HISTORY OF PUBLIC HEALTH Recurring Issues

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HISTORY OF PUBLIC HEALTHRecurring Issues

• Movement of people(s)
• Influence of war on disease and public health
  concerns
• Early historical examples
• Mongol invasions from the East
• Crusades in Middle Ages
• Colonization invasions
• Civil War in the United States
• Spanish-American War
• World War II

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HISTORY OF PUBLIC HEALTHRecurring Issues
(contd.)

• Influence of colonization/immigration on disease
  and public health concerns
• Influence of commercial trade on disease and
  public health concerns

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HISTORICAL PERSPECTIVE

• Primitive societies
• Classical Cultures
• Middle Ages
• Renaissance and the Age of Reason
• Development of Public Health in the United States
• English Influence
• Colonial America
• 19th Century in America
• The Shattuck Report (1850)
• Creation of Federal and State Environmental
  Agencies

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HISTORICAL PERSPECTIVE (contd.)

• Childrens Bureau (1912)
• Food and Drug Administration (FDA)
• Social Security Act (1935)
• Federal Security Agency (1939)
• Department of Heath, Education, and Welfare
• Department of Health and Human Services
• Hill-Burton Act (Hospital Survey and Construction
  Act (1946)
• National Institutes of Health (NIH)
• Medicare and Medicaid

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Roman Civilization -- Public Health Achievements

• Roman civilization that succeeded the Athenian is
  well known for its engineering and administrative
  arrangements affecting public health
• E.g., inspection and removal of dilapidated
  buildings, elimination of dangerous animals and
  foul smells, supervision of weights and measures,
  supervision of public bars and taverns,
  supervision of houses of prostitution, regulation
  of building construction, etc.
• E.g., supply of good and cheap grain guaranteed
  to the poor

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Roman Civilization -- Public Health Achievements
(contd).

• E.g., many streets were paved and had gutters
  that helped to drain by a network of underground
  conduits
• E.g., provision was made for the cleaning and
  repair of streets and for removal of garbage and
  rubbish
• E.g., public baths were constructed and
  extensively used
• E.g., an adequate and relatively safe water
  supply was made available by construction of
  magnificent aqueducts and water tunnels
• Many of these are still in use today, having been
  incorporated into the present-day water and
  sewage systems of Rome and other cities

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MIDDLE AGES

• Negative reactions to Greek/Roman influence
• Disregard of personal hygiene and sanitation
• Rise of pandemics -- e.g., cholera
• Leprosy
• Laws to isolate affected individuals lack of
  treatment or care
• The Black Death (Bubonic Plague)

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HISTORICAL PERSPECTIVE

• Primitive societies
• Classical Cultures
• Middle Ages
• Renaissance and the Age of Reason
• Development of Public Health in the United States
• English Influence
• Colonial America
• 19th Century in America
• The Shattuck Report (1850)
• Creation of Federal and State Environmental
  Agencies

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FOUR ERAS IN THE DEVELOPMENT OF PUBLIC HEALTH IN
THE UNITED STATES

• Colonial Era ? Early 19th Century Characterized
  by the appearance of boards of health, mainly in
  port cities
• The Shattuck Era (c. 1950) ? Characterized by
  the development of organized health departments
  and the impact of the new biological sciences on
  health
• Early 20th Century Characterized by the
  development of state and local health departments
  serving most of the population of the United
  States

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FOUR ERAS IN THE DEVELOPMENT OF PUBLIC HEALTH IN
THE UNITED STATES (contd.)

• Late 20th Century Characterized by the
  expansion of public health concerns into medical
  care, community mental health, chronic diseases,
  and health behavior, and a new concern with the
  impact of environment on health
• Y2K ? Who knows? Likely, considerable
  wrestling with a growing national awareness of
  limited resources and nearly insatiable demands
  for improved health

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• 1800-1850 Although the United States expanded
  greatly in population, public health measures
  remained essentially stationary
• Life expectancy in Boston decreased from27.9
  years in 1820-1825 to 21.4 years in 1840-1845
• In 1950, in Massachusetts the tuberculosis death
  rate was over 300 per 100,000 population, and
  infant mortality was about 200 per 1,000 live
  births

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THE SHATTUCK REPORT -- Report of the Sanitary
Commission of Massachusetts (1850)

• Report of a legislative committee on sanitation
  and health problems in Massachusetts
• A signal event in the development of public
  health in the United States
• In effect, it charted health pathways for future
  generations
• A remarkable document with considerable
  contemporary relevance in its various
  recommendations
• Results started to appear in 1969, when
  Massachusetts establish its first state board of
  health

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RECOMMENDATIONS OF THE SHATTUCK REPORT(1850)

• Establishment of state and local boards of health
• System of sanitary police or inspectors
• Collection and analysis of vital statistics
• Routine system for exchanging data and
  information on public health matters
• Sanitation programs for towns and buildings
• Studies of the health of school children
• Studies of tuberculosis
• Control of alcoholism

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RECOMMENDATIONS OF THE SHATTUCK REPORT(1850)
contd.

• Supervision of mental disease
• Sanitary supervision and study of problems of
  immigrants
• Erection of model tenements, public bath houses
  and wash houses
• Control of smoke nuisances
• Control of food adulteration
• Exposure of nostrums -- I.e., panaceas,
  elixirs, eetc.
• Preaching of health from pulpits
• Establishment of nurses training schools

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RECOMMENDATIONS OF THE SHATTUCK REPORT(1850)
contd.

• Teaching of sanitary science in medical schools
• Inclusion of preventive medicine in clinical
  practice
• Routine physical examinations and maintenance of
  family records of illness

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DEVELOPMENT OF PUBLIC HEALTH AGENCIES AND
LEGISLATION IN THE UNITED STATES

• Local Health Departments
• State Health Departments
• Early Federal Health Agencies
• Marine Hospital Service (est. 1798) -- first
  national health initiative
• Port Quarantine Act (1878)
• Public Health and Advances in Bacteriology
• United States Public Health Service
• Stems from the Marine Hospital Service
• 1902 -- Renamed the Public Health Marine
  Hospital Service
• 1912 -- renamed the U.S. Public Health Service

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DEVELOPMENT OF PUBLIC HEALTH AGENCIES AND
LEGISLATION IN THE UNITED STATES

• American Public Health Association (est. 1872)
• Pure Food and Drug Act (1906) -- FDA
• Childrens Bureau (est. 1912)
• Sheppard-Towner Act (Maternal and Infancy Act)
  (1921)
• Social Security Act (1935)
• Hill-Burton Act (Hospital Survey and Construction
  Act (1946)
• National Institutes of Health
• Medicare and Medicaid (1935)
• Federal and State Environmental Agencies (1970s)

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PUBLIC HEALTH AND ADVANCES IN BACTERIOLOGY

• Between 1877 and the end of the 19th century, the
  identity of numerous bacterial disease agents was
  established
• These agents included those causing gonorrhea,
  typhoid fever, leprosy, tuberculosis, cholera,
  diphtheria, tetanus, pneumonia, plague, and
  dystentery
• The subperiod (1875-1900) has been termed by
  some as the bacteriological period of public
  health
• Examples
• 1862 -- In France, Louis Pasteur proposed his
  germ theory of disease

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PUBLIC HEALTH AND ADVANCES IN BACTERIOLOGY
(contd.)

• Prior to this, miasmas (bad vapors) were
  thought to be thsource of many diseases
• 1890 -- Pasteurization of milk introduced
• 1891 -- Meat inspection inititiated
• 1895 -- Septic tanks for sewage treatment were
  introduced

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SUMMARY OBSERVATIONS

• Public health services as last resort, safety
  net, etc.
• Continuing separation of medical care and (1)
  public health, and (2) mental health
• Recent reorganization of responsibility fot
  environmental health, with inception of the
  Environmental Protection Agency (EPA)
• To understand public health and its
  administration in the United States, must
  understand our intergovernmental system
• Some disarray in public health, partly due to the
  broad spectrum of concerns definable as public
  in scope