A Brief History of Public Health

1. A Brief Historyof Public Health Because, well, death….

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

3. By the time we are done you should be able to… • Define public health. • Describe what it was like before the advent of modern public health. • Describe the role of the CDC.

4. Timeline – what’s coming up • Early Humans/Civilizations • Ancient Greece • Roman Empire • Middle Ages • Birth of Modern Medicine • “Great Sanitary Awakening” • Modern Public Health

5. The Tribe Must Survive!

6. Requirements for Survival Care Shelter Food Water Air

7. Early Civilizations - Public Health Codes • Tribal Rules • Hieroglyphs • Chinese Empire • Bible (Leviticus) • Koran • Roman Senate “Salus populi suprema lex esto!”

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 (b. 460 BC) • Father of Western medicine • Causal relationships • Disease and climate, water, lifestyle, and nutrition have an effect on health • Coined the term epidemic • Epis (“on” or “akin to”) • Demos (“people”)

10. Roman Empire (23 BC – 476 AD) • Adopted Greek health values • Great engineers • Sewage systems • Aqueducts • Administration • Public baths • Water supply • Markets

11. Roman Aqueducts Le Pont du Gard

12. Middle Ages (476-1450 AD) • Shift away from Greek and Roman values • Physical body less important than spiritual self • Decline of hygiene and sanitation • Beginnings of PH tools • Quarantine of ships • Isolation of diseased individuals

13. The Plague – The Black Death Worst years 1348-1352 Death of 25% to 50% of population • More than 60 million dead worldwide.

14. Renaissance (1400-1600 AD)Global Exploration Smallpox, measles, typhoid, and STD’s • Killed 90% of indigenous people in New World Disease, spread by traders and explorers

15. Age of Reason and Enlightenment (1650-1800 AD) Birth of Modern Medicine • William Harvey • 1628 theories of circulation • Edward Jenner • 1796 cowpox experiment • Coined the term vaccine (vacca, Latin for “cow”)

16. IndustrializationUrbanization (1800s) • Slums • Poverty • Disease

17. Great Sanitary Awakening (1800s-1900s) • Growth in scientific knowledge • Humanitarian ideals • Water supply and sewage removal • Monitor community health status • Connection between povertyand disease • Even today, poverty is the single best predictor of poor health.

18. Steps to a Healthier Society • 1840s to 1890’s -focused on the environment of infectious diseases related to “urbanization, poverty and squalor”. • 1890’s to 1930’s - personal preventive medical services and health education on: immunization, family hygiene and family planning • 1930’s and on- improving organized medical services, new meds: insulin and antibiotics, etc. • 80’s on- A recognition that the ‘environment’ is also social, economic and psychological factors affect health

19. Dr. John Snow – Father of Epidemiology –the study of causes, treatment, prevention of disease Cholera Outbreak (1813-1858)

20. Broad Street Pump No pump handle, no water, no cholera

21. Epidemiological Process • Study cases to identify the disease. • Look for possible causes. • Track the source. • -------------------------- • Make a treatment plan. • Stop the origin • Stop the spread. • Prevent further outbreaks

22. Map of Diphtheria DeathsNew York CityMay 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. Growth in Scientific Knowledge(Beforethe late 1800’s – we didn’t know anything about microbial pathogens!) • Louis Pasteur • 1862 germs caused many diseases! (rabies vaccine, Pasturization of milk…) • 1888 first public health lab • Robert Koch • 1883 identified the vibrio (water bacteria) that causes cholera, 20 years after Snow’s discovery • Discovered the tuberculosis bacterium 1822-1895 1843-1910

24. Sanitary Reform England 1842 Edwin Chadwick’s “Survey into the Sanitary Condition of the Labouring Classes in Great Britain” Graphic descriptions of filth and disease spread in urban areas, More than half of working class children died before their fifth birthday; average age of death for common laborers was 16. • 1848 General Board of Health U.S. • 1850 Lemuel Shattuck’s “Report of the Sanitary Commission of Massachusetts” • 1869 State Board of Health 1800-1890

25. Redefining the Unacceptable “The landmarks of political, economic and social history are the moments when some condition passed from the category of the given into the category of the intolerable…The history of public health might well be written as a record of successive redefinings of the unacceptable.” - Geoffrey Vickers, Secretary, Medical Research Council, Great Britain, 1958

26. Sanitation Revolution – Cleaning Up! • 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 • -The death rate in children drops and the average life span increases over the years from less than 40 to 74.

27. The Rest of the Century:Ten Great Achievements in US Public Health, 1900-1999 • Country-wide vaccination. • Motor-vehicle safety. • Safer workplaces. • Control of infectious diseases. • Decline in deaths from coronary heart disease and stroke. • Safer and healthier foods. • Healthier mothers and babies. • Family planning. • Fluoridation of drinking water. (of treated, safe water!) • Recognition of tobacco use as a health hazard. CDC, Morbidity and Mortality Weekly Report, December 24, 1999 / 48(50); 1141.Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4850bx.htm

28. Twentieth Century U.S. Mortality Rate: 1900-2001

29. Challenges AheadNew and Persistent Problemsin Public Health

30. The Top 10 leading Causes of Death in the US (accounting for nearly 75% of all deaths.) • Heart disease • Cancer (malignant neoplasms) • Chronic lower respiratory disease • Stroke (cerebrovascular diseases) • Accidents (unintentional injuries) • Alzheimer's disease • Diabetes (diabetes mellitus) • Influenza and pneumonia • Kidney disease (nephritis, nephrotic syndrome, and nephrosis) • Suicide (intentional self-harm). How many are caused infectious disease?

31. World Population GrowthHouston, we have a resource issue… 2010 Population (in millions) 1850 Year

32. Health Protection: Urgent Challenges Space Shuttle Columbia Disaster Feb 03 Hurricane Katrina Aug. 05 RNC 2004 Aug 04 Hurricane Isabel Sept 03 Tsunami Dec 04 California Wildfires Oct-Nov 03 World Trade Center Sept 2001 G8 Summit June 04 DNC 2004 July 04 Hurricane Isabel Sept 03 West Nile Virus Aug-Nov 02 Hurricane Wilma Oct 04 E.Coli Nov 06 West Nile Virus Aug-Nov 04 Influenza Sept 03 Ricin TularemiaAnthrax Oct-Nov 03 SARS Mar-Aug 03 Guam Typhoon Feb 04 2004 Summer Olympics June 04 Hurricane Rita Sept. 05 Influenza Vaccine Shortage Oct 04 Climate Change Hurricanes (Charley, Frances, Ivan, Jean) Aug-Oct 04 Anthrax AttacksOct-Nov 01 Monkey Pox June-Aug 03 BSE Dec 03 Ricin Domestic Response Feb 04 Avian Influenza Jan-Mar 04 TB May ‘07 Northeast Blackout Aug 03 Marburg Virus Mar 05

33. Healthy People During Every Stage of Life Healthy People in Healthy Places People Prepared for Emerging Health Threats Healthy People in a Healthy World Goals and Strategic Subgoals Infants & Toddlers Children Adolescents Adults Older Adults Workplace Communities Homes Travel & Recreation Healthcare Settings Schools Institutions Health Promotion Health Protection Health Diplomacy Prevent Detect & Report Investigate Control Recover Improve

34. 2015 CDC Targets Tobacco Nutrition, Physical Activity, Obesity, and Food Safety Healthcare-associated infections Motor Vehicle Safety Teen Pregnancy HIV

35. What Factors Does the CDC have to Consider When Planning for the Health of Our Communities? Policies and Interventions Behavior Physical Environment Social Environment Individual Biology Access to Quality Health Care Source: U.S. Department of Health and Human Services, Health People 2010