HISTORY OF PUBLIC HEALTH • there were problems of industrialization,

urban slums leading to unsanitary conditions

• The history of public health goes back to and unsafe work places. Edward Jenner
almost as long as history of civilization. (1796) demonstrated vaccination against
Possible traditions during civilization may be, smallpox.
taboos against waste disposal within
communal areas or near drinking water In the nineteenth century
sources; rites associated with burial of the • there were still problems of industrialization
dead; and communal assistance during birth. but agricultural development led to
improvements in nutrition and there was real
Ancient Societies (before 500 BC) progress towards understanding the causes of
• the history is that of archeological findings communicable diseases towards the last
from the Indus valley (North India) around quarter of the century. The Luis Pasture's
2000 BC with the evidence of bathrooms and germ theory (1862) and Koch's Postulate
drains in homes and sewer below street level. (1876) were remarkable progresses.
• There was evidence of drainage systems in
the middle kingdom of ancient Egypt in the Twentieth century
time 2700 -2000 BC. There were written  has been the period of health resources
records concerning public health, codes of development (1900-1960), social engineering
Hamurabi of Babylon, 3900 years ago. (1960 - 1973), health promotion (Primary
Health Care), and market period (1985 and
The Book Of Leviticus (1500 BC) beyond)
• had guidelines for personal cleanliness,
sanitation of campsites, disinfection of wells, The challenge in the twenty first century is
isolation of lepers, disposal of refuses and reducing the burden of excess morbidity and
hygiene of maternity. mortality among the poor; counter reacting
the threats of economic crisis, unhealthy
The Classical Cultures (500 BC - 500 AD) environment and lifestyle; developing more
• Public health was practiced as Olympics for effective health system and investing in
physical fitness, community sanitation and expanding knowledge base.
water wells in the era golden age of ancient
Greek; and aqueducts to transport water, HISTORICAL MARKERS IN THE
sewer system, regulation on street cleaning DEVELOPMENT OF PUBLIC HEALTH
and infirmaries for slaves by Romans. • 1700 BC The Code of Hammurabi – Rules
governing medical practice
In the middle ages (500 - 1500 AD) • 1500 BC Mosaic Law – Personal, food and
• health problems were considered as having camp hygiene, segregating lepers, overriding
spiritual cause and solutions. They were duty of saving of life (Pikuah Nefesh) as
supernatural powers for pagans and religious imperatives.
punishments for sins for Christians. Leprosy, • 400 BC Greece – Personal hygiene, fitness,
plague (Black Death) during the 14th century nutrition, sanitation, municipal doctors,
and syphilis were some of the deadliest occupational health; Hippocrates –clinical and
epidemics resulted from failure to consider epidemic observation and environmental
physical and biological cause. health
• 500 BC to AD 500 Rome – aqueducts, baths,
The era of renaissance and exploration sanitation, municipal planning, and sanitation
(1500 – 1700 AD) services, public baths, municipal doctors,
• was the rebirth of thinking of about nature of military and occupational health.
the world and humankind. There was a • 500 – 1000 Europe – destruction of Roman
growing belief that diseases were caused by society and the rise of Christianity; sickness
environment, not by spirits and critical as punishment for sin, mortification of the
thinking about disease causation e.g. flesh, prayer, fasting and faith as therapy;
"malaria" - bad air. poor nutrition and hygiene pandemics; ant
science; care of the sick as religious duty.
• 1348 – 1350 Black Death – origins in Asia,
In the eighteen century spread by armies of Genghis Khan, world
pandemic kills 60 million in fourteenth
 century, 1/3 to 1/2 of the population of • 1981 First recognition of cases of acquired
Europe. immune deficiency syndrome (AIDS).
• 1300 Pandemics – bubonic plague, smallpox, • 1989 International Convention on the Rights
leprosy, diphtheria, typhoid, measles, of the Child.
influenza, tuberculosis, anthrax, trachoma, • 1990 W.F. Anderson performs first successful
scabies and others until eighteenth century. gene therapy.
• 1673 Antony van Leeuwenhoek – microscope, • 1992 United Nations Conference on
observes sperm and bacteria. Environmental and Development, Rio de
• 1796 Edward Jenner – first vaccination Janiero
against smallpox. • 1992 International Conference on Nutrition.
• 1830 Sanitary and social reform, growth of • 1993 World Conference on Human Rights,
science. Vienna.
• 1854 John Snow – waterborne cholera in • 1994 International Conference on Population
London: The Broad Street Pump. and Development, Cairo.
• 1854 Florence Nightingale, modern nursing • 1998 WHO Health for All in the Twenty-first
and hospital reform – Crimean War Century adopted.
• 1858 Louis Pasteur - proves no spontaneous
generation of life. Definition of public health
• 1859 Charles Darwin - publishes On the • Public health is defined as the science and art
Origin of Species. of preventing diseases, prolonging life,
• 1862 Louis Pasteur - publishes findings on promoting health and efficiencies through
microbial causes of disease. organized community effort. It is concerned
• 1876 Robert Koch - discovers anthrax bacillus. with the health of the whole population and
• 1879 Neisser - discovers gonococcus the prevention of disease from which it
organism. suffers. It is also one of the efforts organized
• 1882 Robert Koch - discovers the tuberculosis by society to protect, promote, and restore
organism, tubercle bacillus. the peoples’ health. It is the combination of
• 1880 Typhoid bacillus - discovered (Laveran); sciences, skills and beliefs that is directed to
leprosy organism (Hansen); malaria organism the maintenance and improvement of the
(Laveran). health of all the people through collective
• 1883 Robert Koch discovers bacillus of social actions.
cholera.
• 1883 Louis Pasteur vaccinates against Key Terms in the definition
anthrax. Health Promotion
• 1884 Diphtheria, staphylococcus,  Health promotion is a guiding concept
streptococcus, tetanus organisms identified involving activities intended to enhance
• 1890 Anti-tetanus serum (ATS) individual and community health well-being. It
• 1892 Gas gangrene organism discovered by seeks to increase involvement and control of
Welch and Nuttal the individual and the community in their own
• 1894 Plague organism discovered (Yersin, health. It acts to improve health and social
Kitasato); botulism organism (Van welfare, and to reduce specific determinants
Ermengem). of diseases and risk factors that adversely
• 1923 Health Organization of League of affect the health, well-being, and productive
Nations capacities of an individual or society, setting
• 1926 Pertussis vaccine developed targets based on the size of the problem but
• 1928 Alexander Fleming discovers penicillin also the feasibility of successful interventions,
• 1929 – 1936 The Great Depression – wide in a cost-effective way.
spread economic collapse, unemployment,
poverty, and social distress in industrialized The Elements of Health promotion
countries. 1. Addressing the population as a whole in
• 1946 World Health Organization founded. health related issues, in everyday life as well
• 1977 WHO adopts Health for all by the year as people at risk for specific diseases:
2000 2. Directing action to risk factors or causes of
• 1978 Alma-Ata Conference on Primary Health illness or death;
Care. 3. Undertaking activities approach to seek out
• 1979 WHO declares eradication of smallpox and remedy risk factors in the community that
achieved adversely affect health;
4. Promoting factors that contribute to a better a patient’s physical, psychological, social,
condition of health of the population; emotional, and vocational abilities.
5. Initiating actions against health hazards, Interventions are directed towards the
including communication, education, consequences of disease and injury.
legislation, fiscal measures, organizational
change, community development, and
spontaneous local activities;
6. Involving public participation in defining
problems, deciding on action; The provision of high quality rehabilitation
7. Advocating relevant environmental, health, services in a community should include the
and social policy; following:
8. Encouraging health professionals’ participation 1. Conducting a full assessment of people with
in health education and health policy. disabilities and suitable support systems;
2. Establishing a clear care plan;
Prevention 3. Providing measures and services to deliver
• Prevention refers to the goals of medicine the care plan.
that are to promote, to preserve, and to
restore health when it is impaired, and to MAJOR DISCIPLINES IN PUBLIC
minimize suffering and distress. HEALTH
• Nutrition: is the science of food, the
THREE LEVELS OF PREVENTION nutrients and other substances therein, their
A. Primary Prevention action, interaction and balance in relation to
• refers to those activities that are undertaken health and disease.
to prevent the disease and injury from • Reproductive health: is a state of complete
occurring. It works with both the individual physical, mental and social being not only
and the community. It may be directed at the absence of disease or infirmity, in all matters
host, to increase resistance to the agent (such relating to reproductive system and to its
as immunization or cessation of smoking), or functions and process.
may be directed at environmental activities to • Environmental Health The basic approach
reduce conditions favorable to the vector for a to environmental control is first to identify
biological agent, such as mosquito vectors of specific biologic, chemical, social and physical
malaria. factors that represent hazards to health or
well-being and to modify the environment in a
B. Secondary Prevention manner that protects people from harmful
• the early diagnosis and management to exposures. The principal components of
prevent complications from a disease. It environmental health are water sanitation,
includes steps to isolate cases and treat or waste disposal, etc.
immunize contacts to prevent further • Health Education is defined as a
epidemic outbreaks. combination of learning experiences designed
to facilitate voluntary actions conducive to
C. Tertiary Prevention health. It is an essential part of health
• involves activities directed at the host but promotion.
also at the environment in order to • Epidemiology is the study of frequency,
promote rehabilitation, restoration, and distribution, and determinants of diseases and
maintenance of maximum function after other related states or events in specified
the disease and its complications have populations. The application of this study to
stabilized. Providing a wheelchair, special the promotion of health and to the prevention
toilet facilities, doors, ramps, and and control of health problems is evident.
transportation services for paraplegics are • Health Economics is concerned with the
often the most vital factors for alternative uses of resources in the health
rehabilitation. services sector and with the efficient
utilization of economic resources such as
Rehabilitation manpower, material and financial resources.
• Rehabilitation is the process of restoring a • Biostatistics is the application of statistics to
person’s social identity by repossession of biological problems; application of statistics
his/her normal roles and functions in society. especially to medical problems, but its real
It involves the restoration and maintenance of meaning is broader.
• Health Service Management is getting Clinical medicine is concerned with diagnosing
people to work harmoniously together and to and treating diseases in individual patients. It
make efficient use of resources in order to has evolved from primarily a medical and
achieve objectives. nursing service to involve a highly complex
• Ecology: is the study of relationship among team of professionals. The overall objective of
living organisms and their environment. It is both public health and clinical medicine is
the science, which deals with the inter- better health for individual and for society.
relationships between the various organisms Both of them are vital and interdependent to
living in an area and their relationship with improve individual and public health. Ready
the physical environment. Human ecology access to high quality health care services is a
means the study of human groups as right of the population and a requirement of
influenced by environmental factors, including good public health. This requires the
social and behavioral factors. availability of high quality providers of clinical
• Research is a conscious action to acquire and preventive care.
deeper knowledge or new facts about
scientific or technical subjects. It is a Public health involves both direct and indirect
systematic investigation towards increasing approaches. Direct measures in public health
knowledge. It aims at the discovery and include immunization of children, modern
interpretation of facts, revision of accepted birth control, hypertension, and diabetes case
theories, or laws in the light of new facts or findings. Indirect methods used in public
practical application of such new theories or health protect the individual by community –
laws. wide means, such as raising standards of
• Demography is the study of population, environmental safety, assurance of a safe
especially with reference to size and density, water supply, sewage disposal, and improved
fertility, mortality, growth, age distribution, nutrition. In public health practice, both the
migration, and the interaction of all those with direct and indirect approaches are relevant.
social and economic conditions.
Ethical issues and challenges in
CORE ACTIVITIES IN PUBLIC HEALTH public health
1. Preventing epidemics • Public health is usually viewed as a broad
2. Protecting the environment, work place, food social movement, a way of asserting social
and water; justice, value and priority to human life. On
3. Promoting healthy behavior; the other hand, market justice prevents the
4. Monitoring the health status of the fair distribution of burdens and benefits
population; among society.
5. Mobilizing community action;
6. Responding to disasters; The following are challenges and ethical concerns
7. Assuring the quality, accessibility, and in public health
accountability of medical care;
8. Reaching to develop new insights and 1. Political conservatism and public health
innovative solutions and – in this view, politics conserves the broad
9. Leading the development of sound health vision of public health and prefers it to limit
policy and Planning into a technical enterprise focusing on
controlling communicable diseases and a
Community Health, Clinical Medicine safety net providing medical care to the
and Public Health indigent.
• Community health refers to the health 2. Collective scope and individualism –
status of a defined group of people and individualistic societies resist the notion of
the actions and conditions both private public health’s concern for the collective
and public (governmental) to promote, 3. Economic impacts - public health
protect and preserve their health. regulations affect the industries (E.g.
Whereas Public health refers to the health tobacco), those paying for the public health
status of a defined group of people and benefits may not necessarily be the
the governmental actions and conditions beneficiaries (E.g. Regulatory actions for
to promote, protect and preserve their worker safety raising costs to consumers),
health. people may not be willing to pay costs for
benefits that would accrue in the long future
 (E.g. measures to limit global warming) and it
is easier to calculate current costs incurred for
public health than the benefits that would
come later.
4. Promoting public welfare versus
individual liberty – the extent to which
governments should restrict individual
freedom for the purpose of improving
community health (E.g. AIDS control in Cuba)
5. Paternalism versus libertarianism –
restrictions on individual behavior for
protecting their own health (E.g. enforcing
seat belts). Libertarianism claims that “the
only purpose for which power can be
rightfully exercised over any member of a
civilized community, against her / his will is if
her/his act harms others (E.g. regulate drunk
behavior no drinking)
6. Public health measures and
religion/moral – some public health
measures are not acceptable on religious and
moral grounds, (E.g. sex education and
distribution of contraceptives and/or condoms
to adolescences),
7. Values and responsibilities - health
authorities deciding on values and choices of
those they serve (e.g. whether someone
should not take the responsibility on behavior
causing ill health such as smokers, alcoholics,
promiscuous people), decision on whether to
emphasize HIV/AIDS prevention versus ARV
therapy in poor countries, the extent of
providing access to benefits to research
subjects
8. Surveillance versus cure – involves hoe to
deal with sick subjects identified in routine
survey/data collection
9. Dilemmas in cost benefit analysis – the
difficulty of valuing life, and values to be
assigned for the rich versus the poor.