A short discussion on public health developments throughout this millennium. Various lessons learned are discussed in this presentation.

1. LESSONS LEARNT FROM HISTORY
OF PUBLIC HEALTH
A COMPARISON OF INDIAN AND GLOBAL
PERSPECTIVE
Presenter: Dr. JENEFA PERSIS
Moderator: Prof. AMARJEET SINGH

2. DEFINITION
❖ Public health is the science and art of preventing disease,
prolonging life and promoting health and efficiency through
organized community effort
[Winslow A, 1920]

3. DOMAINS OF PUBLIC HEALTH
[Northern Ireland Faculty of Public Health Training Committee, 2004]

4. CONTENT
❖ Pre Historic Era
❖ Ancient or Historic era
❖ Middle ages
❖ Renaissance era
❖ Era of modern scientific discoveries and
advancements
❖ Era of modern medicine and public health

5. PRE-HISTORIC ERA
 Paleolithic age - Hunting & gathering food
 Neolithic Age - Food raising societies
 Concept of supernatural theory of diseases
 Prayer & Shamanism
Understanding/
Disease CAUSE
Lessons Learnt
Supernatural theory Prayer
Shamanism

6. ANCIENT ERA (3000 BC – 500 AD)
❖ Concept of dirt and clean
❖ Personal hygiene as part of religious practice

7. 
 CHINESE CIVILIZATION (2100 BC -1100 BC)
 Concept of Imbalance (yin & yang)
❖ Balanced lifestyle
❖ Herbal medicine
❖ Barefoot doctors
❖ Hygiene
❖ Massage
❖ Acupuncture

8. ❑ EGYPTIAN CIVILIZATION (2000 BC)
❖ Make up around eyes
❖ Cleanliness
❖ Mosquito nets
❖ Prayer, magic
❖ Herbs

9. ❑ HEBREW MOSAIC LAW (1000 BC)
❖ Illness as punishment for sin
Religious obligations :
❖ Personal & community hygiene
❖ Personal & community responsibility for health
❖ Food regulation

10. ❑GREEK CIVILIZATION (460-136 BC)
❖ Why & How disease
❖ Four humorous principle
❖ Healthful living habits (personal hygiene, nutrition,
physical fitness, and community sanitation )
❖ Sport, Olympics
❖ Fit body
❖ Hygeia (Goddess of hygiene)- Preventive medicine
❖ Panacea (Goddess of Cure from disease)- Curative
medicine

11. ROMAN CIVILIZATION (120 BC – 200 AD)
❖ Clean water via aqueducts
❖ Organized garbage disposal
❖ Sewerage system
❖ Public latrine & bathrooms for poor
❖ Municipal Doctors – free care for poor
❖ Occupational health – lead exposure in mining
❖ Fine roads
❖ Drained marshes - control malaria

12. INDIAN CIVILIZATION
❖ Indus Valley Civilization(3000 – 2000 BC)
Planned building, Street paving, sewer drains
❖ Aryan – Vedic Phase (2000 – 500 BC)
Ayurveda – health as way of life , herbalism
Manu’s code of hygiene
Patanjali’s ashtanga yoga

13. INDIAN CIVILIZATION
❑ Post Vedic Phase (500 BC – 500 AD)
❖ Buddhism- way of life to attain good health
❖ Kings – health through regulation
❖ Public hospitals, School of medicine
❖ Life style, self control/ discipline, physical exercise
and regulatory measures for ensuring better
health

14. Understanding /Disease
CAUSE
Lessons Learnt
Imbalance principle
Humorous principle
Within body
Accupuncture
Balanced lifestyle
Diet
Fit Body
Yoga
Clean & Unclean Hygiene
Isolation of Unclean

15. MIDDLE AGES (500-1500AD)
❖ Dark age
❖ Superstition
❖ Ignored cleanliness & personal sanitation
❖ TB, Leprosy and Small Pox
❖ Leprosy – isolation ( application of a public health)
❖ Leper houses (Leprosaria)
❖ Trade, commerce, travel

16. ❖ Black death / Plague – Europe, France , Italy via
trade route
❖ Miasma, person to person contact
❖ Board of Health in Europe
❖ Quarantine
❖ Lazarettos (Isolation houses)
❖ Disinfection procedure

17. Disease Understanding/
CAUSE
Lessons Learnt
Plague Miasma Sanitation
Person to person
contact
Quarantining Ships
Quarantining houses
Disinfection procedure
Leprosy Person to person Isolation

18. RENAISSANCE ERA(1500-1750 AD)
❖ Trade, merchant fleets
❖ Syphilis, typhus, small pox, measles
❖ Syphilis – from America to Europe
❖ Sexual route - Regulation of prostituition
❖ Francastorius- ‘Contagion theory’- New
school of thought of infectious etiology of
diseases

19. ❖ Bills of Mortality by John Graunt (1662) – disease &
living condition
❖ First Health Statistics
❖ Planning for health services

20. ❖ Black death of sea (Scurvy)
❖ James Lind (1747) – First controlled
epidemiological trial
❖ Prevention & treatment of scurvy
❖ Royal Navy- routine issuance of lemon juice

21. Disease Understanding / CAUSE Lessons Learnt
Syphilis Contagion Theory
Sexual route of transmission
Regulation of
Prostitution
Scurvy Dietary deficiency Nutrition
Bills of
Mortality
Poor Living Conditions Heath Statistics
Health Planning

22. ENLIGHTMENT PHASE & INDUSTRIAL
REVOLUTION (1750-1830 AD)
❑ Agricultural Revolution
❑ Industrialization
❖Unhealthy urban cities
❖Unhealthy working environment
❖Focus on economic productivity ruined health

23. SANITARY MOVEMENT (1830-75 AD)
❖ Edwin Chadwick report (1842)- ”sanitary idea”
❖ Great Sanitary Awakening (anti filth crusade)
❖ Public Health Act (1848) – Health of people is State’s
responsibility
❖ Labor law reforms (Mines& Factory act)

24. ❖ Cholera (1830-1854) – Father of Public Health
❖ John Snow –
 Epidemiological investigations (Spot Map)
 Contamination of water supply by sewage
 First International Sanitary Conference (1851)
❖ Board of health in New York (1866)
❖ Board of Health in Germany (1892)
❖ American Public Health Association
(1872)

25. Disease Understanding/
CAUSE
Lessons Learnt
Diseases among
working
Population
(Chadwick’s
report)
Filthy
environment
Public Health Act
States responsibility for
Health
Mines & Factory Act
Cholera Contaminated
water
Safe water
Epidemiological
investigations

26. BACTRIOLOGIC REVOLUTION (1860..
❖ New era in Public health
❖ Germ Theory of Disease
❖ Ended Miasma theory
❖ Disease oriented approach to
Public health was adopted
❖ General hygienic measures to
specific preventive measures
1860- Pathogenic bacteria
1876- Anthrax Bacillus
1876- Gonococcus
1880 – Typhoid bacillus )
1880- Malaria organism
1880- Lepra bacillus
1882 – Tubercle bacilli
1883 – Cholera

27. SMALL POX VACCINATION
❖ Jenner (1796) – small pox vaccine
❖ British armed force (1800) – prevention by
vaccination
❖ Denmark (1803)

28. DISEASE CONTROL PHASE (1880-1920)
❖ Vaccination
❖ Concept of Preventive Medicine
1883- Anti Rabies
treatment (Pasteur)
1892 – Cholera vaccine
1894 – Diphtheria anti
toxin
1898- anti typhoid vaccine
1867- Carbolic spray
antiseptics

29. ❖ Vector borne disease
❖ Blocking channel of
transmission (Preventive
Medicine)
1896-Tsetse fly (African
sleeping sickness)
1898- Anopheles mosquito
(Malaria)
1900 – Aedes mosquito
(Yellow fever)
1898- Rat flea (Plague )

30. Disease Understanding
/ CAUSE
Lessons Learnt
Small Pox Bacteria Vaccination
Vector borne
diseases
Vector Borne Destruction of insects
Mosquito nets

31. WORLD WAR I (1914-18)
❖ Medical examination in US
❖ First barometer of health status
❖ One third of youth found unfit
❖ High rates of Goitre
❖ Iodization of salt

32. Disease Understanding /
CAUSE
Lessons Learnt
Unfit for military
service
Goitre Iodization of salt
Physical health

33. SPANISH FLU (1918)
❖ During First World War
❖ Public Health Actions
 Surveillance – Quarantining
Suspects
 Closure of Public meeting places
 Disinfection of Public Spaces
 Forbidding spitting in streets
 Mandatory face masks

34. Disease Understanding /
CAUSE
Lessons Learnt
Spanish Flu Respiratory route
Person to person
contact
Face Mask
Quarantine
Closure of Public
Spaces
Disinfection

35. ANTIBIOTIC ERA (1930 - 1962)
❖ Antibiotics – control of infectious diseases
1930- Sulfa drugs
1940- Penicillin
1940 – Streptomycin
………..
Antimalarials
Anti tubercular drugs
Anti Leprosy drugs

36. Disease Understanding /
CAUSE
Lessons Learned
Infectious Diseases Microbe Antibiotics

37. INTERNATIONALISATION OF HEALTH
(1946)
❖ Application of public health to developing countries
❖ WHO formed in 7th April 1946
❖ UNICEF formed in 11th December 1946
❖ India joins WHO as a member state in 1948
❖ Eradication of Small pox by 1977

38. Disease/ Event Understanding /
CAUSE
Lessons Learnt
Small Pox
Eradication
Vaccination International
cooperation

39. HEALTH PROMOTIONAL PHASE (1920-60)
❖ Personal health services
 Mother & Child Health
Service
 Concept of Public Health
Nursing (New York)
❖ Basic Health Services through
PHC (England) (1931)
❖ National Health Programs
INDIA
1946- Bhore
Committee (PHC
1952- National Family
Planning Programme

40. Disease/
Event
Understanding/
CAUSE
Lessons Learnt
High Maternal
& Infant
Mortality
Poverty, poor living
conditions, home
deliveries, lack of
prenatal care, poor
nutrition
Basic Health Services
through PHC
National Health
Programs

41. SOCIAL ENGINEERING PHASE (1960- 80)
❖ Concept of Risk Factor as determinants of disease
❖ Social and Behavioural aspects
Disease Understanding /
CAUSE
Lessons
Learned
Non-communicable
diseases
Social factors
Behavioural factors
Balanced
Lifestyle
Balanced Diet

42. DISASTER PREPAREDNESS
❖ International Health Regulations in 1969
(6 diseases)
❖ SARS 2002 in China, trade, international travel
❖ Revised International Health Regulations 2005
❖ Framework for Global Outbreak Alert and Response 2000
❖ India, earthquake & Tsunami - Disaster Management Act
2005

43. Disease/
Event
Understanding /
CAUSE
Lessons Learnt
SARS
pandemic
Delayed notification
International trade
International Health
Regulation
Earthquake,
Tsunami
Poor preparedness Disaster Management
Act

44. COVID 19 (Dec 2019 to…..)
Disease Understanding
CAUSE
Lessons Learnt
COVID
19
pandemi
c
Respiratory
Fomite
transmission
Globalization
Social distancing, Hand hygiene, Mask
Quarantine / Isolation –Curfew-
Lockdown
Digital Health Technology
Telemedicine, E learning

45. Lessons Learnt
COVID
19
• Universal disease surveillance
• Protection of international trade
• Maintaining vital global supply chains
• Economic support
• Greater investment in hospitals
• Aversion to unnecessary travel and meetings
• Adapt to the new normal

46. SARS COVID 19 - INDIA
 High Political commitment
 Health as long term political agenda
 Extensive use of power by the government on
 Behavioural restrictions
 Janta Curfew
 Widespread use of IT applications (Arogya Setu)
 Extensive communication (ICMR, MOHFW)
 Extensive health statistics, epidemiological principles

47. LESSONS LEARNT
 Elements of Modern Public Health
Public Health = People
Public Health = State
Public Health = Preventive medicine
Public Health = Social Medicine
Public Health = Healthy Lifestyle

48. “A wise man should consider that health is the
greatest of human blessings, and learn how by his
own thought to derive benefit from his illnesses”
- Hippocrates
THANK YOU…