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)

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

11. Roman Aqueducts
Le Pont du Gard

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

15. Birth of Modern Medicine(1650-
1800 AD)

16. Industrialization
Urbanization (1800s)

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

19. Dr. John Snow (1813-1858)

20. Epidemiology (1854)

21. Broad Street Pump

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

47. THANK YOU