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.