History of Public Health

West African Primary Revision

Course 2023

Delivered by Oluwafemi Popoola

Lecture Material from ‘Pelumi Adebiyi
 Learning objectives
• To engender an appreciation of the shift in
paradigms of how PH is organized

• To highlight the contributions made by

individuals to PH

• To emphasize the lessons learnt from a

chronicle of PH efforts and paradigm shifts
 About History
• ‘‘The only thing new in the world is the history
you don’t know.’’ (Harry S Truman 1884–1972)

• ‘‘History is a collective memory, the

storehouse of experience through which
people develop a sense of their social identity
and their future prospects”. – Tosh J, 1984
 Historical basis of Public Health Action
and/planning

• The changes/transitions in the nature and

ecology of diseases
• Disease patterns and their control efforts are
linked to the habits of society
• Prevailing societal socio-political consciousness
and priorities determines paradigm
• Thus population health can be seen as a political
phenomenon in different era/periods (Porter D,
1999). Thus lay public dialogue is important
 Approaches to HPH
1. Prose based on social constructs
2. Historical recollection based on eras/periods
3. Paradigm shifts
4. Eras and paradigm shifts

N.B: Eras and paradigm shifts combines the

skills of analysis, synthesis and evaluation. The
key aspect of the evaluation component is the
ability to make comparisons between periods
and countries based on common assumptions.
 Era’s in Public health
• Ancient times:
– African, ?>100,000years ago
– The Indian, 5000BC
– The Chinese, 2700BC
– Jewish, 1490BC
– Greek, 1200BC
– Egyptian, 1150BC
• Pre-industrial (up to 1750)
• Industrial (1750 – 1850)
• Post Industrial to WW2 ( 1850-1948)
• WW2-modern times (1948 - date)
 Ages of civilization and societal
requirements for survival
• Humans originated from Africa (Kaessmann &
Pablo, 2002)
1. Hunters gatherers (up to 10,000 years ago)
2. Agricultural (10,000 – 5,000 years ago)
3. Industrial (1750 – 1850)
4. Information/knowledge
5. Wisdom /knowledge management
 Another view of era in HPH
• Old public Health – biomedical model of
disease

• New Public Health (from the 1970’s) – multi-

causal approach

• Futuristic Public Health- Epigenetic

 Public health as an enterprise!

• “Public health is not a concrete intellectual

discipline, but a field of social activities”
- C.EA Winslow
 Public health defined
• “ .. Is the science and the art of preventing disease,
prolonging life, and promoting physical health and
efficiency through organized community efforts for the
sanitation of the environment, the control of community
infections, the education of the individual in principles of
personal hygiene, the organization of medical and nursing
services for the early diagnosis and preventive treatment
of disease, and the development of the social machinery
which will ensure to every individual in the community a
standard of living adequate for the maintenance of health”
- C.E.A Winslow, 1923.
 Paradigms
• Notional
• Sanitary
• Preventive
ANCIENT TIMES
 ANCIENT TIMES.

• The Indian, 5000BC: Ayuverdic medicine, some

surgery; Trodisha theory of wind, gall and mucus
which when destroyed causes disease.
• The Chinese, 2700BC – the yang and the yin;
acupuncture.
• Egyptian, 1150BC – Alchemy, mummification, baths.
• Greek, 1200BC – Aesculapius & her daughter
goddesses, Hygeia & panacea; sports, dietetics,
aesthetics.
• Jewish - codification of public health laws (levitical
laws)
 HIPPOCRATES & MODERN HEALTH CARE

• Hippocrates (460-370) - delineated link of

medicine & religion through ethics & oaths.
• The Roman era – public baths & sewerages
• The Christian era – medical schools, hospices.
• The Arabic/Islamic contributions (Rhazes) –
the differentiation of the exanthematous
fevers.
• Venice and the birth of sanitary public health.
 Individual contributors to public health

• Galen (130-200) – the theory of humours.

• Venice (1374) – quarantine and birth of sanitary PH.
• Paracelsus (1493-1541) – break with tradition, some
alchemy.
• Fracastorius (1484-1553) - initial germ theory.
• John Graunt (1620-1674) – (Haberdasher) Study of
Bills of mortality, London. Male and female, urban &
rural differences.
• Thomas Sydenham (1624-1689) – Differentiation of
the various fevers
• Bernadino Ramazzini (1633-1714) – Father of
occupational health.
Industrial Era (1750 – 1850)
 The fore-bearer
• Four D’s
–Disruption
–Deprivation
–Disease
–Death
 Pervading Political Belief
• The poor were associated with disease
• The poor were reservoirs of both physical
and social disease
• Transformation of these dangerous
classes would be desirable
• Reactive and regulatory paradigms e.g.,
Nuisance act 1948
 Individual contributors
• Percival Pott (1714-1788) – scrotal cancer
aetiology. Potts fracture and Potts disease in
clinical medicine.
• James Lind (1716-1794) – aetiology and
prevention of scurvy.
• George Baker (1722-1809) – Davonshire colic.
• John Howard – Prison reforms (1770s and aft).
• Edward Jenner (1749-1823) – 1796/8
prevention of small pox.
 Individual contributors
• Thomas Robert Malthus (1766-1834) – theory of
population growth, 1798 .
• Sir Robert Peel – The factory act 1802, etc.
• Charles Turner Thachrah – First British treatise in
occupational health 1832.
• Lord Ashley – the first effective factory act of Britain,
1833.
• Edwin Chadwick – the Father of modern public
health; the poor law reforms, etc.
 Individual contributors
• John Simon – Chadwick’s close collaborator &
later 1st MOH for London.
• William Farr (1807 – 1883) – 1839, First
Registrar General of England and the mortality
reports.
• William Duncan – First Medical Officer of
Health of all (Liverpool, 1847)
• John Snow – observations of the cholera
epidemic of London and eventual discovery in
1854. Other contributions to medicine.
 Sanitation Paradigm

• Edwin Chadwick (1800-1884) introduced the

“sanitary idea” – 1830’s . Justified it on basis of:
1. Investments in water and sewerage systems
saves lives resulting in less government payment
for widows and orphans
2. Remoralizes the “dangerous class”
• Sanitation remained unchallenged as main stay
of improved health (1850-1880)
• Recall Public Health act of 1848
Post Industrial to WW2
1850-1948
 Simon J: English Sanitary Institutions.
London: Casell,1890

• “while modern times are recognizing on a large scale,

as general principles, that every community has an
interest in the health and strength of its individual
members, and that in various important respects the
aggregated individuals cannot secure health for
themselves unless they act solidly together by
appropriate defenses of law and administration, those
principles do not imply that the community relieves its
individual members from the general responsibility of
caring for themselves, or undertakes to prevent
individual acts of unwisdom by which individual causes
injury to his own health”
Preventable mortality & excess morbidity
Paradigm
• Recall work of William Farr
• Understand the disagreements between Farr and
Chadwick
• Cholera and John Snow – 1855
• Comprehensive public act led to state standards for
urban health ad a bureau of state medicine – 1875
• The American Shattuck report – Boston 1850
• Japan: Isei (Medical system) – decree drafted 1874 by
Sensai Nagayo (1838-1902)
• John Simon: pioneer of state medicine.
– Wrote in 1890 – English Sanitary Institutions.
– Drafted the 1875 Public Health act
 Fall out of state medicine
• Previously young doctors were used as MOH’s
• Mid 1870 – Many doctors trained and certificated
in PH to function as MOH in Britain
• Germany and France had their own versions
• Local Government Board established in 1871
• Japan’s Central Sanitary Council established- 1879
• USA (1880) – Individual health a private matter.
Tried to establish national Board of Health which
later failed
 Eugenics Paradigm
• Francis Delton (father of biometrics) –
attributed cause of disease to familial
occurrence
• Eugenics appealed to the wealthy and those in
power
• Social hygiene and use of genetics led to “racial
hygiene” (1890 – 1930)
• Pure bred and Aryan syndrome – extreme
eugenics as found in the Nazi era
 Notable events and people
• 1851; Paris – 1st international conference on controlling
disease (cholera, yellow fever, plague)
• 1853; Brussels – 1st International statistical health
conference
• 1861 – 1st international conference on disease
classification
• 1901 – International health office, Paris
• 1908 – PAHO
• 1850 – Semmelweis (puerperal sepsis)
• 1856- Dr Mills cannons for disease causation
 Notable events and people
• 1854 – Florence Nightingale (Crimean war)
• 1856- JS Mills (Mills cannons).
• 1859 - William Rathbone
• 1880 – Louis Pasteur (fermentation – vaccine for
Anthrax); Robert Koch (did most work by fixing and
staining specimens with different dyes)
• 1852- Kochs discovered Mycobacterium tuberculosis
• 1883 – Discovered V cholera + Kochs postulate
• 1905 – Nobel Prize for bacteriology
• 1913 – Rockefeller foundation
• 1923- CEA Winslow
 Notable people & events

• Patrick Manson (1844 -1922) – tropical diseases

investigator in China, filariasis, schistosomiasis, etc.
Founder of the LSHTM in 1898.
• Movements in TB, Leprosy, child health, school
health, social/sexual hygiene & hlth. education;
1880s-1920s.
• Kenehiro Takaki (1849-1915) – Japanese nobleman &
naval surgeon demonstrating cure of beriberi in
sailors by mixture of high protein diet and rice.
• Thomas Legg – appointed 1st Medical Inspector of
factories 1898 in Britain. 4 aphorisms.
 Notable people & events
• Alphonse Laveran (1845-1922) – French army
surgeon; discovered malaria parasite (1880)
while in service in Algeria. Later confirmed by
Golgi, Grassi & others.
• Walter Reed (1851-1902) – US Army doctor and
epidemiologist. Established YF is caused by
filtrable virus transmitted by Aedes mosquitoes.
• Joseph Goldberger (1874-1927) – proved
pellagra was not an infectious but nutritional
disease.
 Notable people & events
• Alice Hamilton (1869-1970) – heavy metal
occupational & other diseases in the US.
• Noguchi (1876-1920) – Syphilis, YF.
• Ronald Ross (1857-1932) – malaria only by AM.
• Major greenwood (1888-1949) – medical
epidemiologist & 1st professor thereof @ the LS.
• John Anthony Ryle (1889-1950) – originally
internist but 1st professor of social medicine at
the Oxford in 1943.
WW2-modern times
 Aftermath of WW2
• Orphans

• Hunger

• Social & economic problems

 THE IMMEDIATE POST WW2 ERA.

• United Nations Relief and Rehabilitation

Administration UNRRA (precursor to UN)
• San Francisco Conference agrees on a WHO,
1945; constitution 1946 at NY & commencement
after enough ratification 7th April, 1948.
• UNICEF 1946.
• 1st UN Population Conference, 1954; Rome,
mainly for the experts.
• 2nd UN Population Conference, 1965; Belgrade,
Ugoslavia; still for the experts.
 THE IMMEDIATE POST WW2 ERA -2.

• 1st real UN Conference on Population by member

nations, 1974; Bucharest.
• The WHO/UNICEF Alma-Ata Conference on Primary
Health Care, 1978.
• 2nd International UN Conference on Population;
Mexico City, 1984.
• The Ottawa Conference on Health Promotion, 1987;
Jakarta, 1997.
• 3rd International UN Conference on Population and
Development; Cairo, 1994.
 THE IMMEDIATE POST WW2 ERA -3.

• The Riga Conference on PHC 1988.

• The Beijing Conference.

• Conference on the environment.

HISTORY OF THE NIGERIAN HEALTH
SERVICES
 Pre-colonial era
• Traditional medicine
– the dibias,
– the adhunses,
– the oniseguns,
– the babalawos,
– the malams,
– the wambas, etc.
• Western medicine (missionaries)
– Colonial masters
– Staff of colonial masters; professionals; businessmen
• Finally the multinationals – Nigeria Railways, UTC, UAC,
Rubber, Cocoa & other plantations.
 Western medicine
• Lantoro Hospital, Massey Street Hospital, Calabar
Hospital, etc.
• The McGregor Canal and other improvements in
public health.
• Enters Dr. Ladipo I Oluwole as 1st Nigerian MOH
• Auxiliary training schools, Calabar 1916-24, etc.
• The Yaba Medical School, 1930; (Vom VS, 1922);
Kano Med Sch., 1954-58.
• The first colonial health legislations and development
plan.
 Medical School

• Medical school is borne 1948, 1962, etc.

• Further development in public health as well as (a
unitary) medical service. Colonial Development Plan
1942 – 52.
• Regionalization and regionalization of health services
• Independence, medical school indigenization, etc
• 1st Post-colonial developmental plan & its health
services (the 2nd National DP?).
• Health services in a war time.
 MORE MEDICAL SCHOOLS

• Conference on Industrial Safety, 1962; Conference on

OH in Africa, 1968.
• Post war reconciliation, reconstruction and
rehabilitation.
• 3rd National Development Plan & it’s health Services,
1975 - 1980.
• The 4th National Development Plan and the rolling
plans thereafter.
• The National Health Policy, PHC and beyond;
wonderful strides, huge failures.
 Notable Nigerian Contributors.

• Prof. Oladele Ajose,

• Sir (Dr.) Samuel Manuwa,
• Dr. (Chief) Majekodunmi,
• Dr. MP Otolorin,
• Prof. Adeoye Lambo,
• Dr. MI Okpara,
• Dr. Akanu Ibiam,
• Prof. AO Lucas,
• Prof. Olikoye Ransome-kuti,
• Dr. GO Sofoluwe.
• Dr Ayorinde
 Evaluation questions in HPH
• What have we done in the past?
• What aspects of the past was responsible for
our successes and failures?
• What choices were made in the past
• What was the context in which those choices
were made?
• What did the process of decision making entail?
• What lessons can we learn from previous
experiences (negative and positive) for the
present and the future?
Historiographic lessons!
The combination of technical and policy environment factors that made early reduction of
maternal mortality in certain countries possible, and the obstacles in other countries

Ref: Wim Van Lerberghe & Vincent De Brouwere (Studies in HSO&P,17,2001)

 Maternal mortality in 1919-20 in countries with deliveries
predominantly assisted by midwives (bottom), by both midwives
and doctors (mid) and predominantly by doctors (top)

Ref: Wim Van Lerberghe & Vincent De Brouwere (Studies in HSO&P,17,2001)

 Concluding statements

And the latter days shall be

worse than the earlier??

–Our collective responsibility!