Evolution of public health in aspect to Community Medicine

1. presented by:
DR. SUBRAHAM PANY

2. Dr. Lipilekha Pattanaik- For presenting the idea of the topic
Dr. E. Venkat Rao – For guiding me for the presentation.
I thankmy H.O.D. & all the facultymembers for being a great helpto me in
my seminar.
My senior colleagues have providedme a great boost in completing my
seminar

3. DEFINING
PUBLIC HEALTH:
“The science and art of preventing disease, prolonging life and
promoting physical health and efficiency through organized
community efforts for the sanitation of the environment, the
control of community infections, the education of the individual
in principles of personal hygiene, the organization of medical
and nursing services for the early diagnosis and preventive
treatment of diseases and the development of social machinery
which will ensure every individual in the community, a standard
of living adequate for maintenance of health”
:by Winslow
[REF.:TEXT BOOK OF PUBLIC HEATH AND COMMUNITY MEDICINE:AFMC:PG 7]

4. In studying history, we are able to understand how our
predicament is similar to someone else's who came prior to
us.
We might also be able to examine what they did and assess if
this is a path that we want to take or something we wish to
avoid.
Studying history connects us to something larger than
merely subjective consciousness.
[REF:K. PARK’S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICINE.]

5. From time immemorial man has been
interested in trying to control disease. The
medicine man, the priest, the herbalist and
the magician, all undertook in various ways
to cure man's disease and/or to bring relief to
the sick.
It has been truly said that medicine was
conceived in sympathy and born out of
necessity; and that the first doctor was the
first man, and the first woman, the first
nurse.

7. As centuries rolled on , civilisations' emerged in various regions ,
each civilisation having its own characteristic culture and life
style.
Every civilisation had a different hypothesis on health.
Health was considered as a state of balance between various
humors of human body, variously defined by various cultures.
Disease were believed to result from a state of imbalance caused
by disturbance in the relative proportion of these humors.

8. FATALISTIC
THEORY
* God rewards or
punishes
indivisuals on
basis of their
good and evil
deeds
DEMONISTIC
THEORY
*Indivisuals
suffering from
disease were
possessed by
demons
*Demons were
usually evil
CHARMS
THEORY
*Good spirits
bring health &
prosperity
*Evils spirits
bring upon
wrath

9. Dhanvantari : Hindu god of medicine.
Ayurveda: meaning “the science of life” is the
indigenous system of Indian medicine
Ayurveda originated from Atharvaveda.
Siddha: practiced in Tamil speaking areas of
south India.
Yoga: the key to a longer and healthy life is and
was a basic component of health care

10. WORKING HYPOTHESIS
Tri – dosa: Vata (wind)
Pita (gall)
kapha (mucus)
LEADING PERSONALITIES
Atreya : first Indian physician & teacher
Charaka : Composed charaka samhita.
Known as “father of Indian medicine”
Sushuruta : composed sushuruta samhita (which describes various
operative procedures & techiniques of plastic surgery). Known as
“father of Indian Surgery”

11. WORKING HYPOTHESIS
Five fold system : EARTH, METAL,
WATER, WOOD & FIRE
(Each related to five firm organs : Heart, Spleen,
Lungs, liver and Kidney)
3 Celestial emperors:
 Huang Ti : developed medical
facilities
 Nei Ching : a classic master of internal
medicine
LEADING
PERSONALITIES

12. WORKING HYPOTHESIS
They believed that the natural history
of disease starts with the food
consumed by an individual
 Imhotep : was considered a
master in all fields of learning and
medicine. He developed a deep
sense of sanitation among the
Egyptians.
[Ref : Foundations of community medicine: Elsevier publications 4th edition & K. Park’s
Textbook of Preventive and Social Medicine 19th edition]
LEADING
PERSONALITIES

13. WORKING HYPOTHESIS
4 fold system : Blood, Phlegm, Black bile & Yellow bile
(Each possessing properties of Heat, cold, moisture and dryness
respectively)
LEADING
PERSONALITIES
APPOLO
AESCULAPIUS
HYGEIA PANACEA
Greek God of medicine
The staff of Aesculapius -> CADUCACEUS
HYGEIA : Goddess of Hygiene -> PREVENTIVE
MEDICINE
PANACEA : Goddess of Treatment -> CLINICAL
MEDICINE

14. WORKING HYPOTHESIS
BILE & PHLEGM
(Describing Warmth and cold)
 Galen : He produced some 500 treatise which were
studied for around 14 centuries.
 Celsus : A surgeon who developed method for control of
Hemorrhage and Infection
[Ref : Foundations of community medicine: Elsevier publications 4th edition]
LEADING
PERSONALITIES

15. Arabian MEDICINE
They developed UNANI system of medicine
 Rhazes : produced over 200 medical and philosophical
treatise
 Avicenna: Compiled the “canon of medicine” for general
practitioners
 Ibn. An. Nafis : Investigator and writer. He is known to
conceive the idea of pulmonary circulation.
LEADING
PERSONALITIES

16. Mesopotamian MEDICINE
WORKING HYPOTHESIS
Liver was considered as the seat of life.
There were interpretations of dreams
relating them to disease.
Prescription were written on tablets, in
cuneiform writing.
The oldest medical prescription comes to
us from Mesopotamia, dating back to
2100 B.C.
MAJOR
WORK DONE
[Ref : Foundations of community medicine: Elsevier publications 4th edition & K. Park’s Textbook of Preventive and Social Medicine 19th
edition]

17. Miasmic:
Toxic vapor or
miasma
emanated
from decaying
animal &
vegetable
matter are
diffused into
the
surrounding
and spread al
sort of disease.
Contagion/GERM
:
This theory
held that
epidemics
resulted from
transmission
of germs.
Spontaneousgeneration:
Or Abiogenesis was
originally propounded
by Aristotle, who
believed that living
organisms directly
emerged from non
living organisms. Later
the theory was
displaced by theory of
biogenesis, i.e., “Life
originates from life”
– by Louis Pasteur

18. It is believed to be the first written
health code in world.
The book dealt with personal and
community responsibilities and
included guidance regarding the
cleanliness of body, sexual health
behaviors & protection against
contagious diseases. [REF:JOURNAL OF THE AMERICAN
MEDICAL ASSOCIATION IN 1920 AND IN THE
NEW ENGLAND JOURNAL OF MEDICINE]

19. Created by the King of Babylon, is one of the
earliest sets of laws found.
It focuses on theft, farming, Human rights,
murder, death, and injury.
There was also a documented code for
physicians and health practices.
 There was also evidence of bathrooms and
drains in homes as well as written medical
prescriptions

20. (460 – 375 B.C. )
Introduced Scientific methods to the
study of medicine
His famous oath, the "Hippocratic oath"
has become the keystone of medical ethics.
Hippocrates will always be regarded as
one of the “masters of the medical art”.

21. Also during this period, Greeks were
active in the practice of community
sanitation.
Romans improved upon Greek
engineering in the building of
aqueducts to protect water supplies.
 They also created the first hospital.
[REF : FOUNDATIONS OF COMMUNITY MEDICINE: ELSEVIER PUBLICATIONS 4TH
EDITION & K. PARK’S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICINE 19TH
EDITION & GENEVA: WORLD HEALTH ORGANIZATION; 2008. ]

22. The Middle Ages, also known as
"The Dark Ages”.
Health problems were considered
to have spiritual causes and solutions.
Bloodletting and alchemy were common
practices.
Most importantly, the failure was to consider the role of the
environment in health that led to epidemics and thus resulting
in inability to control them.

23.  Black Plague or Black Death or bubonic plague.
 It reappeared in Europe in 1348 after nearly a 1000 year
absence. Up to 2/3rds of the succumbed in the first two
years of the pandemic.
 The pandemic was approached by scientists and by 1350
A.D.
 An interesting historical footnote is that some
scholars contend that corpses were used for “biological
warfare.”

24.  This Era highlighted the value of a healthy and productive population, leading to
advances in occupational health.
 A milestone in the history of public health is the Great Sanitary awakening which took
place in England & gradually spread to other countries.
 Term Public Health came in to general use around 1840’s. It arose from need to protect
the public from the spread of communicable diseases In 1848 (Cholera in London).
 A comprehensive piece of legislation was brought into force in England, the Public
Health Act of 1875 , for the control of man’s physical environment.
 Preventive medicine really dates back to the 18th century. It developed as a branch of
medicine distinct from Public Health. Preventive Medicine got a firm foundation after
the discovery of causative agents of disease and establishment of the Germ Theory of
disease.

25. PREVENTIVE MEDICINE:
“The science and art of preventing disease, prolonging life,
promoting physical and mental health and efficiency..”
Definition: (By Leavell and Clark)
• James Lind conclusively showed in 1748 that scurvy can be
prevented by the use of fresh citrus fruits and vegetables.
• Edward Jenner discovered small pox vaccine.
• Thus the concept of ‘Preventive Medicine’ came.
• And the scope of Preventive Medicine was broadened from the
general measures of health promotion (hygiene) to specific
measures of disease prevention (immunization).

26. COMMUNITY MEDICINE:
 With the emergence of Non-communicable diseases and due
to their multifactorial etiology, the concept of
“MULTIFACTORIAL DISEASE CAUSATION” came into vogue.
 So, measures like early diagnosis, identification of risk
factors, limiting the development of disability and
rehabilitation of handicapped persons were included into
the subject.
 Thus the scope was broadened from –
 HYGIENE  PUBLIC HEALTH PREVENTIVE AND
SOCIAL MEDICINE  COMMUNITY MEDICINE

28. (1620-1674)
The father of demography and descriptive
epidemiology.
The first solid use of data collection for the
purpose of understanding health status
came from John Graunt..
In 1662, He published, Natural and Political
Observation, Upon the Bills of Mortality.
By studying London death data for the
previous 75 years.

29. He was the first to observe bacteria and other
microscopic organisms using a light microscope.
In 1700 Bernardino Ramazzini (1633-1714)
published first comprehensive occupational health treatise.
He is known as the father of occupational health.
[REF : FOUNDATIONS OF COMMUNITY MEDICINE: ELSEVIER PUBLICATIONS 4TH EDITION & K. PARK’S TEXTBOOK OF PREVENTIVE
AND SOCIAL MEDICINE.

30.  French philosopher, Denis Diderot (1713-
1784) in his article on Man, emphasized the
importance of infant mortality on the growth
or decline of a population.
 In his article The Hospital, Diderot
outlined a public assistance scheme including
old age insurance and medical care.

31. (1716 - 1794)
While serving as surgeon on HMS Salisbury, he carried out
experiments to discover the cause of scurvy.
He established the superiority of citrus fruits above all other
‘remedies’.
In 1753, he published ‘A Treatise of the Scurvy’ and in 1757 ‘An
Essay on the Most Effectual Means of Preserving the Health of
Seamen in the Royal Navy’.

32. In 1763 in the New
World, smallpox
infected blankets
were distributed to
Native Americans
starting an
epidemic which
killed thousands.
Now, Controversy
still exists as to
whether this was
deliberate
bioterrorism or a
tragic mistake.

33. In 1796, Edward Jenner published his
first paper on the potential for
inoculation, which led to the
development of the small pox
vaccine.
So successful was Jenner’s discovery,
that in 1840 the government of the day
banned any other treatment for
smallpox other than Jenner’s
(1749-1843)

34. Yellow Fever appeared in the U.S. in the late 17th century.
The deadly virus continued to strike cities, mostly eastern seaports
and Gulf Coast cities, for the next two hundred years, killing
hundreds, sometimes thousands in a single summer.

35. The 19th Century brought tremendous advances in the
understanding of health and medicine.
There was an acceptance of link between environment
and health & there were growing efforts at social reform
as a way of improving the health of the population.

36.  In 1842, Edwin Chadwick,
published his landmark report, “Report on
the Inquiry into Sanitary Conditions of the Laboring Population
of Great Britain”. This report outlined the major public health
challenges facing England at the time leading to the beginnings
of reform.
 Chadwick campaigned for changes in the law. This included the
reform of sanitation, education and transportation.
[REF : National Commission on Macroeconomics and Health. Report of the National Commission on Macroeconomics and Health 2005. MOHFW, GOI. 2005]

37. In 1850 in Boston, Shattuck released a
report. This report outlined the public
health needs in the state of Massachusetts .
Shattuck proposed the establishment of
health offices at the state and local levels in
order to gather statistical information on
public health conditions.
(1793-1859)

38. Cholera first came to
Sunderland, England in 1831-32.
It was not until the epidemic of
1854 that John Snow began to
unravel the mystery of
transmission

39. John Snow was the first to link the
cholera epidemic in London to a
particular water source—the
Broad Street Pump.
When the pump handle was
removed the disease incidence
drastically decreased.
This was the birth of “applied
epidemiology”.
(1813-1858)

40. The century also saw the rise of nursing
as a profession.
Florence Nightingale believed that infection
arose spontaneously in dirty and poorly
ventilated places.
She led to improvements in hygiene and
healthier living and working environments.
Florence Nightingale also advised and supported the
development of district nursing in Liverpool.
(1820-1910)

41.  These criteria are known as Koch’s Postulates.
 Koch was awarded the Nobel Prize for Physiology in 1905.
 German scientist, Robert Koch, was one
of the founders of bacteriology.
 In the process of discovering the causes
of anthrax, cholera and tuberculosis (1882-
1883) He developed methods and technical
procedures still used by epidemiologists.

42. French microbiologist Louis Pasteur
conducted experiments that supported the
germ theory.
His work involved the development of
systems of inoculation including the first
vaccine for rabies.
He invented the process of pasteurization.

43.  Ross studied malaria between 1881 and 1899. He worked
on malaria in Calcutta at the Presidency General Hospital.
 He demonstrated that malaria is transmitted from
infected birds to healthy ones by the bite of a mosquito, a
finding that suggested the disease’s mode of transmission
to humans.
 In 1902, Ross was awarded the Nobel Prize in Physiology /
Medicine for his remarkable work.
(1857 -1932)

44. In 1900 “The Reed Commission" after its
leader, WALTER REED proved that the
Aedes aegypti mosquito was the vector for
yellow fever.
This ended the belief that yellow fever spread
by direct contact with infected people or
"contaminated"

45. Her case exemplified the confrontation of public health,
law, ethics, the media and anti-immigrant attitudes.
In 1907 in New York City, cook Mary
Mallon, was identified as the first healthy
carrier of typhoid.
She was then known as Typhoid Mary,
Mallon spent the rest of her life in and out
of quarantine on New Brother Island.

46. In 1916, published
What Every Girl Should Know.
It provided basic information about topics
such as menstruation & acknowledged the
reality of sexual feelings in adolescents.
It was followed in 1917 by What Every
Mother Should Know.
 Sanger was a tireless pioneer for birth
control and family planning measures.

47.  There were two prevailing forces
shaping health and human
services--the World War I and
the Great Depression.
 There was no health insurance
and people were dependent on
charities for health care.

48. In 1928, Scottish physician ALEXANDER
FLEMING (1881-1955) discovered
Penicillin while studying moulds.
This discovery would be one of the most
important discoveries of the Twentieth
Century for its ability to kill bacteria and
fight infectious disease.

49. Centers for Disease Control and Prevention
(CDC) It was established in 1946 in Atlanta as
the Communicable Disease Center.
The World Health Organization (WHO) was
established by the United Nations on April 7,
1948.
Water Fluoridation began in 1948.

50. It was developed by JONAS SALK and ALBERT SABIN.
The first mass inoculations of children against polio began
in Pennsylvania on February 23, 1954.
This Indian Civil Servant was responsible for the initial concepts
of comprehensive health care.
Bhore committee was set up by the Government of India in 1943
to investigate and recommend improvements to the Indian
Public Health system.
[REF : GOVERNMENT OF INDIA. NATIONAL HEALTH POLICY. MINISTRY OF HEALTH AND FAMILY WELFARE, GOVERNMENT OF INDIA, NEW
DELHI: 2002 & KISHORE J. NATIONAL HEALTH PROGRAMS OF INDIA. NEW DELHI: CENTURY PUBLICATIONS; 2009.]

51. In 1960, Searle receives FDA approval
to sell “Enovid” as an effective birth
control pill.
It transformed women's lives around the world.
SEARLE: first pharmaceutical company to sell an oral
contraceptive.

52. On January 11, 1964, LUTHER L. TERRY,
Surgeon of the U.S. Public Health Service,
released the report of the Surgeon General's
Advisory Committee on Smoking and Health.
That landmark document, now referred to as the
First Surgeon General's Report on Smoking and
Health, was America's first widely publicized
official recognition that cigarette smoking is a
cause of cancer and other serious diseases.

53.  Dr Sushila Nayyar, was the younger sister of
Pyarelal Nayyar, personal secretary to
Mahatma Gandhi.
 She had set up the Mahatma Gandhi
Institute of Medical Sciences in Wardha, in
1969 and remained committed to confine her
energies to developing and extending it.
 Dr. Nayyar also headed the Gandhi
Memorial Leprosy Foundation.
 She was also a campaigner for family
planning.

54. 1981 a mysterious epidemic was identified as
Acquired Immune Deficiency Syndrome
(AIDS).
 It was found to be caused by the Human
immunodeficiency virus (HIV).
 It is now a global pandemic.
More than 23 million people with AIDS have
died since 1981. Millions more are living with
HIV.
GENEVA: WORLD HEALTH ORGANIZATION; 2014.

55. In 1990, the Human Genome
Project was formally
established.
The project endeavored to map
the human genome down to the
nucleotide level and to identify
all the genes present in it.

56. 1. Vaccination
2. Motor vehicle safety
3. Safer workplaces
4. Control of infectious diseases
5. Decline in deaths from coronary heart disease and stroke
6. Safer, healthier food
7. Healthier mothers and babies
8. Family planning
9. Fluoridation of drinking water
10. Recognition of tobacco as a hazard

57. CARE- Co-operative for Assistance And Relief
Everywhere
UNICEF – United Nation International Children
Emergency Fund
WHO – World Health Organization
WORLD BANK GOARN - Global Outbreak Alert and
Response Network
INTERNATIONAL HEALTH ORGANISATION
International Federation Of RED CROSS
ROTARY INTERNATIONAL
BILL & MELINDA GATES FOUNDATION

58.  In January 2000, CDC published
Healthy People 2010
 This was considered to be the
blueprint for the public health
infrastructure in the new century.

59. One month after the 9-11 tragedy, anthrax
contaminated letters were mailed to the New
York Post offices and the U.S. Senate.
Letters to Senator Tom Daschle and Senator
Patrick Leahy, carried a more potent form of
anthrax.
The CDC confirmed anthrax cases at American
Media, in Florida, and at the New York offices.
23 people contracted anthrax, 5 of whom died &
many more exposed.

60. China 2002
Spread to 37 countries through Air travel
8000 infected & 800 dead
A Global Problem
By 2010, 219 million infected world wide & 6,60,000 died
Most common in Africa, Asia Native America
1918 Kansas : 50 million affected
[REF:NATIONAL MUSEUM OF HEALTH & MEDICINE, ARMED FORCES INSTITUTE OF PATHOLOGY ]
2009 Major pandemic in Asian Sub continent
Annual epidemics :3 to 5 Million severe illness & 2,50,000
to 5,00,000 deaths around the world.
REF:WHO 2015

61. By 2012 : 8.3 million people fell ill & 1.3 million dead
Out break in West Africa : March 2014
 Avian Influenza A(H7N9) virus : March 2013

62. PREVENTIVE & PROMOTIVE HEALTH CARE
 Mission Indradhanush
PROGRAMMES FOR COMMUNICABLE
DISEASES
 Revised National Tuberculosis programme
 National Leprosy Eradication programme
 National vector borne disease control programme
 National AIDS control programme
 Pulse Polio Programme
PROGRAMME FOR NON-COOMUNICABLE
DISEASE
 National Tobacco control programme
 National programme for prevention & control of
cancer, Diabetes, Cardiovascular Diseases & stroke
 National programme for control treatment of
occupational diseases
 National programme for prevention & control of
Deafness
 National Mental Health programme
 National programme for Blindness
NATIONAL NUTRITION PROGRAMME
 Integrated Child development Services
 National Iodine Deficiency disease control
programme
 Mid – day meal programme
 Programmes related to system strengthening /
welfare
 National programme for the heath care of the Elderly
 RMNCH
 The National health Mission
 National Urban health Mission
MISCELLANEOUS
 Voluntary blood donation programme
 Universal immunisation programme
 Integrated Disease surveillance project
 Pradhan Mantri Swasthya Suraksha Yojana
 Janani sishu surakshya Karyakram
 Rashtriya kishore Swastha Karyakram
REF: NATIONAL HEALTH PORTAL; WWW.NHP.GOV.IN

63. THANK
YOU !