Public Health

B.E. Nillos, MD Family and Community

Medicine University of Saint La Salle College
of Medicine
Objectives

Define Public Health and its

components
Trace the history and development of
Public Health
Discuss present situations concerning
Public Health in the Philippines
Understand the social determinants of
health

Definition of Public Health

The science and art of preventing disease,
prolonging life, and promoting physical
health and efficiency through organized
community efforts for the sanitation of the
environment, the control of community
infections , the education of the individual in
principles of personal hygiene, the
organization of medical and nursing service
for the early diagnosis and preventive
treatment of disease, and the development
of the social machinery which will ensure to
every individual in the community a standard
of living adequate for the maintenance of
health (Winslow, 1920)
Janay ka what is health?
A state of complete physical, mental, and
social well-being and not merely the absence
of disease or infirmity (WHO, 1948)

choices of the individual and society

(LaLonde Report, 1974)
Every human being is the author of his own
health or disease. (Buddha)
Who is LaLonde?
Marc LaLonde, Canadian Minister of National
Health and Welfare
traditional or generally-accepted view of
the health field is that the art or science of
medicine has been the fount from which all
improvements in health have flowed, and
popular belief equates the level of health
with the quality of medicine ( A New
Perspective On The Health Of Canadians,
1974)
Four Broad Elements Human Biology
Environment Lifestyle Health Care
Organization
History of Public Health
The history of Public Health began when
early Homo sapiens started communal living.
diseases are caused by evil spirits or bad
luck
Thus the presence of Shamans
and they started building cities
It was the exigencies of urban living, not
considerations of health and disease, that
required sanitary engineering.
Rome: built aqueducts to transport water

a resource for everyday life, not the

objective of living. Health is a positive
concept emphasizing social and personal
resources, as well as physical capacities.
(Ottawa Charter for Health Promotion, 1986)

Athens: built public fountains

Health is maintained and improved not

only through the advancement and
application of health science, but also
through the efforts and intelligent lifestyle

Hippocrates noted the effect of food, of

occupation, and especially of climate in
causing disease ( De are, aquis et locis )

Middle east: sewerage system

Hippocrates

His 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
Dark Ages
Western Europe experienced a period of
social and political disintegration. Large
cities disappeared, replaced by small villages
surrounding the castles of landlords.
(Feudalism)
The only unifying force was Christianity, and
it was in the monasteries that the learning
and culture of the Greco-Roman world was
preserved.
Monasteries constructed hospices to shelter
travelers and sick persons
The most important disease of the period
was LEPROSY .
Exclusions of Lepers from community at
large
Leper houses (leprosaria) were established,
and it is estimated that by the end of the
twelfth century there were 19,000 such
houses throughout Europe.
Isolation of cases of leprosy in medieval
times represents the earliest application of a
public health practice still in use.
from cities to nations
As these changes occurred, the responsibility
for communal functions was transferred from
the feudal lords and church leaders to lay
councils presided over by a hierarchy of
hereditary or appointed officials.

welcomed students of any race or creed

faculty included women, who apparently
dealt with obstetric issues, and the renowned
peripatetic scholar, Constantine the African
(10201087), who translated many important
Arabic works into Latin
Regimen Sanitatis Salernitanum
Si tibi deficiant medici, medici tibi fiant
Haec tria: mens laeta, requies, moderata
diaeta
The Regimen emphasized personal hygiene,
diet, exercise, and temperance. It was the
first "health guide" for the
masses.
The Renaissance
Bubonic plague, or "Black Death,"
swept over Europe and the Near East killing
an estimated one-fourth to one-third of the
population between 1347 and 1351.
By the middle of the fifteenth century, the
major cities of the region had established
permanent boards of health who were
responsible for determining the existence of
plague, establishing quarantine, issuing
health passes, arranging for the burial of
plague victims and the fumigation of their
residences, and the management of
lazarettos

Salerno Medical School

The boards maintained close relations with

the local physicians who provided medical
care and prophylactic advice. As time
passed, the boards expanded their purview
to the control of markets, sewage systems,
water supplies, cemeteries, and the
cleanliness of streets; and they took
jurisdiction over the professional activities of
physicians and surgeons, the preparation
and sale of drugs, and the activities of
beggars and prostitutes.

It was a lay organization, independent of the

church

On Contagions and the Cure of

Contagious Diseases

Public health activities, such as overseeing

the water supply and sewerage, street
cleaning, and supervision of the markets, fell
under the jurisdiction of the councils.

Written by Girolamo Fracastoro

proposed that epidemic diseases are caused
by transferable tiny particles or
"spores" that could transmit
infection by direct or indirect contact or even
without contact over long distances
I call fomites such things as clothes, linen,
etc., which although not themselves corrupt,
can nevertheless foster the essential seeds
of the contagion and thus cause infection.
(1546)
Bills of Mortality
By early in the fifteenth century, the Italian
boards of health instituted a system of death
registration, 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.
In seventeenth-century London, analysis of
bills of mortality by John Graunt in his
epochal treatise Natural and Political
Observations Made Upon the Bills of
Mortality (1662) laid the basis for the
modern use of statistics for the planning and
evaluation of public health activities.
In English parishes, beginning in 1538, every
burial required completion of a document
that was the precursor of the modern death
certificate. This made the burial legal and
allowed the deceased's estate to be legally
disposed of. The number of deaths were
compiled on a weekly and an annual basis
The Enlightenment Period
Johann Peter Frank, a leading clinician,
medical educator, and hospital
administrator, published a six-volume
treatise, System of a Complete Medical
Policy ,
proposed a sweeping scheme of
governmental regulations and programs to

protect the population against disease and to

promote health.
His proposals covered the entire life span
from birth to death.
Utilitarianism
Advocated by Jeremy Bentham
Society should be organized to give greater
benefit for the greater number
Constitutional Code (1830) - Bentham
proposed radical new legislation dealing with
such issues as prison reform, the
establishment of a ministry of health, birth
control, and a variety of sanitary measures.
Edwin Chadwick
Secretary of England's Poor Law Commission,
established in 1834 to effectuate the New
Poor Law.
The Commission undertook a special study in
1839 of the prevalence and causation of
preventable diseases, particularly of the
working poor
General Report on the Sanitary Condition of
the Labouring Population of Great Britain
(1842) - is considered one of the most
important documents of modern public
health.
Colonialism
The contagious diseases the colonizers
brought with them frequently ravaged
indigenous populations
Colonial sanitation and medical care was
originally designed to serve the interests of
the colonists. However, after the
establishment of biomedical science, there
was enhanced incentive to control the major
tropical diseases that were interfering with
the economic development of the colonies
Early 20 th Century
Urgent health concern - infant mortality

Maternal and child health programs were

initiated with an emphasis on nutrition,
medical care, and, eventually, health
inspection in schools
High rates of occupational diseases and
industrial injuries led to programs for
industrial hygiene and occupational health
The Late 20 th Century
As infant and child mortality declined in the
industrialized countries, life expectancy and

the proportions of the elderly in populations

increased
After World War II, epidemiological research
concentrated on identifying risk factors for
these and other chronic diseases. A
prominent role for behavioral factors was
readily demonstrated
Social Determinants of Health Lets
pause for a workshop