From a seminar I gave in my first year MD in Shivamogga Institute of Medical Sciences.
Oxford Textbook of Public Health and Textbook of Preventive Medicine and Public Health by Maxcy, Rosenau and Last are my references.
Might help readers learn the evolution of the concept of public health.
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Rise of public health
1. RISE OF PUBLIC
HEALTH
Post-graduate seminar
presentation
Dr. Aniruddh K. Menon
1st year MD Community
Medicine
SIMS, Shimoga
Tuesday, 24 January 2017 DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA 1
2. BACKGROUND
The history of the world has broadly been a history of the
health
Global transition in the perception of life and death
Health is a hallmark of modernity
Economic and political progress are mere subordinates toTuesday, 24 January 2017 2DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
3. RISE OF PUBLIC
HEALTH IN THE
DEVELOPED
COUNTRIES
An approach through
the different themes in
the history of public
health
Tuesday, 24 January 2017 3DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
4. THEMES IN THE HISTORY OF
PUBLIC HEALTH
Three relatively distinct missions:
1. Public health as a reaction to epidemics
- Reactive
- Closing borders, fumigation, shutting down piggeries, isolation of victims
2. Public health as a form of police
- Community standards becoming medical
- Control of food-adulteration, prostitution
3. Public health as a means of betterment
- A proactive political vision
- Mass vaccination, comprehensive urban water and sewerage systems
- Change in the public health threats
Tuesday, 24 January 2017 4DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
5. THE PUBLIC HEALTH OF
EPIDEMIC CRISIS: REACTION
Belief that we ‘can’ – the prerequisite
for public health
‘Will-of-God’ explanations were always a
discouragement
Naturalistic explanations – that ‘mysterious’
element in the atmosphere
Tuesday, 24 January 2017 5DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
6. 1. PLAGUE OF
ATHENS, 430 BC
- The first European
account of a widely
fatal epidemic
Plague outbreak after the Spartan invasion
of Athens
World’s oldest available epidemic data
Accepting one’s fate was the main
response
Islamic doctors called it
‘Allah’s will’
Tuesday, 24 January 2017 6DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
7. 2. LEPROSY IN THE
MEDIEVAL CHRISTIAN
LATIN COUNTRIES
Activist response
Jesus cleansing the ten lepers
Confidence that certain diseases could be
controlled
Concepts in the Old and New
Testaments
Focus on community
welfare
Tuesday, 24 January 2017 7DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
8. 3. THE GREAT PLAGUE OF
THREE CENTURIES
The prototypical
institutional response
to an epidemic
The Great Plague, a 1665 painting
Tuesday, 24 January 2017 8DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
9. THE DEVASTATING PLAGUE
Black Death, the first wave – 1347 to 1351, and every
two decades thereafter
Case fatality rates of 30-100% depending on the strain
Divine will and natural process
Precipitation of a social crisis
False accusations on Jews
Tuesday, 24 January 2017 9DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
10. PUBLIC RESPONSE TO
PLAGUE
Italy took the earliest measures to control the epidemic
40-day quarantine on ships coming from potentially
infected places
Air-purification and decontamination
Isolation
A responsive committed civil society
Atmospheric and miasmal theories
Tuesday, 24 January 2017 10DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
11. 4. THE CHOLERA
PANDEMICS, 1830
Accusations and loss
of faith
Printed cholera notice,
1866
Tuesday, 24 January 2017 11DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
12. THE CHOLERA PANDEMICS,
1830
The poor accused that the rich were poisoning them
The rich accused that the poor wantonly persisted in
unhygienic areas
Successful attempts at disinfection, quarantine and
Tuesday, 24 January 2017 12DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
13. CHOLERA AND DR. JOHN SNOW,
TOWN SOHO, LONDON
Tuesday, 24 January 2017 13DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
14. 5. SYPHILIS AND
VENEREAL DISEASES Typhus, typhoid and
relapsing fever
Vladimir Lenin died of syphilis
Tuesday, 24 January 2017 14DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
15. SYPHILIS AND OTHER
VENEREAL DISEASES
Syphilis was rampant during the 16th century; ‘lustseuche’
Association with wars and brothels
A serious epidemic; adventure for young men
France and U.K. initiated the first prevention strategies; the
Contagious Diseases Act, 1862
Some control was gained by 1885
Tuesday, 24 January 2017 15DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
16. TYPHUS, TYPHOID, RELAPSING
FEVER, YELLOW FEVER
Epidemics arrived in the aftermath of Black Death
Relapsing fever and social catastrophes
Rudolph Virchow and Sebastian Neumann investigated
typhus in Silesia, 1848
Public response was comprehensive improvement of
living conditions
Tuesday, 24 January 2017 16DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
17. 6. THE WAR AGAINST
SMALLPOX
Vaccination victory
Edward Jenner vaccinating James Phipps
Tuesday, 24 January 2017 17DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
18. SMALLPOX
Al-Razi’s naturalistic theory, 9th century
Increasing virulence in 15th to 18th century Europe
Contagious disease of childhood
Survivors were immune
State governments – slow to respond
Edward Jenner, 1798 – vaccination with cowpox
Compulsory vaccination in U.K., 1853
Tuesday, 24 January 2017 18DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
19. THE PUBLIC HEALTH OF
COMMUNAL LIFE: MEDICAL
POLICE
‘Police’ – actions taken at all levels of government
Functions included:
1. Sanitation
2. Caring for the desolate
3. Labour rules
4. Markets and commerce
5. Marriage and midwifery
6. Cattle
7. Military, travel and prostitution
8. Burial of the dead
9. Disaster and injury prevention
10.Forensics
11.Bio-statistic records
12.Regulation of medical practice
Tuesday, 24 January 2017 19DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
20. THE MEDICAL POLICE
Health promotion depublicized
The responsible authorities
Consumerism and technical
advancement
Nuisances Removal Act,
1847
Tuesday, 24 January 2017 20DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
21. PUBLIC HEALTH AS A MEANS OF
BETTERMENT: PUBLIC HEALTH
OF HUMAN POTENTIAL
Goal – reduce the preventable mortality and
morbidity rates
Focus shifted towards analysing vital
statistics
More efficient prevention strategies
The great sanitary campaign against urban
filth
Tuesday, 24 January 2017 21DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
22. PHASES OF PUBLIC HEALTH
Public health has undergone changes in the developed
countries mainly in the last two centuries. These can be
divided into three phases under the evolution of
concepts into:
1. Age of liberalism (1790 - 1880)
2. Golden age of Public health (1880 - 1970)
3. Return to liberalism (1970 onwards)
Tuesday, 24 January 2017 22DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
23. THE AGE OF LIBERALISM: HEALTH IN THE
NAME OF THE PEOPLE - 1790 TO 1880
Age of the anti-slavery movement and rise of
Methodism
Liberty develops a biosocial vision
Sir Edwin Chadwick – laws of
sanitation
Tuesday, 24 January 2017 23DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
24. THE GOLDEN AGE OF PUBLIC
HEALTH: 1880 TO 1970
Tuesday, 24 January 2017 24DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
25. Holocaust and Eugenics
Jews victimized by misinterpreted
theories
Rise of nutritional and agricultural
sciences
Improved methods of cure and
prevention
3 new fears:
1) The invisible germs that can transmit through the most casual
contact (viruses)
2) Mysterious genes (mutations)
3) Deficiencies in food that doesn’t improve with better
consumption (trace nutrients)
Health consciousness met new standards
Improved techniques of disinfection and sanitation
Doctors opinion about critical issues
Tuesday, 24 January 2017 25DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
26. THE RETURN OF LIBERALISM:
1970 TO PRESENT
Tuesday, 24 January 2017 26DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
27. RISE OF PUBLIC
HEALTH IN THE
DEVELOPING
COUNTRIES
Historical development
of comprehensive
public health
Tuesday, 24 January 2017 27DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
28. DEVELOPMENT OF PUBLIC
HEALTH IN THE DEVELOPING
COUNTRIES
Early public health
Empirical public health
Colonial public health
Foundation of international
public health
International health
institution – the WHO
Disease prevention and
control campaigns
Tuesday, 24 January 2017 28DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
29. EMPIRICAL PUBLIC HEALTH
Teachings in the holy scriptures of
the East
Kautilya’s treatises
Epidemics along Chinese trade
routes
Tuesday, 24 January 2017 29DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
30. COLONIAL PUBLIC HEALTH
Massive intercontinental population shift
Health establishments of the colonies:
Indian Medical Service of the East India Company
Gold Coast Medical Department in Ghana
Missionaries and their medical establishments
Calcutta School of Tropical Medicine and Hygiene
All-India Institute of Hygiene and Public Health, Calcutta
Haffkine Institute, Bombay
King Institute of Preventive Medicine, Madras
Central Vaccine Research Institute, Kasauli
National Institute of Communicable Diseases, Delhi
Indian Research Fund Association, Delhi
National Institute of Nutrition, Hyderabad
Tuesday, 24 January 2017 30DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
31. CALCUTTA SCHOOL OF
TROPICAL MEDICINE
AND HYGIENE
Kolkata
Tuesday, 24 January 2017 31DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
32. ALL INDIA INSTITUTE
OF HYGIENE AND
PUBLIC HEALTH
Kolkata
Tuesday, 24 January 2017 32DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
38. FOUNDATION OF
INTERNATIONAL PUBLIC
HEALTH
18th century: European legislations to prevent
importation of epidemics
First International Sanitary Conference,
Paris, 1851: 12 countries
The Inter-governmental Conference of Far-Eastern Countries
on Rural Health, Bandung, 1937
Tuesday, 24 January 2017 38DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
39. OIHP, Paris (Pasteur Institute)
1923
League of Nations Health Organization
INTERNATIONAL HEALTH
OFFICES
Tuesday, 24 January 2017 39DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
40. WORLD HEALTH
ORGANIZATION:
IMPLEMENTATION
Post-WWII
Conference of the Brazilian and Chinese delegations of
the UN
Constitution of the WHO drafted, 22nd July 1946; came
into force on 7th April 1948
7th April 1948: the day WHO officially came into being
Constitutional mandate: Attainment by all people of the
highest possible level of healthTuesday, 24 January 2017 40DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
41. FUNCTIONS OF W.H.O.
1. Directing and coordinating international health work
2. Providing advice and advocacy on international health
development
3. Adoption of international
regulations
4. Set international standards for biological and
pharmaceutical agents, as well as other diagnostic procedures
and products
5. Adoption of international conventions and
agreements
Tuesday, 24 January 2017 41DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
42. W.H.O.: THEN AND AFTER
194 member countries and territories
Worked for over 65 years
6 regional organizations and headquarters
UNICEF and other health systems infrastructures
The Beveridge model of national health and social
welfare policy
Tuesday, 24 January 2017 42DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
43. W.H.O.: THEN AND AFTER
Training of different categories of health auxiliaries
Second conference on rural health, New Delhi, 1957,
under the auspices of W.H.O. focus on MCH
United Nations’ International Women’s Decade: 1976-
1985
Global efforts at popularizing contraception
Tuesday, 24 January 2017 43DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
44. W.H.O.: THEN AND AFTER
Green Revolution of 1960s: fight against anaemia and
IDDs
Vitamin A supplementation programme
International Conference on Nutrition, Rome, 1992: a
W.H.O. – F.A.O. coordination effort
Environmental sanitation and safe drinking water
Tuesday, 24 January 2017 44DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
45. DISEASE PREVENTION AND
CONTROL CAMPAIGNS
W.H.O
U.N.I.C.E.F.
Other UN
agencies
Rockefell
er
Foundati
on
Save the
Children
fund
Global disease control campaigns
Tuesday, 24 January 2017 45DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
46. YAWS
Arsenic and bismuth compounds pro-WWII
Mass treatment campaigns using long-acting penicillin
Only a scattered foci persisted
Tuesday, 24 January 2017 46DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
47. MALARIA
Initial efforts with DDT – a dramatic success
Resistance among the vectors
Tuesday, 24 January 2017 47DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
49. Success story of
public health
SMALLPOX
Tuesday, 24 January 2017 49DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
50. ANCIENT INDIA AND PUBLIC
HEALTH
Tuesday, 24 January 2017 50DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
51. THE TRADITION OF INDIAN
HEALTH
Conceptualized on spirituality
Ayurveda: the science of life
Dehashudhi
(clean body)
Manashudhi
(clean mind)
Jalashudhi
(clean water)
Aharashudhi
(clean food)
Deshashudhi
(clean
environment)
Tuesday, 24 January 2017 51DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
52. THE TRADITION OF INDIAN
HEALTH
Earliest protagonists of Indian medicine:
-Sage Atreya
-Charaka
-Sushruta
-Sage Kashyapa
-Bhela
Sanitation played a major role in the planning of cities
like Harappa and Mohenjadaro.
Tuesday, 24 January 2017 52DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
54. PIONEERS OF PUBLIC
HEALTH
Tuesday, 24 January 2017 54
Edward Jenner (1749-1823)
A fascination that led to
eradication of a pandemic
DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
55. Tuesday, 24 January 2017 55
Dr. John Snow (1813-1858)
A surgeon’s anesthesia
apprentice who
epidemiologized cholera
DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
56. Tuesday, 24 January 2017 56
Dr. James Lind (1716-1794)
British naval doctor who
discovered the treatment for
scurvy
DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
57. Tuesday, 24 January 2017 57
Robert Koch (1843 - 1910)
A microbiologist who
discovered the agents of
tuberculosis, leprosy, cholera,
plague, sleeping sickness and
tick fever
DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
58. Tuesday, 24 January 2017 58
Dr. Joseph Lister (1827-
1912)
A British surgeon who
revolutionized antisepsis
DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
59. Tuesday, 24 January 2017 59
Dr. John Simon (1816-1904)
British physician who
pioneered public sanitation
DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
60. Tuesday, 24 January 2017 60
Lemuel Shattuck (1793-1859)
American political analyst
who emphasized on vital
statistics
DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
61. Tuesday, 24 January 2017 61
Edwin Chadwick (1800-1890)
British Commissioner who
legalized sanitation reforms
DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
62. Tuesday, 24 January 2017 62
Sir Ronald Ross (1857 -1932)
A Garrison Surgeon posted at
Bangalore who developed
malaria prevention measures
and introduced mathematical
concepts to epidemiological
studies
DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
63. Tuesday, 24 January 2017 63
Dr. William Farr (1807-1883)
British doctor who went on to
become the Father of modern
epidemiological surveillance
DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
64. Tuesday, 24 January 2017 64
Sir Joseph William Bhore (1878-
1960)
Indian Civil Servant who
conceptualized comprehensive
primary health care
DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
65. Tuesday, 24 January 2017 65
Dr. Sushila Nayyar (1914-
2000)
Gandhian doctor who is aptly
called as the founder of
Indian Community Medicine
DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
66. Tuesday, 24 January 2017 66
Dr. Alexander Duncan
Langmuir
(1910-1993)
Community physician who is
known as the founder of 20th
century epidemiology and
public health surveillance
DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
67. 5-POINT SUMMARY OF WHAT
WAS SPOKEN
Public health is health in the name of people, for and unto
Health is not rocket-science; best measures emerged from
common sense
Responsibility of individual health is with the individual, the
country’s with the government
All religions are pro-health; scriptures spoke science,
superstitions were a misinterpretation
Developed and developing countries have separate issues
to address
Tuesday, 24 January 2017 67DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
68. GLIMPSE AT THE WAY AHEAD .
. .
Universal access to affordable and effective health care
A new vision for public health, where truth and equity
propel the decisions and common sense frames the
priorities
“ Those who fail to read history
are destined to suffer the
repetition of its mistakes ”
Tuesday, 24 January 2017 68DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
69. BIBLIOGRAPHY
1. Oxford Textbook of Public Health. 4th edition
2. Textbook of Public Health and Community Medicine.
Armed Forces Medical Services. 1st edition
Tuesday, 24 January 2017 69DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA
70. THANK YOU!
[Hygeia and Asclepius
engraved in an arch
over the Nyam door,
Venice]
Tuesday, 24 January
2017
DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA 70