Lecture Outline:Black Death, Influenza & SARS

Introduction: • Epidemiology • Public Health

1. Case Studies• Black Death• Influenza• SARS

2. Issues in Public Health :• Health Promotion • Economies of Public Health• Emerging Approaches

3. Lessons from History? • Public Health can work• The Global Community• Fear, Blame & the Other• Public Health as Democracy

Epidemiology:Epidemiology:

The study of distribution, The study of distribution, determinants & frequency of determinants & frequency of human disease.human disease.

Epidemiological Transition:Epidemiological Transition:

Somewhere between 1910 and 1912 in this Somewhere between 1910 and 1912 in this country, a random patient, with a random country, a random patient, with a random

disease, consulting a doctor chosen at disease, consulting a doctor chosen at random, had for the first time in the history random, had for the first time in the history of mankind, a better than fifty-fifty chance of mankind, a better than fifty-fifty chance

of profiting from the encounterof profiting from the encounter..

““The science and art of preventing The science and art of preventing disease, prolonging life, & promoting disease, prolonging life, & promoting physical health & efficiency through physical health & efficiency through organized community efforts for the organized community efforts for the sanitation of the environment, the sanitation of the environment, the control of community infections, the control of community infections, the education of the individual in principles education of the individual in principles of personal hygiene, the organization of personal hygiene, the organization of medical and nursing service for the of medical and nursing service for the diagnosis & preventative treatment of diagnosis & preventative treatment of disease, & the development of the disease, & the development of the social machinery which will ensure to social machinery which will ensure to every individual in the community a every individual in the community a standard of living adequate for the standard of living adequate for the maintenance of health.”maintenance of health.”

Charles Winslow, Professor of Public Charles Winslow, Professor of Public Health, Yale University, 1920.Health, Yale University, 1920.

Deconstructing Winslow On Public Health:(or how to take notes from what Megan just

said)

Defining Public Health: (Charles Winslow, Yale Uni, 1920)

• Prevention not treatment,

• Org + control of infection, sanitation etc

• Public education key – knowledge + res

• Medical profs + org good indiv health

Education

CommunityHealth

Practitioner

Wellbeing

Sanitation

Public Health

The Black DeathThe Black Death• Timeline: 1347-51 ADTimeline: 1347-51 AD

• 10 – 24 million dead in Europe & 1/3 10 – 24 million dead in Europe & 1/3 Muslim population in Middle EastMuslim population in Middle East

• Mode of transmissionMode of transmission

• Economic & social impactEconomic & social impact

The Black DeathThe Black Death

BBllaacckk DDeeaatthh,, IIttaallyy

Father abandoned child & wife. Huge pits were Father abandoned child & wife. Huge pits were dug and the multitude of the dead were piled dug and the multitude of the dead were piled within them. And I, Angnolo di Tura buried my within them. And I, Angnolo di Tura buried my five children with my own hands. And there were five children with my own hands. And there were those so poorly covered with earth that the dogs those so poorly covered with earth that the dogs dug them up & gnawed their bodies throughout dug them up & gnawed their bodies throughout the city. And there were none who wept for any the city. And there were none who wept for any death, for everyone expected to die.death, for everyone expected to die.

Eyam, Eyam, England England Plague Plague Village 1665Village 1665

1918-1919 Influenza 1918-1919 Influenza PandemicPandemic

1918-1919 Influenza 1918-1919 Influenza PandemicPandemic

1918-1919 Influenza 1918-1919 Influenza PandemicPandemic

SARSSARS

Severe Acute Severe Acute Respiratory Respiratory Syndrome Syndrome

• 8, 096 known cases & 8, 096 known cases & 774 deaths 774 deaths

• Toronto – WHO Travel Toronto – WHO Travel Advisory & hospital Advisory & hospital quarantines quarantines

• Racism – Toronto & Racism – Toronto & New YorkNew York

For those of you who eat in Chinatown, please be For those of you who eat in Chinatown, please be advised that SARS has hit that area. As of today I advised that SARS has hit that area. As of today I heard that the owner’s sons(s) & the entire staff of heard that the owner’s sons(s) & the entire staff of Fancy Pho have been infected with the SARS. The Fancy Pho have been infected with the SARS. The owner was infected & has passed away recently due owner was infected & has passed away recently due to what have seemed to be flue like symptoms. I to what have seemed to be flue like symptoms. I think it is best that you either stay away from that think it is best that you either stay away from that area or eat in.area or eat in.

Email dated April 1, 2003 found at Email dated April 1, 2003 found at http://urbanlegends

Anti-Asian Laundry Advert, 1911Anti-Asian Laundry Advert, 1911

Health PromotionHealth Promotion

Economies of Public HealthEconomies of Public Health

Public health departments across America have Public health departments across America have never recovered from decades of cutbacks, despite never recovered from decades of cutbacks, despite injections of funding in response to specific injections of funding in response to specific emergencies such as AIDS or the threat of emergencies such as AIDS or the threat of bioterrorism. Purchases of newer and more reliable bioterrorism. Purchases of newer and more reliable diagnostic-testing equipment have been deferred; diagnostic-testing equipment have been deferred; technical staff and other employees needed to technical staff and other employees needed to support epidemiologic and testing programs have support epidemiologic and testing programs have been downsized; vital on-site bacteriological and viral been downsized; vital on-site bacteriological and viral laboratories have been closed and the testing laboratories have been closed and the testing outsourced to the lowest bidder or simply abandoned.outsourced to the lowest bidder or simply abandoned.

Ronald J Glasser, M.D.,Ronald J Glasser, M.D.,Harpers MagazineHarpers Magazine, July 2004, July 2004

Emerging Approaches:Emerging Approaches:

Emerging Approaches:Emerging Approaches: How did U.S. communities cope with

the 1918 flu pandemic? http://www.med.umich.edu/medschool/chm/influenza/index.htm

Emerging Approaches:Emerging Approaches:

Lessons from History?Lessons from History?

• Public Health can work

• Fear, Blame & the Other

• The Global Community

• Public Health as Democracy