Public Health Historical Perspective Dr Anjum Odhwani MD

Public Health Historical Perspective Dr. Anjum Odhwani MD, MPH

Public Health in Primitive Societies § Have a sense of community hygiene l l l bury excreta burial of the dead tribal rituals for the diseased temporary isolation for the sick smoke for fumigation

Public Health in Ancient Societies (Before 500 B. C. ) § Northern India - excavations dating from around 2000 B. C. have evidence of bathrooms, drains and sewers § Middle Kingdom Egypt (2700 -2000 B. C. ) showed the presence of drainage systems § Code of Hammurabi (earliest written record concerning public health), King of Babylon in 1900 B. C. included laws pertaining to physicians and public health practices

Public Health in Ancient Societies (Before 500 B. C. ) § Sumerian clay tablet from 2100 B. C. contains prescriptions for drugs § Minoans lived on Crete (3000 -1430 BC) l drainage systems, toilets, water flushing system § Myceneans 1430 -1150 BC l same as Minoans § Egyptians knew more than 700 drugs and were some of the healthiest of ancient civilizations.

Public Health in Ancient Societies (Before 500 B. C. ) § Hebrews wrote Book of Leviticus in about 1500 B. C. l first written hygienic code • • keep a clean body protect against contagious diseases isolation for lepers disinfecting of home after an illness sanitation of campsites protect food and water hygiene of maternity

Public Health in Classical Cultures (500 B. C. to 500 A. D. ) § Greeks began to travel to Egypt § Greeks took information from the Babylonians, Egyptians, Hebrews and other people of the Eastern Mediterranean § Included these in the Greek philosophy of health and medicine § Active in the practice of community sanitation § Supplemented water from city wells by water from the mountains if necessary

Public Health in Classical Cultures (500 B. C. to 500 A. D. ) § Romans l l l Had extensive systems for public and private hygiene Brought clean water into their cities using aqueducts Had extensive bath and wash houses Had system for getting rid of garbage and other wastes. Built the first hospital

Public Health of the Middle Ages (500 -1500 A. D. ) § Dark Ages in Western Europe (500 -1000 A. D. ) • saw the fall of Rome due to evil behavior • went to the opposite extreme – immoral to view one’s own body – seldom bathed – filthy clothes; used perfume – diets were poor; used spices – sanitation ignored; waste in streets • many pandemics

Public Health of the Middle Ages (500 -1500 A. D. ) § Both pagan rites and Christian beliefs blamed disease on supernatural causes. § Christians generally believed that disease was a judgement from God for sin § This led to a failure to prevent the spread of communicable diseases § This is often called “The spiritual era of Public Health”

Public Health of the Middle Ages (500 -1500 A. D. ) § During the 7 th century Islam appeared l religion stressed cleanliness l one problem---each Hajj (pilgrimage to Mecca) was followed by a cholera pandemic l crusades brought cholera back to urbanizing Europe

Public Health of the Middle Ages (500 -1500 A. D. ) § Leprosy spread from Egypt to Asia Minor to Europe l lepers were banished lepers succumbed quickly to starvation and elements inhumane measures ended leprosy in Europe • One of the earliest recorded epidemic disease was Leprosy

Public Health of the Middle Ages (500 -1500 A. D. ) § Ghengis Khan brought plague west in 1219 § Millions died in the known world l In some parts of France only 1 in 10 survived § Known as the Black Death § Epidemics in Europe occurred periodically l 1603, 1625, 1665, 1743, 1759, 1790 § Control measures l quarantine of sailors at ports for 2 months

Public Health in the Renaissance Period (1500 -1700 A. D. ) § Time of great trade l experience of the Dark Ages was not forgotten § People now asked how diseases arose began to think that disease was not a punishment from God § Careful record keeping showed that infections killed the godly and the godless alike § Growing belief that it was environmental factors that caused disease e. g. malaria= bad air l

Public Health in the Renaissance Period (1500 -1700 A. D. ) § In reality conditions did not change much in the Renaissance period § Careful observations led to the recognition of separate diseases l cholera, typhoid, TB, smallpox, etc. § Explorers, traders and colonists took indigenous European diseases and spread them to indigenous peoples in the New World

Public Health in the Eighteenth Century § Although there had been a recognition of the role of the environment as a cause of disease, living conditions were not conducive to good health § This period had the beginnings of industrialization and urbanization § Living conditions were poor and overcrowded, water supplies were contaminated and working conditions were unsafe

Public Health in the Eighteenth Century § Significant milestone for both medicine and Public Health occurred in 1796, when Dr. Edward Jenner demonstrated the process of vaccination as a protection against small pox § Before this there had been only variolation (inoculation with small pox material)

Public Health in the Eighteenth Century § The first US census was taken in 1790 § Average at death in the US was 29 § In 1798 Marine Hospital Service was formed to deal with diseases on vessels

Public Health in the Nineteenth Century § It was realized that social and sanitary conditions impacted the economy § Industrialization led to the concentration of populations in cities § Better agricultural methods produced better nutrition § First sanitation legislation in England 1837 l National Vaccination Board

Public Health in the Nineteenth Century § Edwin Chadwick 1842 l Report on an Inquiry into the Sanitary Conditions of the Laboring Population of Great Britain § General Board of Health for England 1848 § John Simon - 1848 l first medical officer of London

Public Health in the Nineteenth Century § John Snow - 1850 l l deduced that cholera was caused by a small entity in the water used epidemiological data Predated the discovery that micro-organisms can cause disease Predominant theory of contagious disease at the time was the “miasma theory” (noxious atmosphere or influence )

Public Health in the Nineteenth Century § Ignaz Semmelweiss- 1850 - decreased death-rate of women from puerperal fever by introducing hand washing § Theory of spontaneous generation (living organisms could arise from inorganic or nonliving matter) § Pasteur in 1862 proposed the germ theory of disease and later introduced pasteurization of milk. Gave the death blow to theory of spontaneous generation. § Joseph Lister - 1867 - antisepsis

Public Health in the Nineteenth Century § Koch in 1876 demonstrated his postulates with the anthrax bacillus § He formulated 4 postulates contributing to germ theory l l The disease agent must be found in all cases of the disease The disease agent must be isolated in pure culture Inoculation of this disease agent must produce the same disease in healthy animals/people The disease agent must be re-isolated from the inoculated animal/person

Public Health in the Nineteenth Century § Between 1877 and the end of the century many bacteria that caused particular infectious diseases were identified § 1875 to 1900 The Bacteriological Period of Public Health

Public Health in the Colonies § Massachusetts l l l first to record births and deaths - 1639 law against pollution of Boston Harbor - 1647 Isolation of smallpox patients and ships - 1701 hard to enforce no agency to do it § Even the Federation of Colonies had little luck really dealing with public health issues

Eighteenth century America § 1790 George Washington ordered the first census of the population to be made § 1798 the Marine Hospital Service formed to deal with diseases brought in by ships § 1799 some cities (Boston, Philadelphia, New York and Baltimore) formed Municipal Boards of Health

19 th Century America § § Population increases Country increases in size Public health measures stationary Epidemics common for l smallpox, yellow fever, cholera, typhoid, typhus § Endemic diseases l tuberculosis, malaria

Shattuck Report - 1850 § Lemuel Shattuck - legislator - MA l l interested in public health appointed to study sanitary problems in MA document he wrote was ahead of its time no national or state PH programs at the time

Shattuck's Recommendations § § § Establish state and local boards of health Hire sanitary police or inspectors Collect and analyze vital statistics Exchange data and information Sanitation programs for towns and buildings Study health of school children

Recommendations continued § Study, supervise and/or control l § § TB, alcoholism, mental disease Supervise and study immigrants Erect model tenements, bath/wash houses Control smoke Control food adulteration

Recommendations continued § § § Establish nursing schools Teach sanitary science in medical school Include prevention in clinical practice Get routine physical exams Keep records of family illnesses Preach health from the pulpit

Shattuck Report - 1850 § Impact of this report was to start the Modern Era of Public Health in America § Proposals took some time to implement l l Massachusetts's State Board of Health was founded in 1869 and by 1900 only 38 states had state health departments There were few county health departments

Public Health in the Twentieth Century § At the beginning of the century l l Life expectancy was less than 50 years Leading causes of death were communicable diseases (influenza, pneumonia, tuberculosis and GI infections) l l Vitamin deficiency diseases were common including rickets, pellagra and scurvy Deaths associated with pregnancy and childbirth were also high

Public Health in the Twentieth Century § Health resources development period (19001960) is further divided into l l The reform phase (1900 -1920) The 1920 s The great depression and World War II The post war years

Public Health in the Twentieth Century § Period of social engineering (1960 -1973) § Period of health promotion (1973 to present)

Public Health in the Twentieth Century § The Reform Phase of Public Health l l Involved both social and moral as well as health issues Public health nursing started with a school nursing program in New York in 1902 In 1906 the passage of the Pure Foods and Drugs Act In 1910 New York passed Worker’s Compensation Act

Public Health in the Twentieth Century § First School of Public Health was established in 1918 at Johns Hopkins University § 1918 was the birth of school health education § Birth of first national level volunteer health agencies l l American Cancer Society 1913 Rockefeller Foundation established 1913

Public Health in the Twentieth Century § The 1920 s l l Period of slow development in Public Health Prohibition produced decline in alcoholics and alcohol related deaths Number of county health departments rose to 467 Life expectancy in 1930 risen to 59. 7 years

Public Health in the Twentieth Century § The Great Depression and World War II l l l by 1933 private resources could no longer meet the needs of the people who needed assistance Beginning in 1933, President Roosevelt’s New Deal created agencies and programs for public works Building of hospitals and laboratories, control of malaria and the construction of municipal water and sewer systems

Public Health in the Twentieth Century § The Great Depression and World War II l l 1935 The Social Security Act marked the beginning of the involvement of the government in social issues including health World War II decreased the availability of funds and resources for public health, but led to the development of many important medical discoveries that were made available once the war ended

Public Health in the Twentieth Century § The post war years l l l Antibiotic penicillin was made available Insecticide DDT to kill insects that transmitted communicable diseases was made available Communicable Disease Center was set up in Atlanta during the war, now known as the Center for Disease Control and Prevention (CDC)

Public Health in the Twentieth Century § The post war years l Two major events in the 1950 s • Development of a vaccine to prevent polio • President Eisenhower’s heart attack focused attention on the nations number one killer, heart disease

Public Health in the Twentieth Century § Period of Social Engineering l 1965 passage of the Medicare and Medicaid bills • Medicare provides for health care to the elderly and some disable people • Medicaid provides health care for the poor § Period of Health Promotion (1974 -present) l Recognition that the greatest potential for saving lives is by education and life-style changes by individuals

Public Health in the Twentieth Century § Situation by the end of the Twentieth Century l l l Life expectancy increased by 30 years Major infectious diseases brought under control Infant and maternal mortality rates decreased by 90 and 99% respectively Safer workplaces Safer and healthier foods

Public Health in the Twentieth Century § In 1970 s, CDC conducted a study that examined premature death § Study revealed that approx 48% of all premature deaths were because of lifestyle or health behavior-choices people make § This led the way for U. S. government’s publication Healthy People: The surgeon General’s Report on Health Promotion and Disease Prevention

Major Eras in Public Health History in the United States § Prior to 1850 Battling Epidemics § 1850– 1949 Building State and Local Infrastructure § 1950– 1999 Filling Gaps in Medical Care Delivery § After 1999 Preparing for and Responding to Community Health Threats

Public Health in the Twenty First Century § Problems to be faced l l l Health care delivery Environmental problems Lifestyle diseases Alcohol and other drug abuse New communicable diseases or old diseases that have become resistant to drug therapy

Healthy People 2010 § These are the governments goals for improved health in the population § Also includes projected mechanisms to be used to help to reach these goals

Healthy people 2010 § Comprehensive, nationwide health promotion and disease prevention agenda. § Designed to serve as a roadmap for improving the health of all people in the United States during the first decade of the 21 st century. § Committed to a single, overarching purpose: promoting health and preventing illness, disability, and premature death.

Healthy people 2010 § Can be used by many different people, States, communities, professional organizations, and others to help them develop programs to improve health.

Healthy People Entering its Third Decade 1979 Healthy People: The Surgeon General’s Report on Health Promotion and Disease Prevention 1980 Promoting Health/Preventing Disease: Objectives for the Nation 1990 Healthy People 2000: National Health Promotion and Disease Prevention Objectives 2000 Healthy People 2010

Healthy People 2010 § Two overarching goals § 28 focus areas § 467 specific objectives § 10 Leading Health Indicators

Goals of Healthy People 2010 1. Increase quality and years of healthy life. (Health related quality of life, Global assessment, Healthy days, Years of healthy life) 2. Eliminate health disparities. (gender, race and ethnicity, income and education)

Bottom Line of Healthy People 2010 § A tremendous national resource § A remarkable intellectual investment § An important part of a national action plan