Dr Saadiyah Rao Senior Lecturer School of Public Health Dow University of Health sciences

To give overview of History of Pubic health To discuss time line from primitive medicine to birth of Public Health To review the evolution of Public Health in developed countries

 Public health is not an invention of the 20th century, and

the issues we debate today have many parallels in history.

Brockington noted (1960) that,

public health in some form has existed as long as civilisation. Inoculation against smallpox was practiced in India and China more than two thousand years ago. Isolation of leprosy was enforced in the Roman Empire which built leprosaria; the first isolation hospitals, and many religious abstentions concerned food and excretal pollution.
Dr Saadiyah Rao- School of Public Health, DUHS 3

Time line
Primitive societies
Ancient societies: before 500BC Classical cultures: (500BC to 500 AD) Middle Ages: (500 to 15 00AD) Renaissance period: (1500 to 1700 AD) Eighteen century Nineteen century

Twentieth century
Twenty first century
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Public Health in Primitive Societies

Have a sense of community hygiene bury excreta burial of the dead tribal rituals for the diseased temporary isolation for the sick smoke for fumigation

Dr Saadiyah Rao- School of Public Health, DUHS

Public Health in Ancient Societies Before 500BC

Indus Valley Civilization (2000BC): Excavations provide

evidence of: bathrooms & drains in home Sewers below street levels

Dr Saadiyah Rao- School of Public Health, DUHS

Dr Saadiyah Rao- School of Public Health, DUHS

Public Health in Ancient Societies

Middle Kingdom of ancient Egypt (2700-2000BC): Ruins

showed the presence drainage system knew more than 700 drugs
Sumerian clay tablet from 2100 B.C. contains prescriptions

for drugs

Dr Saadiyah Rao- School of Public Health, DUHS

Public Health in Ancient Societies

Code of Hammurabi Babylon(1700-1800BC) : earliest

written record concerning Public Health: included laws pertaining to physicians & health practices :

Physicians provide a service to the society, and in return were paid money but would be punished if the results of treatment ended up killing the patient !
Mycenaeans in Crete-Greece (1600BC): had toilets,

flushing system & underground drainage system

Dr Saadiyah Rao- School of Public Health, DUHS

Public Health in Ancient Societies

Hebrews wrote Book of Leviticus in about 1500 B.C.

- the first written health code in the world keep a clean body protect against contagious diseases isolation for lepers disinfecting of home after an illness sanitation of campsites protect food and water hygiene of maternity
Dr Saadiyah Rao- School of Public Health, DUHS 10

Public Health in Classical Cultures 500 B.C. to 500 A.D.

Greeks began to travel to Egypt Took information from other people Included it in Greek philosophy of health and medicine

Active in the practice of community sanitation

Supplemented water of city wells and built cistern Hippocrates (460-370 BC) In his book On Airs, Waters,

Places; presented relations of disease to physical, social, and behavioural settings The first rational guide to the establishment of a sciencebased public health
Dr Saadiyah Rao- School of Public Health, DUHS 11

Public Health in Classical Cultures

Romans Had extensive systems for public and private hygiene Had extensive bath and wash houses Brought clean water into their cities using aqueducts Had system for getting rid of garbage and other wastes Cloaca Maxima, still serves as part of the sewage of the modern Rome ! Street cleaning & repair system Built the first hospital

Dr Saadiyah Rao- School of Public Health, DUHS

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Public Health of the Middle Ages (500-1500 A.D.)

Period from end of Roman Empire to 1500AD
Most of knowledge was preserved in churches &

monasteries Medieval approach to health & disease was different from Romans Health problems were considered as to have spiritual causes, hence spiritual solutions

Dr Saadiyah Rao- School of Public Health, DUHS

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Public Health of the Middle Ages

Dark Ages (500-1000 A.D.): Western Europe experienced a period

of social and political disintegration. In Eastern Europe and Asia medicine advanced and major hospitals established in Baghdad, and Cairo. Western Europes condition:
immoral to view ones own body sanitation ignored; waste in streets many pandemics

Blamed disease on supernatural causes St Augustine: taught that disease were caused by demons sent to

torture the human spirit and diseases were punishment for sins! This is often called The spiritual era of Public Health
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Public Health of the Middle Ages

(500-1500 A.D.)
During the 7th century A.D. Islam appeared
religion stressed cleanliness

"There is no disease that Allah has created, except that He

also has created its remedy." Volume 7, Book 71, Number 58 Taking proper care of one's health is the right of the body. Bukhari as-Sawm 55, an-Nikah 89, Muslim assiyyam 183, 193, Nisai The Prophet (PBUH)not only instructed sick people to take medicine, but he himself invited expert physicians for this purpose. D.o.H. p.50, As-Suyuti's Medicine of the Prophet p.125
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 There were Mobile dispensary

The concept of quarantine was first introduced in the 7th

century A.D. by the prophet Muhammad (PBUM), who warned against entering or leaving a region suffering from plague. Al-Razi wrote encyclopaedias of Medicine As early as the 10th century, Muslim physicians innovated the use of isolation wards for individuals suffering with communicable diseases. Also had public baths and sewage systems.

Dr Saadiyah Rao- School of Public Health, DUHS

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Public Health of the Middle Ages (500-1500 A.D.)

Back to western world: One of the earliest recorded epidemic disease was Leprosy : 6th-

15th century - rules and regulations - leper houses The deadliest plague epidemic 14th century---------plague was named as black death killed 25 million people in Europe Other epidemics : smallpox, diphtheria, measles, influenza (English Sweat), TB, and many other unidentifiable diseases Last epidemic : syphilis appeared in 1492 & killed thousands

Dr Saadiyah Rao- School of Public Health, DUHS

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Public Health in the Renaissance & Exploration Period 1500-1700 A.D.

Period characterised by rebirth of thinking about

nature & humankind : exploration & discovery Led to great commercial, scientific, cultural, and political development Effects of this period on Public Health were substantial However, experience of the Dark Ages was not forgotten People now asked how diseases arose?
not a punishment from God because Growing belief was environmental factors that caused

disease
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Public Health in the Renaissance Period (1500-1700 A.D.)

Careful observations of symptoms & disease outcomes

led to the first recognition of separate diseases

Whooping cough, typus, scarlet fever, and malaria

Practically the conditions were not much changed

from Dark ages Explorers, traders and migrants took European diseases and spread them to indigenous peoples around the world

Dr Saadiyah Rao- School of Public Health, DUHS

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Public Health in the Renaissance Period (1500-1700 A.D.)

Three most important contributions to public health of

the Renaissance period: The organization of boards of health : were responsible for :
determining of plague
quarantine burial of plague victims the fumigation

A model for nineteenth-century organization of public

health activities
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Public Health in the Renaissance Period (1500-1700 A.D.)

The promulgation of a theory of contagion

Girolamo Fracastoro proposed that epidemic diseases are caused by transferable tiny particles seeds of disease, seminaria" He analysed diseases according to three specific modes of dissemination by contact, through objects such as cloth (fomes), by distance The earliest theoretical conceptualizations of something approximating germ theory !
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Public Health in the Renaissance Period (1500-1700 A.D.)

The introduction of health statistics
The Italian boards of health instituted a system of

death registration In 17th century (London) analysis of bills of mortality by John Graunt (Natural and Political Observations Made Upon the Bills of Mortality) laid the basis for the modern use of statistics for the planning and evaluation of public health activities.

Dr Saadiyah Rao- School of Public Health, DUHS

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Public Health in the Eighteenth Century

Beginnings of industrialization and urbanization
Although there had been a recognition of the role of the

environment as a cause of disease, living conditions were not conducive to good health Significant milestone (1796), when Dr. Edward Jenner demonstrated the process of vaccination as a protection against small pox Before this: variolation

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Public Health in the Eighteenth Century

The first US census was taken in 1790: Average age at

death was 29 years at that time ! US continued to face epidemics of small pox, cholera, typhoid fever & yellow fever Hence, in 1798 Marine Hospital Service was formed to deal with diseases on vessels Several other governmental health agencies were created to deal with epidemics, sanitation problems & protection of water

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Public Health in the Eighteenth Century

In Germany, J P Frank, published System of a Complete

Medical Policy:
proposed a extensive scheme of governmental regulations and

programs to protect the population against disease and to promote health.

The actions that he advocated ranged from measures of

personal hygiene and medical care to environmental regulation and social engineering. In England, Jeremy Bentham in his Constitutional Code, proposed radical new legislation dealing with issues as prison reform, the establishment of a ministry of health, birth control, and a variety of sanitary measures.
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Dr Saadiyah Rao- School of Public Health, DUHS

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Public Health in the Nineteenth Century

Public health provision was completely transformed

as the 19th century progressed. Overcrowding, poverty and disease went hand in hand at the century's start, but social reform had comprehensively turned things round Initially living conditions remained unsanitary in Europe & England but realized that social and sanitary conditions impacted the economy Parliament made reforms to improve the lives of men, women and children in the poorer sections of society. Government involvement in welfare provision, and in regulating conditions of work in factories, workshops and mines.
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Public Health in the Nineteenth Century

General Registration (from 1837) gather statistics on

mortality for the whole of England and Wales. Edwin Chadwick 1842

Report on an Inquiry into the Sanitary Conditions of the

Laboring Population of Great Britain Key conclusion: That the various forms of epidemic, endemic, and other disease caused, ...... chiefly amongst the labouring classes ...... by decomposing ...... substances, by damp and filth, and close and overcrowded dwellings prevail amongst the population in every part of the kingdom That the annual loss of life from filth and bad ventilation are greater than the loss from death or wounds in any wars in which the country has been engaged in modern times.
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 Public Health Act & General Board of Health for

England 1848 1849 first annual report called for municipal action to:
eradicate slums and build model dwellings public wash-houses control the water supply municipal cemetery

drainage system with a permanent sanitary inspector

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Public Health Acts

1848 Public Health Act encouraged local Health Boards to

appoint Medical Officer, inspect lodging houses and check food and provide sewers. 1855 Nuisance Removal Act overcrowded housing illegal 1864 Factory Act unhealthy conditions in factories illegal 1866 Sanitary Act local authorities responsible for sewers, water and street cleaning. 1871 Vaccinations Act vaccinations were made compulsory (1853) 1875 Artisans Dwelling Act made the house owners responsible for keeping their properties in good order and gave local authorities the right to buy and demolish slums if they were not improved.
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Public Health in the Nineteenth Century

In 1848-49, 2nd cholera epidemic John Snow 1849 : On the Mode of Communication of

Cholera
Predominant theory (contagious disease) : miasma

theory : Diseases were caused by the presence in the air of a miasma; a poisonous vapour

1853-54, 3rd outbreak of cholera 1854 He figured out the origins of cholera: the classical

study in Epidemiology 1850- Ignaz Semmelweiss- introduced hand washing

Source: http://www.choleraandthethames.co.uk/
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Public Health in the Nineteenth Century

Theory of spontaneous generation: living organisms

could arise from inorganic or nonliving matter equivocal generation considered that one type of contagious microbe could change into another type. Pasteur (1862) proposed the germ theory of disease Gave the death blow to the theory of spontaneous generation and radically changed the practice of medicine. Later introduced pasteurization of milk Joseph Lister (1867)- - antisepsis

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Public Health in the Nineteenth Century

Koch in (1876) establish a causal relationship through

his postulates 4 postulates contributing to germ theory

The disease agent must be found in all cases of the disease The disease agent must be isolated in pure culture Inoculation of this disease agent must produce the same

disease in healthy animals/people The disease agent must be re-isolated from the inoculated animal/person

Developed ways of staining bacteria and identify the

bacterial causes of anthrax (1877), tuberculosis (1882) and cholera (1883) 1875 to 1900 The Bacteriological Period of Public Health
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Shattuck Report -US 1850

19th Century America: Population increased Epidemics common Lemuel Shattuck - legislator Massachusetts appointed to study sanitary problems no national or state PH programs were at the time Drew up a health report that outlined the public health needs of state

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Shattuck's Recommendations
Health education Study, supervise and/or control TB, alcoholism, mental disease Supervise and study immigrants Control smoke and food adulteration Teach sanitary science in medical school Include prevention in clinical practice Get routine physical exams Keep records of family illnesses Impact of this report was to start the Modern Era of

Public Health in America

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Public Health in the Twentieth Century

At the beginning of the century Life expectancy was less than 50 years Leading causes of death were communicable diseases (influenza, pneumonia, tuberculosis , GI infections , malaria & diphtheria) Vitamin deficiency diseases were common including rickets, pellagra and scurvy (symptoms of these diseases were known but the cause was mystery) Deaths associated with pregnancy and childbirth were also high

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Public Health in the Twentieth Century

1.Health resources development period (1900-1960) : much growth & development of health care facilities & providers took place during these 60years - is further divided into
The reform phase (1900-1920)
The 1920s The great depression (1929-1935) and World War II (1939-45 ) The post war years

2.Period of social engineering (1960-1973) 3.Period of health promotion (1973 to present)

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Public Health in the Twentieth Century

The Reform Phase of Public Health (1900-1920) Growing concern about social problems in America due deepening gap between upper lower classes led to reform movement Broad movement involving social, moral & health issues Upton Sinclair The Jungle drew attention to unsafe working condition in meat packing factory 1906, the passage of the Pure Foods and Drugs Act
In 1910 first international congress on occupational disease was

held New York passed Workers Compensation Act: Employers are required to make compensations to workers First School of Public Health was established in 1918 at Johns Hopkins University
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Public Health in the Twentieth Century

The 1920s Period of slow development in Public Health Prohibition resulted in decline in alcoholics and alcohol related deaths Life expectancy in 1930 risen to 59.7 years

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Public Health in the Twentieth Century

The Great Depression (1929-1935) and World War II

(1939-45 )
by 1933 private resources could no longer meet the needs of

the people who needed social & medical assistance Beginning in 1933, President Roosevelts New Deal created agencies and programs for public works Building of hospitals and laboratories, control of malaria and the construction of municipal water and sewer systems World War II decreased the availability of funds and resources for public health, but led to the development of many important medical discoveries that were made available once the war ended
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Public Health in the Twentieth Century

The post war years
Antibiotic penicillin was made available Insecticide DDT to kill insects that transmitted

communicable diseases was made available Communicable Disease Center was set up in Atlanta during the war, now known as the Center for Disease Control and Prevention (CDC).leading epidemiological center of world Two major events in the 1950s Development of a vaccine to prevent polio President Eisenhowers heart attack focused attention on the nations number one killer, heart disease
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Public Health in the Twentieth Century

Period of Social Engineering (1960-1973) 1965 passage of the Medicare and Medicaid bills

Medicare provides for health care to the elderly and some disable people Medicaid provides health care for the poor

Period of Health Promotion (1974-present) Recognition that the greatest potential for saving lives is by education and life-style changes by individuals In 1970s, CDC conducted a study that examined premature death : approx 48% of all premature deaths were because of lifestyle or health behavior-choices people make
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Public Health in the Twenty-first Century

World health leaders recognized the need to plan for

21st century in 1977 WHO set a target for health for all by year 2000 Health resources should be distributed in such a way that essential health care services are accessible to everyone Alma Ata conference adopted declaration on Primary Health Care as a key to attain this goal

Dr Saadiyah Rao- School of Public Health, DUHS

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Public Health in the Twenty-first Century

Goal is not achieved but it is not abandoned !
Renamed to Health of All(HFA) HFE seeks to create the conditions where people

have, as a fundamental human right, the opportunity to reach and maintain the highest level of health Although slow but achieved increase in life expectancy globally

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Public Health in the Twenty First Century

Problems to be faced Health care delivery cost Environmental problems Lifestyle diseases Drug abuse New communicable diseases or old diseases that have become resistant to drug therapy

Dr Saadiyah Rao- School of Public Health, DUHS

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References
An Introduction to Community Health :James

McKenzie, Robert Pinger, Jerome Kotecki http://www.sciencemuseum.org.uk/broughttolife/the mes/publichealth.aspx http://www.islamic-study.org/public_health.htm http://www.parliament.uk

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