Phases of Public health- Developed countries Tracing back public health concept

1. Tracking back public health concept
Presented by: Tilak Mahatara
MPH, 5th Batch Pokhara University

2. Age of liberalism
1790-1880
Golden age of Public Health
1880 - 1970
Return to liberalism
1970 onwards

3.  Political and social philosophy based on:
o individual rights
o civil liberties
o democracy
o free enterprise and
o equality before the law
 Liberalism: a political and economic doctrine that takes protecting and enhancing the
freedom of the individual.
Social and intellectual movement: Included a wide range of philosophical, political ,
economical and religious ideas, but at its heart were notions of individual freedom

4. Background
American War of
Independence: founded
liberal principles, “ all men
are created equal.‟
1 7 The Declaration of the Rights of
Man and of the Citizen, first codified
in 1789 in France, is a foundational
document of both liberalism and
human rights.
7 5 - 1 7 8 3
 Monarchy + Church= Political Power
 Nothing was produced or sold, imported or
exported, without government approval
and regulation.
 Social Inequality in France due to the Estates
System.
 High tax burden on the Third Estate
(merchants, lawyers, laborers and peasants)
 Financial Crisis caused due to Costly Wars.
 Food shortages and economic crises led to
the outbreak of the French Revolution
 End to the French monarchy &
feudalism
 Took political power from the Catholic
church.
 Brought new ideas to Europe including:
o liberty and freedom for the
commoner
o the abolishment of slavery and
the rights of women.
 Liberalism spread across Europe, South
& North America
1 7 8 9
T h e F r e n c h Revo l u t i o n Befor e the Fr ench
r evolution
A f t e r m a t h o f F r e n c h
r evo l u t i o n
1 7 7 5 - 1 7 8 3
 No regulation for medical
licensing
 Physicians focused on their
social class-organized like
clergy
 Medical practice based on
physicians‟ theories
 Hospital & Prison combined
into one all-purpose, also
included hospice &
orphanage care
 4-6 patients
accommodated to one bed
 Abolishment of medical licensing
 Meritocracy: encouragement of
ability instead of privilege
 Hospitals were reformed and
established as scientific institutions.
 One bed per patient
 Patients separated by type of
disease & wards became specialized
 Patients treated as source of
knowledge
 Medical practice was based on
physical examination of signs &
symptoms
 Lesions of dead patient: source of
knowledge to pathologist & surgeons
who practiced their techniques
 The new mottos of the medical
profession were words such as
“reform,” “progress,” “observation
"and “precision.”
Data sources: https://www.hamilton.edu/news/story/revolutionary-medicine-and-the-medical-revolution
https://oyc.yale.edu/history/hist-234/lecture-8; https://www.tandfonline.com/doi/abs/10.1080/21548331.1977.11707230?journalCode=ihop20
1792

5. Many liberals themselves arrived at a biosocial vision which recognized that liberty had
biological prerequisites:
 it was impractical, inhumane, and injudicious to impose economic and political responsibilities on
people who were biologically incapable of meeting those responsibilities.
Governments in France and Britain concerned about this underclass of people and considered
them as:
 representing a reservoir of disease, both literal physical disease and metaphorical social disease
(who could not be trusted with political rights and seemed immune to the incentives of the market)
 Reformers proposed to transform these dangerous classes, usually with Bibles, schools, or
experimental colonies.

6. 1
2
3
4
5
6
1854-58
1854: Dr John Snow
proved that cholera was
caused by a polluted
water supply.
1858: The 'Great Stink',
the River Thames became
so polluted that Parliament
had to stop sitting because
of the smell. Beginning of
the London main drainage
scheme, largely because
of the 'stink„.
1832
First Cholera
Epidemic
resulted in
13,000 deaths in
Britain.
1842
Edwin Chadwick‟s
national „Report on
the sanitary
condition of the
labouring
population of Great
Britain formed the
basis of first public
health act
1848
1st Public Health Act
A central board was set up
to make recommendations
to the local boards for
improving sanitation &
living standards.
•Act not successful: boards
had no real power – Too
few boards set up
• 1858 abolished
1866
Sanitary Act
was passed as a result
of which local authorities
had to take action to
provide fresh water,
sewage and waste
disposal.
1875
2nd Public Health Act
Forced local authorities
to appoint a Medical
Officer
Authorities had to:
• Cover & maintain
sewers properly .
• Provide clean water
• Pave and clean the
streets
AGE OF LIBERALISM (1790-1880)
KEY EVENTS RELATING TO PUBLIC HEALTH
Cholera epidemics
1848-49
1853-54
1853: Compulsory small pox
vaccination in the UK
Cholera epidemic
1865-66
1830-1880
Sanitary Awakening Era
Of Public Health
1861: Pasteur‟s germ
theory of disease

7. Influential people in the age of liberalism

8.  Best known for his theory that states:
 populations would continue expanding until growth is stopped or reversed by disease, famine,
war, or calamity.
 population growth will always tend to outrun the food supply and that betterment of humankind
is impossible without strict limits on reproduction
 His ideas led a broad range of learned public opinion in early-19th century
Britain that concluded:
 Disease - natural checks to keep population within the margins of survival.
 Successful prevention of disease would be temporary only; it would postpone an inevitable
equilibration of the food–population balance that would then need to occur through some other
form of catastrophe.
 Malthusian sentiment blocked attempts to establish foundling hospitals
 Also known for developing an exponential formula used to forecast population growth,
which is currently known as the Malthusian growth model.
Thomas Robert Malthus
(1766 –1834)
English economist &
demographer
Founder of Population
studies

9. O
His report on the Sanitary Conditions of the Labouring
Population
 showed that:
 People were living in overcrowded dirty, overpopulated
conditions which caused illness
 Many people become ill and are too sick to work which make
them poorer.
 People have to pay higher taxes to help the poor.
He made 4 recommendations:
 Improve drains and sewers to remove waste from cities.
 Remove rubbish from the streets and homes.
 Provide clean water.
 Appoint a medical officer to check above three had been
done.
1848: Public Health Act
 Chadwick‟s ideas formed the basis for the 1848 Public Health Act
which allowed city councils to implement Chadwick‟s
recommendations and collect taxes (called rates) to pay for them.
Edwin Chadwick
(1800 –1890)
English social reformer
Chadwick‟s report on the
Sanitary Conditions of the
Labouring Population
He concluded that what was really needed was not more physicians, but civil engineers to provide drainage
of streets and to devise more efficient ways of delivering clean water and removing sewage and other
noxious substances.

10. To deal with the threat of cholera,
 Simon was appointed the first Medical Officer of Health for the City of London
 Produced comprehensive annual reports on various matters such as:
 the relation of cholera to London water supply (1856)
 vaccination (1857)
 the sanitary state of the people of England (1858).
Influenced Sanitary Act 1866 & Public Health Act 1875
 made it compulsory for local authorities to improve sanitary conditions
 overcrowding in residences became illegal
 local authorities were required to take responsibility for ensuring sewerage systems
In 1890, he surveyed progress in public health during the past two centuries in his English Sanitary
Institutions, chapter „New Humanity‟ and covered
• the antislavery movement
• the rise of methodism
• growing concern about cruelty to criminals and animals
• legislation promoting religious freedom
• the introduction of free markets,
• the rationalization of criminal and civil law
• efforts towards international peace.
Sir John Simon
(1816-1904)
English surgeon
Public Health Reformer
First Chief Medical Officer of
Health for London
(1848-1855)
No longer were humans so much cannon fodder; the best policies were those which maximized
‘human worth and welfare’

11.  Maintained a system of marine hospitals for controlling the spread of epidemics
 National Board of Health was established in early 1880s but scrapped as
Public health was believed to be the business of individual states & cities
 Many state legislatures had little enthusiasm for public health.
 Towns and cities were more active, but often only sporadically, taking steps
when faced with epidemics.
 States that did establish boards of health usually focused on specific problems
rather than on public health in general

12. Roger Detels et.al., 2015 Age of liberalism Oxford textbook of Global Public
Health volume 1, fifth edition. Oxford university press. 2015; p26-328.
Christopher Hamlin- The history and development of public health in
developed countries

13. Thank you !!