THE NEW PUBLIC HEALTH

PROLOGUEFrom 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.

CONTENTSPREVIOUS ERAS OF PUBLIC HEALTH

Health ProtectionMiasma Control

Contagion ControlPreventive MedicinePrimary Health Care

Health Promotion – NEW PUBLIC HEALTH

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

(1920)

HISTORY6 major approaches to public health practice implemented between ancient times and the contemporary era, defined more by important milestones than by convention.

Health Protectio

n

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

HEALTH PROTECTION ERA

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DOMINANT PARADIGM

Enforced regulation of Human Behavior

mediated by ruling elites through society’s religious, political, cultural practices

Health related societal

responses to the 1346 black death plague in

venice and marseilles

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HISTORY OF QUARANTINEBLACK 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

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.

ADAPTATIONS ADAPTATIONS• 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 .

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MIASMA CONTROL ERA

ENGLAND Industrial

Revolution• Influence of filthy

environmental conditions on adverse health outcomes.

• The great cholera epidemic occurred in 1832.

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THE GREAT

SANITARY AWAKENING

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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.

PUBLIC HEALTH ACT

- 1848

Responsibility of the

state for the health of its

people.CHOLERA - FATHER OF PUBLIC HEALTH

[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.

• 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

CONTAGION CONTROL ERA

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.

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.

ADAPTATIONS

Evidence based public health

practice

Ethical vaccination principles

Foundations for modern

chemotherapy

PREVENTIVE MEDICINE ERA

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”

• Disease “Vectors”

• Identification of Useful microbes

• Role of nutrient deficiencies

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.

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.

PRIMARY HEALTH CARE ERA

ALMA ATA 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

ADAPTATIONS

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

HEALTH PROMOTION ERA

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.

“ 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 EducationPreventionProtection

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

WHATS NEW ABOUT THE NEW PUBLIC HEALTH?

LEGACIES AND

INNOVATIONS IN HEALTH

PROMOTION Health promotion as a

distinct professional discipline.

QUARANTINE :WHAT

CHANGED?

Earlier – intense stigma and stifling autonomy

Now – more humane and less stigmatizing measures.

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.

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TOBACCO CONTROL

Use of legislations to effectively implement contemporary public health activities.

SOCIAL DETERMINANTS OF HEALTHCurrent 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

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 protection laws.

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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

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.

REFERENCESAwofeso 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.

THANK YOUThe 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.