PATHFINDERS on the ROAD to HEALTH

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PATHFINDERS on the ROAD to HEALTH
Usher Institute
1902 - 100 years of academic public health - 2002

• John Last
• University of Ottawa, Canada

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THREE GIANT STEPS

• Fire to cook meat
• (?750-500k BCE)
• Planting harvesting crops
• Animal husbandry
• (10-12k BCE)

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HUMAN SETTLEMENTS

• Origins of culture history, tradition, myths,
  legends, religious beliefs, science
• Ecosystem changes human influences on natural
  environment due to agriculture, waste disposal,
  etc
• Ecological origin of diseases fecal/oral,
  vector-borne, parasitic, trans-species, etc
• Population surge

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AIRS, WATERS, PLACES

• Seasons, Winds (hot, cold)
• Water
• Place Aspect to winds, sun
• (sheltered or exposed)
• Life of the people
• Hard working, eat drink wisely,
• Indolent, eat and drink a lot

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James Lind 1716-1794
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Edward Jenner 1749-1823
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Lady Mary Wortley Montague
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John Snow 1813-1858
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Cholera in South London, 1854in Relation to
Water Supply
Southwark Vauxhall Water Company 40,046 houses 286 deaths 71 per 10,000 houses
Lambeth Water Company 26,107 houses 14 deaths 5 per 10,000 houses
All other Water Companies 287,345 houses 277 deaths 9 per 10,000 houses
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IDENTIFYING,CLASSIFYING BACTERIAVACCINES,
SERA(Late 19th century onward)
Contributions of Bacteriology to Public
Health

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Louis Pasteur 1822-1895
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19th Cent. Public Health Heroes

• Snow, Farr, Nightingale
• Henle, Koch, Virchow, Pasteur
• Semmelweiss, O.W. Holmes
• Chadwick, Shattuck
• Mayhew, Kingsley
• Newspaper editors, cartoonists
• Politicians

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THE SANITARY REVOLUTIONLate 19th-Early 20th
CenturyClean, pure, safe waterSanitation
(sanitary disposal of human waste)Improved
household and personal hygiene
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Essential Ingredients

• 1. AWARE THAT THE PROBLEM EXISTS
• Health Information System
• Public perception
• (Role of media)

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Essential Ingredients

• Aware problem exists
• 2. KNOW WHAT CAUSES IT
• (Dont necessarily need complete understanding,
  just enough to be able to take action)

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Essential Ingredients

• Aware problem exists
• Know what causes it
• 3. ABILITY TO CONTROL THE CAUSE
• (Dont always need to understand a cause
• in order to be able to control it)

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Essential Ingredients

• Aware problem exists
• Know what causes it
• Able to control cause
• 4. BELIEF THAT IT IS IMPORTANT
• This requires a sense of values a moral
  imperative, the public health ethic, the concept
  of Redefining the Unacceptable
• (Geoffrey Vickers)

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Essential Ingredients

• Aware problem exists
• Know what causes it
• Able to control cause
• Believe it is important
• 5. POLITICAL WILL
• Advocacy, lobby (pressure) groups

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ESSENTIAL INGREDIENTS

• Aware that the problem exists
• Know what causes the problem
• Ability to control the cause
• Believe it is important (Values)
• Political will

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21st CENTURY CHALLENGES(Huge public health
impacts)

• Human disruption of global ecosystems
  Atmosphere global warming, ozone attenuation,
  smog resource depletion (fresh water, ocean
  fisheries) loss of biodiversity, species
  extinctions
• Violent armed conflicts
• HIV/AIDS pandemic
• Tobacco addiction pandemic
• Petroleum fuel addiction pandemic

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PROMOTING HEALTH

• SAFE ENVIRONMENT
• ENHANCED IMMUNITY
• SENSIBLE BEHAVIOUR
• GOOD NUTRITION
• WELL-BORN CHILDREN
• PRUDENT TREATMENT

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ESSENTIAL CONCEPTS

• Food and nutrition science
• Environmental management
• Contagion and its control
• Behavioural and social determinants
• Counting, measuring, surveillance
• Multi-sectoral, trans-disciplinary commitment to
  control health problems