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THE HISTORY OF PUBLIC HEALTH��DR PREITY VENIS�SENIOR RESIDENT�

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DEFINITION OF HEALTH

• WHO: A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. (1948)

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Definition of Public Health

The science and art of :

1) preventing disease

2) prolonging life and

3) promoting health

and efficiency

through organized

community effort.

(C.E.A.Winslow,1920)

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DEFINITIONS OF PUBLIC HEALTH (cont’d)

To fulfill society’s interest in assuring conditions in which people can be healthy (Wisconsin) .

• The field of health science concerned with safeguarding and improving the physical, mental and social well-being of the community as a whole. (1992)

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Key Events in the�History of Public Health

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Roots of Public Health

The account in Leviticus about 1500 B.C. probably represents the first written health code in the world.

It dealt with

:

Cleanliness of the body,

Protection against the spread of contagious diseases,

Isolation of lepers,

Disinfection of dwellings after illness,

Sanitation of camp sites,

Waste disposal and

Protection of water and food.

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Roots of Public Health

During the classical civilization beginning around 400 B.C. to 500 A.D., the Romans placed much emphasis on engineering achievement to provide safe water and prevent disease.

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Roots of Public Health

Early Egyptians in the 13th and 15th centuries B.C. used sedimentation apparatus and wick siphons, and utilized alum to remove suspended solids.

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Johanna Peter Frank�

He conceived public health as good health laws enforced by the police and enunciated the principle that the state is responsible for the health of its people.

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EDWIN CHADWICK REPORT

Edwin Chadwick's report," The Sanitary Conditions of the Labouring Population”, was published in 1842. In the report Chadwick argued that disease was directly related to living conditions and that there was a desperate need for public health reform.

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Public Health Act

In 1848 Parliament passed a Public Health Act that provided for the formation of a Central Board of Health. This new body had powers to create local boards to oversee street cleansing, refuse collection, water supply and sewerage systems.
The Indian Public Health Association was formed in 1958.

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John Snow and Cholera�

The science of epidemiology was founded by John Snow's identification of a polluted public water well as the cause of an 1854 cholera outbreak in London.
Dr. Snow believed in the germ theory of disease.

John Snow and the Broad Street Pump is the classic tale of basic epidemiology, the core science of public health. Prior to identification of Vibrio cholera as the causative agent of cholera, and absent any of the modern laboratory supports or computer analysis, Snow developed a theory of the source of the outbreak. He devised a simple map identifying the number and distribution of cases of the disease in the community and the specific water system serving each house in which disease occurred. On this information (His tables are reproduced on the next slide) he hypothesized that one water pump was responsible for transmission of the disease. Disabling the pump by the simple expedient of removing the handle brought the outbreak of cholera to a close.

Teacher’s Note:

The University of Illinois at Chicago has posted a web site which includes case studies of this outbreak and intervention. This might be used as a homework assignment for your students and can be found at:

http://www.uic.edu:80/classes/chsc/chsc400/resources/snowcase1.htm

and

http://www.uic.edu:80/classes/chsc/chsc400/resources/snowcase2.htm

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WILLIAM BUDD

In 1856, he made a careful observation of an outbreak of typhoid fever and concluded that the spread was by drinking water.

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JOHN SIMON

Sir John Simon was the first medical officer of health of London.

The system of public health in England was set up under his supervision.

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Massachusetts and the Shattuck Report

1850 review of sanitation practices and the potential for improving health status by enforcement of a sanitary code led to creation of local board of health in Massachusetts.

Lemuel Shattuck conducted a comprehensive survey of sanitation conditions and practices, and outlined the potential for improving health status by enforcing a sanitary code. His report led to early communal action to protect the public health and created the political support necessary to create a local board of health in Massachusetts. This movement spread to other localities.

The strong role of sanitary engineers such as C. E-A Winslow in the early decades of public health in this country is often overlooked in our current attention to individual health improvement efforts. Winslow was an early leader in public health and a prolific writer on the need for community-wide action to improve health.

South Carolina established its first State Board of Health in 1898, a period of active public health law reform around the nation.

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CHLORINE BOAT

Chlorine Boat, Green Lake, 1930s.
There were constant problems with pollution in Green Lake. Following U.S. Government strategy, the Health Department used a boat equipped with apparatus for the application of chlorine to purify water.

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Phases of Public Health�

Disease control phase (1880-1920) : sanitary legislations and reforms aimed at the control of man’s physical environment were made. eg: water supply, sewage disposal .

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Phases of Public Health

Health promotional phase (1920-1960) :

Public health departments began their programmes towards health promotional activities .

A) Provision of basic health services was made through health centres and subcentres

B) Community Development Programme was started to promote village development through active participation of the whole community .

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Phases of Public Health

Social engineering phase (1960-1980): social and behavioural aspects of disease and health were given priority. Public health expanded to include the preventive and rehabilitative aspects of chronic diseases and behavioural problems.

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Phases of Public Health

Health for all phase (1981-2000AD) :

John Bryant’s book “Health and the Developing World” lead to a new awakening that the health gap between rich and poor within countries and between countries should be narrowed.

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In 1981, the WHO pledged to provide Health for All by the year 2000.
The global strategy of Health for All was adapted by the 34th World Health Assembly in 1981.

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THE CONTENT OF PUBLIC HEALTH PRACTICE

• Focus on primary prevention.

• Community protection through monitoring and surveillance for infectious and toxic agents.

• Response to unanticipated natural and human-generated disasters.

• Health promotion through programs to notify and educate the community about risks and protective measures.

• Target hard-to-reach populations with clinical services.

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PUBLIC HEALTH – SUB-FIELDS

The population in question can be as big as a handful of people or, in the case of a pandemic, whole continents. Public health has many sub-fields, but is typically divided into the categories of epidemiology, biostatistics and health services. Environmental, social and behavioral health, and occupational health, are also important fields in public health.

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Public Health Services

Assessment

Monitor
Diagnose and Investigate
Inform

Policy

Mobilize
Develop
Enforce

Assurance

Link people to services
Assure competent workforce
Evaluate
Research

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Great Public Health Achievements of This Century

Vaccination
Motor vehicle safety
Safer workplaces
Control of infectious diseases
Decline in deaths from coronary heart disease and stroke

Safer, healthier food
Healthier mothers and babies
Family planning
Flouridation of drinking water
Recognition of tobacco as a hazard

A summary article on these achievements appeared in the Morbidity & Mortality Weekly Report (MMWR) and may be found at:

http://www.cdc.gov/tobacco/mm4812.pdf

Subsequent articles (locate through the MMWR index at www.cdc.gov)

provide more details on each.

Activity: Select one or more of these topics that are particularly pertinent to your students for more detailed discussion at this point. Or, as an out-of-class activity, have each student select one of these topics, locate the detailed article, and be prepared to discuss current/future implications in the area specific to the students profession or experience.

Each one illustrates both disease prevention and health promotion, and the involvement of private and voluntary health groups with official agencies and policy-making bodies to achieve the progress that we have experienced.

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Thank you