A Brief History

of Public Health
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What is Public Health?
To promote health and quality of life
by preventing and controlling
disease, injury, and disability.
CDC Mission Statement
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Objectives
Define public health.
Describe conditions that existed before
the advent of modern public health.
Describe three public health interventions
since 1900 that have increased life
expectancy in the U.S.

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Survive the Tribe
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Requirements for Survival
Air
Water
Food
Shelter
Care
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Public Health Codes
Tribal Rules
Hieroglyphs
Chinese Empire
Bible (Leviticus)
Koran
Roman Senate
Salus populi: suprema lex esta
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Timeline
Ancient Greece
Roman Empire
Middle Ages
Birth of Modern Medicine
Great Sanitary Awakening
Modern Public Health
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Ancient Greeks
(500-323 BC)
Personal hygiene
Physical fitness
Olympics
Naturalistic concept
Disease caused by
imbalance between man
and his environment
Hippocrates
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Hippocrates (b. 460 BC)
Father of Western medicine
Causal relationships
Disease and climate, water,
lifestyle, and nutrition
Coined the term epidemic
Epis (on or akin to)
Demos (people)
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Roman Empire
(23 BC 476 AD)
Adopted Greek
health values
Great engineers
Sewage systems
Aqueducts
Administration
Public baths
Water supply
Markets
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Roman Aqueducts
Le Pont du Gard
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Middle Ages
(476-1450 AD)
Shift away from Greek and
Roman values
Physical body less important
than spiritual self
Decline of hygiene and
sanitation
Beginnings of PH tools
Quarantine of ships
Isolation of diseased individuals
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The Plague
Death of
25% to 50%
of population
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Renaissance (1400-1600 AD)
Global Exploration
Disease, spread by
traders and explorers
Killed 90% of
indigenous people in
New World
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Age of Reason and
Enlightenment (1650-1800 AD)
Birth of Modern Medicine

William Harvey
1628 theories of circulation

Edward Jenner
1796 cowpox experiment
Coined the term vaccine
(vacca, Latin for cow)

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Industrialization
Urbanization (1800s)
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Great Sanitary Awakening
(1800s-1900s)
Growth in scientific knowledge
Humanitarian ideals
Connection between poverty
and disease
Water supply and sewage
removal
Monitor community health
status
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Dr. John Snow (1813-1858)
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Epidemiology (1854)
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Broad Street Pump
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Map of Diphtheria Deaths
New York City
May 1, 1874 to December 31, 1875
Made under the direction of
W. De F. Day, M.D., Sanitary Superintendent, NYC Health Dept.
www.ihm.nlm.nih.gov

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Growth in Scientific Knowledge
Louis Pasteur
1862 germs caused many diseases
1888 first public health lab
Robert Koch
1883 identified the vibrio that causes
cholera, 20 years after Snows
discovery
Discovered the tuberculosis
bacterium
1843-1910
1822-1895
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Sanitary Reform
England
1842 Edwin Chadwicks
Survey into the Sanitary
Condition of the Labouring
Classes in Great Britain
Landmark research
Graphic descriptions of filth and
disease spread in urban areas
1848 General Board of Health

1800-1890
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Sanitary Reform
U.S.
1850 Lemuel Shattucks
Report of the Sanitary
Commission of
Massachusetts
1869 State Board of
Health

1793-1859
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Redefining the Unacceptable
The landmarks of political, economic and social
history are the moments when some condition
passed from the category of the given into the
category of the intolerableThe history of public
health might well be written as a record of
successive redefinings of the unacceptable.

- Geoffrey Vickers, Secretary, Medical Research Council, Great Britain, 1958

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Redefining the Unacceptable
In the next 5 minutes:
Brainstorm and record a list of
things affecting the publics health
that have passed from tolerable
(accepted) to intolerable
(unaccepted).
Include items that you wish would
become unacceptable.

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Sanitation Revolution
Clean water; water treatment
Food inspection
Soaps, disinfectants, and pharmaceuticals
Personal hygiene (bathing)
Public works departments; garbage
collection, landfills, and street cleaning
Public health departments and regulation
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Twentieth Century
Source: www.infoplease.com
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U.S. Mortality Rate: 1900-2001
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Public Health Nursing
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Ten Great Achievements in
Public Health, 1900-1999
1. Vaccination.
2. Motor-vehicle safety.
3. Safer workplaces.
4. Control of infectious diseases.
5. Decline in deaths from coronary heart disease and stroke.
6. Safer and healthier foods.
7. Healthier mothers and babies.
8. Family planning.
9. Fluoridation of drinking water.
10. Recognition of tobacco use as a health hazard.
CDC, Morbidity and Mortality
Weekly Report, December 24, 1999
/ 48(50); 1141.
Available at:
http://www.cdc.gov/mmwr/preview/
mmwrhtml/mm4850bx.htm
Challenges Ahead

New and Persistent Problems
in Public Health
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Cause of Death (U.S. 1990)
Tobacco 19%
Diet/Activity 14%
Alcohol 5%
Microbial agents 4%
Toxic Agents 3%
Firearms 2%
Sexual Behavior 1%
Motor Vehicles 1%
Illicit Drug Use <1%
McGinnis & Foege, JAMA, 1993

Tobacco
Diet/Activity
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World Population Growth
0
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2000
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6000
7000
8000
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1850
2010
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Health Disparities
Access and Outcomes
Infant Mortality
Cancer Screening and Management
Cardiovascular Disease
Diabetes
HIV Infection/ AIDS
Immunizations
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Multiple Determinants
of Health
Individual
Biology
Behavior
Physical
Environment
Social
Environment
Access to Quality Health Care
Policies and Interventions
Source: U.S. Department of Health and Human Services, Health People 2010
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Globalization
Emerging infectious
diseases
Reemerging infectious
diseases
Health disparities
between industrial and
nonindustrial countries

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