Historical Glimpse of Public Health
Ancient Greece (500-323 BC)
Roman Empire (23 BC – 476 AD)
Middle Ages (476-1450 AD)
Birth of Modern Medicine (1650-1800 AD)
Great Sanitary Awakening (1800s-1900s)
Modern Public Health (1900 AD & onward)
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History of public health
1. Presented by : Sirjana Tiwari
School of Health and Allied Science , Pokhara
University
History of Public Health
2. What is Public Health?
“To promote health and quality of life by
preventing and controlling disease,
injury, and disability.”
—CDC Mission Statement
3. Definition of Public Health 1
“the science and art of
preventing disease,
prolonging life and
promoting health and
efficiency through organized
community effort”
CEA Winslow (1920)
4. Winslow’s definition….
the science and the art of:
(1) preventing disease,
(2) prolonging life, and
(3) promoting physical health and efficiency through
organized community efforts for:
(a) the sanitation of the environment,
(b) the control of community infections,
(c) the education of the individual in principles of
personal hygiene,
(d) the organization of medical and nursing service
for the early diagnosis and preventive treatment of
disease, and
5. Winslow’s definition….
(e) the development of the social machinery which
will ensure to every individual in the community
a standard of living adequate for the maintenance
of health
so organizing these benefits as to enable every
citizen to realize his birthright of health and
longevity
6. Definition of Public Health 2
“Public health is defined as the practices, procedures,
institutions, and disciplines required to achieve the
desired state of population health.” (Friedman, D. J.,
Parrish, R., & Ross, D. A. 2013)
7. Historical glimpse
Ancient Greece (500-323 BC)
Roman Empire (23 BC – 476 AD)
Middle Ages (476-1450 AD)
Birth of Modern Medicine (1650-1800 AD)
Great Sanitary Awakening (1800s-1900s)
Modern Public Health (1900 AD & onward)
8. Ancient Greeks (500-323 BC)
Personal hygiene
Physical fitness
Olympics
Naturalistic concept
Disease caused by
imbalance between man and
his environment
Hippocrates
9. Hippocrates (460 - 375 BC)
Father of Western medicine
Recognized body consist of
4 humours: blood, black bile,
yellow bile and phlegm
To create balance in body : exercise,
Nutrition, excretion and rest required
Causal relationships
Disease and climate, water, lifestyle,
and nutrition
Coined the term epidemic and endemic
10. Roman Empire (23 BC – 476 AD)
Adopted Greek health
values by hiring greek
Physician as personnel healer
Great engineers
Built Sewage systems
Aqueducts: bringing fresh
water in city
Establish bereaurocratic system
Administration
Public baths
Private Water supply
Physician were employed by municipalities to
provide health sercvice
Markets
12. Middle Ages (476-1450 AD)
Urbanization in Europe
overcrowding
Decline of hygiene and
sanitation
Major epidemic of bubonic
Plague and black death
Church endorsed public
health
Faith and prayer were the
accepted treatment for illness.
Beginnings of PH tools
Quarantine of ships for 40
days
13. At the end of middle age
The Plague (The Black Death)
Worst from 1348-1352
Killed at least 25 million
people in Europe (1/3 of the
population).
Killed more than 60 million
worldwide.
Death of
25% to 50%
of population
14. Renaissance (1400-1600 AD)
Global Exploration
Disease (Small pox,
measles and typhoid),
spread by traders and
explorers
Killed 90% of
indigenous people in
New World/Americas
17. Birth of Modern Medicine(1650-
1800 AD)
After Industrialization
Malnutrition , overcrowding, poor
working condition contribute to
severe disease outbreak: typhus,
typhoid, cholera
18. Great Sanitary Awakening
(1800s-1900s)
Growth in scientific
knowledge
Humanitarian ideals
Connection between
poverty
and disease
Water supply and sewage
removal
Monitor community health
status
22. Map of Diphtheria Deaths
New York City
May 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
23. Birth of Modern Medicine
Louis Pasteur
1862 germs caused many diseases
1888 first public health lab
Robert Koch
1883 identified the vibrio that causes
cholera, 20 years after Snow’s
discovery
Discovered the tuberculosis bacterium
1843-1910
1822-1895
24. Sanitary Reform
England
1842 Edwin Chadwick’s “Survey
into the Sanitary Condition of the
Laboring Classes in Great Britain”
Landmark research
Graphic descriptions of filth and
disease spread in urban areas
1848 General Board of Health
Public Health act : 1848
1800-1890
25. Sanitary Reform
United States
Colonial period
Endemic disease are: malaria,
smallpox, cholera, typhoid, diphtheria
50thousand people contacted with
yellow fever.
1850 Lemuel Shattuck’s “Report of
the Sanitary Commission of
Massachusetts”
1869 State Board of Health
Qurantine act, quarntain law was
formed 1793-1859
26. 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
27. Modern Public Health (1900 AD & onward)
At the beginning of the 20th century
Life expectancy was less than 50 years
Leading causes of death were communicable
diseases (influenza, pneumonia, tuberculosis
and GI infections)
Vitamin deficiency diseases were common
including rickets, pellagra and scurvy
Deaths associated with pregnancy and
childbirth were also high
C.E.A Winslow characterized sanitation as the
first step to uplift public health.
28. Health resources development period (1900-1960) is
further divided into
The reform phase (1900-1920)
The 1920s
The great depression and World War II
The post war years
Modern Public Health (1900 AD & onward)
29. Period of social engineering (1960-1973)
Period of health promotion (1973 to present)
Modern Public Health (1900 AD & onward)
30. The Reform Phase of Public Health
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
Modern Public Health (1900 AD & onward)
31. 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
American Cancer Society 1913
Rockefeller Foundation established 1913
Modern Public Health (1900 AD & onward)
32. Modern Public Health (1900 AD & onward)
The 1920s
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
33. Modern Public Health (1900 AD & onward)
The Great Depression and World War II
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
34. Modern Public Health (1900 AD & onward)
The Great Depression and World War II
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
35. Modern Public Health (1900 AD & onward)
The post war years
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)
36. Modern Public Health (1900 AD & onward)
The post war years
Two major events in the 1950s
Development of a vaccine to prevent polio
President Eisenhower’s heart attack focused
attention on the nations number one killer, heart
disease
37. Modern Public Health (1900 AD & onward)
Period of Social Engineering
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)
Recognition that the greatest potential for saving
lives is by education and life-style changes by
individuals
38. Modern Public Health (1900 AD & onward)
Situation by the end of the Twentieth Century
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
39. Modern Public Health (1900 AD & onward)
In 1970s, 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
40. Modern Public Health (1900 AD & onward)
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
41. Modern Public Health (1900 AD & onward)
Problems to be faced
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
42. 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
43. 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 21st century.
Committed to a single, overarching purpose:
promoting health and preventing illness, disability,
and premature death.
44. Healthy people 2010
Can be used by many different people, States,
communities, professional organizations, and
others to help them develop programs to improve
health.
45. 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
2000 - Healthy People 2010
46. Healthy People 2010
Two overarching goals
28 focus areas
467 specific objectives
10 Leading Health Indicators