Pharmacy in Public Health: History of Public Health Course, date, etc. info

Learning Outcomes State a general definition of public health Describe how public health practices have changed or not changed over time Describe how science has influenced public health practice Describe the role of government in public health Differentiate between prevention and treatment

Public health practice is: Aimed at improving health or preventing illness Intended for a population group Implemented by a government or group accountable to a population group

Treatment vs. Prevention Treatment of illness or disease – Person is already ill – Requires medical treatment Prevention – Person is not yet ill – Goal is to prevent exposure to the cause of illness – May require very different actions than medical treatment

Vocabulary Disease – Disease typically refers to the illness resulting from a specific cause – Before the late 19 th century, specific causes could not be identified Illness – A more general term which includes a wide variety of diseases and does not denote a specific cause

Smallpox: 1775 Smallpox is an infectious disease that produces pustules on the skin; mortality is about 50%; survivors developed immunity – Most Americans, including patriot soldiers, had no immunity to smallpox – The severity of the disease is decreased substantially by inoculation (placing infectious matter into a small cut or scratch)

George Washington at Boston, 1775 American soldiers were susceptible but British soldiers were immune If smallpox spread through the American army, the army could be incapacitated Smallpox was present in Boston in 1775 If Washington was going to defeat the British, he had to prevent American soldiers from becoming ill with smallpox

Boston’s location on a peninsula allowed the use of quarantine (Figure courtesy of American Antiquities Society)

Inoculation Hospitals At Washington’s winter camp, while no battles were being fought, inoculation hospitals were built All susceptible soldiers were inoculated Smallpox was no longer a threat to the American army First public health campaign in America

Historical Timeline Before 500 BC—written records inadequate 500 BC-500 AD—Greeks and Romans To 1500 AD—Medieval era 1775—American Revolution 1800 – 1875—Sanitary era 1875 – 1950—Infectious disease epidemiology 1950 – 2000—Chronic disease epidemiology 2000—Back to the future

The Greek and Roman Eras Health issues included access to clean water and nutritious food as well as general environmental conditions Greeks specifically addressed these concerns when establishing new settlements Romans used their engineering expertise to assure access to clean water and ample food

Greek and Roman Eras, cont’d Both Greeks and Romans defined a role for government in public health Romans believed that access to foods, water, and adequate sanitation were requirements of civil life Romans developed administrative departments and bureaucracies for assuring that basic needs were met

Bubonic Plague in the Medieval Era Bubonic plague is caused by bacteria carried by fleas that live on rodents, esp. rats Humans are infected when rodents die and fleas seek another animal to live on Bubonic plague epidemics occurred several times during the medieval era

Medieval Walled City (Figure reprinted from Pounds N. The Medieval City. Westport, CT: Greenwood Press; 2005)

Response to the Bubonic Plague Isolated persons with symptoms of plague outside the city walls Quarantined persons suspected of having plague or would not allow travelers into city Formed boards of health to address health issues Established hospitals for the treatment of poor sick people

Cholera: 1848 Cholera is an infectious disease caused by a bacterium resulting in severe diarrhea and dehydration that can result in death – In 1848, cholera was thought to be caused by miasma, a gas arising from garbage and filth – No way of preventing cholera was known – Did not understand the pathology of the disease and what caused death

The mortality for cholera was very high (Figure courtesy of the National Library of Medicine.)

John Snow and the Scientific Method Snow was able to investigate a problem using the scientific method, i.e. asking a question then collecting and analyzing data to answer the question Tested the hypothesis that cholera was transmitted by contaminated water by collecting data on the number of deaths in homes served by one water company versus a second water company

Example mortality data collected by John Snow

Smoking as a cause of chronic disease: Late 20 th Century

Public Health Campaign: Smoking (Figure courtesy of the National Library of Medicine.)

Public health in the 21 st century Infectious disease – Avian (bird) flu – Extensively drug resistant tuberculosis Environment – Water, sanitation, and food supply – Global climate change Role of Government

Review Review each era based on the three parts to the definition of public health: – How government was involved – Identify the population served – Identify the purpose of the activity (promote health or prevent disease)

Historical Examples How public health practice helped George Washington win the American Revolution Establishing cities in ancient Greece and in the Roman Empire The Medieval Era and the bubonic plague John Snow and the cholera epidemic Tobacco use in the 20 th century George and his environment in the 21 st century