Public Health in 21 st century

1. Public Health in 21st century Dr. Syed Muhammad Baqui Billah Assistant Professor of Epidemiology Sulaiman AlRajhi Colleges

2. Public Health • Define: To promote health and quality of life by preventing and controlling disease, injury and disability (CDC Mission statement)

3. Brief history • Ancient Greeks (500-323 BC) • Personal hygiene • Physical fitness (Olympics) • Naturalistic concept (disease caused by imbalance between man and his environment) • Hippocrates (considered father of modern medicine) • Causal relationship (disease relation to climate, water, nutrition and lifestyle) • Coined the term epidemic

4. Greek to Roman • Greek values diffused (23 BC-476 AD) • Engineering works (sewage, aqueducts) • Administration • Public baths • Water supply • Markets

5. Middle ages (476-1400 AD) • Beginning of public health tools • Quarantine of ships • Isolation of diseased individuals • Outbreak of disease • Death from plague

6. Global exploration (1400-1600 AD) • Disease spread by traders and explorers • Killed 90% of indigenous people • Animal extinct (DODO)

7. Modern medicine (1650-1800 AD) • William Harvey • Circulation theory • Edward Jenner • Cowpox experiment • Coined the term vaccine (vacca, Latin for “cow”) • Industrialization/Urbanization effect • Scientific knowledge grew • Water, sanitation, poverty, society with disease

8. Public Health in the 19th century - overview • Firm foundations were created for public health by Chadwick, Simon, Farr, Snow, Duncan, Budd and many others. • Manifested by • the Poor Law Institutions • the Public Health Act of 1875 • sanitary issues (control of cholera in urban areas) • concern with the provision of unadulterated food.

9. Public Health in the 20th century • The initial part of this century was dominated by public health – concern with the health and fitness of young men, the health of the school child, introduction of the Lloyd George National scheme for the employed • First World War – cataclysmic event consuming all energies • 1918 – creation of the Ministry of Health, also responsible for housing • Interwar period between the two world wars – use of the MoH’s Annual Report to highlight particular problems of poverty, unemployment and so on.

10. Public Health in the 20th century - continued • During the Second World War – Beveridge report led to improvements in health, education, housing, pensions and employment, and rationing of food ensured availability of nutritious diet for all. • 1948 – NHS introduced • 1948 – 1972 – Social and Environmental services became independent from public health • 1972 – change in title to community medicine

11. Public Health in the 20th century - continued • Past 25 years – Return to the title of public health and numerous reorganizations • Major landmarks: • Concerns with management • Black Report on Inequalities in Health • Health of the Nation Initiative • Purchaser-provider split

12. Public health in 21st century

13. Major issues in public health that have recurred time and again

14. Issues affecting health • Housing • The move to demolish unsanitary slums • The Garden City Movement • Destruction wreaked by the Second World War, led to a need to rebuild and improve housing. • Nutrition • Under-nutrition before 1939 • M’Gonigle - demonstrated deleterious effects of an inadequate diet on health, despite improved living conditions • Rationing during World War II was an important impetus to change • Recently there is an increasing tendency towards overweight and obesity http://www.tcpa.org.uk/downloads/1899-1999.pdf

15. Morbidity and Mortality • 20th century decline of infectious disease mortality - most important cause of increased life expectancy • Problems of antibiotic resistant organisms, and new conditions such as AIDS and Legionella • Decline in mortality due to respiratory diseases, and major declines in mortality due to diseases of the digestive, genito-urinary and nervous systems. • Dramatic reduction in maternal, infant and child mortality. • Increases in mortality for circulatory diseases and cancer

16. The environment Source – The London Smog Disaster of 1952. Days of toxic darkness. http://www.portfolio.mvm.ed.ac.uk/studentwebs/session4/27/greatsmog52.htm

17. The environment • Dramatic environmental change has been the improvement of air quality. • Clean Air Act of 1956 • Problems of air pollution are still a matter of considerable concern - in the form of nitrogen dioxide and carbon monoxide • new issues have arisen - lead in the environment, in paint, in petrol, in food or in the soil; the impact of the use of pesticides in farming; the content of some animal feeds; the sitting of waste dumps, or the building of houses and schools on sites formerly used for industrial waste disposal.

18. The cons of progress • Increase is cigarette smoking • Less physical exercise - increase in diseases as coronary heart disease, stroke and arthritis • Recent advances in reproductive medicine and treatment of infertility, have vast ethical implications yet to be fully addressed by the profession, politicians and society at large.

19. The cons of progress - continued • Mental illnesses have been a continuing concern. • Life expectancy has increased - issues of long-term care, dementia, arthritis and multiple diseases • Rise in the side-effects for drugs • Poverty - inequalities in levels of health between the various social groupings

20. Organizational issues • Change from the Poor Law administration of hospitals in 1929-30, to local authority control - first major change • Major drawback - those involved became more concerned with the problems and minutiae of clinical/hospital administration, became medical superintendents and thus directed clinical care

21. Organizational issues - continued • National Health Services (NHS) introduced in 1948 changed this picture radically • PH was separated from clinical practice and remained under Local Authority control • The 1974 reorganization integrated all health authorities • One of the most effective tools for the PHP - the public annual report of health

22. Education, Research, Manpower • PH over the last 80 years - search for identity, perceived by the profession, society in general • For a role towards bureaucracy and administration • Progress only in recent years - academic departments of public health in every medical school, structured post-graduate training • Research, in general has been neglected

23. Where Now? Concerns • Control of communicable diseases - the law currently lags behind the reforms of both the health service and Local Authorities • Directors of Public Health now have authority in areas of clinical concern in which they are not expert • The public health function is now frequently labeled as “health policy”, responsible for contracting for clinical services

24. Conflict • Control of communicable diseases – who will govern, the health service or local authorities? • Public Health authority: in areas of clinical concern without expertise! • The public health function: labeled as “health policy”, responsible to contract for clinical services • PH is budget: large budgets for clinical services? or field service to improve health?

25. Public Health Responsibilities Today • Major public health problems • Outbreaks by infective or toxic agents • Social and environmental problems • Behavioral concerns • Health service issues • Public health should not become involved in the management of clinical services!?

26. Public Health Responsibilities Today - Continued • Public health: must develop skills in detecting and controlling outbreaks • Training in epidemiology is crucial • For the effective monitoring of health needs and outcome: data collected about patients are linked to individuals, and not merely based on events • Appropriate epidemiological and other studies are necessary to determine the factors responsible for ill-health

27. Behavior Change Communication • Risk perception and communication - extremely complex process, central to any modern public health function and structure • Ability to communicate with the media, stakeholders and decision makers about enormous implications for any future public health structure and function

28. What Next • Clarification of the role of individuals in PH • Implications for staffing and personnel • Establish interdisciplinary collaboration firmly • Communicate findings of emerging problems and prevention measures • Establish surveillance with the clinicians for assessing upcoming trends and effective control of the future outbreak

29. Thanks you very much