A BRIEF HISTORY OF PUBLIC HEALTH Because, well, death…. “To promote health and quality of life by preventing and controlling disease, injury, and disability.” —CDC.
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A BRIEF HISTORY OF PUBLIC HEALTH Because, well, death…. “To promote health and quality of life by preventing and controlling disease, injury, and disability.” —CDC Mission Statement Define public health. Describe what it was like before the advent of modern public health. Describe the role of the CDC. Requirements for Survival Care Shelter Food Water Air Tribal Rules Hieroglyphs Chinese Empire Bible (Leviticus) Koran Roman Senate “Salus populi suprema lex esto!” Ancient Greece Roman Empire Middle Ages Birth of Modern Medicine “Great Sanitary Awakening” Modern Public Health Personal hygiene Physical fitness Olympics Naturalistic concept Disease caused by imbalance between man and his environment Hippocrates Father of Western medicine Causal relationships Disease and climate, water, lifestyle, and nutrition Coined the term epidemic Epis (“on” or “akin to”) Demos (“people”) Adopted Greek health values Great engineers Sewage systems Aqueducts Administration Public baths Water supply Markets Le Pont du Gard 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 Worst years 1348-1352 More than 60 million dead worldwide. Death of 25% to 50% of population Disease, spread by traders and explorers Smallpox, measles, typhoid, and STD’s Killed 90% of indigenous people in New World Birth of Modern Medicine William Harvey 1628 theories of circulation Edward Jenner 1796 cowpox experiment Coined the term vaccine (vacca, Latin for “cow”) -Slums -Poverty -Disease Growth in scientific knowledge Humanitarian ideals Water supply and sewage removal Monitor community health status Connection between poverty and disease Even today, poverty is the single best predictor of poor health. • 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 The Cholera Outbreak of (1813-1858) 1. Study cases to identify the disease. 2. Look for possible causes. 3. Track the source. -------------------------1. Make a treatment plan. 2. Stop the origin 3. Stop the spread. 4. Prevent further outbreaks No pump handle, no water, no cholera Made under the direction of W. De F. Day, M.D., Sanitary Superintendent, NYC Health Dept. www.ihm.nlm.nih.gov Louis Pasteur 1862 germs caused many diseases! (rabies vaccine, Pasturization of milk…) 1888 first public health lab Robert Koch 1822-1895 1883 identified the vibrio (water bacteria) that causes cholera, 20 years after Snow’s discovery Discovered the tuberculosis bacterium 1843-1910 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” 1800-1890 “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 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. CDC, Morbidity and Mortality Country-wide vaccination. Weekly Report, December 24, 1999 / 48(50); 1141. 2. Motor-vehicle safety. Available at: http://www.cdc.gov/mmwr/preview/ 3. Safer workplaces. mmwrhtml/mm4850bx.htm 4. Control of infectious diseases. 5. Decline in deaths from coronary heart disease and stroke. 6. Safer and healthier foods. 7. Healthier mothers and babies. 8. Family planning. 9. Fluoridation of drinking water. (of treated, safe water!) 10. Recognition of tobacco use as a health hazard. 1. U.S. Mortality Rate: 1900-2001 The Top 10 leading Causes of Death in the US (accounting for nearly 75% of all deaths.) How many are caused infectious disease? 1. Heart disease 2. Cancer (malignant neoplasms) 3. Chronic lower respiratory disease 4. Stroke (cerebrovascular diseases) 5. Accidents (unintentional injuries) 6. Alzheimer's disease 7. Diabetes (diabetes mellitus) 8. Influenza and pneumonia 9. Kidney disease (nephritis, nephrotic syndrome, and nephrosis) 10.Suicide (intentional self-harm). 00 0 -3 00 0 -1 00 0 1 AD 10 00 12 00 14 00 16 00 17 50 18 50 19 10 19 30 19 50 19 70 19 90 20 10 -8 Population (in millions) 8000 3000 2010 7000 6000 5000 4000 1850 2000 1000 0 Year Health Protection: Urgent Challenges World Trade Center Sept 2001 Space Shuttle Hurricane Isabel Columbia Disaster Sept 03 Feb 03 West Influenza Nile Sept 03 Virus Aug-Nov SARS 02 Mar-Aug 03 Anthrax Attacks Oct-Nov 01 Monkey Pox RNC 2004 California Wildfires Northeast Blackout Aug 03 G8 Summit Oct-Nov 03 June 04 Ricin Tularemia Anthrax Oct-Nov 03 June-Aug 03 Aug 04 BSE Dec 03 Guam Typhoon Feb 04 Avian Influenza Jan-Mar 04 DNC 2004 July 04 2004 Summer Olympics June 04 Ricin Domestic Response Feb 04 Tsunami Dec 04 West Nile Virus Aug-Nov 04 Hurricanes (Charley, Frances, Ivan, Jean) Aug-Oct 04 Hurricane Katrina Aug. 05 Hurricane Wilma E.Coli Nov 06 Oct 04 Influenza Vaccine Shortage Hurricane Isabel Sept 03 Hurricane Rita Sept. 05 Climate Change Oct 04 Marburg Virus Mar 05 TB May ‘07 Goals and Strategic Subgoals Healthy People During Every Stage of Life Infants & Toddlers Children Adolescents Adults Older Adults Healthy People in Healthy Places Workplace Communities Homes Travel & Recreation Healthcare Settings Schools Institutions People Prepared for Healthy People in a Emerging Health Healthy World Threats Prevent Detect & Report Investigate Control Recover Improve Health Promotion Health Protection Health Diplomacy 2015 CDC Targets Tobacco Nutrition, Physical Activity, Obesity, and Food Safety Healthcare-associated infections Motor Vehicle Safety Teen Pregnancy HIV Policies and Interventions Behavior Physical Environment Individual Biology Access to Quality Health Care Source: U.S. Department of Health and Human Services, Health People 2010 Social Environment