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History and Mission of Public Health 1 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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Page 1: The History of Public Health - Weebly · Sanitation Revolution •Clean water; water treatment •Food inspection •Soaps, disinfectants, and pharmaceuticals •Personal hygiene

History and Mission of Public Health 1

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

Page 2: The History of Public Health - Weebly · Sanitation Revolution •Clean water; water treatment •Food inspection •Soaps, disinfectants, and pharmaceuticals •Personal hygiene

History and Mission of Public Health 2

Survive the Tribe

Requirements for Survival

Air

Water

Food

Shelter

Care

Page 3: The History of Public Health - Weebly · Sanitation Revolution •Clean water; water treatment •Food inspection •Soaps, disinfectants, and pharmaceuticals •Personal hygiene

History and Mission of Public Health 3

Public Health Codes

• Tribal Rules

• Hieroglyphs

• Chinese Empire

• Bible (Leviticus)

• Koran

• Roman Senate

Timeline

• Ancient Greece

• Roman Empire

• Middle Ages

• Birth of Modern Medicine

• “Great Sanitary Awakening”

• Modern Public Health

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History and Mission of Public Health 4

Ancient Greeks (500-323 BC)

• Personal hygiene

• Physical fitness

• Olympics

• Naturalistic concept

• Disease caused by imbalance

between man and his environment

• Rejected supernatural theory of

disease

• Introduction of scientific method

• Hippocrates

Hippocrates (b. 460 BC)

• Father of Western medicine

• Hippocratic oath

• Causal relationships

• Disease and climate, water,

lifestyle, and nutrition

• Coined the term epidemic

• Epis (“on” or “akin to”)

• Demos (“people”)

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History and Mission of Public Health 5

Roman Empire (23 BC – 476 AD)

• Adopted Greek health values

• Great engineers

• Sewage systems

• Aqueducts

• Administration

• Public baths

• Water supply

• Markets

Roman Aqueducts

Le Pont du Gard

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History and Mission of Public Health 6

Galen (130-205 AD)

• Disease is due to predisposing, exciting and

environmental factors (Epidemiological

triad)

• His teachings remained unquestioned for 1400 years

Indian system of medicine

Indus valley civilization

• (3500BC to 1500 BC)

First Urban sanitation systems

Elaborate drainage systems were built

Drains were covered with slabs

Wells and baths in houses

Knowledge of dentistry

Page 7: The History of Public Health - Weebly · Sanitation Revolution •Clean water; water treatment •Food inspection •Soaps, disinfectants, and pharmaceuticals •Personal hygiene

History and Mission of Public Health 7

Middle Ages (476-1450 AD)

• Saw deterioration of Roman

infrastructure

• Shift away from Greek and Roman

values

• Physical body less important than

spiritual self

• Decline of hygiene and sanitation

• Diseases were widely viewed as inescapable

• Beginnings of PH tools

• Quarantine of ships

• Isolation of diseased individuals

The Plague

Epidemic of plague

(black death) in

14th century

Death of 25% to 50%

of population

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History and Mission of Public Health 8

700-1200 AD

• Islam-preservation of ancient health

knowledge, schools of medicine, medical

advances (Ibn Sinna)

• Rise of cities, trade and commerce.

• Crusades-contact with Arabic medicine.

Chinese

They developed a system of variolation

to protect against small pox

Health is a result of balance between

Yin and Yang

Hygiene was recognized as

determinant of Health

Hydrotherapy, massage, acupuncture

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History and Mission of Public Health 9

Renaissance (1400-1600 AD)

Global Exploration

• Disease, spread by

traders and explorers

• Killed 90% of

indigenous people in

New World

18

Age of Enlightenment (1700’s)

• Period of revolution, industrialization, and

the growth of cities

• Miasma – “Bad Air”

• Dr. James Lind discovered that scurvy

could be controlled by lime juice

• Jenner discovered a vaccine against

smallpox

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History and Mission of Public Health 10

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”)

Industrialization Urbanization (1800s)

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History and Mission of Public Health 11

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

22

The 1800’s

• Smallpox, cholera, typhoid, TB, and other diseases reached exceedingly high endemic levels

• Dr. John Snow was the first to say that diseases were caused by microorganisms

• Louis Pasteur furthered the study of disease etiology (germs/bacteria) and introduced the 1st scientific approach to immunization and pasteurization

• Lister developed the antiseptic method of treating wounds by using carbolic acid & he introduced the principle of asepsis to surgery

Page 12: The History of Public Health - Weebly · Sanitation Revolution •Clean water; water treatment •Food inspection •Soaps, disinfectants, and pharmaceuticals •Personal hygiene

History and Mission of Public Health 12

Dr. John Snow (1813-1858)

Epidemiology (1854)

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History and Mission of Public Health 13

Broad Street Pump

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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History and Mission of Public Health 14

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

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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History and Mission of Public Health 15

Ten Great Achievements in Public Health, 1900-1999

1. 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

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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History and Mission of Public Health 16

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

Challenges Ahead

New and Persistent Problems

in Public Health

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History and Mission of Public Health 17

35

…modern sanitation was

one of the greatest public

health accomplishments of

the late 19th and early 20th

centuries.

What determines health?

Disease Health Care

Cure, Care

Growing health care costs

This is not the case!!

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History and Mission of Public Health 18

Mortality rates US 1900-1970 + GNP on medical care

0 2 4 6 8

10 12 14 16 18 20

1900 1920 1940 1960

total mortality

TM -infectious diseases %GNP on medical care

Fall in std death rates for infectious diseases US 1900-1973 ( Pneumonia)

0 0.2 0.4 0.6 0.8

1 1.2 1.4 1.6 1.8

1900 1920 1940 1960 1973

Sulphonamide

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History and Mission of Public Health 19

Fall in std death rates for infectious diseases US 1900-1973 (Diphteria)

0 0.05 0.1

0.15 0.2

0.25 0.3

0.35 0.4

0.45 0.5

1900 1920 1940 1960

Toxoid

Fall in std death rates for infectious diseases US 1900-1973 (Poliomyelitis)

0

0.005

0.01

0.015

0.02

0.025

0.03

1900 1920 1940 1960 1973

Vaccine

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History and Mission of Public Health 20

Fall in std death rates for infectious diseases US 1900-1973 (Tuberculosis)

0

0.5

1

1.5

2

2.5

Isoniazid

Fall in std death rates for infectious diseases US 1900-1973 (Measles)

0

0.02

0.04

0.06

0.08

0.1

0.12

0.14

1900 1920 1940 1960 1973

Vaccine

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History and Mission of Public Health 21

Measles incidence

0 50

100 150 200 250 300 350 400 450

12 20 28 36 44 52 60 70 78

Year

Measles case rate per

100,000 population

Deaths

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History and Mission of Public Health 22

Multiple Determinants of 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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