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What is Public Health?

Public Health isHealthy People inHealthy Communities

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Definition of Public Health

• Public health is the science and art of• Preventing disease.

• Prolonging life.

• Organizing community efforts for the:

• Sanitation of the environment.

• Control of communicable diseases.

• Education of the individual in personal hygiene.

• Organization of medical and nursing services for the early diagnosis and preventive treatment of disease.

• Development of the social machinery to ensure everyone a standard of living adequate for the maintenance of health.

(Winslow, 1923)

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“On Airs, Waters, and Places”

“ These things one ought to consider most attentively, and concerning the waters which the inhabitants use, whether they be marshy and soft, or hard, and running from elevated and rocky situations, and then if saltish and unfit for cooking; and the ground, whether it be naked and deficient in water, or wooded and well watered, and whether it lies in a hollow, confined situation, or is elevated and cold; and the mode in which the inhabitants live, and what are their pursuits, whether they are fond of drinking and eating to excess, and given to indolence, or are fond of exercise and labor, and not given to excess in eating and drinking.”

Hippocrates, 400 BC, translated by Francis Adam

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Plague in Marseilles, 1720

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0

500

1000

1500

2000

2500

3000

3500

1860 1870 1880 1890 1900 1910 1920 1930 1940 1950 1960 1970

Tuberculosis

Whooping Cough

Measles

Death Rates 1860 – 1970D

eath

s p

er 1

00,0

00

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Leading Causes of Death, 1990

1. Heart disease

2. Cerebrovascular disease

3. Cancer – lung, trachea

4. Lower respiratory infections

5. Chronic Obstructive Pulmonary Disease

6. Cancer – colon, rectum

7. Cancer – stomach

8. Traffic accidents

9. Self-inflicted injuries

10. Diabetes

Developed Nations 1. Lower respiratory infections

2. Heart disease

3. Cerebrovascular disease

4. Diarrhoeal diseases

5. Perinatal conditions

6. Tuberculosis

7. Chronic Obstructive Pulmonary Disease

8. Measles

9. Malaria

10. Traffic accidents

Developing Nations

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Twentieth Century

• Governmental Reform

• 1908 First Bureau of Child Hygiene, New York City Health Dept.

• Dr. Josephine Baker

• Appointed Bureau chief.

• Established school nurse program.

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Representations (1800s)

Dickens Daumier

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What are the Requirements for Survival?

• Write down a list of critical things that humans need.

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Mortality Rates U.S. vs % GNP Spent on Medical Care, 1900-1970

J. McKinley and S. McKinley, “The Questionable Contribution of Medical Measures to the Decline of Mortality in the Twentieth Century.” Millbank Memorial Fund Quarterly 55 (1977): 413 Millbank Memorial

5

7.5

10

12.5

15

17.5

1900 1910 1920 1930 1940 1950 1960 1970

8.5%

7.5%

6.5%

5.5%

4.5%

3.5%

% G

NP

on

Med

ical

Car

e Percent GNP on Medical Care

Total Mortality

Mortality Minus 11 Infectious DiseasesM

ort

alit

y ra

tes

per

1,0

00

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New York State Courts

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U.S. Congress

State Legislatures

Federal Agencies

State Agencies

Local Health Dept.

Municipal Home Rule

U.S. Constitution

State Constitution

Legal Hierarchy

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Legal Functions

Rules, Regulations Laws, Statutes,

Ordinances

Legislative Branch Executive Branch

Judicial Branch

Interpretations

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Examples

Host Agent Environment

Human Bacteria, Virus Water, Food, Air

Human Energy Automobile