A Brief History of Public Health

A BRIEF HISTORYOF PUBLIC HEALTH

Because, well, death….

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

—CDC Mission Statement

What is Public Health?

Define public health.Describe conditions that existed before the advent

of modern public health.Describe the role of the CDC.

Objectives

Survive the Tribe

Requirements for Survival

Air

Water

Food

Shelter

Care

Tribal RulesHieroglyphsChinese EmpireBible (Leviticus)KoranRoman Senate

Salus populi: suprema lex esta

Public Health Codes

Ancient GreeceRoman EmpireMiddle AgesBirth of Modern Medicine“Great Sanitary Awakening”Modern Public Health

Timeline

Personal hygienePhysical fitness

OlympicsNaturalistic concept

Disease caused by imbalance between man and his environment

Hippocrates

Ancient Greeks (500-323 BC)

Father of Western medicineCausal relationships

Disease and climate, water, lifestyle, and nutrition

Coined the term epidemicEpis (“on” or “akin to”)Demos (“people”)

Hippocrates (b. 460 BC)

Adopted Greek health values

Great engineersSewage systemsAqueducts

AdministrationPublic bathsWater supplyMarkets

Roman Empire (23 BC – 476 AD)

Roman Aqueducts

Le Pont du Gard

Shift away from Greek and Roman valuesPhysical body less important

than spiritual selfDecline of hygiene and

sanitationBeginnings of PH tools

Quarantine of shipsIsolation of diseased individuals

Middle Ages (476-1450 AD)

The Plague

Death of 25% to 50% of population

Disease, spread by traders and explorers

Killed 90% of indigenous people in New World

Renaissance (1400-1600 AD)Global Exploration

Birth of Modern Medicine

William Harvey1628 theories of circulation

Edward Jenner1796 cowpox experiment Coined the term vaccine (vacca,

Latin for “cow”)

Age of Reason and Enlightenment (1650-1800 AD)

IndustrializationUrbanization (1800s)

Growth in scientific knowledgeHumanitarian idealsConnection between poverty

and diseaseWater supply and sewage

removalMonitor community health

status

Great Sanitary Awakening (1800s-1900s)

Dr. John Snow (1813-1858)

Epidemiology (1854)

Broad Street Pump

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

Louis Pasteur1862 germs caused many diseases1888 first public health lab

Robert Koch1883 identified the vibrio (water bacteria)

that causes cholera, 20 years after Snow’s discovery

Discovered the tuberculosis bacterium

Growth in Scientific Knowledge

1843-1910

1822-1895

England1842 Edwin Chadwick’s “Survey

into the Sanitary Condition of the Labouring Classes in Great Britain”Landmark researchGraphic descriptions of filth and

disease spread in urban areas1848 General Board of Health

Sanitary Reform

1800-1890

U.S.1850 Lemuel Shattuck’s

“Report of the Sanitary Commission of Massachusetts”

1869 State Board of Health

Sanitary Reform

1793-1859

“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 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.

Redefining the Unacceptable

Clean water; water treatmentFood inspectionSoaps, disinfectants, and pharmaceuticalsPersonal hygiene (bathing)Public works departments; garbage collection,

landfills, and street cleaningPublic health departments and regulation

Sanitation Revolution

Twentieth CenturyU.S. Mortality Rate: 1900-2001

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.

Ten Great Achievements in Public Health, 1900-1999

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

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%

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

McGinnis & Foege, JAMA, 1993

Tobacco

Diet/Activity

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

World Population Growth

Year

Popu

latio

n (in

mill

ions

)

1850

2010

Health Equity

Health Protection…

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

Healthy People inEvery Stage of Life

Healthy People inHealthy Places

Healthy People in aHealthy World

People Prepared forEmerging Health Threats

Health Protection Goals

Goals and Strategic Subgoals

Health PromotionHealth ProtectionHealth Diplomacy

WorkplaceCommunitiesHomesTravel &

RecreationHealthcare

SettingsSchoolsInstitutions

Infants & Toddlers

ChildrenAdolescentsAdultsOlder Adults

Healthy People During Every Stage of Life

Healthy People in Healthy Places

People Prepared for Emerging Health Threats

Healthy People in a Healthy World

PreventDetect & Report InvestigateControlRecoverImprove

Health Protection: Urgent Challenges RNC 2004 Aug 04

West Nile VirusAug-Nov 02

Space Shuttle

Columbia Disaster

Feb 03

SARS Mar-Aug 03

Monkey Pox

June-Aug 03

Northeast Blackout

Aug 03

California Wildfires

Oct-Nov 03

Ricin TularemiaAnthrax Oct-Nov 03

BSE Dec 03 Avian

InfluenzaJan-Mar 04

Guam Typhoon

Feb 04

Ricin Domestic Response

Feb 04

G8 Summit

June 04

2004 Summer Olympics June 04

DNC 2004 July 04

Hurricanes (Charley, Frances, Ivan, Jean) Aug-Oct 04

West Nile Virus Aug-Nov 04

Influenza VaccineShortage Oct 04

Tsunami Dec 04

World Trade Center Sept2001

AnthraxAttacksOct-Nov 01

Influenza Sept 03

Hurricane IsabelSept 03

Hurricane KatrinaAug. 05

Marburg VirusMar 05

Hurricane Rita

Sept. 05

HurricaneWilmaOct 04

E.ColiNov 06

Climate Change

Hurricane IsabelSept 03

TBMay ‘07

Health Protection – Urgent Realities