Health and The Healer- Lecture Fifteen

What is public health?

- When society collectively organize to protect against health dangers to populations
Health Dangers
- Classically, hey have meant epidemics and endemic diseases (there are serious diseases that occur
within a given society in very large numbers)
- Diseases related to social conditions such as occupation, physical environment and social environment
- For some people the social environment is a health risk and danger (tendencies in public health to look
at these social issues)
- Some practices are collective in how we produce food and how food gets used in society,
prositution
- Increasingly individual behavior like infant hygiene, tobacco and obesity
Require Decisions
- What constitutes a health danger requiring collective response?
- What is its cause, usually choices
- Which of several possible responses to the assumed cause is appropriate?
- Each response involves uncertainty, risks, discomfort for someone
- Is this a serious enough issue to choose to turn this into a public health problem requiring
solutions?
- Each of these causes provides you with a range of solutions which are more or less extreme
- Political roles play a component in this (some people hate being told what to do), you get a
sense of how complicated decision making can get
- People are making decisions by the seat of their pants with insufficient data, and if it is
serious enough they need to act as if they knew what they were doing
Historical Tendency
- The tendency has been to constantly expand the scope of public health
- Often dealing with a public health problem can mean making people deal with things that they don’t
want to do, which is an integral part
- Public health dates from 15, 16, 17th century and even though authorities didn’t know the measures
seemed to have some success
- The real expansion of the public scale took place in the 18th century
The State and Medicine: 18 and 19th century
- Created by absolute monarchies
- Centralized power and bureaucratic intervention
- The power of state= size of population
- The need for information about population
- Standing Armies
- Second factor was that increasingly states were running armies
Statistics and Public Health
- The government collected statistics on births and deaths in order to get a sense of what the population is
and what they are responsible for
- You can begin to analyze it as statistical data
The Modern World- 19th Century
- The enlightenment and liberalism which they use to make society larger and that there are things that
could be done about the conditions that caused diseases and death
- There was a rapid, massive urbanization
- The slums of the Industrial Revolution were a breeding ground for disease
- It was a ground for small spaces, people shared the streets with animals
- Humans were not much better, most people couldn’t afford toilets and human waste became a
major component
- The quality of water from many rivers was particularly known to be semi-poisonous
Industrialization
- People who worked in match factories got a disease that was called phossy jaw (deterioration of the
bones in the jaw) and could mean loss of teeth
- Manufacturing was dependent on machines and industrialization and made old social problems like
overcrowding much worse
- Although epidemics didn’t kill more people than pandemics, epidemics cause the breakdown of social
life and disorder and violence which was often accompanied with the Jews
Mediatized Epidemics Cholera, 1832
- There were all kinds of media and it gradually made its way West eventually hitting West Europe and it
happened in a way that was possible to follow its spread
- In 1851 the outbreak took place in Paris, any people that could flee the city many believed that death
was everywhere and the doctors were helpless by dealing with the epidemic
- Because you could watch the spread of an epidemic cities that expected Cholera
Public Health: Germany