This presentation describes what is new public health with adapted components from the previous eras of public health. Health promotion and evolution of public health is covered here.

1. THE NEW PUBLIC HEALTH

2. PROLOGUE
From its origins, when public health was integral
to societies’ social structures, through the sanitary
movement and contagion eras, when it evolved as
a separate discipline, to the “new public health”
era, when health promotion projects like Healthy
Cities appear to be steering the discipline back to
society’s social structure, public health seems to
have come full circle.

3. CONTENTS
PREVIOUS ERAS OF PUBLIC HEALTH
Health Protection
Miasma Control
Contagion Control
Preventive Medicine
Primary Health Care
Health Promotion – NEW PUBLIC HEALTH

4. “the science and art of
preventing disease,
prolonging life and
promoting health and
efficiency through organized
community effort”
CEA Winslow
(1920)

5. HISTORY
6 major approaches to public health
practice implemented between
ancient times and the contemporary
era, defined more by important
milestones than by convention.

6. Health
Protection
Contagion
Control
Miasma
Control
Preventive
Medicine
Primary
Health Care
Health
Promotion
ERAS OF PUBLIC HEALTH
Antiquity
--1830s 1840s —
1870s
1880s —
1930s
1940s –
1960s
1970s —
1980s
1990s–
present

7. HEALTH PROTECTION
ERA

9. DOMINANT
PARADIGM
Enforced regulation
of Human Behavior
mediated by ruling
elites through
society’s religious,
political, cultural
practices

10. Health related
societal responses
to the 1346 black
death plague in
venice and
marseilles

11. HISTORY OF QUARANTINE
BLACK DEATH IN ITALY -1347
- some ports began turning away ships
suspected of coming from infected areas.
- authorities in Venice were the first to
formalise such protective actions against
plague, closing the city’s waters to suspect
vessels, and subjecting travellers and
legitimate ships to 30 days’ isolation.
This period was
extended to 40 days
some years later -
hence the term
QUARANTINE

12. LEVITICUS 13
The biblical laws of
sanitation were clearly
ahead of their time!
People showing signs of
sickness were to be
isolated—quarantined—
until examined by a priest
and declared well.

13. ADAPTATIONSADAPTATIONS
• Quarantine of illegal
migrants.
• Enforcement of some
environmental
protection laws.
• Aspects of spirituality in
prevention and coping
with disease.
• Some occupational and
transport safety laws .

14. MIASMA CONTROL ERA

15. ENGLAND
Industrial
Revolution
• Influence of filthy
environmental conditions
on adverse health
outcomes.
• The great cholera
epidemic occurred in
1832.

16. THE
GREAT
SANITARY
AWAKENING

17. SIR.
EDWIN CHADWICK
• Data to correlate
sanitation trends with
variations in mortality
rates and economic
status, thus laying the
foundations of modern
epidemiology and
surveillance.

18. PUBLIC
HEALTH ACT
- 1848
Responsibility
of the state
for the health
of its people.
CHOLERA - FATHER OF PUBLIC

19. [Today]
Cholera remains a global threat to public health and a key
indicator of lack of social development
The actual global burden is estimated to be 3-5 million cases
and 1-1.3 Lakh deaths per year.
Two vaccines are available , but the best control measures
remain patient care, improved water and sanitation, and
community response.

20. • Addressing unsanitary
environmental conditions may
prevent disease
• Public health legislations
• Foundations of modern
epidemiology and surveillance
• Minimum standards for
drainage, sewage, and refuse
disposal
ADAPTATIONS

21. CONTAGION CONTROL ERA

22. ROBERT KOCH
GERM THEORY
(1882)
Landmark study in the
etiology of TB
Proposed the germ
theory postulates to
demonstrate the parasitic
nature of a disease.

23. DOMINANT
PARADIGM
Improved understanding of the
pathogenesis of infectious
diseases like cholera.
Improved water filtration practices
Advances in bacteriology
Contemporary measures to
control the outbreak of
communicable diseases
Laid a scientific basis for
vaccination.

24. ADAPTATIONS
Evidence based public
health practice
Ethical vaccination
principles
Foundations for
modern chemotherapy

25. PREVENTIVE MEDICINE ERA

26. DOMINANT
PARADIGM
• Improved understanding
of the pathogenesis of
communicable and non
communicable diseases
• Focus on the prevention
and cure of diseases in
“High Risk groups”

27. • Disease “Vectors”
• Identification of
Useful microbes
• Role of nutrient
deficiencies

28. BRITAIN NATIONAL
HEALTH SERVICE
• Physician enhanced
ability to shape political
and public perceptions of
health policy.
• Professional / medical
bias into the
perspectives of key
politicians and
policymakers.

29. ADAPTATIONS
• Focus on “high-risk
groups” in the planning
• And implementation of
public health programs;
• Improved understanding of
the pathogenesis of
communicable and non-
communicable diseases.

30. PRIMARY HEALTH CARE ERA

31. ALMAATA
DECLARATION
“Health for All”
Alma-Ata declaration 1978
Emphasis on Global Cooperation
and peace
Equity in health care
Adapting health services to
countries and communities
Links b/w healthcare and
socioeconomic development
Inter-sectoral cooperation in health
promotion and disease prevention

32. ADAPTATIONS
Concepts underpinning
multicultural health and
Healthy Cities initiatives,
health inequalities, and
community participation in
health promotion activities.

33. HEALTH PROMOTION ERA

34. DOMINANT
PARADIGM
• ADVOCACY FOR HEALTH.
• ENABLING INDIVIDUALS AND
COMMUNITIES TO ATTAIN
OPTIMUM HEALTH.
• Individuals and communities
assisted by educational,
economic, and political actions
to increase control over and
improve their health through
attitudinal, behavioural, social
and environmental changes.

35. “ Health Promotion ”
Dr. Henry Sigerist
Describes the health
education interventions and
related organizational,
political and economic
interventions that are
designed to facilitate
behavioral and
environmental changes to
improve Health.
3 Core Components
Health
Education
Prevention
Protection

36. OTTAWA CHARTER
- 1986
5 key principles
1) Build healthy public policy
2) Create supportive environments
3) Strengthen community action
4) Develop personal skills
5) Reorient health services

37. WHATS NEW ABOUT THE NEW PUBLIC
HEALTH?

38. LEGACIES AND
INNOVATIONS
IN HEALTH
PROMOTION
Health promotion as a
distinct professional
discipline.

39. QUARANTINE :
WHAT
CHANGED?
Earlier – intense stigma and stifling
autonomy
Now – more
humane and less
stigmatizing
measures.

40. AUSTRALIA’S QUARANTINE
AMENDMENT BILL (2003)
People ordered to be quarantined in Australia on health
grounds will have the right to request independent medical
assessment, thus protecting them against arbitrary
retention.
INDIVIDUAL AUTONOMY has been enhanced.

41. TOBACCO
CONTROL
Use of legislations to effectively
implement contemporary public
health activities.

42. SOCIAL DETERMINANTS OF
HEALTH
Current centralized systems of environmental protection owe a lot
to Chadwicks initiatives.
Attribution of the cause of ill health to environmental and social
factors, rather than specifics of biology, constitutes the foundation
of
SOCIAL DETERMINENTS OF HEALTH

43. ENVIRONMENTAL
PROTECTION
LAWS
• Most government agencies
charge individuals and
communities for
environmental sanitation
services such as garbage
disposal.
• Stiff penalties for those who
breached environmental

44. MULTIDISCIPLINARY
APPROACH
Sociologists
Health economists
Health promotion specialists
Dominance of the
medical profession in
public health, which
characterized the
preventive medicine era
is being superseded by
a multidisciplinary
approach

45. CONCLUSION
What is new about public health is not
originality of strategies, but the manner in
which health promotion discourse has
adapted core doctrines of previous eras to
address the public health threats of our era.

46. REFERENCES
Awofeso N. What’s New About the “New Public Health”? American Journal of
Public Health. 2004;94(5):705-709.
Steinberg K. Wellness in Every Stage of Life: A New Paradigm for Public
Health Programs. Preventing Chronic Disease. 2007;4(1):A02.
Hanratty, Barbara et al. The new new public health: The Lancet , Volume 352 ,
Issue 9131 , 903 - 904
Graham H. Where Is the Future in Public Health? The Milbank Quarterly.
2010;88(2):149-168. doi:10.1111/j.1468-0009.2010.00594.x.

47. THANK YOU
The river called PUBLIC HEALTH started as a
small spring, a small tricklet from the timeless
womb of humanity.
It became a rivulet, then a stream and then a
river; its journey towards the ocean called
HEALTH FOR ALL is still on.