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 what it was like before the advent of modern public health. Describe the role of the CDC.

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

Requirements for Survival Air Water Food Shelter Care

Tribal Rules Hieroglyphs Chinese Empire Bible (Leviticus) Koran Roman Senate “Salus populi suprema lex esto!”

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 have an effect on health 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 Worst years More than 60 million dead worldwide.

Smallpox, measles, typhoid, and STD’s Killed 90% of indigenous people in New World Disease, spread by traders and explorers

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

-Slums -Poverty -Disease

Growth in scientific knowledge Humanitarian ideals Water supply and sewage removal Monitor community health status Connection between poverty and disease Even today, poverty is the single best predictor of poor health.

1840s to 1890’s -focused on the environment of infectious diseases related to “urbanization, poverty and squalor”. 1890’s to 1930’s - personal preventive medical services and health education on: immunization, family hygiene and family planning 1930’s and on- improving organized medical services, new meds: insulin and antibiotics, etc. 80’s on- A recognition that the ‘environment’ is also social, economic and psychological factors affect health

( ) Cholera Outbreak – Father of Epidemiology – the study of causes, treatment, prevention of disease

No pump handle, no water, no cholera

1.Study cases to identify the disease. 2.Look for possible causes. 3.Track the source Make a treatment plan. 2.Stop the origin 3.Stop the spread. 4.Prevent further outbreaks

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

Louis Pasteur 1862 germs caused many diseases! (rabies vaccine, Pasturization of milk…) 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” Graphic descriptions of filth and disease spread in urban areas, More than half of working class children died before their fifth birthday; average age of death for common laborers was 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

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 - The death rate in children drops and the average life span increases over the years from less than 40 to 74.

1. Country-wide 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. (of treated, safe 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

U.S. Mortality Rate:

The Top 10 leading Causes of Death in the US (accounting for nearly 75% of all deaths.) 1.Heart disease 2.Cancer (malignant neoplasms) 3.Chronic lower respiratory disease 4.Stroke (cerebrovascular diseases) 5.Accidents (unintentional injuries) 6.Alzheimer's disease 7.Diabetes (diabetes mellitus) 8.Influenza and pneumonia 9.Kidney disease (nephritis, nephrotic syndrome, and nephrosis) 10.Suicide (intentional self-harm). How many are caused infectious disease?

Year Population (in millions)

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

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

2015 CDC Targets Tobacco Nutrition, Physical Activity, Obesity, and Food Safety Healthcare-associated infections Motor Vehicle Safety Teen Pregnancy HIV

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