public health historical perspective dr. anjum odhwani md, mph

Public Health

Historical PerspectiveDr. Anjum Odhwani MD, MPH

Public Health in Primitive Societies

Have a sense of community hygiene bury excreta burial of the dead tribal rituals for the diseased temporary isolation for the sick smoke for fumigation

Public Health in Ancient Societies (Before 500 B.C.)

Northern India - excavations dating from around 2000 B.C. have evidence of bathrooms, drains and sewers

Middle Kingdom Egypt (2700-2000 B.C.) showed the presence of drainage systems

Code of Hammurabi (earliest written record concerning public health), King of Babylon in 1900 B.C. included laws pertaining to physicians and public health practices

Public Health in Ancient Societies (Before 500 B.C.)Sumerian clay tablet from 2100 B.C. contains

prescriptions for drugsMinoans lived on Crete (3000-1430 BC)

drainage systems, toilets, water flushing system

Myceneans 1430-1150 BC same as Minoans

Egyptians knew more than 700 drugs and were some of the healthiest of ancient civilizations.

Public Health in Ancient Societies (Before 500 B.C.)Hebrews wrote Book of Leviticus in about

1500 B.C. first written hygienic code

• keep a clean body

• protect against contagious diseases

• isolation for lepers

• disinfecting of home after an illness

• sanitation of campsites

• protect food and water

• hygiene of maternity

Public Health in Classical Cultures (500 B.C. to 500 A.D.)

Greeks began to travel to EgyptGreeks took information from the Babylonians,

Egyptians, Hebrews and other people of the Eastern Mediterranean

Included these in the Greek philosophy of health and medicine

Active in the practice of community sanitationSupplemented water from city wells by water

from the mountains if necessary

Public Health in Classical Cultures (500 B.C. to 500 A.D.)Romans

Had extensive systems for public and private hygiene

Brought clean water into their cities using aqueducts

Had extensive bath and wash houses Had system for getting rid of garbage and other

wastes. Built the first hospital

Public Health of the Middle Ages(500-1500 A.D.)Dark Ages in Western Europe (500-1000

A.D.)• saw the fall of Rome due to evil behavior

• went to the opposite extreme

– immoral to view one’s own body

– seldom bathed

– filthy clothes; used perfume

– diets were poor; used spices

– sanitation ignored; waste in streets

• many pandemics

Public Health of the Middle Ages(500-1500 A.D.)

Both pagan rites and Christian beliefs blamed disease on supernatural causes.

Christians generally believed that disease was a judgement from God for sin

This led to a failure to prevent the spread of communicable diseases

This is often called “The spiritual era of Public Health”


During the 7th century Islam appeared religion stressed cleanliness one problem---each Hajj (pilgrimage to

Mecca) was followed by a cholera pandemic

crusades brought cholera back to urbanizing Europe


Leprosy spread from Egypt to Asia Minor to Europe lepers were banished lepers succumbed quickly to starvation and

elements inhumane measures ended leprosy in Europe

• One of the earliest recorded epidemic disease was Leprosy

Public Health of the Middle

Ages (500-1500 A.D.)

Ghengis Khan brought plague west in 1219Millions died in the known world

In some parts of France only 1in 10 survived

Known as the Black DeathEpidemics in Europe occurred periodically

1603, 1625, 1665, 1743, 1759, 1790

Control measures quarantine of sailors at ports for 2 months

Public Health in the Renaissance Period (1500-1700 A.D.)

Time of great trade experience of the Dark Ages was not forgotten

People now asked how diseases arose began to think that disease was not a punishment

from GodCareful record keeping showed that infections killed

the godly and the godless alikeGrowing belief that it was environmental factors that

caused disease e.g. malaria= bad air

Public Health in the Renaissance Period (1500-1700 A.D.)

In reality conditions did not change much in the Renaissance period

Careful observations led to the recognition of separate diseases cholera, typhoid, TB, smallpox, etc.

Explorers, traders and colonists took indigenous European diseases and spread them to indigenous peoples in the New World

Public Health in the Eighteenth Century

Although there had been a recognition of the role of the environment as a cause of disease, living conditions were not conducive to good health

This period had the beginnings of industrialization and urbanization

Living conditions were poor and overcrowded, water supplies were contaminated and working conditions were unsafe


Significant milestone for both medicine and Public Health occurred in 1796, when Dr. Edward Jenner demonstrated the process of vaccination as a protection against small pox

Before this there had been only variolation (inoculation with small pox material)


The first US census was taken in 1790Average age at death in the US was 29 In 1798 Marine Hospital Service was

formed to deal with diseases on vessels

Public Health in the Nineteenth Century

It was realized that social and sanitary conditions impacted the economy

Industrialization led to the concentration of populations in cities

Better agricultural methods produced better nutrition

First sanitation legislation in England 1837 National Vaccination Board


Edwin Chadwick 1842 Report on an Inquiry into the Sanitary

Conditions of the Laboring Population of Great Britain

General Board of Health for England 1848John Simon - 1848

first medical officer of London


John Snow - 1850 deduced that cholera was caused by a small

entity in the water used epidemiological data Predated the discovery that micro-organisms

can cause disease Predominant theory of contagious disease at the

time was the “miasma theory” (noxious atmosphere or influence )


Ignaz Semmelweiss- 1850- decreased death-rate of women from puerperal fever by introducing hand washing

Theory of spontaneous generation (living organisms could arise from inorganic or nonliving matter)

Pasteur in 1862 proposed the germ theory of disease and later introduced pasteurization of milk. Gave the death blow to the theory of spontaneous generation.

Joseph Lister - 1867 - antisepsis


Koch in 1876 demonstrated his postulates with the anthrax bacillus

He formulated 4 postulates contributing to germ theory The disease agent must be found in all cases of the

disease The disease agent must be isolated in pure culture Inoculation of this disease agent must produce the

same disease in healthy animals/people The disease agent must be re-isolated from the

inoculated animal/person


Between 1877 and the end of the century many bacteria that caused particular infectious diseases were identified

1875 to 1900 The Bacteriological Period of Public Health

Public Health in the Colonies

Massachusetts first to record births and deaths - 1639 law against pollution of Boston Harbor - 1647 Isolation of smallpox patients and ships - 1701 hard to enforce no agency to do it

Even the Federation of Colonies had little luck really dealing with public health issues

Eighteenth century America

1790 George Washington ordered the first census of the population to be made

1798 the Marine Hospital Service formed to deal with diseases brought in by ships

1799 some cities (Boston, Philadelphia, New York and Baltimore) formed Municipal Boards of Health

19th Century America

Population increasesCountry increases in sizePublic health measures stationaryEpidemics common for

smallpox, yellow fever, cholera, typhoid, typhus

Endemic diseases tuberculosis, malaria

Shattuck Report - 1850

Lemuel Shattuck - legislator - MA interested in public health appointed to study sanitary problems in MA document he wrote was ahead of its time no national or state PH programs at the time

Shattuck's Recommendations

Establish state and local boards of healthHire sanitary police or inspectorsCollect and analyze vital statisticsExchange data and informationSanitation programs for towns and

buildingsStudy health of school children

Recommendations continued

Study, supervise and/or control TB, alcoholism, mental disease

Supervise and study immigrantsErect model tenements, bath/wash housesControl smokeControl food adulteration

Recommendations continued

Establish nursing schoolsTeach sanitary science in medical schoolInclude prevention in clinical practiceGet routine physical examsKeep records of family illnessesPreach health from the pulpit

Shattuck Report - 1850

Impact of this report was to start the Modern Era of Public Health in America

Proposals took some time to implement Massachusetts's State Board of Health was

founded in 1869 and by 1900 only 38 states had state health departments

There were few county health departments

Public Health in the Twentieth Century

At the beginning of the 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


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


Period of social engineering (1960-1973)Period of health promotion (1973 to

present)


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


First School of Public Health was established in 1918 at Johns Hopkins University

1918 was the birth of school health educationBirth of first national level volunteer health

agencies American Cancer Society 1913 Rockefeller Foundation established 1913


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


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


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


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)


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


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


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


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

Major Eras in Public Health History in the United StatesPrior to 1850 Battling Epidemics1850–1949 Building State and Local

Infrastructure1950–1999 Filling Gaps in Medical Care

DeliveryAfter 1999 Preparing for and Responding to

Community Health Threats

Public Health in the Twenty First Century

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

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

Healthy people 2010Comprehensive, 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.

Healthy people 2010

Can be used by many different people, States, communities, professional organizations, and others to help them develop programs to improve health.

Healthy PeopleEntering 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

Objectives

2000 - Healthy People 2010

Healthy People 2010

Two overarching goals28 focus areas467 specific objectives10 Leading Health Indicators

Goals of Healthy People 2010

1. Increase quality and years of healthy life.

(Health related quality of life, Global assessment, Healthy days, Years of healthy life)

2. Eliminate health disparities. (gender, race and ethnicity, income and education)

Bottom Line of Healthy People 2010

A tremendous national resourceA remarkable intellectual investmentAn important part of a national action plan

public health historical perspective dr. anjum odhwani md, mph

Documents

public health practices

europe slide

mph slide

fumigation slide

necessary slide

hospital slide

greek philosophy of

middle ages