General Introduction to Public Health

 

General Introduction to Public Health


The focus of public health intervention is to improve health and quality of life through the prevention and treatment of disease and other physical and mental health conditions, through surveillance of cases and health indicators, and through the promotion of healthy behaviours. Promotion of hand washing and breastfeeding, delivery of vaccinations, and distribution of condoms to control the spread of sexually transmitted diseases are examples of common public health measures.

Its programmes range from Immunization, health promotion, and childcare to food labeling and food fortification to the assurance of well-managed, accessible health care service. The planning, management, and monitoring functions of a health system are indispensable in a world of limited 6 resources and high expectations. This requires a well-developed health information system to provide them feedback and control data needed for good management. It includes responsibilities and coordination at all levels of government and by nongovernmental organizations (NGO‘S) and participation of a well-informed media and strong professional and consumer organization. No less important are clear designations of responsibilities of the individual for his/her own health, and of the provider of care for human, high quality professional care.

Modern public health practice requires multidisciplinary teams of public health workers and professionals including physicians specializing in public health/community medicine/infectious diseases, psychologists epidemiologists, biostatisticians, medical assistants or Assistant Medical Officers, public health nurses, medical microbiologists, environmental health officers / public health inspectors, pharmacists, dental hygienists, dieticians and nutritionists, veterinarians, public health engineers, public health lawyers, sociologists, community development workers, communications experts, bioethicists, and others.

General Historical Background of Public Health

The history of public health goes back to almost as long as history of civilization. Possible traditions during civilization may be, taboos against waste disposal within communal areas or near drinking water sources; rites associated with burial of the dead; and communal assistance during birth.

In the Ancient Societies (before 500 BC) the history is that of archaeological findings from the Indus valley (North India) around 2000 BC with the evidence of bathrooms and drains in homes and sewer below street level. There was evidence of drainage systems in the middle kingdom of ancient Egypt in the time 2700 -2000 BC. There were written records concerning public health, codes of Hammurabi of Babylon, 3900 years ago.

The Book of Leviticus (1500 BC) had guidelines for personal cleanliness, sanitation of campsites, disinfection of wells, isolation of lepers, disposal of refuses and hygiene of maternity.

In The Classical Cultures (500 BC - 500 AD) public health was practiced as Olympics for physical fitness, community sanitation and water wells in the era, golden age of ancient Greek; and aqueducts to transport water, sewer system, regulation on street cleaning and Infirmaries for slaves by Romans.

In the Middle Ages (500 - 1500 AD), health problems were considered as having spiritual cause and solutions. They were supernatural powers for pagans and punishments for sins for Christians. Leprosy, plague (Black Death) during the 14th century and syphilis were some of the deadliest epidemics which resulted from failure to consider physical and biological causes.

The era of renaissance and exploration (1500 – 1700 AD) was the rebirth of thinking about nature of the world and humankind. There was a growing belief that diseases were caused by environment, not by spirits and critical thinking about disease causation e.g. "malaria" - bad air. In the eighteenth century, there were problems of industrialization, urban slums leading to unsanitary conditions and unsafe work places.

 

In the nineteenth century there were still problems of industrialization but agricultural development led to improvements in nutrition and there was real progress towards understanding the causes of communicable diseases towards the last quarter of the century. The Luis Pasture's germ theory (1862) and Koch's Postulate (1876) were remarkable progresses.

 

Twentieth century has been the period of health resources development (1900-1960), social engineering (1960 - 1973), health promotion (Primary Health Care), Alma Ata Declaration (1978) and market period (1985 and beyond)

The challenge in the twenty first century are reducing the burden of excess morbidity and mortality among the poor; counter reacting the threats of economic crisis, unhealthy environment and lifestyle; developing more effective health system and investing in expanding knowledge base.

 

HISTORICAL MARKERS IN THE DEVELOPMENT OF PUBLIC HEALTH (SELECTED)

1700 BC The Code of Hammurabi – Rules governing medical practice

1500 BC Mosaic Law – Personal, food and camp hygiene, segregating lepers,         overriding duty of saving of life (Pikuah Nefesh) as religious imperatives.

9400 BC Greece – Personal hygiene, fitness, nutrition, sanitation, municipal      doctors, occupational health; Hippocrates – clinical and epidemic observation        and environmental health.

500 BC- AD 500 Rome – aqueducts, baths, sanitation, municipal planning, and      sanitation services, public baths, municipal doctors, military and occupational         health.

500 – 1000 Europe – destruction of Roman society and the rise of Christianity;          sickness as punishment for sin, mortification of the flesh, prayer, fasting and       faith as therapy; poor nutrition and hygiene pandemics; ant science; care of        the sick as religious duty.

1348-1350 Black Death – origins in Asia, spread by armies of Genghis Khan,         world pandemic kills 60 million in fourteenth century, 1/3 to 1/2 of the                 population of Europe.

1300 Pandemics – bubonic plague, smallpox, leprosy, diphtheria, typhoid,             measles, influenza, tuberculosis, anthrax, trachoma, scabies and others until        eighteenth  century.

1673 Antony van Leeuwenhoek – microscope, observes sperm and bacteria.

1796 Edward Jenner – first vaccination against smallpox.

1830 Sanitary and social reform, growth of science.

1854 John Snow – waterborne cholera in London: the Broad Street Pump.

1854 Florence Nightingale, modern nursing and hospital reform – Crimean War 1858 Louis Pasteur proves no spontaneous generation of life.

1859 Charles Darwin publishes On the Origin of Species.

1862 Louis Pasteur publishes findings on microbial causes of disease.

1876 Robert Koch discovers anthrax bacillus.

1879 Neisser discovers gonococcus organism.

1882 Robert Koch discovers the tuberculosis organism, tubercle bacillus.

1880 Typhoid bacillus discovered (Laveran); leprosy organism (Hansen); malaria         organism (Laveran).

1883 Robert Koch discovers bacillus of cholera.

1883 Louis Pasteur vaccinates against anthrax.

1884 Diphtheria, staphylococcus, streptococcus, tetanus organisms identified

1890 Anti-tetanus serum (ATS)

1892 Gas gangrene organism discovered by Welch and Nuttal

1894 Plague organism discovered (Yersin, Kitasato); botulism organism (Van         Ermengem).

1923 Health Organization of League of Nations

1926 Pertussis vaccine developed

1928 Alexander Fleming discovers penicillin

1929-1936 The Great Depression – wide spread economic collapse, unemployment,         poverty, and social distress in industrialized countries.

1946 World Health Organization founded.

1977 WHO adopts Health for all by the year

2000 1978 Alma-Ata Conference on Primary Health Care

1979 WHO declares eradication of smallpox achieved 1981 First recognition of cases of acquired immune deficiency syndrome (AIDS).

1989 International Convention on the Rights of the Child.

1990 W.F. Anderson performs first successful gene therapy.

1992 United Nations Conference on Environment and Development, Rio de Janiero 1992 International Conference on Nutrition.

1993 World Conference on Human Rights, Vienna, Austria.

1994 International Conference on Population and Development, Cairo, Egypt.

1998 WHO Health for All in the Twenty-first Century adopted

The need to study the history of public health cannot be overemphasized. It reveals the steady progress in the field of public health and the contributions of different individuals are recognized.

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