History of public health

Definition and Historical Glimpse of Public Health

Ancient Greece (500-323 BC)
Roman Empire (23 BC – 476 AD)
Middle Ages (476-1450 AD)
Birth of Modern Medicine (1650-1800 AD)
Great Sanitary Awakening (1800s-1900s)
Modern Public Health (1900 AD & onward)

1. Presented by : Sirjana Tiwari School of Health and Allied Science , Pokhara University History of Public Health

2. What is Public Health? “To promote health and quality of life by preventing and controlling disease, injury, and disability.” —CDC Mission Statement

3. Definition of Public Health 1 “the science and art of preventing disease, prolonging life and promoting health and efficiency through organized community effort” CEA Winslow (1920)

4. Winslow’s definition…. the science and the art of: (1) preventing disease, (2) prolonging life, and (3) promoting physical health and efficiency through organized community efforts for: (a)    the sanitation of the environment, (b)   the control of community infections, (c)    the education of the individual in principles of personal hygiene, (d)   the organization of medical and nursing service for the early diagnosis and preventive treatment of disease, and

5. Winslow’s definition…. (e)   the development of the social machinery which will ensure to every individual in the community a standard of living adequate for the maintenance of health so organizing these benefits as to enable every citizen to realize his birthright of health and longevity

6. Definition of Public Health 2 “Public health is defined as the practices, procedures, institutions, and disciplines required to achieve the desired state of popula t ion health.” ( Friedman, D. J., Parrish, R., & Ross, D. A. 2013)

7. Historical glimpse Ancient Greece (500-323 BC) Roman Empire (23 BC – 476 AD) Middle Ages (476-1450 AD) Birth of Modern Medicine (1650-1800 AD) Great Sanitary Awakening (1800s-1900s) Modern Public Health (1900 AD & onward)

8. Ancient Greeks (500-323 BC) Personal hygiene Physical fitness Olympics Naturalistic concept Disease caused by imbalance between man and his environment Hippocrates

9. Hippocrates (460 - 375 BC) Father of Western medicine Recognized body consist of 4 humours : blood, black bile, yellow bile and phlegm To create balance in body : exercise, Nutrition, excretion and rest required Causal relationships Disease and climate, water, lifestyle, and nutrition Coined the term epidemic and endemic

10. Roman Empire (23 BC – 476 AD) Adopted Greek health values by hiring greek Physician as personnel healer Great engineers Built Sewage systems Aqueducts: bringing fresh water in city Establish bereaurocratic system Administration Public baths Private Water supply Physician were employed by municipalities to provide health sercvice Markets

11. Roman Aqueducts Le Pont du Gard

12. Middle Ages (476-1450 AD) Urbanization in Europe overcrowding Decline of hygiene and sanitation Major epidemic of bubonic Plague and black death Church endorsed public health Faith and prayer were the accepted treatment for illness. Beginnings of PH tools Quarantine of ships for 40 days Isolation of diseased individuals

13. At the end of middle age The Plague (The Black Death) Worst from 1348-1352 Killed at least 25 million people in Europe (1/3 of the population ). Killed more than 60 million worldwide. Death of 25% to 50% of population

14. Renaissance (1400-1600 AD) Global Exploration Disease (Small pox, measles and typhoid), spread by traders and explorers Killed 90% of indigenous people in New World/Americas

15. Birth of Modern Medicine (1650-1800 AD)

16. Industrialization Urbanization (1800s)

17. Birth of Modern Medicine (1650-1800 AD) After Industrialization Malnutrition , overcrowding, poor working condition contribute to severe disease outbreak: typhus, typhoid, cholera

18. Great Sanitary Awakening (1800s-1900s) Growth in scientific knowledge Humanitarian ideals Connection between poverty and disease Water supply and sewage removal Monitor community health status

19. Dr. John Snow (1813-1858)

20. Epidemiology (1854)

21. Broad Street Pump

22. Map of Diphtheria Deaths New York City May 1, 1874 to December 31, 1875 Made under the direction of W. De F. Day, M.D., Sanitary Superintendent, NYC Health Dept. www.ihm.nlm.nih.gov

23. Birth of Modern Medicine Louis Pasteur 1862 germs caused many diseases 1888 first public health lab Robert Koch 1883 identified the vibrio that causes cholera, 20 years after Snow’s discovery Discovered the tuberculosis bacterium 1843-1910 1822-1895

24. Sanitary Reform England 1842 Edwin Chadwick’s “Survey into the Sanitary Condition of the Laboring Classes in Great Britain” Landmark research Graphic descriptions of filth and disease spread in urban areas 1848 General Board of Health Public Health act : 1848 1800-1890

25. Sanitary Reform United States Colonial period Endemic disease are: malaria, smallpox, cholera, typhoid, diphtheria 50thousand people contacted with yellow fever. 1850 Lemuel Shattuck’s “Report of the Sanitary Commission of Massachusetts” 1869 State Board of Health Qurantine act, quarntain law was formed 1793-1859

26. Sanitation Revolution Clean water; water treatment Food inspection Soaps, disinfectants, and pharmaceuticals Personal hygiene (bathing) Public works departments; garbage collection, landfills, and street cleaning Public health departments and regulation

27. Modern Public Health (1900 AD & onward) At the beginning of the 20 th century Life expectancy was less than 50 years Leading causes of death were communicable diseases (influenza, pneumonia, tuberculosis and GI infections) Vitamin deficiency diseases were common including rickets, pellagra and scurvy Deaths associated with pregnancy and childbirth were also high C.E.A Winslow characterized sanitation as the first step to uplift public health.

28. Health resources development period (1900-1960) is further divided into The reform phase (1900-1920) The 1920s The great depression and World War II The post war years Modern Public Health (1900 AD & onward)

29. Period of social engineering (1960-1973) Period of health promotion (1973 to present) Modern Public Health (1900 AD & onward)

30. The Reform Phase of Public Health Involved both social and moral as well as health issues Public health nursing started with a school nursing program in New York in 1902 In 1906 the passage of the Pure Foods and Drugs Act In 1910 New York passed Worker’s Compensation Act Modern Public Health (1900 AD & onward )

31. First School of Public Health was established in 1918 at Johns Hopkins University 1918 was the birth of school health education Birth of first national level volunteer health agencies American Cancer Society 1913 Rockefeller Foundation established 1913 Modern Public Health (1900 AD & onward )

32. Modern Public Health (1900 AD & onward ) The 1920s Period of slow development in Public Health Prohibition produced decline in alcoholics and alcohol related deaths Number of county health departments rose to 467 Life expectancy in 1930 risen to 59.7 years

33. Modern Public Health (1900 AD & onward) The Great Depression and World War II by 1933 private resources could no longer meet the needs of the people who needed assistance Beginning in 1933, President Roosevelt’s New Deal created agencies and programs for public works Building of hospitals and laboratories, control of malaria and the construction of municipal water and sewer systems

34. Modern Public Health (1900 AD & onward) The Great Depression and World War II 1935 The Social Security Act marked the beginning of the involvement of the government in social issues including health World War II decreased the availability of funds and resources for public health, but led to the development of many important medical discoveries that were made available once the war ended

35. Modern Public Health (1900 AD & onward) The post war years Antibiotic penicillin was made available Insecticide DDT to kill insects that transmitted communicable diseases was made available Communicable Disease Center was set up in Atlanta during the war, now known as the Center for Disease Control and Prevention (CDC)

36. Modern Public Health (1900 AD & onward) The post war years Two major events in the 1950s Development of a vaccine to prevent polio President Eisenhower’s heart attack focused attention on the nations number one killer, heart disease

37. Modern Public Health (1900 AD & onward) Period of Social Engineering 1965 passage of the Medicare and Medicaid bills Medicare provides for health care to the elderly and some disable people Medicaid provides health care for the poor Period of Health Promotion (1974-present) Recognition that the greatest potential for saving lives is by education and life-style changes by individuals

38. Modern Public Health (1900 AD & onward) Situation by the end of the Twentieth Century Life expectancy increased by 30 years Major infectious diseases brought under control Infant and maternal mortality rates decreased by 90 and 99% respectively Safer workplaces Safer and healthier foods

39. Modern Public Health (1900 AD & onward) In 1970s, CDC conducted a study that examined premature death Study revealed that approx 48% of all premature deaths were because of lifestyle or health behavior-choices people make This led the way for U.S. government’s publication Healthy People: The surgeon General’s Report on Health Promotion and Disease Prevention

40. Modern Public Health (1900 AD & onward) Prior to 1850 Battling Epidemics 1850–1949 Building State and Local Infrastructure 1950–1999 Filling Gaps in Medical Care Delivery After 1999 Preparing for and Responding to Community Health Threats

41. Modern Public Health (1900 AD & onward) Problems to be faced Health care delivery Environmental problems Lifestyle diseases Alcohol and other drug abuse New communicable diseases or old diseases that have become resistant to drug therapy

42. Healthy People 2010 These are the governments goals for improved health in the population Also includes projected mechanisms to be used to help to reach these goals

43. Healthy people 2010 Comprehensive, nationwide health promotion and disease prevention agenda. Designed to serve as a roadmap for improving the health of all people in the United States during the first decade of the 21st century. Committed to a single, overarching purpose: promoting health and preventing illness, disability, and premature death.

44. Healthy people 2010 Can be used by many different people, States, communities, professional organizations, and others to help them develop programs to improve health.

45. Healthy People Entering its Third Decade 1979 - Healthy People: The Surgeon General’s Report on Health Promotion and Disease Prevention 1980 - Promoting Health/Preventing Disease: Objectives for the Nation 1990 - Healthy People 2000: National Health Promotion and Disease Prevention 2000 - Healthy People 2010

46. Healthy People 2010 Two overarching goals 28 focus areas 467 specific objectives 10 Leading Health Indicators

47. THANK YOU