A BRIEF HISTORY OF PUBLIC HEALTH Because, well, death….

“To promote health and quality of life by preventing and controlling disease, injury, and disability.” —CDC Mission Statement

Define public health. Describe conditions that existed before the advent of modern public health. Describe the role of the CDC.

Requirements for Survival Air Water Food Shelter Care

Tribal Rules Hieroglyphs Chinese Empire Bible (Leviticus) Koran Roman Senate Salus populi: suprema lex esta

Ancient Greece Roman Empire Middle Ages Birth of Modern Medicine “Great Sanitary Awakening” Modern Public Health

Personal hygiene Physical fitness Olympics Naturalistic concept Disease caused by imbalance between man and his environment Hippocrates

Father of Western medicine Causal relationships Disease and climate, water, lifestyle, and nutrition Coined the term epidemic Epis (“on” or “akin to”) Demos (“people”)

Adopted Greek health values Great engineers Sewage systems Aqueducts Administration Public baths Water supply Markets

Le Pont du Gard

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

Death of 25% to 50% of population

Disease, spread by traders and explorers Killed 90% of indigenous people in New World

Birth of Modern Medicine William Harvey 1628 theories of circulation Edward Jenner 1796 cowpox experiment Coined the term vaccine (vacca, Latin for “cow”)

Growth in scientific knowledge Humanitarian ideals Connection between poverty and disease Water supply and sewage removal Monitor community health status

Made under the direction of W. De F. Day, M.D., Sanitary Superintendent, NYC Health Dept.

Louis Pasteur 1862 germs caused many diseases 1888 first public health lab Robert Koch 1883 identified the vibrio (water bacteria) that causes cholera, 20 years after Snow’s discovery Discovered the tuberculosis bacterium

England 1842 Edwin Chadwick’s “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

U.S Lemuel Shattuck’s “Report of the Sanitary Commission of Massachusetts” 1869 State Board of Health

“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 intolerable…The 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

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

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

U.S. Mortality Rate:

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); Available at: mmwrhtml/mm4850bx.htm

Tobacco19% Diet/Activity14% Alcohol5% Microbial agents4% Toxic Agents3% Firearms2% Sexual Behavior1% Motor Vehicles1% Illicit Drug Use<1% McGinnis & Foege, JAMA, 1993 Tobacco Diet/Activity

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

Year Population (in millions)

Health Equity Health Protection…

To promote health and quality of life by preventing and controlling disease, injury, and disability

Healthy People in Every Stage of Life Healthy People in Healthy Places Healthy People in a Healthy World People Prepared for Emerging Health Threats Health Protection Goals

Goals and Strategic Subgoals Health Promotion Health Protection Health Diplomacy Workplace Communities Homes Travel & Recreation Healthcare Settings Schools Institutions Infants & Toddlers Children Adolescents Adults Older Adults Healthy People During Every Stage of Life Healthy People in Healthy Places People Prepared for Emerging Health Threats Healthy People in a Healthy World Prevent Detect & Report Investigate Control Recover Improve

Health Protection: Urgent Challenges RNC 2004 Aug 04 West Nile Virus Aug-Nov 02 Space Shuttle Columbia Disaster Feb 03 SARS Mar-Aug 03 Monkey Pox June-Aug 03 Northeast Blackout Aug 03 California Wildfires Oct-Nov 03 Ricin Tularemia Anthrax Oct-Nov 03 BSE Dec 03 Avian Influenza Jan-Mar 04 Guam Typhoon Feb 04 Ricin Domestic Response Feb 04 G8 Summit June Summer Olympics June 04 DNC 2004 July 04 Hurricanes (Charley, Frances, Ivan, Jean) Aug-Oct 04 West Nile Virus Aug-Nov 04 Influenza Vaccine Shortage Oct 04 Tsunami Dec 04 World Trade Center Sept 2001 Anthrax Attacks Oct-Nov 01 Influenza Sept 03 Hurricane Isabel Sept 03 Hurricane Katrina Aug. 05 Marburg Virus Mar 05 Hurricane Rita Sept. 05 Hurricane Wilma Oct 04 E.Coli Nov 06 Climate Change Hurricane Isabel Sept 03 TB May ‘ 07