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THE NEW PUBLIC HEALTH
PROLOGUEFrom its origins, when public health was integral to societies’ social structures, through the sanitary movement and contagion eras, when it evolved as a separate discipline, to the “new public health” era, when health promotion projects like Healthy Cities appear to be steering the discipline back to society’s social structure, public health seems to have come full circle.
CONTENTSPREVIOUS ERAS OF PUBLIC HEALTH
Health ProtectionMiasma Control
Contagion ControlPreventive MedicinePrimary Health Care
Health Promotion – NEW PUBLIC HEALTH
“the science and art of preventing disease, prolonging life and promoting health and efficiency through organized community effort” CEA Winslow
(1920)
HISTORY6 major approaches to public health practice implemented between ancient times and the contemporary era, defined more by important milestones than by convention.
Health Protectio
n
Contagion Control
Miasma Control
Preventive Medicine
Primary Health Care
Health Promotion
ERAS OF PUBLIC HEALTH
Antiquity --1830s 1840s
—1870s
1880s —1930s
1940s – 1960s
1970s —1980s
1990s– present
HEALTH PROTECTION ERA
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DOMINANT PARADIGM
Enforced regulation of Human Behavior
mediated by ruling elites through society’s religious, political, cultural practices
Health related societal
responses to the 1346 black death plague in
venice and marseilles
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HISTORY OF QUARANTINEBLACK DEATH IN ITALY -1347- some ports began turning away ships suspected of coming from infected areas.- authorities in Venice were the first to formalise such protective actions against plague, closing the city’s waters to suspect vessels, and subjecting travellers and legitimate ships to 30 days’ isolation.
This period was extended to 40
days some years later - hence the
term QUARANTINE
LEVITICUS 13
The biblical laws of sanitation were clearly ahead of their time!
People showing signs of sickness were to be isolated—quarantined—until examined by a priest and declared well.
ADAPTATIONS ADAPTATIONS• Quarantine of illegal
migrants.
• Enforcement of some environmental protection laws.
• Aspects of spirituality in prevention and coping with disease.
• Some occupational and transport safety laws .
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MIASMA CONTROL ERA
ENGLAND Industrial
Revolution• Influence of filthy
environmental conditions on adverse health outcomes.
• The great cholera epidemic occurred in 1832.
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THE GREAT
SANITARY AWAKENING
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SIR. EDWIN CHADWICK
• Data to correlate sanitation trends with variations in mortality rates and economic status, thus laying the foundations of modern epidemiology and surveillance.
PUBLIC HEALTH ACT
- 1848
Responsibility of the
state for the health of its
people.CHOLERA - FATHER OF PUBLIC HEALTH
[Today]
Cholera remains a global threat to public health and a key indicator of lack of social development
The actual global burden is estimated to be 3-5 million cases and 1-1.3 Lakh deaths per year.
Two vaccines are available , but the best control measures remain patient care, improved water and sanitation, and community response.
• Addressing unsanitary environmental conditions may prevent disease
• Public health legislations
• Foundations of modern epidemiology and surveillance
• Minimum standards for drainage, sewage, and refuse disposal
ADAPTATIONS
CONTAGION CONTROL ERA
ROBERT KOCH GERM THEORY
(1882)Landmark study in the etiology of TB
Proposed the germ theory postulates to demonstrate the parasitic nature of a disease.
DOMINANT PARADIGM
Improved understanding of the pathogenesis of infectious diseases like cholera.
Improved water filtration practices
Advances in bacteriology
Contemporary measures to control the outbreak of communicable diseases
Laid a scientific basis for vaccination.
ADAPTATIONS
Evidence based public health
practice
Ethical vaccination principles
Foundations for modern
chemotherapy
PREVENTIVE MEDICINE ERA
DOMINANT PARADIGM
• Improved understanding of the pathogenesis of communicable and non communicable diseases
• Focus on the prevention and cure of diseases in “High Risk groups”
• Disease “Vectors”
• Identification of Useful microbes
• Role of nutrient deficiencies
BRITAIN NATIONAL HEALTH SERVICE• Physician enhanced
ability to shape political and public perceptions of health policy.
• Professional / medical bias into the perspectives of key politicians and policymakers.
ADAPTATIONS• Focus on “high-risk
groups” in the planning
• And implementation of public health programs;
• Improved understanding of the pathogenesis of communicable and non-communicable diseases.
PRIMARY HEALTH CARE ERA
ALMA ATA DECLARATION
“Health for All”
Alma-Ata declaration 1978
Emphasis on Global Cooperation and peace
Equity in health care
Adapting health services to countries and communities
Links b/w healthcare and socioeconomic development
Inter-sectoral cooperation in health promotion and disease prevention
ADAPTATIONS
Concepts underpinning multicultural health and Healthy Cities initiatives, health inequalities, and community participation in health promotion activities.
HEALTH PROMOTION ERA
DOMINANT PARADIGM
• ADVOCACY FOR HEALTH.
• ENABLING INDIVIDUALS AND COMMUNITIES TO ATTAIN OPTIMUM HEALTH.
• Individuals and communities assisted by educational, economic, and political actions to increase control over and improve their health through attitudinal, behavioural, social and environmental changes.
“ Health Promotion ” Dr. Henry Sigerist
Describes the health education interventions and related organizational, political and economic interventions that are designed to facilitate behavioral and environmental changes to improve Health.
3 Core Components
Health EducationPreventionProtection
OTTAWA CHARTER - 1986
5 key principles
1) Build healthy public policy
2) Create supportive environments
3) Strengthen community action
4) Develop personal skills
5) Reorient health services
WHATS NEW ABOUT THE NEW PUBLIC HEALTH?
LEGACIES AND
INNOVATIONS IN HEALTH
PROMOTION Health promotion as a
distinct professional discipline.
QUARANTINE :WHAT
CHANGED?
Earlier – intense stigma and stifling autonomy
Now – more humane and less stigmatizing measures.
AUSTRALIA’S QUARANTINE AMENDMENT BILL (2003)
People ordered to be quarantined in Australia on health grounds will have the right to request independent medical assessment, thus protecting them against arbitrary retention.INDIVIDUAL AUTONOMY has been enhanced.
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TOBACCO CONTROL
Use of legislations to effectively implement contemporary public health activities.
SOCIAL DETERMINANTS OF HEALTHCurrent centralized systems of environmental protection owe a lot to Chadwicks initiatives.Attribution of the cause of ill health to environmental and social factors, rather than specifics of biology, constitutes the foundation of
SOCIAL DETERMINENTS OF HEALTH
ENVIRONMENTAL PROTECTION
LAWS• Most government
agencies charge individuals and communities for environmental sanitation services such as garbage disposal.
• Stiff penalties for those who breached environmental protection laws.
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MULTIDISCIPLINARY APPROACH
Sociologists Health economists Health promotion specialists
Dominance of the medical profession in public health, which characterized the
preventive medicine era is being
superseded by a multidisciplinary
approach
CONCLUSION
What is new about public health is not originality of strategies, but the manner in which health promotion discourse has adapted core doctrines of previous eras to address the public health threats of our era.
REFERENCESAwofeso N. What’s New About the “New Public Health”? American Journal of
Public Health. 2004;94(5):705-709.
Steinberg K. Wellness in Every Stage of Life: A New Paradigm for Public Health
Programs. Preventing Chronic Disease. 2007;4(1):A02.
Hanratty, Barbara et al. The new new public health: The Lancet , Volume 352 ,
Issue 9131 , 903 - 904
Graham H. Where Is the Future in Public Health? The Milbank Quarterly.
2010;88(2):149-168. doi:10.1111/j.1468-0009.2010.00594.x.
THANK YOUThe river called PUBLIC HEALTH started as a small spring, a small tricklet from the timeless womb of humanity. It became a rivulet, then a stream and then a river; its journey towards the ocean called HEALTH FOR ALL is still on.
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