1. Public Health 11
The “Big Picture”

2. What is Public Health?
The sum of all official or governmental efforts to promote, protect, and preserve the people’s health.

3. Public Health, WHO definition
The art and science of preventing disease, prolonging life and promoting health through organized efforts of society, organizations, public and private communities and individuals.
Health is complete physical, mental and social wellbeing's not merely absence of disease or infirmity.

4. Public Health Achievements
Top Ten PH achievements:
Seat belts
Tobacco as a health risk
Safer work places
Healthier moms & babies
Vaccines
Food safety
Water fluoridation
Motor vehicle safety
Control of infectious diseases
Decreased morbidity from heart disease

5. However,
“For decades, public health had been eclipsed by novel surgeries and the drama of the emergency room… The big problem is that when public health is successful, nothing happens, because we’ve prevented it from happening.”
Stephen Smith, Boston Globe, 1/7/2003

6. Public Health is many things
A System
A Profession
A Method
Government Service
The Health of the Public

7. Three Core Functions of Public Health
Assessment
What are the health problems of a population or individual?
Policy Development
Collectively deciding which actions or interventions are most appropriate for the problems identified.
Assurance
The necessary interventions will be put into place, assuring conditions in which people can be healthy.

9. Unique Features of Public Health
**Social Justice Philosophy
Inherently Political Nature
Grounded in Science
Expanding Agenda
Link with Government
**Uncommon Culture
Focus on Prevention

10. What is Social Justice?
Justice indicates fairness in the distribution of benefits and burdens in society.
Access to health services, or even good health itself is considered a social benefit… and conversely, poor health is considered a burden.
There are significant factors within society that impede the fair distribution of benefits and services (e.g. social class, heredity, racism)

11. Problems requiring collective actions?
Health Care Reform
Poor Public Education Systems
Poverty

12. Uncommon Culture
Public health is multidisciplinary/interdisciplinary and utilizes a population-level focus.
The link between people working in Public Health is NOT a specific professional degree or work setting…
Public Health professionals are connected by the intended outcomes of their work.. Promoting, protecting, and preserving the public’s health.

13. Modern public health professions
Physicians
Psychologists
Epidemiologist
Biostatisticians
pharmacists
Medical assistants
Nurses
Midwives
Dentists , nutritionist, veternarians….

14. Public Health Issues Medical Care Alcohol, tobacco and other drugs
Mental Health
Occupational Health and Safety
Oral Health
Podiatric Health
Population, Family Planning & Reproductive Health
Public Health Education and Health Promotion
Public Health Nursing
School Health Education and Services
Social Work
Alcohol, tobacco and other drugs
Chiropractic health care
Community health planning and policy development
Environment
Epidemiology
Food and nutrition
Gerontological health
Health administration
HIV AIDS
Injury Control and Emergency Health Services
International Health
Maternal and Child Health

15. Early Medicine
Early thinking on disease, probably from the time of Hippocrates, was ruled by superstition
Sickness, it was thought, stemmed from an imbalance of the humors
Blood-letting, emetics, purges, applying hot cups
intended to adjust this imbalance
often, in the meantime, weakened the patient!

16. Social Epidemiology Rudolf Virchow (Germany, 1821-1902)
1847 Archiv für Pathologische Anatomie und Physiologie
Identified with what came to be called “social medicine”
Report on typhus epidemic (1848) highlighted social
conditions that fostered the
spread of the disease
Portrait by Hanns Fechner, 1891

17. Public Health and Social Hygiene/ Social Medicine
Social medicine as precursor of public health was founded in Germany
Rudolph Virchow ( ): investigated the health and living conditions of weavers in the German region “Oberschlesien”;
…claimed the right for healthy living conditions of the working population
… was engaged in social and health policy in Berlin; (supported the foundation of the first hospitals in Berlin; slaughterhouses; sewage; central water supply; parks, playgrounds)
“Medicine is a social science, and politics nothing else than medicine on a great scale.”

18. Explaining Infectious Disease
Jacob Henle (Austria, )
Pathologische Untersuchingen (1840)
Defined concepts of epidemic versus endemic disease
Described the existence of “contagia animata” – causal agents for infectious diseases

19. Explaining Infectious Disease
Snow (England, – 1858)
Elucidated the concept of incubation time
erformed one of the first population- based epidemiologic investigations
Dr. John Snow, 1857

20. Lancet Obituary
John Snow ( ), exemplary citizen and useful physician. He demonstrated that cholera is communicated by contaminated water, and he made the art of anaesthesia a science."

21. Explaining Infectious Disease
Robert Koch (Germany, 1843–1910)
Student of Henle
Isolated causal agents:
Anthrax, 1876
Tuberculosis, 1882
Cholera, Vibrio cholerae
Photo by Andreas Steinhoff, at commons.wikimedia.org

22. Explaining Infectious Disease
Henle-Koch Postulates
Nobel Prize awarded to Koch, 1905

23. Explaining Vector-Borne Disease
Juan Carlos Finlay (Cuba, (1833– 1915)
Discovered the mosquito as a vector of yellow fever transmission (1881)
Work did not gain acceptance for nearly 20 years until Walter Reed’s famous experiments in Cuba in 1900

24. Beyond Infectious Disease
Austin Bradford Hill (England, )
Hill’s research showed a strong association between smoking and lung cancer
Like many other pioneers in epidemiology, his work was ridiculed
Undeterred, he launched a cohort study in 1951 that continued for 50 yrs
Lecturing at London School of Health and Tropical Medicine, ca. 1950