Assistant Professor Department of Community Medicine DMC Rise of Public Health The industrial revolution of the 18th century sparked off numerous problems
Creation of slums, over crowding with all its ill effects,
- Accumulation of filth in the cities and towns, high sick
ness and death rates especially among women and children.
- Infectious diseases like tuberculosis, Industrial and
social problems, which deteriorated the health of the people to lower ebb.
Contd - Frequent vegetation of cholera compounded the misery of the people
- The great cholera epidemic of 1832 led Edwin
Chadwick (1800-1890), a lawyer in ENGLAND to investigate the health of inhabitants of the large towns with a view to improve the condition under which they lived. Chadwicks report on The sanitary Conditions of the Labouring Population in Great Britain a land mark in the history of public health
Chadwicks report focussed the attention of
the people and government on urgent need to improve public health.
The great sanitary awakening led to the
enactment of the Public Health Act of 1848in England. Contd
The early history of public health in India
of which Bangladesh was once a part.
India has one of the most ancient
civilizations in recorded history. Contd
Thousands of years before the
Christian era, there existed practices of environmental sanitation, by ancient people as far back as 3000 B.C
Contd
Before the advent of British in Indian
subcontinent, the Ayurvedic system of medicine in most areas and Unani- Tibbi system in some cities and towns were the means for catering the medical and health needs of the vast multitude in all regions of the subcontinent. Contd
The existence of public health
services in the past and its history is not well documented, recording of which began with the arrival of east India Company in India for trade. History of public health in Bangladesh may be described in three phases. Public health in British India: The British established their rule in India in 1757 and initiated organization of civil and military services. In England the state of public health was far from satisfactory till the middle of nineteenth century. Contd
Edwin Chadwick (1842), Lord Simon
(1858) and many other social scientist was the pioneer to develop public health in England the urgency of which were felt to reduce high morbidity and mortality due to epidemic of cholera, typhus, plague and small pox. Contd
The health services initiated by the
East India company were specially meant for the protection of the health for the military personnel and European civilian.
The real development in public health
administration began 1n 1859. Contd On the back drop of the extremely unsatisfactory condition of health and high mortality among British troops Royal commission was appointed in 1859 to inquire in to the cause thereof. The commission suggested the establishment of commission of Public health in each presidency and recommended protection of water a civilization in the Indus Valley, known as the Indus valley Civilization. Contd
Excavation in the Indus valley ( e.g.
Mohenjodaro and Harappa), showed relics of planned cities with drainage, houses and public baths built of backed bricks suggesting the supplies, construction of drains and prevention of epidemics as the measures of safe guard the health of British Army . Contd
. During the next eighty five years there
were slow but often significant progress in public health services. An important land mark in the developmental history of public health was development of health circle scheme in1927 as proposed by chittaranjan Das in Bengal. Contd Under this scheme the post of Health officers for the district and sanitary inspector for each police station (Thana) were created.
Socio political unrest and military involvement engulfed
the subcontinent for long eight years (1929-1947) and witnessed the Second the World War, the great Bengal famine of 1943, quit India movement, Pakistan movement and some such upheavals, resulting in almost a total break down of public health administration Bore Committee:
The government of British India
having felt the need to improve the health service of the country, appointed in 1943, a commission which was designated as health survey and development committee headed by Sir Joseph Bhore. Important recommendations of the Bhore Committee were Contd 1). Integration of preventive and curative services at all levels 2). Development of primary health centres in two stages a). A short -term measure for the establishment of one primary health centre in the rural areas to cover 40,000 population with a secondary health centre to serve as a supervisory, coordinating and referral institution Contd
b) A long term programme of setting
up primary health centre unites with 75-bedded hospitals for each 10,000 to 20,000 population and secondary unites, Contd 3).Major changes in medical education which includes 3months training in preventive and social medicine.
Before implementation of the recommendations
of the Bhore committee the subcontinent was partitioned with the emergence of India and Pakistan as independent countries in August 1947. Contd
However, the Bhore committee report
continues to be an important document for national health development. Contd A chorological citation of the events in the in the history of public health in India during British rule is given below:
1859- Appointment of a Royal
commission to enquire into the cause of illness and ill health in British Army stationed in India. Contd
1864- Appointment of Sanitary
commissioners in three presidencies Bengal, Madras and Bombay. The Civil Surgeons of all districts became ex- officio District Health Officers of their respective districts. Contd
1869- Appointment of public Health
Commissioners and a Statistical officer With the Government of India.
1873- Promulgation of Birth and Death
registration Act by Government of India. cond
1880- Promulgation of the Vaccination
Act. 1881- Promulgation of the first Indian factory Act. 1888- Central Governments decision to place the responsibilities of looking after sanitation on the local bodies. Contd
1896- Occurrence of a severe epidemic
of plague and appointment of a Plague Commission. 1897- Promulgation of epidemic disease Act. 1904- Recommendation of plague commission. 1909- Establishment of Central Malaria Bureau. Cond
1911- Establishment of Indian Research
fund Association. 1930- Establishment of all India institute of Hygiene and public health, Calcutta. Child Marriage Restraint Act. (Sarda Act) passed fixing the minimum age of marriage at 14 for girls and 18 for boys. Contd
1940- The Drug Act was passed.
1943- Appointment of the Health Survey and Development committee (Bhor committee) 1946- Submission of Bhore committees Report Public health in Pakistan era
The first all Pakistan Conference, held in
1947 at Lahore, adopted the bore Committee Report and its recommendations as the basis of planning and development of health administration in Pakistan Cond
In 1947, with the exception of
international health, quarantine, health legislation and research health administration of Pakistan was decentralized with maximum authority given to the provincial government. Cond
The second the all Pakistan medical
conference, held in Dhaka in 1951, approved a six year health plane which envisaged increase of beds in existing hospitals, increased number of rural dispensaries, conversion of medical school into colleges setting up new medical colleges, Contd
Establishment of institute of Hygiene
and Preventive medicine, Medical research institute and drug testing laboratories at both wings amalgamation of curative and medical services and organization of anti- malarial operations. Contd
Government of East Pakistan through
a Five-year development plan initiated action for the improvement of the health administration. Contd
An ambitious scheme was prepared
for establishing Rural Health Centre (RHC) with three Sub centre in each Thana on the basis of report of Bhore Committee. Contd
Besides the RHC scheme, several
vertical projects Malaria eradication, family planning, Smallpox control, BCG vaccination campaign etc were also launched in the East Pakistan Contd
Along with the government health
services, District Board used to provide health services by appointing District Health Officers (DHO) whose activities were limited to preventive medicine. e.g. Control of epidemics, mass vaccination, checking of food adulteration. DHO function through Thana Sanitary Inspector. Contd
There was little co-operation between
curative health services headed by Surgeon General and preventive health services headed by Director of Public Health and as well as between government and non - government Health Authority. Contd
During the Pakistani Era, East Bengal,
latter on renamed East Pakistan, did not receive equitable share of central allocation and support for the development of its health manpower and health service Contd
Four new medical colleges including
one exclusively for women functioning in West Pakistan by 1952. The first new medical college started functioning at chittagong in its Easretn wings in 1957. Cont
The only institute of Hygiene and
Preventive Medicine was established in Lahore . More over in the developmental activities the traditional stress on the curative medicine continued and public health activities for prevention of disease and promotion of health did not receive the desired attention . Contd
In fifties creation of job opportunities
in Eastern wing was neglected.
While doctors in West Pakistan were
favoured with scholarships for higher studies and absorbed in Arm Forces Medical services in good number. Contd
East Pakistani doctors were
conscripted under the General Practitioners (National Service) Act 1950 and allocated to West Pakistan provinces for serving in remort underdeveloped parts. Contd
The gross disparity in the development of
health services, like that in other spheres, was not an insignificant reason for developing a sense of deprivation among the people which resulted in the birth of Bangladesh as an independent sovereign.: Contd
A chronological history of events in the
field of public health taking place during Pakistani Era is given below: Contd
1947- Partition of India and emergence
of Pakistan as an independent country with four provinces in its western wings and East Bengal as the sole province in the eastern wing. Contd
1947- Holding of First All Pakistan Health
conference at Lahore, which adopted the recommendations of Bhore committee as the basis of health development in Pakistan. Contd
1948- Setting up of the Medical Council of
Pakistan under the Medical council Act with dual function of maintaining a uniform standard of medical education in the country and liaison with medical councils of foreign countries on the issue of mutual reciprocity in the matter of recognition of medical degrees Contd
1949- Anti-malaria Pilot Project in East
Bengal started by WHO Malaria Control and demonstration team 1950- Port Health authority started functioning at Chittagong port. Contd
1951- Four new medical colleges
including one for women were established in western wing. 1957- One new Medical college started functioning at Chittagong. Contd
1960-70 150 Rural Health Centers were
established. Each having 6maternity beds and 3 sub centers. Three vertical projects namely Malaria Eradication, Family planning and small pox Eradication programmed was launched Public Health in Post- independence Bangladesh On attainment of independence, the Government of Bangladesh initiated activities in the field of public health with right earnest.
Particular stress was given on organizing
primary health care, maternal and child health and family planning activities. Contd
The issue of development of health man
power was given due to importance and gradually several institutes namely Contd institute of Postgraduate medicine, National Institute of Ophthalmology, Institute Of Disease of Chest and Hospital, Rehabilitation Institute and Hospital for Disable, Institute of mental Health, Bangladesh institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorder and National institute of Preventive and Social Medicine were built and reorganized to run post graduate courses in all most all disciplines of curative and preventive Medicine Contd
. PHC philosophy has been accepted by
the Government of Bangladesh and all Its public health activities and efforts are now aimed to realizing the goal of HFA. Chronological mention of certain development is made here under. Contd 1972- Introduction of Thana Health Complex Scheme(THC) upgrading the rural health centre (RHC)
1972-Establishment of National Health
Library and Documentation centre. 1972- Establishment of Bangladesh Medical and Research Council . Contd
Upgrading of Dhaka Medical School
and Milford Hospital into Sir Solimullah Medical College and Medford hospital. Contd 1972- Establishment of Bangladesh College of Physician and Surgeon (attended in 1972 and 1976) for the post Graduate medical education (FCPS,MCPS)in all specialties
1973- Promulgation of medical council Act.
Contd 1974- Establishment of Instituted of Public Health Nutrition, Dietetic, and Food Science. 1975- Amendment of the Pharmacy Act 1957. Promulgation of Children Act. 1976- Promulgation of Blind Relief (Donation of Eye) Act. 1975 Establishment of National Nutrition Council (NNC) Contd 1975- Order of Bangladesh Red Cross Society passed, amend 1975. 1976- Establishment of Institute of Epidemiology, Disease Control and Research(IEDCR) 1977- Thana Health complex Scheme with 31 beds each and 4 or 5 Sub-centers approved. 1977- Modification and recognition of under graduate teaching in Hygiene and preventive Medicine. Department of Community Medicine strengthened. Contd 1977- Promulgation of Environmental Pollution Control Ordinance. 1977- Creation of the Directorate of Nursing Service s(DNS) by order of President. 1978- Bangladesh becomes a signatory to Alma Ata Declaration following endorsement of World Health Organization resolution on HFA 2000. 1978 - Establishment of National institute of Opthalmology. contd 1978- Commencement of formal academic programmed of NIPSOM with two courses: Diploma in Public Health (DPH), Diploma in Community Medicine (DCM).
1979 - Establishment of National institute of
Cardiovascular diseases
1979 - Launcing of Expanded Programme of
Immunization (EPI).
1980 - The post of Director of Health Services upgraded
to Director General of Health Services (DGHS). 1981- Palli-chikitsak Scheme introduced but subsequently abandoned after a few years. 1981- In troduction of PHC pilot project in six Upozilla Health complexes. 1982- Private Clinic and Laboratory Ordinances adopter by GOB 1983- Promulgation of Drug Control Ordinance. Contd
1986- Foundation of the Cancer Institute
and Research Hospital 1990- Narcotics Control Act promulgated. 1998 - Establishment of Bangabandhu Sheikh Mujib Medical University. Community medicine is a new comer
It is the successor of what was previously known
as public health, community health, preventive and social medicine.
All these share common ground i.e. prevention
of disease and promotion of health. Contd
It has emerged as a new science, with a
new outlook, new approach, and a new method of delivery of health care system to the people or the community at large. Contd Community medicine is a stage in the evolution of medicine as that branch of medical practice which is concerned with promotion of health of human communities Contd
It thus differs from clinical specialties
where primary concern is the health of the individual. In which led to further broadening of the out look of public heath. The emergence of community medicine is the result of dissatisfaction both within the health profession and the public at large
Because of the fact the modern scientific
medicine could not be translated into community oriented patient practice. Public Health:
The science and arts of preventing disease,
prolonging life and promoting health and efficiency through organised community efforts for the sanitation of the environment,control of communicable infection, the education of the individual in personal Hygiene the organization of medical and nursing services for early diagnosis and preventive treatment of disease and the development of machinery to ensure for . So organising