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A Brief History of Public Health

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  1. A Brief Historyof 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. Objectives • Define public health. • Describe conditions that existed before the advent of modern public health. • Describe three public health interventions since 1900 that have increased life expectancy in the U.S.

  4. Survive the Tribe

  5. Requirements for Survival Care Shelter Food Water Air

  6. Public Health Codes • Tribal Rules • Hieroglyphs • Chinese Empire • Bible (Leviticus) • Koran • Roman Senate • Salus populi: suprema lex esta

  7. Timeline • Ancient Greece • Roman Empire • Middle Ages • Birth of Modern Medicine • “Great Sanitary Awakening” • Modern Public Health

  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 • 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 Death of 25% to 50% of population

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

  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)

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

  18. Dr. John Snow (1813-1858)

  19. Epidemiology (1854)

  20. Broad Street Pump

  21. 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

  22. Growth in Scientific Knowledge • 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 1822-1895 1843-1910

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

  24. Sanitary Reform U.S. • 1850 Lemuel Shattuck’s “Report of the Sanitary Commission of Massachusetts” • 1869 State Board of Health 1793-1859

  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. Redefining the Unacceptable In the next 5 minutes: Brainstorm and record a list of “things” affecting the public’s health that have passed from tolerable (accepted) to intolerable (unaccepted). Include items that you wish would become unacceptable.

  27. 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

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

  29. Public Health Nursing

  30. Ten Great Achievements in Public Health, 1900-1999 • 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. • 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

  31. Challenges AheadNew and Persistent Problemsin Public Health

  32. Cause of Death (U.S. 1990) • Tobacco 19% • Diet/Activity 14% • Alcohol 5% • Microbial agents 4% • Toxic Agents 3% • Firearms 2% • Sexual Behavior 1% • Motor Vehicles 1% • Illicit Drug Use <1% Tobacco Diet/Activity McGinnis & Foege, JAMA, 1993

  33. World Population Growth 2010 Population (in millions) 1850 Year

  34. Health Disparities Access and Outcomes • Infant Mortality • Cancer Screening and Management • Cardiovascular Disease • Diabetes • HIV Infection/ AIDS • Immunizations

  35. Multiple Determinantsof Health 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

  36. Globalization • Emerging infectious diseases • Reemerging infectious diseases • Health disparities between industrial and nonindustrial countries

  37. http://www.healthypeople.gov