A Brief History of Public Health

What is Public Health?

“To promote health and quality of life by preventing and controlling disease, injury, and disability.”

—CDC Mission Statement

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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.

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Survive the Tribe

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Requirements for Survival Care Shelter Food Water Air

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Public Health Codes

• • • • • • Tribal Rules Hieroglyphs Chinese Empire Bible (Leviticus) Koran Roman Senate • Salus populi: suprema lex esta 6 of 37

Timeline

• Ancient Greece • Roman Empire • Middle Ages • Birth of Modern Medicine • “Great Sanitary Awakening” • Modern Public Health 7 of 37

Ancient Greeks (500-323 BC)

• • Personal hygiene Physical fitness • Olympics • Naturalistic concept • Disease caused by imbalance between man and his environment • Hippocrates 8 of 37

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”) 9 of 37

Roman Empire (23 BC – 476 AD)

• • • Adopted Greek health values Great engineers • • Sewage systems Aqueducts Administration • • • Public baths Water supply Markets 10 of 37

Roman Aqueducts Le Pont du Gard

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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 12 of 37

The Plague

Death of 25% to 50% of population 13 of 37

Renaissance (1400-1600 AD) Global Exploration

• • Disease, spread by traders and explorers Killed 90% of indigenous people in New World 14 of 37

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

(v

acca,

Latin for “cow”) 15 of 37

Industrialization Urbanization (1800s)

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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 17 of 37

Dr. John Snow (1813-1858)

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Epidemiology (1854)

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Broad Street Pump

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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

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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 22 of 37

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 23 of 37

Sanitary Reform

U.S.

• 1850 Lemuel Shattuck’s “Report of the Sanitary Commission of Massachusetts” • 1869 State Board of Health 1793-1859 24 of 37

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 25 of 37

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.

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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 of 37

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

Source:

www.infoplease.com

18 17 16 15 14 13 12 11 10 9 8 19 00 19 25 19 34 19 39 19 44 19 49 19 54 19 59 19 65 19 70 19 75 19 80 19 85 19 90 19 95 20 00 Year

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Public Health Nursing

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Ten Great Achievements in Public Health, 1900-1999

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

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. CDC, Morbidity and Mortality Weekly Report, December 24, 1999 / 48(50); 1141.

Available at: http://www.cdc.gov/mmwr/preview/ mmwrhtml/mm4850bx.htm

Fluoridation of drinking water. Recognition of tobacco use as a health hazard.

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Challenges Ahead New and Persistent Problems in Public Health

Cause of Death (U.S. 1990)

• • • • • • • • • Tobacco Diet/Activity Alcohol Microbial agents Toxic Agents Firearms Sexual Behavior Motor Vehicles Illicit Drug Use

McGinnis & Foege, JAMA, 1993

19% 14% 5% 4% 3% 2% 1% 1% <1%

Tobacco Diet/Activity

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World Population Growth

8000 7000 6000 5000

2010

4000 3000 2000 1000

1850

0 -8 00 0 -3 00 0 -1 00 0 1 A D 1000 1200 1400 1600 1750 1850 1910 1930 1950 1970 1990 2010

Year

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Health Disparities

Access and Outcomes • Infant Mortality • Cancer Screening and Management • Cardiovascular Disease • Diabetes • HIV Infection/ AIDS • Immunizations 34 of 37

Multiple Determinants of Health Policies and Interventions Physical Environment Behavior Individual Biology Access to Quality Health Care Social Environment

Source: U.S. Department of Health and Human Services, Health People 2010 35 of 37

Globalization

• Emerging infectious diseases • Reemerging infectious diseases • Health disparities between industrial and nonindustrial countries 36 of 37

http://www.healthypeople.gov

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