Changing concepts – Health and Public Health

Dr B Manoj Aravind

Health

“ Health is a state of complete physical, mental and social well-being and not merely absence of disease or infirmity”

- WHO (1948)

Public Health

“Public health is the Science and Art of preventing disease, prolonging life, and promoting health and efficiency through organized community effort”

(C.E.A. Winslow, 1920)

Public Health

“Public health is the Science and Art of preventing disease, prolonging life, and promoting health and efficiency through organized community effort”

(C.E.A. Winslow, 1920)

Public Health

Organized community effort for 1. Sanitation of the environment2. Control of communicable disease3. Education of the individuals in personal hygiene 4. Organization of medical and nursing services for

early diagnosis and preventive treatment of disease

5. Development of the social machinery to insure everyone a standard of living adequate for maintenance of health

(C.E.A. Winslow, 1920)

History

Primitive medicine

• ADAM and EVE• Supernatural Theory of Disease– Wrath of Gods– Invasion by “evil spirits”– Stars and Planets

• Healing by rituals, magic, witchcraft• “Traditional Healers” still prevalent

Medicine of Ancient Civilizations

• Indian• Chinese• Egyptian• Mesopotamian• Greek• Roman

Indian Medicine

• Ayurveda and Siddha• “Tridosha theory of disease”– Disease is dysequilibrium

• “Manusmrithi” – code of personal hygiene• Indus valley civilization –

(3300 – 1700 BC) advanced engineering systems for urban sanitation and water supply

Chinese Medicine

• Two principles – yang and yin• Balance of the two opposing forces meant

good health• Early pioneers of immunization (variolation to prevent smallpox)• Bare-foot doctors

Egyptian Medicine

• Imhotep (2600 BC) – description of diagnosis and treatment of over 200 diseases

• Prevalent “specializations” – Eye, head and tooth• “Disease due to absorption from the intestines of

harmful substances which gave rise to putrefaction of blood and formation of pus”

• Planned cities, public baths and underground drains• Innoculation against smallpox,

value of mosquito nets, association of plague with rats

Mesopotamian Medicine• Religious concepts, magic, necromancy,

geomancy, interpretation of dreams, medical astrology

• Herb doctors, knife doctors and spell doctors

• Babylonian code of Hammurabi – first codification of medical practice

Greek Medicine

• “Theory of four humors”• Legend of Aesculapius and his two daughters• Father of Medicine – “Hippocrates” – an

epidemiologist and master of medical art– Challenged the tradition of magic in medicine– Radically new approach in medicine by application

of clinical methods– “Airs, Water and Places” – Man and environment

• Hippocratic Oath – keystone of medical ethics

Roman Medicine

• State was supreme• Public Health was more robust – fine roads,

aqueducts bringing pure water to cities, drained marshes to combat Malaria, built sewerage systems, hospitals for sick

• Galen (130 -205 AD) – Predisposing, exciting and environmental factors– Preserving health more important than cure

Dark Ages of Medicine500 – 1500 AD

• Fall of Roman Empire• Europe fell into darkness ravaged by disease and

pestilence• Rise of Arabic medicine“The Arabs lit a brilliant torch from the Greecian

lamps” – Sir William Osler• Abu Becr (aka Rhazes) 865 – 925 AD• Sina (aka Avicenna) 980 – 1037 AD• Pharmacology - in search of “Elixir of life”

Dawn of Scientific Medicine

• Early revival – Renaissance • Sanitary awakening• Rise of Public health• Germ theory of disease• Birth of preventive medicine• Era of Modern Medicine

Early revival - Rennaisance(1453 – 1600 AD)

Paracelsus (1493 – 1541)•Publicly burnt works of Galen and Avicenna•Attacked superstition and dogma•Turned medicine towards rational research

Fracastorius (1483 – 1553)•“Theory of Contagion”•Invisible particles spread infection causing epidemics•Syphilis is sexually transmitted•Founder of Epidemiology

Early revival - Rennaisance(1453 – 1600 AD)

Andreas Vesalius“Science of Anatomy”

Ambroise Pare“Father of Surgery ” – specially the art

17th and 18th Centuries

• Period of exciting discoveries• William Harvey• Leeuwenhoek• Edward Jenner• Morgagni• John Hunter• Thomas

Sydenham

Sanitary Awakening

• Industrial revolution and its problems• Great Cholera Epidemic of 1832• Edwin Chadwick’s (1800-1890) Report

– “The Sanitary Conditions of the Labouring Population in Great Britain”

– Recommended improved housing and working conditions• “Great sanitary awakening” : anti-filth crusade • Enactment of the Public Health Act of 1848• “State is responsible for the health of its people”• Birth of Public health concept

Rise of Public Health

• Cholera - “Father of Public Health”• John Snow (Cholera 1848 – 54)• William Budd (Typhoid 1856)• Clean drinking water: Felt need Demand

Rise of Public Health

• Sir John Simon “ The State of Public Health in England” Sanitary Act, 1866

• Result: Comprehensive legislation - the Public Health Act of 1875

Disease Control Phase of Public Health(1880 – 1920)

• Sanitary legislation and reforms aimed at control of man’s physical environment

• General Cleanliness and clean water• Garbage and refuse disposal• Quarantine• Great achievement in improving people’s

health without targeting any specific disease• Broad foundations of public health laid

Clean Water Clean surroundings Improved housing Control of offensive trades

Supernatural Theory

Theory of Humors

Miasmatic Theory & Theory of Contagion

Theory of Spontaneous generation

Germ Theory of Disease

Germ theory of disease

• Louis Pasteur proposed in 1873• Robert Koch – 4 postulates for explaining

causation• Golden age of bacteriology – Simultaneous

discoveries in immunology• Birth of Preventive medicine

Preventive Medicine

• Distinct from Public Health when developed• “Disease prevention by specific measures”• James Lind and Edward Jenner – Early phase• Discoveries in Bacteriology, Immunology,

Parasitology, disease transmission & antibiotics

• Investigations for early detection of disease furthered the advances

Health Promotional Phase(1920-1960)

• Concept of “Health Promotion” – of individuals• State’s direct responsibility for the health of the

individual– Provision of Basic health services– Community Development programme

• Personal Health services – mother and child health, school health, industrial health

• Public health nursing

Modern Medicine

• Curative Medicine• Preventive Medicine• Social Medicine• Family Medicine• Community Medicine

Social Engineering Phase(1960-1980)

• Epidemiological transition• Diseases of the civilization and the concept of

“risk factors”• Social and behavioural aspects of disease

prioritized• Goals of preventive medicine and public health

became identical• Emergence of community health – population

health

“Health for All” Phase(1981-2000)

• Health inequalities• “Health & Developing World” – John Bryant• “Health for all by 2000: attainment of a level

of health that will permit all peoples to lead a socially and economically productive life.”

WHO (1981)• Primary Health Care approach

Now – Towards MDGs(2000-2015)

• September 2000 – UN Millienium Declaration• Road Map – till 2015: goals and targets• Health is one of the seven social areas

targeted• 3/8 Goals, 8 /18 targets, 18/48 indicators of

progress are health related

Thank you