I've seen some indications that many people in the public health field feel that everything that affects morbidity and mortality is potentially within scope for them, including, for example, intentional actions like assault or murder.

A difficulty with this view, at least potentially, is that it seems to allow everything in the world (certainly almost every area of public policy) to be in scope for public health, because almost everything in the world has potential to affect morbidity and mortality. At one level this broad view seems obviously correct, but at another level it seems obviously crazy (or at least likely to bring the public health profession into conflict with everyone over weighing in on every kind of decision that anyone ever makes).

In the past there was a fight between some CDC researchers and Congress over something about handgun policy because the researchers were studying something about guns and violence that made some gun rights activists nervous that there would be an argument presented under the banner of public health to limit access to guns. I believe the conclusion was that they told CDC to stop studying this, which, again, seems to me to be susceptible of some mix of "there might be a lot of legitimate reasons to have this information" and "does the public health profession get to weigh in with claimed expertise on every issue?".

I think it's a legitimately thorny conceptual problem because if you think of health as something like "flourishing" or "people having success in living the way they want" or "eudaemonia" or something, almost every public policy question can be conceived of as a "health" question. (Or even, maybe, "minimizing all-cause mortality"?) But if someone says that the policy answer to each question is therefore obvious because a particular profession thinks it knows what would maximize things it thinks it knows how to measure, I imagine a lot of the public is going to say that this doesn't match up with its notion of what health is.

Edit: after writing this, I had this weird imagine of public health as like a superintelligent AI that's super-focused on one goal and doesn't understand, or doesn't care very much, that people might have other goals too. We think there's obviously something that's going to remain outside of the scope of the AI's interest, but since the AI is smarter than we are, it discovers a way that that thing is actually relevant to its interests according to its utility function, after all! (I realize people have also had this kind of concern about other institutions that are happy to define their scope of action more broadly over time, such as profit-maximizing corporations, or militaries. The corporation says "we need to figure out what actions will maximize profit" or the military says "we need to figure out what actions will maximize our capacity to win wars" and perhaps the scope and ambition of their actions are soon larger than anyone would have expected.) I feel like this analogy is actually weirdly apposite, at least for some audiences. :-)

Yeah, that is a really broad definition. That results in everything becoming everything. For example, everything has some kind of economic impact, so everything becomes economics. Or, everything can have some affect on the arts, so everything becomes arts. This kind of failure to make distinctions makes the scope of every field to encompass everything, which eliminates the very notion of separate fields of study.

Probably a more sensible approach is to say the medical field concerns itself with the operation of the human body, and how to correct malfunctioning operations.

Good points!

However, public health continues to actively distinguish itself from medicine (they're different degrees and different departments in universities, for example, and you can get both an MD and a DPH), so I don't think your proposed definition for medicine will satisfy public health experts as a definition of their field. Although county health departments are often led by someone who has both a medical and public health degree, many of the people working in them will have public health training but not medical training.

Even looking at classic public health activities like sanitation/environmental health and epidemiology, sanitation and epidemiology aren't really about the functioning of the human body! They're more about conditions under which the human body is more likely to experience some particular kinds of morbidity...

Even your definition of medicine might be unsatisfactory to some people in the medical field, for example because they think mental health is medicine, or because (to pick an amusing example from my health insurer's claim form) pregnancy is not a disorder or malfunction of the body, but it requires a lot of medical expertise to manage its outcomes well. Other examples could be pain management and anaesthesia (pain, for example during surgery, is not necessarily a malfunction of the body—typically you would like the body to make you aware when it's being cut!) and elective surgeries.

Should public health officials weigh in on all issues? Yes. In my home state, every bill before the legislature has a financial assessment tied t it, because most laws cost money. The same should be true for health: we should figure out if an issue is positive, negative, mixed or neutral on public health. It should be part of the deliberation process.

Take your gun example: people should know that if they support the status quo gun laws how many people will die, or what the impact of a new lw is. That doesn’t mean the CDC regulates guns, but it does mean they should have a voice in the conversation.

Courts struck down a law in Florida in 2017 preventing Pediatricians from talking to parents about gun safety.

In my country, what counts as a 'public health' matter is essentially arbitrary. Or at least seems that way to me.

For example, smoking, sunblock usage, sugary drinks, STDs, binge drinking and falls by elderly people are widely seen as public health issues.

Safety nets on trampolines, malnutrition, illegal drugs, suicide, bad diets and road traffic accidents are sometimes seen as public health issues.

Skiing, rugby, workplace fall prevention, migrants using unseaworthy boats and violence between drug dealers are almost never seen as public health issues.

If there's a clear dividing line, I can't see what it is :)

Out of curiosity, were guns or poor maternal outcomes for black women discussed as public health issues? The former has long been thought of as a public health problem but it is rarely discussed due to politics. The latter has been a problem for decades but only acknowledged recently. I recognize you have some expertise here, but I don’t think there is a finite set of issues that can fall under ‘public health’.

I’ve never heard of guns spoken of as a public health issue by public health experts, as opposed to politicians. This is among a fairly uniformly left-leaning bunch of people. The worse maternal outcomes for black women is something I’ve heard discussed, because maternal health is a central focus of public health (it happens to be my dad’s area of expertise). Maternal mortality for black mothers is a problem everywhere in the world. Most developed countries don’t have enough black people to have rigorous data on this. Some that do, like France, don’t track these statistics by race as a matter of formal policy. But the UK has about the same maternal mortality rate for black women, (40 per 100k) as the US (37 per 100k). The gap between black and white is actually bigger in the UK (5x) than the US (3x). Nobody does a good job with maternal care for black women, and nobody really knows what the problem is.

By the way, I have no public health expertise myself; just recounting as a lay person what I’ve heard public health experts talk about as a proxy for the metes and bounds of the field.

Yes. But the Feds won’t allow government funded research into gun violence. For black moms the issue is wrapped up in obstetrics in the US which basically has refused to use checklists, crash carts etc... I am not sure if this has changed but there was no national standard protocol in the US. It varied by state! This has been widely reported on if you do a few google searches. Lastly there’s also a lack of access to prenatal care.

I wouldn’t expect that textbook to list all examples of public health issues, nor would I expect you to overhear discussion about all examples.