED TO PROXIMATE HEALTH RISKS

Proximal means nearest to

And this means it has to be the closest cause in a chain of events

BROAD DEFINITIONS OF PUBLIC HEALTH ARE BAD

In support of a narrower definition

BROAD DEFINITIONS OF PUBLIC HEALTH ARE BAD

BROAD DEFINITIONS OF PUBLIC HEALTH ARE BAD

The term “public health” is limitless

BROAD DEFINITIONS OF PUBLIC HEALTH ARE BAD

Broad definitions of public health are totally meaningless

AT: 10 ESSENTIAL PUBLIC HEALTH SERVICES DEFINITION

AT: PUBLIC HEALTH IS POPULATION HEALTH GENERALLY

PUBLIC HEALTH INCLUDES NON-GOVERNMENTAL ORGANIZATIONS

Assistance can be channeled through NGOs

Public health can involve NGOs

AT: ROTHSTEIN DEFINITION OF PUBLIC HEALTH

PUBLIC HEALTH INCLUDES MEDICAL TREATMENT

There’s no brightline between individual medical care and public health

Public health includes treatment

PUBLIC HEALTH ALLOWS TARGETING SUBGROUPS

BROAD DEFINITIONS OF PUBLIC HEALTH

Public health includes 10 essential services

The Ten Essential Public Health Services*

•Monitor health status to identify community health problems

PUBLIC HEALTH DEFINITIONS – LAUNDRY LIST

2.2. Definitions of 'Public Health'

PUBLIC HEALTH IS DISEASE PREVENTION AND COMMUNITY

Public health is broad and includes almost all prevention services

AIDS ASSISTANCE IS PUBLIC HEALTH ASSISTANCE

PEPFAR is a public health assistance program

BIOTERRORISM IS A PUBLIC HEALTH PROBLEM

PUBLIC HEALTH INCLUDES ENVIRONMENTAL HEALTH

Public health includes environmental health threats

PUBLIC HEALTH INCLUDES ENVIRONMENTAL HEALTH

Ozone depletion is a public health problem

PUBLIC HEALTH INCLUDES CRIME PREVENTION

VIOLENCE PREVENTION IS A PUBLIC HEALTH ISSUE

Violence prevention is a public health issue

PUBLIC HEALTH ASSISTANCE CAN BE MULTILATERAL