The History & Development of Public Health in Developing Countries

1. The History & Development of Public Health in Developing Countries Dept. of Public Health & Preventive Medicine Padjadjaran University Medical School

2. INTRODUCTION • Historical reviews: provide valuable insights that can contribute to the solution of present & future health problems • Barton (1979): development the health sciences over 5 major area. - empirical health - basic science - clinical science - public health science - political science

3. Institute of Medicine (IOM), 1988: Growing demand for Public Health, as: • a profession • a governmental activity • a commitment to society The goals of PH (in broad terms): • To identify problems that affect entire communities or populations • To marshal support to address these problems • To ensure that the solutions are implemented

4. Detels & Breslow (1997): Public Health: the process of mobilizing local, state, national & international resources to ensure the conditions in which people can be healthy Historically, public health efforts meant health development to be undertaken by the government as a public sector activity Public health cover promotive, preventive, curative, & rehabilitative health measures Later, the connotation of the term ‘public’ was widened to encompass the involvement of people together with the government in health development efforts

5. EARLY PUBLIC HEALTH EMPIRICAL PUBLIC HEALTH The concept of ‘disease’ had been postulated within the limited ‘scientific’ knowledge available Traditional medicine focused on management of illnesses at the individual rather than the public level. However, the spread of diseases due to contact amongst people or due to hereditary transmission was recognized centuries ago. Quarantine & prohibition were major measures used historically to protect the transmission of diseases

6. EMPIRICAL PUBLIC HEALTH (cont’d) Among figures: • Sir Jeremy Bentham • Thomas Southwood Smith • Edwin Chadwick • Sir John Simon • John Snow • William Farr • Max von Pettenkoffer Question: What are health-related concepts hold or discoveries during this empirical public health era?

7. Colonial public health • Trading around the world during the 18th & 19th centuries for the exploration & exploitation of natural resources led to the discovery of new territories in different parts of the world • The colonials established their own administrative, legal, & medical care systems with varying degrees of autonomy & authority • To protect the health of their own people & the workers, colonial rulers established laws similar to those in their home countries, e.g. the Public Health Acts, Local Government Act, Civil Registration Act, Factory Acts, Food Adulteration Act, Vaccination Act, & Contagious Diseases Acts

8. Colonial public health (cont’d) • European & American religious missionaries also embarked on expeditions around the world along with the colonial powers. Many of them established medical care institutions, as well as general educational systems including nursing & medical schools. • However, the actual development of public health & medical care services for the general public remained rudimentary • Moving millions of people to totally unfamiliar areas had led to a high incidence of death & disability  died due to: smallpox, malaria, yellow fever, typhus, typhoid  disabled due to: yaws, leprosy, & syphilis • The development of in the areas of physics, microbiology, biochemistry, pharmacology & other diagnostics led to an explosion of its application in public health practices

9. Foundation of international public health Int’l public health efforts intensified in the early 18th century when European nations applied protective legislative measures to prevent importation of epidemic diseases by trading ships The First Int’l Sanitary Conference (1851): the first attempt to reach a consensus on drafting int’l quarantine regulations. For the next 50 years, a series of similar int’l sanitary conference were held but failed to produce an int’l sanitary code  partly due to: - the non-availability of a sound scientific basis for the prevention & control of epidemics - the vested political & commercial interests of each colonial power The 11th Int’l Sanitary Conference (1903): the first sanitary convention for the prevention & control of three epidemics: plague, cholera, & yellow fever

10. Foundation of international public health (cont’d) Based on the convention, L’ Office International d’ Hygiene Publique (OIHP) was established in 1907 as the first int’l health office  objective: - to protect Europe against three notifiable diseases (at the beginning) - to monitor & report the outbreaks of the three notifiable diseases - to provide general public health information on measures taken to combat these diseases through monthly bulletin In Bandoeng (1937) Conference of far eastern countries on Rural hygiene.

11. Foundation of international public health (cont’d) Around the time of the establishment of the League of Nations: - major epidemics were rampant in various parts of the world - some infectious diseases, e.g. cholera & plague, were threatening to become pandemics The League had to cope with many other postwar rehabilitation problems & the Paris-based OIHP was unable to deal with such pandemics even with its originally assigned tasks Based on the proposal of the Brazilian delegation, the League of Nations agreed, in 1920, to the establishment of an int’l health organizations  The League of Nations Health Organizations was formed in 1923, originally assigned to handle int’l health matters relating to both technical assistance & clearing-house functions

12. Foundation of international public health (cont’d) The League of Nations Health Organizations organized the int’l health conferences in the early 1930s, provided a forum for sharing experiences on public health development in the countries under colonial rule The Intergovernmental Conference of Far-Eastern Countries on Rural Hygiene held in 1937 in Bandung, West Java, Indonesia • Studied the public health interventions of the participating countries, defined the central role of health in development, & emphasized the need for integrating health care & intersectoral action However, the onset of the devastating Second World War delayed effective follow-up of the Bandung Conference principles After the 2nd world war, the WHO Constitution was approved on 22 July 1946, initiating the establishment of the Organization as a specialized agency of the United Nations

13. Foundation of international public health (cont’d) The WHO constitutional mandate: Attainment by all people of the highest possible level of health The WHO’s main functional roles: Directing & coordinating int’l health work & providing advice & advocacy on int’l health development The WHO’s authority: - To adopt int’l regulations • To set int’l standards for biological & pharmaceutical agents, as well as other diagnostic procedures & products • To adopt int’l conventions & agreements

14. SCIENCE-ORIENTED PUBLIC HEALTH • The age of opportunity that saw remarkable scientific & technological advancements which opened up limitless vistas & unlimited possibilities for solving the age-old problems of poverty & disease • Inventions & innovations: quinine, DDT, penicillin, sulphonamide, vaccines, birth-control pills & injectables, imaging diagnostic technologies

15. After the 2nd world war, developing countries started to building up health systems infrastructures based on a network of hospitals & health centers • During the early 1950s most countries adopted the Beveridge model of national health & social welfare policy & they initiated ‘free’ health services for all • Training of different categories of health auxiliaries, e.g. health assistants, medical assistants, health visitors, nurses, midwives, vaccinators, sanitary workers, community workers, laboratory technicians, pharmacists, was initiated by the establishment of paramedical training institutes

16. Int’l rural health conference in New Delhi (1937): • The concepts & functioning of rural health services • The training & use of multipurpose village workers • The enhancement of prevention & control of epidemic & endemic diseases • The utilization of local resources & promoting intersectoral action, • The participation of local people, incl. formation of village health committees • The rural health centers as the basic units where comprehensive health care could be provided to the rural population was recognized

17. Science-oriented PH….Cont • 1960most countries started population policy/ family planning. • 1960’s Green revolution started • 1970 WHO survey :Only 29% of rural and 50% of urban population have access to a save drinking water.

18. Science oriented PH…..cont • Disease prevention and control campaign - yaws-start 1948 ;mass treatment with long acting penicillin. -malaria-->start with DDT in 1950’s. Result  dramatic ;after that faced problem of resistence of mosquito to DDT and parasite to drug.

19. Disease prevention………cont -Leprosy in 1943 discovered Diamino-diphenyl sulphon(DDS)-global leprosy control program • Sexual transmitted disease: 1948 in Europe. 1992 who used long acting penicillin. • Cholera: eltor appear in Indonesia in 1961.

20. Public health sucesses