The document discusses the changing concepts of public health over time. It outlines 4 phases - the disease control phase from 1880-1920 which focused on sanitation reforms; the health promotion phase from 1920-1960 which added a focus on individual health; the social engineering phase from 1960-1980 which addressed chronic diseases and risk factors; and the 'Health for All' phase from 1981-2000 which aimed to provide a basic level of health for all people. It also provides some examples of important figures in public health like Edwin Chadwick and outlines how public health systems have contributed to increased life expectancy worldwide through programs like immunization.

1. CHANGING CONCEPTS
IN PUBLIC HEALTH
Dr. Prashant G Panchal.
MPH-22-05

2. CONTENTS
Introduction
Definition
Phases of public health
References

3. IN TR OD U C TION
Public health refers to all organized measures
(whether public or private) to prevent disease,
promote health and prolong life among the
population as a whole.
Its activities aim to provide conditions in which
people can be healthy and focus on entire
populations, not on individual patients or
diseases.
Thus, public health is concerned with the total
system and not only the eradication of a
particular disease.

4. DEFINITION
• CEA Winslow, a leading figure in the history of public health,
defined the term public health as follows:
• "The science and art of preventing diseases, prolonging life and
promoting health and efficiency through organized community
efforts for the sanitation of the environment, the control of
community infections, the education of the individual in personal
health, the organization of medical and nursing services for the
early diagnosis and preventive treatment of disease and the
development of the society machinery which will ensure to every
individual in a community, a standard of living adequate for the
maintenance or improvement of health".

5. PHASES OF PUBLIC HEALTH
• In the history of public health, four distinct phases may be
demarcated.
1. Disease Control phase (1880 –1920)
2. Health promotional phase (1920–1960)
3. Social engineering phase (1960–1980)
4. 'Health for All' phase (1981–2000 AD)

6. 1) DISEASE CONTROL PHASE.....
(1880-1920)
 Public health during the 19th century was largely a matter of
sanitary legislation and sanitary reforms aimed at the control of
man's physical environment, e,g., water supply, sewage
disposal, etc.
 Clearly these measures were not aimed at the control of any
specific disease, however these measures vastly improved the
health of the people due to diseases and death control.

7. 2) HEALTH PROMOTIONAL PHASE....
(1920-1960)
• At the beginning of the 20th century a new concept, the concept of
"health promotion" began to take shape.
• It was realized that public health had neglected the citizen as an
individual and that the state had a direct responsibility for the health of
the individual. In addition to Disease Control activities, one more goal
was added to public health, that is, health promotion of individuals.
• It was initiated as personal health services such as mother and child
health services, school health services, industrial health services,
mental health and rehabilitation services.

9. Since the state had assumed direct
responsibility for the health of the
individual, two great movements
were initiated for human
development during the first fault of
the present century, namely:-
A] Provision of basic health services
through the medium of Primary Health
centres and sub centres for rural and
urban areas is an important
development in the history of public
health.
B] The second great movement was the
community development program to
provide village development through
the active participation of the whole
community and by the initiative of the
community.

10. • 3) SOCIAL ENGINEERING PHASE....
(1960- 1980)
• With the advances in preventive medicine and practice of public
health, the pattern of disease began to change in the developed
world. Many of acute illness problems have been brought under
control.
• However, as old problems were solved, new health problems in the
form of chronic diseases began to emerge, e.g. cancer, diabetes,
cardiovascular diseases, alcoholism and drug addiction etc.
especially in the affluent societies.

11. • A new concept, the concept of risk
factors as determinants of these
diseases came into existence.
• The consequences of these
diseases, unlike the swift death
brought by the acute infectious
diseases, was to place a chronic
burden on the society that created
them fully. These problems brought
new challenges to public health which
needed reorientation more towards
social objectives.

12. PUBLIC HEALTH ENTERED A NEW PHASE IN
THE 1960S, DESCRIBED AS THE SOCIAL
ENGINEERING PHASE

13. NEW PRIORITY WERE GIVEN TO
Social and behavioral aspects of disease and health.
Public health moved into the preventive and
rehabilitative aspects of chronic diseases and
behavioral problems.

14. • 4) 'HEALTH FOR ALL' PHASE....
(1981- 2018 AD)
> As the centuries have unfolded, the glaring contrasts in the
picture of health in the developed and developing countries
came into a sharper focus despite advances in medicine.
> Most people in the developed countries, and the elite of the
developing countries, enjoy all the determinants of good health,
adequate income, nutrition, education, sanitation safe drinking
water and comprehensive health care.
> In contrast, only 10 to 20 percent of the population in the
developing countries enjoy ready access to health services of
any kind.

15. • The global conscience was stirred leading to a new awakening that the
health gap between rich and poor within countries and between
countries should be narrowed and ultimately eliminated.
• It is conceded that the neglected 80% of the world's population too have
an equal claim to healthcare, to protection from the killer diseases of
childhood, to Primary Health care for mothers and children, to treatment
for those ills that mankind has long ago learned to control, if not cure.
• Against this background, in 1981, the members of the WHO
pledged themselves to an ambitious target to provide health for all by
the year 2000 that is attainment of a level of health that will permit all
people to lead a socially and economically productive life.

16. 5 FAMOUS PUBLIC HEALTH
OFFICIALS WHO CHANGED THE
WORLD..

17. SIR EDWIN
CHADWICK
• He was an English social
reformer noted for his work
to reform the poor laws and
improve sanitary conditions
and public health

18. MC NAMARA
• Robert Strange McNamara was an
American business executive and the 8th
secretary of defence.
• Following that he served as president of
the World Bank from 1968 to 1981.
• McNamara was responsible for the
institution of systems analysis and public
policy which developed into the discipline
known today as policy analysis.

19. LEE JONG
WOOK
• Lee Jong Wook was
nominated on 28th
January 2003 by the
World Health
organization's executive
board for the post of
director general of the
agency and elected to
the post on 21st may by
the member states of
WHO for a five year
term.

20. DR. MIRTA ROSES
PERIAGO
• Dr Mirta Roses Periago is an
Argentine epidemiologist who
served as director of the Pan
American Health Organization from
2003 until 2013.

21. DR.
MARGARET
CHAN
• Dr Margaret Chan is the
director general of WHO and
was first appointed by the
World Health assembly on 9th
November 2006.
• She is responsible for
curbing communicable
diseases including
HIV/AIDS, tuberculosis, and
other vaccine preventable
diseases.

22. EFFECTS OF
CHANGING
CONCEPT OF
PUBLIC
HEALTH.
One of the earliest examples of a public health system was during the
Roman times, when a system for disposing of human waste was
developed in order to prevent the population from disease.
One of the biggest accomplishments of worldwide public health programs
is immunization, and the eradication of diseases like polio because of
immunization.
One of the first examples of immunization came as early as 100 BC in
China. Children were inoculated against smallpox by putting the pus from
a lesion of an infected individual into a scratch on their arm to prevent
them from contracting the disease
Another example of the early public health programs was in the
14th century during the Black Death in Europe. Officials found that they
could stop the spread of disease by burning portions of the cities
where infestations had been so prevalent. We now know that the disease
was rodent borne. So, burning the cities killed off the infestations of rats
that were spreading the disease.

23. The idea of quarantining those with infectious diseases came about during the
medieval period. This was also an early example of a public health measure.
Even the development of regular garbage collection programs as cities grew is an
example of a public health program. Scientists quickly discovered how dangerous
garbage was to public.
One of the primary reasons that average life expectancy across the world has increased
so dramatically in the last few years is the development of public health systems which
have brought vaccinations public health departments and health education program to the
masses.
Today's public health departments focus their efforts on broadening public health's reach
through education in addition to the work they've performed for example, newer public
health programs often educating the people about risky behaviors such as obesity
alcoholism and unsafe sex. These programs seek to reduce the number of health issues

24. REFERENCE
• Marion Willard Evans Jr, chapter 2, basic concepts in public health,
Jones and Barlett.
• WHO website.
• Park's textbook of preventive and social medicine 23rd edition, M/S
Banarasidas Bhanot publishers, Jabalpur.
• www.googleimages.com.