the history and development of public health part1

7/28/2019 The History and Development of Public Health Part1

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Dr Saadiyah Rao

Senior Lecturer

School of Public Health

Dow University of Health sciences


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To give overview of History of Pubic healthTo discuss time line from primitive medicine to birth ofPublic HealthTo review the evolution of Public Health in developed

countries


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Public health is not an invention of the 20th century, andthe issues we debate today have many parallels in history.

Brockington noted (1960) that,

public health in some form has existed as long ascivilisation. Inoculation against smallpox was practiced inIndia and China more than two thousand years ago.

Isolation of leprosy was enforced in the Roman Empirewhich built leprosaria; the first isolation hospitals, andmany religious abstentions concerned food and excretalpollution.

3Dr Saadiyah Rao- School of Public Health, DUHS


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Time line

Primitive societies

Ancient societies: before 500BC

Classical cultures: (500BC to 500 AD) Middle Ages: (500 to 15 00AD)

Renaissance period: (1500 to 1700 AD)

Eighteen century

Nineteen century Twentieth century

Twenty first century

Dr Saadiyah Rao- School of Public Health, DUHS 4


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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



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Public Health in Ancient Societies Before

500BC Indus Valley Civilization (2000BC): Excavations provide

evidence of:

bathrooms & drains in home Sewers below street levels



7/467Dr Saadiyah Rao- School of Public Health, DUHS


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Public Health in Ancient Societies

Middle Kingdom of ancient Egypt (2700-2000BC): Ruinsshowed the presence drainage system

knew more than 700 drugs

Sumerian clay tablet from 2100 B.C. contains prescriptionsfor drugs



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Code of Hammurabi Babylon(1700-1800BC) : earliestwritten record concerning Public Health:

included laws pertaining to physicians & health practices :

Physicians provide a service to the society, and in return were

paid money but would be punished if the results of treatment

ended up killing the patient !

Mycenaeans in Crete-Greece (1600BC): had toilets,flushing system & underground drainage system



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Hebrews wrote Book ofLeviticus in about 1500 B.C.

- the first written health code in the world

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



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Public Health in Classical

Cultures 500 B.C. to 500 A.D. Greeks began to travel to Egypt

Took information from other people

Included it in Greek philosophy of health and medicine

Active in the practice of community sanitation

Supplemented water of city wells and built cistern

Hippocrates (460-370 BC) In his book On Airs, Waters,Places; presented relations of disease to physical, social,

and behavioural settings

The first rational guide to the establishment of a science-based public health



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Public Health in Classical Cultures

Romans

Had extensive systems for public and private hygiene

Had extensive bath and wash houses

Brought clean water into their cities using aqueducts

Had system for getting rid of garbage and other wastes

Cloaca Maxima, still serves as part of the sewage of themodern Rome !

Street cleaning & repair system

Built the first hospital



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Public Health of the Middle Ages

(500-1500 A.D.) Period from end of Roman Empire to 1500AD

Most of knowledge was preserved in churches &monasteries

Medieval approach to health & disease was different fromRomans

Health problems were considered as to have spiritualcauses, hence spiritual solutions



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Dark Ages (500-1000 A.D.): Western Europe experienced a periodof social and political disintegration. In Eastern Europe and Asiamedicine advanced and major hospitals established in Baghdad,and Cairo.

Western Europes condition: immoral to view ones own body

sanitation ignored; waste in streets

many pandemics

Blamed disease on supernatural causes St Augustine: taught that disease were caused by demons sent to

torture the human spirit and diseases were punishment for sins!

This is often called The spiritual era of Public Health



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(500-1500 A.D.) During the 7th century A.D. Islam appeared

religion stressed cleanliness

"There is no disease that Allah has created, except that He

also has created its remedy."Volume 7, Book 71, Number 58 Taking proper care of one's health is the right of the

body.Bukhari as-Sawm 55, an-Nikah 89, Muslim as-siyyam 183, 193, Nisai

The Prophet (PBUH)not only instructed sick people totake medicine, but he himself invited expert physicians forthis purpose.D.o.H. p.50, As-Suyuti's Medicine of theProphet p.125

http://www.usc.edu/dept/MSA/fundamentals/hadithsunnah/bukhari/071.sbt.htmlhttp://www.crescentlife.com/wellness/every_illness_has_a_cure.htmhttp://www.crescentlife.com/wellness/every_illness_has_a_cure.htmhttp://www.crescentlife.com/wellness/every_illness_has_a_cure.htmhttp://www.crescentlife.com/wellness/every_illness_has_a_cure.htmhttp://www.crescentlife.com/wellness/every_illness_has_a_cure.htmhttp://www.crescentlife.com/wellness/every_illness_has_a_cure.htmhttp://www.crescentlife.com/wellness/every_illness_has_a_cure.htmhttp://www.crescentlife.com/wellness/every_illness_has_a_cure.htmhttp://www.crescentlife.com/wellness/every_illness_has_a_cure.htmhttp://www.crescentlife.com/wellness/every_illness_has_a_cure.htmhttp://www.crescentlife.com/wellness/every_illness_has_a_cure.htmhttp://www.crescentlife.com/wellness/every_illness_has_a_cure.htmhttp://www.crescentlife.com/wellness/every_illness_has_a_cure.htmhttp://www.crescentlife.com/wellness/every_illness_has_a_cure.htmhttp://www.crescentlife.com/wellness/every_illness_has_a_cure.htmhttp://www.crescentlife.com/wellness/every_illness_has_a_cure.htmhttp://www.crescentlife.com/wellness/every_illness_has_a_cure.htmhttp://www.crescentlife.com/wellness/every_illness_has_a_cure.htmhttp://www.crescentlife.com/wellness/every_illness_has_a_cure.htmhttp://www.crescentlife.com/wellness/every_illness_has_a_cure.htmhttp://www.crescentlife.com/wellness/every_illness_has_a_cure.htmhttp://www.crescentlife.com/wellness/every_illness_has_a_cure.htmhttp://www.crescentlife.com/wellness/every_illness_has_a_cure.htmhttp://www.crescentlife.com/wellness/every_illness_has_a_cure.htmhttp://www.crescentlife.com/wellness/every_illness_has_a_cure.htmhttp://www.usc.edu/dept/MSA/fundamentals/hadithsunnah/bukhari/071.sbt.html


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There wereMobile dispensary

The concept ofquarantinewas first introduced in the 7thcentury A.D. by the prophet Muhammad (PBUM), who

warned against entering or leaving a region suffering fromplague.

Al-Razi wrote encyclopaedias of Medicine As early as the 10th century, Muslim physicians innovated

the use of isolation wards for individuals suffering withcommunicable diseases.

Also had public baths and sewage systems.



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(500-1500 A.D.) Back to western world:

One of the earliest recorded epidemic disease was Leprosy :6th-15thcentury

- rules and regulations- leper houses

The deadliest plague epidemic 14th century---------plague wasnamed as black death killed 25 million people in Europe

Other epidemics : smallpox, diphtheria, measles, inf luenza(English Sweat), TB, and many other unidentifiable diseases

Last epidemic : syphilis appeared in 1492 & killed thousands



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Public Health in the Renaissance &

Exploration Period 1500-1700 A.D. Period characterised by rebirth of thinking about

nature & humankind : exploration & discovery

Led to great commercial, scientific, cultural, and

political development Effects of this period on Public Health were substantial

However, experience of the Dark Ages was notforgotten

People now asked how diseases arose?

not a punishment from God because

Growing belief was environmental factors that caused

disease 18Dr Saadiyah Rao- School of Public Health, DUHS


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Public Health in the Renaissance Period

(1500-1700 A.D.) Careful observations of symptoms & disease outcomes

led to the first recognition of separate diseases

Whooping cough, typus, scarlet fever, and malaria

Practically the conditions were not much changedfrom Dark ages

Explorers, traders and migrants took European

diseases and spread them to indigenous peoplesaround the world



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(1500-1700 A.D.) Three most important contributions to public health of

the Renaissance period:

The organization of boards of health : were responsible

for : determining of plague

quarantine

burial of plague victims

the fumigation

A model for nineteenth-century organization of publichealth activities



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(1500-1700 A.D.) The promulgation of a theory of contagion

Girolamo Fracastoro proposed that epidemic diseases arecaused by transferable tiny particles seeds of

disease,seminaria"He analysed diseases according to three specific modes of

dissemination

by contact,

through objects such as cloth (fomes),by distance

The earliest theoretical conceptualizations of somethingapproximating germ theory !



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(1500-1700 A.D.) The introduction of health statistics

The Italian boards of health instituted a system ofdeath registration

In 17th century (London) analysis of bills of mortalityby John Graunt (Natural and Political Observations

Made Upon the Bills of Mortality) laid the basis for the

modern use of statistics for the planning andevaluation of public health activities.



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Public Health in the Eighteenth

Century Beginnings of industrialization and urbanization

Although there had been a recognition of the role of theenvironment as a cause of disease, living conditionswere not conducive to good health

Significant milestone (1796), when Dr. Edward Jennerdemonstrated the process of vaccination as a protection

against small pox Before this: variolation



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Public Health in the Eighteenth Century

The first US census was taken in 1790: Average age atdeath was 29 years at that time !

US continued to face epidemics of small pox, cholera,

typhoid fever & yellow fever Hence, in 1798 Marine Hospital Service was formed to

deal with diseases on vessels

Several other governmental health agencies were

created to deal with epidemics, sanitation problems &protection of water



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Public Health in the Eighteenth

Century In Germany, J P Frank, published System of a Complete

Medical Policy: proposed a extensive scheme of governmental regulations and

programs to protect the population against disease and topromote health.

The actions that he advocated ranged from measures ofpersonal hygiene and medical care to environmentalregulation and social engineering.

In England, Jeremy Bentham in his Constitutional Code,proposed radical new legislation dealing with issues as prisonreform, the establishment of a ministry of health, birthcontrol, and a variety of sanitary measures.



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Public Health in the Nineteenth

Century Public health provision was completely transformed

as the 19th century progressed. Overcrowding, poverty and disease went hand in hand at

the century's start, but social reform had comprehensivelyturned things round

Initially living conditions remained unsanitary in Europe &England but realized that social and sanitary conditionsimpacted the economy

Parliament made reforms to improve the lives of men,women and children in the poorer sections of society.

Government involvement in welfare provision, and inregulating conditions of work in factories, workshops andmines.



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Century General Registration (from 1837) gather statistics on

mortality for the whole of England and Wales. Edwin Chadwick 1842

Report on an Inquiry into the Sanitary Conditions of theLaboring Population of Great Britain Key conclusion: That the various forms of epidemic, endemic, and other

disease caused, ...... chiefly amongst the labouring classes...... by decomposing ...... substances, by damp and filth, and

close and overcrowded dwellings prevail amongst thepopulation in every part of the kingdom That the annual loss of life from filth and bad ventilation are

greater than the loss from death or wounds in any wars inwhich the country has been engaged in modern times.



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Public Health Act & General Board of Health forEngland 1848

1849 first annual report called for municipal action to:

eradicate slums and build model dwellings

public wash-houses

control the water supply

municipal cemetery drainage system with a permanent sanitary inspector



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Public Health Acts 1848 Public Health Act encouraged local Health Boards to

appoint Medical Officer, inspect lodging houses and check foodand provide sewers.

1855 Nuisance Removal Act overcrowded housing illegal

1864 Factory Act unhealthy conditions in factories illegal 1866 Sanitary Act local authorities responsible for sewers, water

and street cleaning.

1871 Vaccinations Act vaccinations were made compulsory (1853)

1875 Artisans Dwelling Act made the house owners responsiblefor keeping their properties in good order and gave localauthorities the right to buy and demolish slums if they were notimproved.



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Century In 1848-49, 2nd cholera epidemic

John Snow 1849 : On the Mode of Communication ofCholera Predominant theory (contagious disease) : miasma

theory : Diseases were caused by the presence in the airof a miasma; a poisonous vapour

1853-54, 3rd outbreak of cholera

1854 He figured out the origins of cholera: the classicalstudy in Epidemiology

1850- Ignaz Semmelweiss- introduced hand washing


Source: http://www.choleraandthethames.co.uk/
http://www.choleraandthethames.co.uk/http://www.choleraandthethames.co.uk/http://www.choleraandthethames.co.uk/


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Century Theory of spontaneous generation: living organisms

could arise from inorganic or nonliving matter

equivocal generation considered that one type of

contagious microbe could change into another type. Pasteur (1862) proposed the germ theory of disease

Gave the death blow to the theory of spontaneousgeneration and radically changed the practice of medicine.

Later introduced pasteurization of milk

Joseph Lister (1867)- - antisepsis



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Public Health in the Nineteenth Century

Koch in (1876) establish a causal relationship throughhis postulates

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

Developed ways of staining bacteria and identify thebacterial causes of anthrax (1877), tuberculosis (1882)and cholera (1883)

1875 to 1900 The Bacteriological Period of PublicHealth



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Shattuck Report -US 1850 19th Century America:

Population increased

Epidemics common

Lemuel Shattuck - legislator Massachusetts

appointed to study sanitary problems

no national or state PH programs were at the time

Drew up a health report that outlined the public healthneeds of state



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Shattuck's Recommendations Health education

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

Supervise and study immigrants Control smoke and food adulteration

Teach sanitary science in medical school

Include prevention in clinical practice

Get routine physical exams Keep records of family illnesses

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



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Public Health in the Twentieth

CenturyAt the beginning of the century

Life expectancy was less than 50 years

Leading causes of death were communicable diseases

(influenza, pneumonia, tuberculosis , GI infections ,malaria & diphtheria)

Vitamin deficiency diseases were common includingrickets, pellagra and scurvy (symptoms of these diseases

were known but the cause was mystery)

Deaths associated with pregnancy and childbirth werealso high



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Century1.Health resources development period(1900-1960) :

much growth & development of health care facilities &providers took place during these 60years

- is further divided into The reform phase (1900-1920)

The 1920s

The great depression (1929-1935) and World War II (1939-45 )

The post war years

2.Period of social engineering (1960-1973)

3.Period of health promotion (1973 to present)



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Public Health in the Twentieth Century

The Reform Phase of Public Health (1900-1920) Growing concern about social problems in America due deepening

gap between upper lower classes led to reform movement

Broad movement involving social, moral & health issues

Upton Sinclair The Jungle drew attention to unsafe working

condition in meat packing factory 1906, the passage of the Pure Foods and Drugs Act

In 1910 first international congress on occupational disease washeld

New York passed Workers Compensation Act: Employers arerequired to make compensations to workers

First School of Public Health was established in 1918 at JohnsHopkins University



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Century The 1920s

Period of slow development in Public Health

Prohibition resulted in decline in alcoholics and alcoholrelated deaths

Life expectancy in 1930 risen to 59.7 years



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Century The Great Depression (1929-1935) and World War II

(1939-45 ) by 1933 private resources could no longer meet the needs of

the people who needed social & medical assistance Beginning in 1933, President Roosevelts New Deal created

agencies and programs for public works

Building of hospitals and laboratories, control of malaria andthe construction of municipal water and sewer systems

World War II decreased the availability of funds andresources for public health, but led to the development ofmany important medical discoveries that were made availableonce the war ended



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Public Health in the Twentieth Century The post war years

Antibiotic penicillin was made available

Insecticide DDT to kill insects that transmittedcommunicable diseases was made available

Communicable Disease Center was set up in Atlanta duringthe war, now known as the Center for Disease Control andPrevention (CDC).leading epidemiological center of

world

Two major events in the 1950s

Development of a vaccine to prevent polio

President Eisenhowers heart attack focused attention onthe nations number one killer, heart disease



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Public Health in the Twentieth Century

Period of Social Engineering (1960-1973) 1965 passage of the Medicare and Medicaid bills

Medicare provides for health care to the elderly and somedisable people

Medicaid provides health care for the poor Period of Health Promotion (1974-present)

Recognition that the greatest potential for saving lives isby education and life-style changes by individuals

In 1970s, CDC conducted a study that examinedpremature death : approx 48% of all premature deaths

were because of lifestyle or health behavior-choicespeople make



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Public Health in the Twenty-first

CenturyWorld health leaders recognized the need to plan for

21st century in 1977

WHO set a target for health for all by year 2000

Health resources should be distributed in such a waythat essential health care services are accessible toeveryone

Alma Ata conference adopted declaration on PrimaryHealth Care as a key to attain this goal



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Public Health in the Twenty-first

Century Goal is not achieved but it is not abandoned !

Renamed to Health of All(HFA)

HFE seeks to create the conditions where peoplehave, as a fundamental human right, the opportunityto reach and maintain the highest level of health

Although slow but achieved increase in life expectancy

globally



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Public Health in the Twenty First

Century Problems to be faced

Health care delivery cost

Environmental problems

Lifestyle diseases

Drug abuse

New communicable diseases or old diseases that have

become resistant to drug therapy



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ReferencesAn Introduction to Community Health:James

McKenzie, Robert Pinger, Jerome Kotecki

http://www.sciencemuseum.org.uk/broughttolife/themes/publichealth.aspx

http://www.islamic-study.org/public_health.htm

http://www.parliament.uk
http://books.google.co.uk/books?id=WDZ-vrgN5GoC&pg=PA12&lpg=PA12&dq=Code+of+Hammurabi+Babylon(3900+BC)+:+earliest+written+record+concerning+Public+Health:+included+laws+pertaining+to+physicians+&+health+practices&source=bl&ots=5oKDIWRFEP&sig=tWIOINCQC4bD-zGx9Zti-wLRTQo&hl=en&sa=X&ei=tiJEUeKKG6T4yQHY9oFI&ved=0CC0Q6AEwAAhttp://books.google.co.uk/books?id=WDZ-vrgN5GoC&pg=PA12&lpg=PA12&dq=Code+of+Hammurabi+Babylon(3900+BC)+:+earliest+written+record+concerning+Public+Health:+included+laws+pertaining+to+physicians+&+health+practices&source=bl&ots=5oKDIWRFEP&sig=tWIOINCQC4bD-zGx9Zti-wLRTQo&hl=en&sa=X&ei=tiJEUeKKG6T4yQHY9oFI&ved=0CC0Q6AEwAAhttp://books.google.co.uk/books?id=WDZ-vrgN5GoC&pg=PA12&lpg=PA12&dq=Code+of+Hammurabi+Babylon(3900+BC)+:+earliest+written+record+concerning+Public+Health:+included+laws+pertaining+to+physicians+&+health+practices&source=bl&ots=5oKDIWRFEP&sig=tWIOINCQC4bD-zGx9Zti-wLRTQo&hl=en&sa=X&ei=tiJEUeKKG6T4yQHY9oFI&ved=0CC0Q6AEwAAhttp://www.sciencemuseum.org.uk/broughttolife/themes/publichealth.aspxhttp://www.sciencemuseum.org.uk/broughttolife/themes/publichealth.aspxhttp://www.islamic-study.org/public_health.htmhttp://www.parliament.uk/http://www.parliament.uk/http://www.islamic-study.org/public_health.htmhttp://www.islamic-study.org/public_health.htmhttp://www.islamic-study.org/public_health.htmhttp://www.sciencemuseum.org.uk/broughttolife/themes/publichealth.aspxhttp://www.sciencemuseum.org.uk/broughttolife/themes/publichealth.aspxhttp://books.google.co.uk/books?id=WDZ-vrgN5GoC&pg=PA12&lpg=PA12&dq=Code+of+Hammurabi+Babylon(3900+BC)+:+earliest+written+record+concerning+Public+Health:+included+laws+pertaining+to+physicians+&+health+practices&source=bl&ots=5oKDIWRFEP&sig=tWIOINCQC4bD-zGx9Zti-wLRTQo&hl=en&sa=X&ei=tiJEUeKKG6T4yQHY9oFI&ved=0CC0Q6AEwAAhttp://books.google.co.uk/books?id=WDZ-vrgN5GoC&pg=PA12&lpg=PA12&dq=Code+of+Hammurabi+Babylon(3900+BC)+:+earliest+written+record+concerning+Public+Health:+included+laws+pertaining+to+physicians+&+health+practices&source=bl&ots=5oKDIWRFEP&sig=tWIOINCQC4bD-zGx9Zti-wLRTQo&hl=en&sa=X&ei=tiJEUeKKG6T4yQHY9oFI&ved=0CC0Q6AEwAAhttp://books.google.co.uk/books?id=WDZ-vrgN5GoC&pg=PA12&lpg=PA12&dq=Code+of+Hammurabi+Babylon(3900+BC)+:+earliest+written+record+concerning+Public+Health:+included+laws+pertaining+to+physicians+&+health+practices&source=bl&ots=5oKDIWRFEP&sig=tWIOINCQC4bD-zGx9Zti-wLRTQo&hl=en&sa=X&ei=tiJEUeKKG6T4yQHY9oFI&ved=0CC0Q6AEwAAhttp://books.google.co.uk/books?id=WDZ-vrgN5GoC&pg=PA12&lpg=PA12&dq=Code+of+Hammurabi+Babylon(3900+BC)+:+earliest+written+record+concerning+Public+Health:+included+laws+pertaining+to+physicians+&+health+practices&source=bl&ots=5oKDIWRFEP&sig=tWIOINCQC4bD-zGx9Zti-wLRTQo&hl=en&sa=X&ei=tiJEUeKKG6T4yQHY9oFI&ved=0CC0Q6AEwAA

the history and development of public health part1

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