A brief history of public health
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A Brief History of Public Health. Because, well, death…. What is Public Health?. “ To promote health and quality of life by preventing and controlling disease, injury, and disability. ” — CDC Mission Statement. Objectives. Define public health.

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A brief history of public health

A Brief Historyof Public Health

Because, well, death….


What is public health

What is Public Health?

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

—CDC Mission Statement


Objectives

Objectives

  • Define public health.

  • Describe conditions that existed before the advent of modern public health.

  • Describe the role of the CDC.


Survive the tribe

Survive the Tribe


A brief history of public health

Requirements for Survival

Care

Shelter

Food

Water

Air


Public health codes

Public Health Codes

  • Tribal Rules

  • Hieroglyphs

  • Chinese Empire

  • Bible (Leviticus)

  • Koran

  • Roman Senate

    • Salus populi: suprema lex esta


Timeline

Timeline

  • Ancient Greece

  • Roman Empire

  • Middle Ages

  • Birth of Modern Medicine

  • “Great Sanitary Awakening”

  • Modern Public Health


Ancient greeks 500 323 bc

Ancient Greeks (500-323 BC)

  • Personal hygiene

  • Physical fitness

    • Olympics

  • Naturalistic concept

    • Disease caused by imbalance between man and his environment

  • Hippocrates


Hippocrates b 460 bc

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”)


Roman empire 23 bc 476 ad

Roman Empire (23 BC – 476 AD)

  • Adopted Greek health values

  • Great engineers

    • Sewage systems

    • Aqueducts

  • Administration

    • Public baths

    • Water supply

    • Markets


Roman aqueducts

Roman Aqueducts

Le Pont du Gard


Middle ages 476 1450 ad

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


The plague

The Plague

Death of

25% to 50%

of population


Renaissance 1400 1600 ad global exploration

Renaissance (1400-1600 AD)Global Exploration

  • Disease, spread by traders and explorers

  • Killed 90% of indigenous people in New World


Age of reason and enlightenment 1650 1800 ad

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

IndustrializationUrbanization (1800s)


Great sanitary awakening 1800s 1900s

Great Sanitary Awakening (1800s-1900s)

  • Growth in scientific knowledge

  • Humanitarian ideals

  • Connection between povertyand disease

  • Water supply and sewage removal

  • Monitor community health status


Dr john snow 1813 1858

Dr. John Snow (1813-1858)


Epidemiology 1854

Epidemiology (1854)


Broad street pump

Broad Street Pump


Map of diphtheria deaths new york city may 1 1874 to december 31 1875

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


Growth in scientific knowledge

Growth in Scientific Knowledge

  • Louis Pasteur

    • 1862 germs caused many diseases

    • 1888 first public health lab

  • Robert Koch

    • 1883 identified the vibrio (water bacteria) that causes cholera, 20 years after Snow’s discovery

    • Discovered the tuberculosis bacterium

1822-1895

1843-1910


Sanitary reform

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


Sanitary reform1

Sanitary Reform

U.S.

  • 1850 Lemuel Shattuck’s “Report of the Sanitary Commission of Massachusetts”

  • 1869 State Board of Health

1793-1859


Redefining the unacceptable

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


Redefining the unacceptable1

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.


Sanitation revolution

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


Twentieth century

Twentieth Century

U.S. Mortality Rate: 1900-2001


Ten great achievements in public health 1900 1999

Ten Great Achievements in Public Health, 1900-1999

  • 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.

  • Fluoridation of drinking water.

  • 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 problems in public health

Challenges AheadNew and Persistent Problemsin Public Health


Cause of death u s 1990 what are they now

Cause of Death (U.S. 1990 – what are they now?)

  • Tobacco19%

  • Diet/Activity14%

  • Alcohol5%

  • Microbial agents4%

  • Toxic Agents3%

  • Firearms2%

  • Sexual Behavior1%

  • Motor Vehicles1%

  • Illicit Drug Use<1%

Tobacco

Diet/Activity

McGinnis & Foege, JAMA, 1993


Multiple determinants of health

Multiple Determinantsof Health

Policies and Interventions

Behavior

Physical Environment

Social Environment

Individual

Biology

Access to Quality Health Care

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


World population growth

World Population Growth

2010

Population (in millions)

1850

Year


A brief history of public health

Health Protection…

Health Equity


Cdc mission

To promote health and quality of lifeby preventing and controlling disease,injury, and disability

CDC Mission


A brief history of public health

Health Protection Goals

Healthy People inEvery Stage of Life

Healthy People inHealthy Places

People Prepared forEmerging Health Threats

Healthy People in aHealthy World


A brief history of public health

Healthy People During Every Stage of Life

Healthy People in Healthy Places

People Prepared for Emerging Health Threats

Healthy People in a Healthy World

Goals and Strategic Subgoals

Infants & Toddlers

Children

Adolescents

Adults

Older Adults

Workplace

Communities

Homes

Travel & Recreation

Healthcare Settings

Schools

Institutions

Health Promotion

Health Protection

Health Diplomacy

Prevent

Detect & Report

Investigate

Control

Recover

Improve


A brief history of public health

Health Protection: Urgent Challenges

Space

Shuttle

Columbia

Disaster

Feb 03

Hurricane Katrina

Aug. 05

RNC 2004

Aug 04

Hurricane Isabel

Sept 03

Tsunami

Dec 04

California

Wildfires

Oct-Nov 03

World Trade Center

Sept

2001

G8 Summit June 04

DNC 2004

July 04

Hurricane Isabel

Sept 03

West Nile Virus

Aug-Nov 02

Hurricane

Wilma

Oct 04

E.Coli

Nov 06

West

Nile Virus Aug-Nov 04

Influenza Sept 03

Ricin TularemiaAnthrax

Oct-Nov 03

SARS

Mar-Aug 03

Guam

Typhoon

Feb 04

2004

Summer

Olympics

June 04

Hurricane

Rita

Sept. 05

Influenza Vaccine

Shortage

Oct 04

Climate Change

Hurricanes (Charley, Frances, Ivan, Jean)

Aug-Oct 04

Anthrax

AttacksOct-Nov 01

Monkey

Pox

June-Aug 03

BSE Dec 03

Ricin Domestic

Response

Feb 04

Avian

Influenza

Jan-Mar 04

TB

May ‘07

Northeast Blackout

Aug 03

Marburg Virus

Mar 05


Health protection urgent realities

Health Protection – Urgent Realities


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