INTRODUCTION TO PUBLIC HEALTH

What Is Public Health?

“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” (Edward A. Winslow, 1920)

COMMUNITY

• Small or large units that have something in common such as norms, religion,
values, or identity.
• TYPES:

1. Location-based Communities: village, town, nation

2. Identity-based Communities: ethnic group, religious group, subculture

3. Organizationally based Communities: organization (private or public)

KNFS 2021
 MAJOR INCIDENTS IN PUBLIC HEALTH:

AIDS EPIDEMIC:

• JULY 3, 1981: “Rare Cancer Seen in 41 Homosexuals”

•8 out of 41 died within 24 months being diagnosed
• May 1982 “Gay-Related Immune Deficiency Syndrome (GRID)” •
1983 “Acquired Immune Deficiency Syndrome (AIDS)”
• April 23, 1984: Dr. Robert Gallo discovered Human Immunodeficiency Virus
(HIV)
• 1985: US began screening donated blood.

EPIDEMIC: disease that affects a large number of people within a community,

population, or region.
PANDEMIC: is an epidemic that’s spread over multiple countries or continents.
ENDEMIC: is something that belongs to a particular people or country.

OUTBREAK: is greater-than-anticipated increase in the number of endemic

cases. It can also be a single in a new area. If it’s not quickly controlled, an
outbreak can become an epidemic.
 KNFS 2021

CRYPTOSPORIDIUM IN MILWAUKEE WATER

• April 1993
o Outbreak of “interstitial flu”
o “Massive cryptosporidiosis”
• Confirm incident through phone call
• Intestinal parasite spread through contaminated water
• Clinical symptom: Acute Watery Diarrhea
• March 1 to May 30, 1993
o 739 stool samples positive for Cryptosporidium
• March 25 to April 9, 1993
o Confirmed that the organism was present in ice.
o Specifically, cryptosporidium oocysts were identified in ice.
• 403, 000 made ill, 54 died

PUBLIC HEALTH IN RUSSIA

• The Soviet Union set a high priority on public health after the Russian
Revolution Government that governed Russia.
• Effects of war: famine, plague, general lack of sanitation
• Educational campaign to teach people to practice basic hygiene and prevent
 diseases.
• 1980: Infant mortality rate has been rising but not reported because they were
embarrassing to the government.
• 1991

o Deaths were almost twice as common as births

o Increase cancer rates, respiratory disease and birth defects, shortage of
vaccines, drugs and medical supplies, reuse needles, poor training of
physicians.
• The Russian population fell by 6 million people since 1992 to about 143 million in
2008.

KNFS 2021

PUBLIC HEALTH AND TERRORISM

• September 11, 2001 US was struck by foreign terrorists

o 4 passenger airlines were simultaneously hijacked, 3 were crashed
into buildings (WORLD TRADE CENTER)
o Activation of emergency plans in the region.
o Longer-term response has focused on law enforcement and
national defense.
• ·October 2, 2001, anthrax incident, 22 cases and 5 died
o Robert Stevens, an editor for a supermarket tabloid admitted to
hospital suffering from high fever and disorientation.
o Inhalation of anthrax; bioterrorism (causative agent: Bacillus
anthracis)
o Suspicious letter containing powdered anthrax spores

• "Shamans “
o In remote parts of the world—in the Amazon, Indonesia, Australia, and
Africa—isolated communities exist that anthropologists believe follow
lifestyles typical of prehistoric populations. These peoples share the belief
 that diseases are caused by malevolent supernatural forces.
o To diagnose, treat, and, in some cases, prevent the spread of these
malevolent forces, all primitive societies have created a class of
"shamans"—persons specially trained to intervene on the spiritual and
physical level.
o Supernatural explanations of disease did not evoke or require an
environmental origin for disease.

KNFS 2021

• Greece (4th and 5th century): Hippocrates

o An empirical explanation of disease was proposed by the physician
Hippocrates (FATHER OF MEDICINE) and his followers who described
diseases in objective terms, and rejected supernatural causes.
o HIPPOCRATIC OATH: to treat the ill to the best of one's ability, to
preserve a patient's privacy, to teach the secrets of medicine to the next
generation.
o Aesculapius: symbol of medical profession
o Book: On Airs, Waters and Places
▪ The relations of disease to physical, social, and behavioral settings
are presented for the first time. This book served as a guide for
decisions regarding the location of urban sites in the Greco-Roman
world, and may be considered the first rational guide to the
establishment of a science-based public health.
▪ Rejected supernatural theory of disease

THE DARK AGES AND THE MEDIEVAL PERIOD

 • About 500–1000 C.E. Romans inherited the theory from Greek o
Sewage disposal
o Keen sense of sanitation
o Baths, sewers and aqueducts were constructed.
• Leprosy (6 -15 Century)
th th

o Isolation of cases of leprosy in medieval times represents the earliest

application of a public health practice still in use.
o Manifested by a continent-wide epidemic
o Lepers were excluded from communities and segregated. Elaborate rules
and regulations were set up to diagnose the disease and isolated cases.
o First treatment is medicinal oil from the seeds of the chaulmoogra tree had
little effect, and no real work has done until Norwegian physician GH/
Gerhard Henrick Armauer Hansen isolated the bacillus in 1873.

KNFS 2021

o Leprosy is also known as Hansen’s bacillus

o Causative agent: Mycobacterium leprae also known as Hansen’s
bacillus

THE RENAISSANCE AND THE PLAGUE CENTURIES

•A period of great commercial, scientific, cultural, and political development •

Organization of boards of health
• Promulgation of a theory of contagion
• Introduction of health statistics.
• Europe: “Black Death”-bubonic plague an infection spread mostly to humans by
infected fleas that travel on rodents; causative agent is Yersinia pestis • Syphilis:
spread by Christopher Columbus while exploring the New World which is now
called United States of America; causative agent is Treponema pallidum. •
“English sweat”: an ill-defined condition, possibly a form of influenza, • Smallpox
was transported to America.
15th Century Development:

• First for contagious diseases and subsequently for all diseases. The resulting
bills of mortality have provided continuous data on mortality in Italy from the
Renaissance to the present.
• Permanent boards of health
• Determining the existence of plague
• Establishing quarantine and issuing health passes
• Arranging for the burial of plague victims
• The fumigation of their residences and control of markets
• Sewage systems, water supplies, cemeteries,
• Preparation and sale of drugs
• activities of beggars and prostitutes
• Italian boards of health instituted a system of death registration

KNFS 2021

19th Century:

• With the disappearance of plague at the end of the seventeenth century, the
boards of health of northern Italy withered away. Nevertheless, they provided a
model for the nineteenth-century organization of public health activities.

THE ENLIGHTENMENT AND SANITARY REFORM

• The period from 1750 until the mid–nineteenth century) was characterized by
unprecedented industrial, social, and political developments, and the result • Louis
Pasteur and Robert Koch demonstrated the involvement of bacteria in disease
in societal impacts were immense, culminating in the Industrial Revolution.
• Joseph Lister 's implementation of the use of a disinfectant spray and fresh
changes of operating smocks for surgeons greatly decreased the mortality rate
associated with operations.
 • Because of these public health efforts, operations moved from a position of last
resort to a procedure that could improve health and alleviate suffering in people. •
Typhoid Mary (Mary Mallon): most harmless yet the most dangerous woman in
America; a cook who spread Typhoid fever in America.
o Causative agent of Typhoid fever: Salmonella typhi

19th-21st CENTURY

• The increasing disparity between the developed and underdeveloped countries

of the world spawned major international public health efforts in the twenty-first
century.
• World Health Organization (WHO) in 1948.
• United Nations International Children's Emergency Fund (UNICEF) in1946 • The
average life expectancy in the world was 46 years. As of the late 1990s, this
average life expectancy had risen to 65 years of age. Much of this increase is
attributable to organize

KNFS 2021

• AIDS Lessening the chances of exposure to such infectious agents has become
another public health concern
• Watershed

One expectation about living in a civilized society is that the living conditions will be
basically healthy. There are a number of reasons why people’s lives are basically
healthier today than they were 150 years ago: cleaner water, air, food, safe disposal.
Although many sectors of the community may be involved in promoting public health,
people most often look to the government to take the primary responsibility.
Governmental regulation ensures the safety of the food supply, ensures the quality of
medical services, laws inquiring immunization of children, and sponsoring research.
Over the following decades, public health had many successes, carrying out many of
the tasks

Public health was not prepared to deal with these problems:

 • Environmental pollution
• Aging population: increased health services
• Social problems: teenage pregnancy
• Violence

• Drug abuse

Four-Part Definition (The Future of Public Health, 1988):

1. Mission: the fulfillment of society’s interest in assuring the conditions in which

people can be healthy.

2. Substance: organized community efforts aimed at the prevention of disease and

the promotion of health.

3. Organizational Framework: both activities undertaken within the formal structure

of government and the associated efforts of private and voluntary organizations
and individuals.

KNFS 2021

4. Core Functions: assessment, policy development, and assurance. •

Monitor health status to identify community health problems
• Diagnose and investigate health problems and health hazards in the
community
• Inform, educate and empower people about health issues
• Mobilize community partnership to identify and solve health problems •
Develop policies and plans that support individual and community health
efforts
• Enforce laws and regulations that protect health and ensure safety • Link
people to needed personal health services and assure the provision of
health care when otherwise unavailable
• Assure a competent public health and personal healthcare workforse •
Evaluate effectiveness, accessibility, and quality of personal and
 population-based health services
• Research for new insights and innovative solutions to health problems.

KNFS 2021

PREVENTION AND INTERVENTION:

• Prevention: develop interventions designed to prevent specific problems that

have been identified either through an assessment process initiated by a public
health agency or through community concern raised by an unusual course of
events
• Public health approach to health problems in a community has been described
as a five-step process:
1. Define the health problem.
2. Identify the risk factors associated with the problem.
3. Develop and test community-level interventions to control or prevent the
cause of the problem.
 4. Implement interventions to improve the health of the population.
5. Monitor those interventions to assess their effectiveness.

KNFS 2021

LEVELS OF PREVENTION:

• Public health has developed systematic ways of thinking about such problems
that facilitate the process of designing interventions that prevent undesirable
health outcomes.
• PRIMARY PREVENTION: prevents an illness or injury from occurring at all, by
preventing exposure to risk factors.
o Examples:
▪ Discourage teenager to smoke to prevent cancer, smokers to quit ▪
Preventing crashes and motor vehicle, traffic lights, divided
highways
SECONDARY PREVENTION: seeks to minimize the severity of the illness or the
damage due to an injury causing event once the event has occurred. • Examples:
▪ Screening program are established to detect cancer at an early
stage when it is still treatable
▪ Design of safer automobiles, seatbelts, airbag
TERTIARY PREVENTION: seeks to minimize disability by providing medical care and
rehabilitation services.
• Examples:

▪ Medical treatment and rehabilitation of cancer patients

▪ Development of emergency medical services 911, ambulance,
trauma center

KNFS 2021