EVOLUTION OF PUBLIC HEALTH

presented by:

DR. SUBRAHAM PANY

“Life is short, the art long, opportunity fleeting, experience treacherous and judgment difficult”.

…Hippocrates

A SLIDE OF THANKS GIVING

Dr. Lipilekha Pattanaik- For presenting

the idea of the topic

Dr. E. Venkat Rao – For guiding me for

the presentation.

I thank my H.O.D. & all the faculty

members for being a great help to me in

my seminar.

My senior colleagues have provided me

a great boost in completing my seminar

And thankful to my colleague for being

the supporting hand in accomplishing

my seminar.

DEFINING PUBLIC HEALTH:

“The science and 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 diseases and the development of social machinery which will ensure every individual in the community, a standard of living adequate for maintenance of health”

:by Winslow

[REF.:TEXT BOOK OF PUBLIC HEATH AND COMMUNITY MEDICINE:AFMC:PG 7]

WHY TO STUDY HISTORY AND UNDERSTAND EVOLUTION ?

"Those who fail to read history are destined to suffer the repetition of its mistakes"

In studying history, we are able to understand how our predicament is similar to someone else's who came prior to us. We might also be able to examine what they did and assess if this is a path that we want to take or something we wish to avoid.Studying history connects us to something larger than merely subjective consciousness.

[REF:K. PARK’S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICINE.]

INTRODUCTION From time immemorial man has been

interested in trying to control disease.

The medicine man, the priest, the

herbalist and the magician, all undertook

in various ways to cure man's disease

and/or to bring relief to the sick.

It has been truly said that medicine was

conceived in sympathy and born out of

necessity; and that the first doctor was

the first man, and the first woman, the

first nurse.

ANCIENT ERA OF MEDICINE / PRIMITIVE MEDICINE

As centuries rolled on , civilisations' emerged in various regions , each civilisation having its own characteristic culture and life style.

Every civilisation had a different hypothesis on health.

Health was considered as a state of balance between various humors of human body, variously defined by various cultures.

Disease were believed to result from a state of imbalance caused by disturbance in the relative proportion of these humors.

FATALISTIC THEORY

* God rewards or punishes

indivisuals on basis of their good and evil deeds

DEMONISTIC THEORY

*Indivisuals suffering

from disease

were possessed by demons*Demons

were usually evil

CHARMS THEORY

*Good spirits bring

health & prosperity

*Evils spirits bring upon wrath

CERTAIN THEORIES OF THE ANCIENT ERA OF MEDICINE

INDIAN MEDICINEDhanvantari : Hindu god of

medicine.

Ayurveda: meaning “the science of life” is the indigenous system of Indian medicine

Ayurveda originated from Atharvaveda.

Siddha: practiced in Tamil speaking areas of south India.

Yoga: the key to a longer and healthy life is and was a basic component of health care

WORKING HYPOTHESIS

Tri – dosa: Vata (wind) Pita (gall) kapha (mucus)

LEADING PERSONALITIESAtreya : first Indian physician & teacher

Charaka : Composed charaka samhita.

Known as “father of Indian medicine”

Sushuruta : composed sushuruta samhita (which describes

various operative procedures & techiniques of plastic surgery). Known as “father of Indian Surgery”

CHINESE MEDICINEWORKING HYPOTHESISFive fold system : EARTH, METAL, WATER,

WOOD & FIRE(Each related to five firm organs : Heart,

Spleen, Lungs, liver and Kidney)

3 Celestial emperors: Huang Ti : developed medical

facilities Nei Ching : a classic master of

internal medicine Hua More : surgeon and

physiotherapist[Ref : Foundations of community medicine: Elsevier publications 4th edition]

LEADING PERSONALITIE

S

Egyptian MEDICINEWORKING HYPOTHESIS

They believed that the natural history of disease starts with the food consumed by an individual

Imhotep : was considered a master in all fields of learning and medicine. He developed a deep sense of sanitation among the Egyptians.

[Ref : Foundations of community medicine: Elsevier publications 4th edition & K. Park’s Textbook of Preventive and Social Medicine 19th edition]

LEADING PERSONALITIE

S

Greek MEDICINEWORKING HYPOTHESIS

4 fold system : Blood, Phlegm, Black bile & Yellow bile

(Each possessing properties of Heat, cold, moisture and dryness respectively)LEADING

PERSONALITIES

APPOLO

AESCULAPIUS

HYGEIA

PANACEA

Greek God of medicine

The staff of Aesculapius -> CADUCACEUS

HYGEIA : Goddess of Hygiene -> PREVENTIVE MEDICINE

PANACEA : Goddess of Treatment -> CLINICAL MEDICINE

roman MEDICINEWORKING HYPOTHESIS

BILE & PHLEGM(Describing Warmth and cold)

Galen : He produced some 500 treatise which were studied for around 14 centuries.

Celsus : A surgeon who developed method for control of Hemorrhage and Infection

[Ref : Foundations of community medicine: Elsevier publications 4th edition]

LEADING PERSONALITIE

S

Arabian MEDICINEThey developed UNANI system of medicine

Rhazes : produced over 200 medical and philosophical treatise

Avicenna: Compiled the “canon of medicine” for general practitioners

Ibn. An. Nafis : Investigator and writer. He is known to conceive the idea of pulmonary circulation.

[Ref : Foundations of community medicine: Elsevier publications 4th edition]

LEADING PERSONALITIE

S

Mesopotamian MEDICINE

WORKING HYPOTHESIS

Liver was considered as the seat of life.

There were interpretations of dreams relating them to disease.

Prescription were written on tablets, in cuneiform writing.

The oldest medical prescription comes to us from Mesopotamia, dating back to 2100 B.C.

MAJOR WORK DONE

[Ref : Foundations of community medicine: Elsevier publications 4th edition & K. Park’s Textbook of Preventive and Social Medicine 19th edition]

THEORIES OF THE MODERN ERA OF MEDICINE

Miasmic:Toxic vapor or miasma emanated

from decaying animal & vegetable matter are

diffused into the

surrounding and spread al sort of disease.

Contagion/ GERM :

This theory held that epidemics resulted

from transmission of germs.

Spontaneous generation:Or Abiogenesis was originally propounded by Aristotle, who

believed that living organisms directly emerged from non living organisms. Later the theory was displaced by

theory of biogenesis, i.e.,

“Life originates from life” – by Louis Pasteur

Leviticus :It is believed to be the first

written health code in world.

The book dealt with personal and community responsibilities and included guidance regarding the cleanliness of body, sexual health behaviors & protection against contagious diseases.

1500 BC

[REF:JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION IN 1920

AND IN THE NEW ENGLAND JOURNAL OF MEDICINE]

The Code of HammurabiCreated by the King of Babylon, is one of

the earliest sets of laws found.

It focuses on theft, farming, Human

rights, murder, death, and injury.

There was also a documented code for

physicians and health practices.

There was also evidence of bathrooms

and drains in homes as well as written

medical prescriptions

HIPPOCRATES :(460 – 375 B.C. )Introduced Scientific methods to the study of medicineHis famous oath, the "Hippocratic oath" has become the keystone of medical ethics. Hippocrates will always be regarded as one of the “masters of the medical art”.

500 BC – 500 AD

The Romanian pre-math

Also during this period, Greeks were active in the practice of community sanitation.

Romans improved upon Greek engineering in the building of aqueducts to protect water supplies.

They also created the first hospital. [REF : FOUNDATIONS OF COMMUNITY MEDICINE: ELSEVIER

PUBLICATIONS 4TH EDITION & K. PARK’S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICINE 19TH EDITION & GENEVA: WORLD HEALTH

ORGANIZATION; 2008. ]

The Middle Ages:The Middle Ages, also known as "The Dark Ages”.

Health problems were considered to have spiritual causes and solutions.

Bloodletting and alchemy were common practices.

Most importantly, the failure was to consider the role of the environment in health that led to epidemics and thus resulting in inability to control them.

500 AD – 1500 AD

The Black Plague Black Plague or Black Death or bubonic

plague.

It reappeared in Europe in 1348 after nearly a

1000 year absence. Up to 2/3rds of the

succumbed in the first two years of the

pandemic.

The pandemic was approached by scientists

and by 1350 A.D.

An interesting historical footnote is that

some scholars contend that corpses were used

for “biological warfare.”

1500 AD – 1700 AD

This Era highlighted the value of a healthy and productive population,

leading to advances in occupational health.

A milestone in the history of public health is the Great Sanitary awakening which

took place in England & gradually spread to other countries.

Term Public Health came in to general use around 1840’s. It arose from need to

protect the public from the spread of communicable diseases In 1848 (Cholera in

London).

A comprehensive piece of legislation was brought into force in England, the Public

Health Act of 1875 , for the control of man’s physical environment.

Preventive medicine really dates back to the 18th century. It developed as a branch of

medicine distinct from Public Health. Preventive Medicine got a firm foundation after

the discovery of causative agents of disease and establishment of the Germ Theory of

disease.

The Renaissance , the dawn of scientific medicine &THE AWAKENING:

EVOLUTION OF COMMUNITY MEDICINEPREVENTIVE MEDICINE:

“The science and art of preventing disease, prolonging life, promoting physical and mental health and efficiency..”

Definition: (By Leavell and Clark)

• James Lind conclusively showed in 1748 that scurvy can be prevented by the use of fresh citrus fruits and vegetables.

• Edward Jenner discovered small pox vaccine.

• Thus the concept of ‘Preventive Medicine’ came.

• And the scope of Preventive Medicine was broadened from the general measures of health promotion (hygiene) to specific measures of disease prevention (immunization).

COMMUNITY MEDICINE: With the emergence of Non-communicable diseases and due

to their multifactorial etiology, the concept of “MULTIFACTORIAL DISEASE CAUSATION” came into vogue.

So, measures like early diagnosis, identification of risk factors, limiting the development of disability and rehabilitation of handicapped persons were included into the subject.

Thus the scope was broadened from –

HYGIENE PUBLIC HEALTH PREVENTIVE AND SOCIAL MEDICINE COMMUNITY MEDICINE

PIONEERS / MILESTONE EVENTS OF

PUBLIC HEALTH

John Graunt (1620-1674)

The father of demography and descriptive epidemiology.

The first solid use of data collection for the purpose of understanding health status came from John Graunt..

In 1662, He published, Natural and Political Observation, Upon the Bills of Mortality. By studying London death data for the previous 75 years.

He was the first to observe bacteria and other

microscopic organisms using a light microscope.

Antoni van Leeuwenhoek

Bernardino RamazziniIn 1700 Bernardino Ramazzini (1633-1714)

published first comprehensive occupational health

treatise. He is known as the father of occupational health.

[REF : FOUNDATIONS OF COMMUNITY MEDICINE: ELSEVIER PUBLICATIONS 4TH EDITION & K. PARK’S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICINE.

Denis Diderot

1700 AD – 1800 AD“ Era of Epidemics, Migration and Discovery “

French philosopher, Denis Diderot (1713-1784) in his article on Man, emphasized the importance of infant mortality on the growth or decline of a population.

In his article The Hospital, Diderot outlined a public assistance scheme including old age insurance and medical care.

James Lind (1716 - 1794)

While serving as surgeon on HMS Salisbury, he

carried out experiments to discover the cause of

scurvy.

He established the superiority of citrus fruits above

all other ‘remedies’.

In 1753, he published ‘A Treatise of the Scurvy’ and

in 1757 ‘An Essay on the Most Effectual Means of

Preserving the Health of Seamen in the Royal Navy’.

Germ WarfareIn 1763 in the New World, smallpox infected blankets were distributed to Native Americans starting an epidemic which killed thousands.

Now, Controversy still exists as to whether this was deliberate bioterrorism or a tragic mistake.

Edward Jenner In 1796, Edward Jenner published

his first paper on the potential for inoculation, which led to the development of the small pox vaccine.

So successful was Jenner’s discovery, that in 1840 the government of the day banned any other treatment for smallpox other than Jenner’s

(1749-1843)

Yellow Fever

Yellow Fever appeared in the U.S. in the late 17th century.

The deadly virus continued to strike cities, mostly eastern seaports and Gulf Coast cities, for the next two hundred years, killing hundreds, sometimes thousands in a single summer.

In 1793, Philadelphia

was the scene of one of the

worst outbreaks

The 19th Century brought tremendous advances in

the understanding of health and medicine.

There was an acceptance of link between

environment and health & there were growing

efforts at social reform as a way of improving the

health of the population.

1800 AD – 1900 AD

Edwin Chadwick In 1842, Edwin Chadwick,

published his landmark report, “Report on the Inquiry into Sanitary Conditions of the Laboring Population of Great Britain”. This report outlined the major public health challenges facing England at the time leading to the beginnings of reform.

Chadwick campaigned for changes in the law. This included the reform of sanitation, education and transportation.

[REF : National Commission on Macroeconomics and Health. Report of the National Commission on Macroeconomics and Health 2005. MOHFW, GOI. 2005]

Lemual ShattuckIn 1850 in Boston, Shattuck released a

report. This report outlined the public health needs in the state of Massachusetts .

Shattuck proposed the establishment of health offices at the state and local levels in order to gather statistical information on public health conditions.

(1793-1859)

Cholera Cholera first came to

Sunderland, England in 1831-32.

It was not until the

epidemic of 1854 that John Snow began to unravel the mystery of transmission

John Snow John Snow was the first to link

the cholera epidemic in London to a particular water source—the Broad Street Pump.

When the pump handle was removed the disease incidence drastically decreased.

This was the birth of “applied epidemiology”.

(1813-1858)

Florence NightingaleThe century also saw the rise of nursing as a profession.

Florence Nightingale believed that infection arose spontaneously in dirty and poorly ventilated places.

She led to improvements in hygiene and healthier living and working environments.

Florence Nightingale also advised and supported the development of district nursing in Liverpool.

(1820-1910)

Robert Koch

These criteria are known as Koch’s Postulates. Koch was awarded the Nobel Prize for Physiology in

1905.

(1843-1910)

German scientist, Robert Koch, was one of the founders of bacteriology. In the process of discovering the causes of anthrax, cholera and tuberculosis (1882-1883) He developed methods and technical procedures still used by epidemiologists.

Louis PasteurFrench microbiologist Louis Pasteur conducted experiments that supported the germ theory.

His work involved the development of systems of inoculation including the first vaccine for rabies.

He invented the process of pasteurization.

(1822-1895)

Sir Ronald RossRoss studied malaria between 1881 and 1899. He

worked on malaria in Calcutta at the Presidency General Hospital.

He demonstrated that malaria is transmitted from infected birds to healthy ones by the bite of a mosquito, a finding that suggested the disease’s mode of transmission to humans.

In 1902, Ross was awarded the Nobel Prize in Physiology / Medicine for his remarkable work.

(1857 -1932)

Yellow Fever UnderstoodIn 1900 “The Reed Commission" after

its leader, WALTER REED proved

that the Aedes aegypti mosquito was

the vector for yellow fever.

This ended the belief that yellow fever

spread by direct contact with infected

people or "contaminated"

1900 AD – 1920 AD

A Healthy Carrier

Her case exemplified the confrontation of public health, law, ethics, the media and anti-immigrant attitudes.

In 1907 in New York City, cook

Mary Mallon, was identified as

the first healthy carrier of typhoid.

She was then known as Typhoid

Mary, Mallon spent the rest of her

life in and out of quarantine on

New Brother Island.

In 1916, MARGARET SANGER published What Every Girl Should Know.

It provided basic information about topics such as menstruation & acknowledged the reality of sexual feelings in adolescents.

It was followed in 1917 by What Every Mother Should Know.

Sanger was a tireless pioneer for birth control and family planning measures.

Family Planning

Reform, Depression and War There were two prevailing

forces shaping health and human services--the World War I and the Great Depression.

There was no health insurance and people were dependent on charities for health care.

1920 AD – 1940 AD

PenicillinIn 1928, Scottish physician

ALEXANDER FLEMING (1881-1955) discovered Penicillin while studying moulds.

This discovery would be one of the most important discoveries of the Twentieth Century for its ability to kill bacteria and fight infectious disease.

1940 AD – 1980 AD

Centers for Disease Control and Prevention (CDC) It was established in 1946 in Atlanta as the Communicable Disease Center.

The World Health Organization (WHO) was established by the United Nations on April 7, 1948.

Water Fluoridation began in 1948.

The Polio Vaccine It was developed by JONAS SALK and ALBERT

SABIN. The first mass inoculations of children against polio began in Pennsylvania on February 23, 1954.Sir Joseph William Bhore This Indian Civil Servant was responsible for the initial concepts of comprehensive health care. Bhore committee was set up by the Government of India in 1943 to investigate and recommend improvements to the Indian Public Health system.

[REF : GOVERNMENT OF INDIA. NATIONAL HEALTH POLICY. MINISTRY OF HEALTH AND FAMILY WELFARE, GOVERNMENT OF INDIA, NEW DELHI: 2002  & KISHORE J. NATIONAL HEALTH PROGRAMS OF INDIA. NEW DELHI:

CENTURY PUBLICATIONS; 2009.]

The Pill

In 1960, Searle receives FDA approval

to sell “Enovid” as an effective birth

control pill.

It transformed women's lives around the world.

SEARLE: first pharmaceutical company to sell an

oral contraceptive.

Tobacco Declared a Hazard On January 11, 1964, LUTHER L.

TERRY, Surgeon of the U.S. Public Health Service, released the report of the Surgeon General's Advisory Committee on Smoking and Health.

That landmark document, now referred to as the First Surgeon General's Report on Smoking and Health, was America's first widely publicized official recognition that cigarette smoking is a cause of cancer and other serious diseases.

DR SUSHILA NAYYAR Dr Sushila Nayyar, was the younger

sister of Pyarelal Nayyar, personal secretary to Mahatma Gandhi.

She had set up the Mahatma Gandhi Institute of Medical Sciences in Wardha, in 1969 and remained committed to confine her energies to developing and extending it.

Dr. Nayyar also headed the Gandhi Memorial Leprosy Foundation.

She was also a campaigner for family planning.

A Deadly New Virus

1981 a mysterious epidemic was identified as Acquired Immune Deficiency Syndrome (AIDS).

It was found to be caused by the Human immunodeficiency virus (HIV).

It is now a global pandemic.

More than 23 million people with AIDS have died since 1981. Millions more are living with HIV.

GENEVA: WORLD HEALTH ORGANIZATION; 2014.

The Human Genome Project Begins

In 1990, the Human Genome Project was formally established.

The project endeavored to map the human genome down to the nucleotide level and to identify all the genes present in it.

Top 10 Public Health Achievements of the Twentieth Century

1. Vaccination2. Motor vehicle safety3. Safer workplaces4. Control of infectious diseases5. Decline in deaths from coronary heart disease

and stroke6. Safer, healthier food7. Healthier mothers and babies8. Family planning9. Fluoridation of drinking water10. Recognition of tobacco as a hazard

INTERNATIONAL AGENCIES OF PUBLIC

HEALTH CARE- Co-operative for Assistance And Relief

Everywhere UNICEF – United Nation International Children

Emergency Fund WHO – World Health Organization WORLD BANK GOARN - Global Outbreak Alert and

Response Network INTERNATIONAL HEALTH ORGANISATIONInternational Federation Of RED CROSSROTARY INTERNATIONALBILL & MELINDA GATES FOUNDATION

In January 2000, CDC published Healthy People 2010

This was considered to be the blueprint for the public health infrastructure in the new century.

Healthy People 2010

21st century

BioterrorismOne month after the 9-11 tragedy, anthrax

contaminated letters were mailed to the New York Post offices and the U.S. Senate.

Letters to Senator Tom Daschle and Senator Patrick Leahy, carried a more potent form of anthrax.

The CDC confirmed anthrax cases at American Media, in Florida, and at the New York offices. 23 people contracted anthrax, 5 of whom died & many more exposed.

SARS China 2002Spread to 37 countries through Air

travel8000 infected & 800 deadMALARIAA Global Problem

By 2010, 219 million infected world wide & 6,60,000 diedMost common in Africa, Asia Native AmericaINFLUENZA1918 Kansas : 50 million affected

[REF:NATIONAL MUSEUM OF HEALTH & MEDICINE, ARMED FORCES INSTITUTE OF PATHOLOGY ]

2009 Major pandemic in Asian Sub continentAnnual epidemics :3 to 5 Million severe illness & 2,50,000 to 5,00,000 deaths around the world.

REF:WHO 2015

T.B.By 2012 : 8.3 million people fell ill & 1.3

million deadEBOLAOut break in West Africa : March 2014

AVIAN INFLUENZA Avian Influenza A(H7N9) virus : March 2013

NATIONAL HEALTH PROGRAMMESPREVENTIVE & PROMOTIVE HEALTH CARE Mission Indradhanush

PROGRAMMES FOR COMMUNICABLE DISEASES Revised National Tuberculosis programme National Leprosy Eradication programme National vector borne disease control

programme National AIDS control programme Pulse Polio Programme

PROGRAMME FOR NON-COOMUNICABLE DISEASE National Tobacco control programme National programme for prevention &

control of cancer, Diabetes, Cardiovascular Diseases & stroke

National programme for control treatment of occupational diseases

National programme for prevention & control of Deafness

National Mental Health programme National programme for Blindness

NATIONAL NUTRITION PROGRAMME Integrated Child development Services National Iodine Deficiency disease control

programme Mid – day meal programme Programmes related to system strengthening

/ welfare National programme for the heath care of

the Elderly RMNCH The National health Mission National Urban health Mission

MISCELLANEOUS Voluntary blood donation programme Universal immunisation programme Integrated Disease surveillance project Pradhan Mantri Swasthya Suraksha Yojana Janani sishu surakshya Karyakram Rashtriya kishore Swastha Karyakram

REF: NATIONAL HEALTH PORTAL; WWW.NHP.GOV.IN

THANK YOU !