a brief history of public health because, well, death…
TRANSCRIPT
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A BRIEF HISTORYOF PUBLIC HEALTH
Because, well, death….
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“To promote health and quality of life by preventing and controlling disease, injury, and disability.”
—CDC Mission Statement
What is Public Health?
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Define public health.Describe conditions that existed before the advent
of modern public health.Describe the role of the CDC.
Objectives
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Survive the Tribe
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Requirements for Survival
Air
Water
Food
Shelter
Care
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Tribal RulesHieroglyphsChinese EmpireBible (Leviticus)KoranRoman Senate
Salus populi: suprema lex esta
Public Health Codes
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Ancient GreeceRoman EmpireMiddle AgesBirth of Modern Medicine“Great Sanitary Awakening”Modern Public Health
Timeline
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Personal hygienePhysical fitness
OlympicsNaturalistic concept
Disease caused by imbalance between man and his environment
Hippocrates
Ancient Greeks (500-323 BC)
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Father of Western medicineCausal relationships
Disease and climate, water, lifestyle, and nutrition
Coined the term epidemicEpis (“on” or “akin to”)Demos (“people”)
Hippocrates (b. 460 BC)
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Adopted Greek health values
Great engineersSewage systemsAqueducts
AdministrationPublic bathsWater supplyMarkets
Roman Empire (23 BC – 476 AD)
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Roman Aqueducts
Le Pont du Gard
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Shift away from Greek and Roman valuesPhysical body less important
than spiritual selfDecline of hygiene and
sanitationBeginnings of PH tools
Quarantine of shipsIsolation of diseased individuals
Middle Ages (476-1450 AD)
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The Plague
Death of 25% to 50% of population
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Disease, spread by traders and explorers
Killed 90% of indigenous people in New World
Renaissance (1400-1600 AD)
Global Exploration
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Birth of Modern Medicine
William Harvey1628 theories of circulation
Edward Jenner1796 cowpox experiment Coined the term vaccine (vacca,
Latin for “cow”)
Age of Reason and Enlightenment (1650-1800 AD)
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IndustrializationUrbanization (1800s)
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Growth in scientific knowledgeHumanitarian idealsConnection between poverty
and diseaseWater supply and sewage
removalMonitor community health
status
Great Sanitary Awakening (1800s-1900s)
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Dr. John Snow (1813-1858)
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Epidemiology (1854)
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Broad Street Pump
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Map of Diphtheria DeathsNew York CityMay 1, 1874 to December 31, 1875
Made under the direction of W. De F. Day, M.D., Sanitary Superintendent, NYC Health Dept.www.ihm.nlm.nih.gov
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Louis Pasteur1862 germs caused many diseases1888 first public health lab
Robert Koch1883 identified the vibrio (water bacteria)
that causes cholera, 20 years after Snow’s discovery
Discovered the tuberculosis bacterium
Growth in Scientific Knowledge
1843-1910
1822-1895
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England1842 Edwin Chadwick’s “Survey
into the Sanitary Condition of the Labouring Classes in Great Britain”Landmark researchGraphic descriptions of filth and
disease spread in urban areas1848 General Board of Health
Sanitary Reform
1800-1890
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U.S.1850 Lemuel Shattuck’s
“Report of the Sanitary Commission of Massachusetts”
1869 State Board of Health
Sanitary Reform
1793-1859
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“The landmarks of political, economic and social history are the moments when some condition passed from the category of the given into the category of the intolerable…The history of public health might well be written as a record of successive redefinings of the unacceptable.”
- Geoffrey Vickers, Secretary, Medical Research Council, Great Britain, 1958
Redefining the Unacceptable
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In the next 5 minutes:Brainstorm and record a list of “things” affecting the public’s health that have passed from tolerable (accepted) to intolerable (unaccepted).Include items that you wish would become unacceptable.
Redefining the Unacceptable
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Clean water; water treatmentFood inspectionSoaps, disinfectants, and pharmaceuticalsPersonal hygiene (bathing)Public works departments; garbage collection,
landfills, and street cleaningPublic health departments and regulation
Sanitation Revolution
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Twentieth CenturyU.S. Mortality Rate: 1900-2001
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1. Vaccination.2. Motor-vehicle safety. 3. Safer workplaces.4. Control of infectious diseases. 5. Decline in deaths from coronary heart disease and stroke. 6. Safer and healthier foods.7. Healthier mothers and babies. 8. Family planning. 9. Fluoridation of drinking water. 10. Recognition of tobacco use as a health hazard.
Ten Great Achievements in Public Health, 1900-1999
CDC, Morbidity and Mortality Weekly Report, December 24, 1999 / 48(50); 1141.Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4850bx.htm
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Challenges Ahead
New and Persistent Problemsin Public Health
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Tobacco 19% Diet/Activity 14%Alcohol 5%Microbial agents 4%Toxic Agents 3%Firearms 2%Sexual Behavior 1%Motor Vehicles 1%Illicit Drug Use <1%
Cause of Death (U.S. 1990 – what are they now?)
McGinnis & Foege, JAMA, 1993
Tobacco
Diet/Activity
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Multiple Determinantsof Health
Individual
Biology
Behavior
Physical Environment
Social Environment
Access to Quality Health Care
Policies and Interventions
Source: U.S. Department of Health and Human Services, Health People 2010
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World Population Growth
Year
Po
pu
lati
on
(in
mil
lio
ns)
1850
2010
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Health Equity
Health Protection…
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CDC Mission
To promote health and quality of lifeby preventing and controlling disease,injury, and disability
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Healthy People inEvery Stage of Life
Healthy People inHealthy Places
Healthy People in aHealthy World
People Prepared forEmerging Health Threats
Health Protection Goals
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Goals and Strategic Subgoals
Health PromotionHealth ProtectionHealth Diplomacy
WorkplaceCommunitiesHomesTravel &
RecreationHealthcare
SettingsSchoolsInstitutions
Infants & Toddlers
ChildrenAdolescentsAdultsOlder Adults
Healthy People During Every Stage of Life
Healthy People in Healthy Places
People Prepared for Emerging Health Threats
Healthy People in a Healthy World
PreventDetect & Report InvestigateControlRecoverImprove
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Health Protection: Urgent Challenges RNC 2004 Aug 04
West Nile VirusAug-Nov 02
Space Shuttle
Columbia Disaster
Feb 03
SARS Mar-Aug 03
Monkey Pox
June-Aug 03
Northeast Blackout
Aug 03
California Wildfires
Oct-Nov 03
Ricin TularemiaAnthrax Oct-Nov 03
BSE Dec 03
Avian InfluenzaJan-Mar 04
Guam Typhoon
Feb 04
Ricin Domestic Response
Feb 04
G8 Summit
June 04
2004 Summer Olympics June 04
DNC 2004 July 04
Hurricanes (Charley, Frances, Ivan, Jean) Aug-Oct 04
West Nile Virus Aug-Nov 04
Influenza VaccineShortage Oct 04
Tsunami Dec 04
World Trade Center Sept2001
AnthraxAttacksOct-Nov 01
Influenza Sept 03
Hurricane IsabelSept 03
Hurricane KatrinaAug. 05
Marburg VirusMar 05
Hurricane Rita
Sept. 05
HurricaneWilmaOct 04
E.ColiNov 06
Climate Change
Hurricane IsabelSept 03
TBMay ‘07
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Health Protection – Urgent Realities