A Brief Historyof Public Health

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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

Air

Water

Food

Shelter

Care

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Public Health Codes

• Tribal Rules

• Hieroglyphs

• Chinese Empire

• Bible (Leviticus)

• Koran

• Roman Senate• Salus populi: suprema lex esta

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Timeline

• Ancient Greece

• Roman Empire

• Middle Ages

• Birth of Modern Medicine

• “Great Sanitary Awakening”

• Modern Public Health

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Ancient Greeks (500-323 BC)

• Personal hygiene

• Physical fitness

• Olympics

• Naturalistic concept

• Disease caused by imbalance between man and his environment

• Hippocrates

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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”)

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Roman Empire (23 BC – 476 AD)

• Adopted Greek health values

• Great engineers• Sewage systems

• Aqueducts

• Administration• Public baths

• Water supply

• Markets

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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

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The Plague

Death of 25% to 50% of population

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Renaissance (1400-1600 AD)Global Exploration

• Disease, spread by traders and explorers

• Killed 90% of indigenous people in New World

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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”)

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IndustrializationUrbanization (1800s)

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Great Sanitary Awakening (1800s-1900s)

• Growth in scientific knowledge

• Humanitarian ideals

• Connection between povertyand disease

• Water supply and sewage removal

• Monitor community health status

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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 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

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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

1843-1910

1822-1895

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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

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Sanitary Reform

U.S.• 1850 Lemuel Shattuck’s

“Report of the Sanitary Commission of Massachusetts”

• 1869 State Board of Health 1793-1859

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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

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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

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Twentieth Century

Source: www.infoplease.com

89

101112131415161718

Year

Dea

ths

per

1,00

0

U.S. Mortality Rate: 1900-2001

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Public Health Nursing

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Ten Great Achievements in Public Health, 1900-19991. Vaccination.

2. Motor-vehicle safety.

3. Safer workplaces.

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.

10. 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

Challenges Ahead

New and Persistent Problemsin Public Health

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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%

McGinnis & Foege, JAMA, 1993

Tobacco

Diet/Activity

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World Population Growth

0

1000

2000

3000

4000

5000

6000

7000

8000

Year

Po

pu

lati

on

(in

mil

lio

ns)

1850

2010

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Health Disparities

Access and Outcomes

• Infant Mortality

• Cancer Screening and Management

• Cardiovascular Disease

• Diabetes

• HIV Infection/ AIDS

• Immunizations

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Multiple Determinantsof Health

Individual

Biology

Behavior

Physical Environment

Social Environment

Access to Quality Health Care

Policies and Interventions

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

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Globalization

• Emerging infectious diseases

• Reemerging infectious diseases

• Health disparities between industrial and nonindustrial countries

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