history of public health essay

history of public health essay

History of Public Health

1. Introduction

Public health has probably existed as long as humans have lived together. Clean water, safe food, control of disease, and maternal and child health are all thought to have been concerns from prehistoric times. Later, many societies developed hygienic customs, and the Romans in particular had a complex system of public health laws. The origins of public health research lie in the 19th century. The first attempt to establish a formal scientific methodology for the improvement of public health (the British Public Health Act in 1848) was a response to the Great Cholera Epidemic of 1836-50. The terrible conditions of sanitation in the slums of the Industrial Revolution had led to a series of debates in the British Parliament. The discovery by John Snow, through a simple mapping of cases, that cholera in London is waterborne was an early example of epidemiology in the context of public health. Public health was then an attempt to apply preventive and educational measures to a population suffering from various diseases in epidemic proportions. Nowadays, the aim is to make the population as a whole healthier, and substantial improvements in health have been achieved via public health initiatives throughout the world. In the developed world, these improvements have led to a notable increase in life expectancy. Public health is still concerned basically with populations instead of individual patients, and modern practitioners face new problems (such as BSE, also known as “mad cow disease”) as well as the old. They have at their disposal an array of modern scientific techniques, and confidence in these methods has led to the burgeoning field of public health research. The following essays will present a critical overview of several high profile diseases and other topics which are relevant to current public health.

2. Early Developments in Public Health

6.2. The Roman legions contributed to the dissemination of public health information to many parts of the Western World. Public health going back to the time of the twelve tables or even earlier was declared a special function of the State with a body of organized sanitary law. During the Republic and early Empire the water supply and drainage of Rome were a marvel to the ancients and the ruins of aqueducts and Cloacae demonstrate it was a skilled application of engineering and public health principles. The Romans possessed an intimate knowledge of the sanitary properties and uses of lead. Whether lead poisoning was a major cause of the decline and fall of Rome as some historians claim is nevertheless a medical question which has interesting public health implications. From the Mediterranean area and Western Europe there is evidence of organized public health efforts through many centuries including the sanitary legislation of the Italian city-states guilds and corporations the maintenance of village health officers and the regulation of many trades and health occupations.

Mortality 6.1. The evidence of the early history of public health consists of data on the sanitary practices of prehistoric and ancient peoples and of the writings of early historians and physicians. Such references to early public health information are found in the sacred writings of Hindus and in the Old Testament of the Bible. The Old Testament Mosaic Law provided the Israelites with an organized body of hygienic rules. The importance of these rules was attested by their survival through long periods of oral tradition and their reiteration by prophets and priests. These scriptural records and the Law demonstrate an advanced concept of public health. From other early information it is evident that cleanliness was a part of the religious rituals in ancient India. The Greeks were the first to advocate a high standard of physical fitness and this ideal became an integral part of many nationalities. While Hippocratic medicine in general showed a high development of public health practices there is a scarcity of specific information on the sanitary practices of the times.

3. Major Milestones in Public Health

The concept of public health has been around since the beginning of recorded time and has waxed and waned in importance throughout history. In the ancient world, the Greeks were to create from the ruins of the Mycenaean civilization a bright new culture, the culture that would shape Western civilization. It laid a cornerstone for modern Western ideas on social justice and the responsibility of the state to protect its citizens. The Greeks felt that they were not immune to the disasters that plagued earlier civilizations. At a mythological and religious level, Homer’s Iliad and other stories are full of plagues and pestilence. At a more factual level, classical Greece does not appear to have been affected by major epidemics, and it is easy to idealize the past. However, the early Greek historical period brought changes to the social and political structure of the state – the famous law-giver Solon was responding to a population weakened and disaffected by the effects of previous warfare and strife. Often called the first “Golden Age,” the following period under the leadership of Pericles was the time of the great Athenian building programs and the great monuments of Greek architecture and sculpture. This was also the time of the Peloponnesian War and the seminal event for the development of Western political thought, the destruction of classical Athens by the army of Alexander the Great. Similarly to the age of Pericles, Rome’s republic brought major advancements in societal structure and the ruling class. During both the Grecian and Roman periods, the leaders and ruling class strived to secure for themselves lives of longevity and relative ease. So in the fifth century B.C., Hippocrates was a man ahead of his time. Born on the island of Cos in 460 B.C., miles from the battlefields and political turmoil of the mainland, he was providing services for the ruling class and the well-to-do. He would become known as the father of Western medicine, pioneering the idea of using observation and reason to determine the causes of illnesses. It was Hippocrates who wrote, “There are certain signs and symptoms by which a physician aware of them will detect the presence of all illnesses,” and it was he who gave birth to the idea of medicine as a theoretical discipline. He was able to put his ideas into practice and move away from the traditional reliance upon the Gods for relief from illnesses.

The history of public health is filled with major events and ideas that have shaped the world. Public health has been defined as “the science and art of preventing disease, prolonging life, and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities, and individuals.” It is concerned with threats to health based on population health analysis. The population in question can be as small as a handful of people or as large as all the inhabitants of several continents (for instance, in the case of a pandemic). The dimensions of health can encompass “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity,” as defined by the United Nations’ World Health Organization. Public health incorporates the interdisciplinary approaches of epidemiology, biostatistics, and health services. Environmental, social, behavioral, and occupational health are other important subfields.

4. Challenges and Advances in Public Health

Summary: Public health has been defined as the art and science of prolonging life and reducing disease through the organized efforts of society. The definition implies the idea that public health can be seen as a series of responses to public health challenges throughout history, entailing a range of organized and regulated fields of expertise. The history of public health has been a history of tackling challenges to health as they emerge, at a population level, and then using an organized or regulated response to prevent a further threat to the public’s health and status quo in that particular time and place. We must always be cognizant of the fact that public health practice is shaped by the prevailing cultural, political, and social values and that it is largely defined by the response of those with the power to make change or hold change at bay.

Table of Contents: 4. Challenges and Advances in Public Health A. Health in the Colonial Period B. Movement for Public Health in 18th Century Europe C. The Sanitary Movement in 19th Century D. Bacteriology and the Influence of the Germ Theory E. Tropical Medicine F. The Modern Health Movement

5. Future Directions in Public Health

The final section of the book explores the future directions of public health. Part of this section was written many years ago, so it is fascinating to see what the authors of the day envisaged for the future. Salazar Parreñas is critical of globalization and argues that globalization and economic restructuring “will relentlessly add to the difficulties of the poor and accelerate income inequalities between nations and social groups within nations.” She argues that this will limit the efficacy of social policy as a health intervention in the future, and health will suffer as a result. According to her, the future of public health will see a shifting of responsibility from the state to the individual or to communal organization; health will become increasingly privatized with individuals and communities being required to take greater responsibility for their health and well-being, and to fulfill an increasing number of regulatory functions to safeguard the health of local populations. Heiman and Art examine the future of public health in Europe and the US, and while the details of their predictions may differ, both see a health future characterized by growing inequalities and resource allocation based on economic interests rather than health needs. The event of September 11th, 2001 has changed the global political landscape, and Heiman and Art argue that public health will need to be even more engaged with foreign policy in the future, if it is to respond effectively to global security threats and to work to influence policy that has an impact on the health of populations. Looking specifically at health policy in the US, they foresee a future in which the public sector’s role “will shift from being the sole provider or insurer to a guarantor of services or care arrangements provided by the private sector.” This is a prospect that has already begun to materialize.