HISTORY OF PUBLIC HEALTH Recurring Issues

1. HISTORYOF PUBLIC HEALTHRecurring Issues • Movement of people(s) • Influence of war on disease and public health concerns • Early historical examples • Mongol invasions from the East • Crusades in Middle Ages • Colonization invasions • Civil War in the United States • Spanish-American War • World War II

2. HISTORY OF PUBLIC HEALTHRecurring Issues (cont’d.) • Influence of colonization/immigration on disease and public health concerns • Influence of commercial trade on disease and public health concerns

3. HISTORICALPERSPECTIVE • Primitive societies • Classical Cultures • Middle Ages • Renaissance and the Age of Reason • Development of Public Health in the United States • English Influence • Colonial America • 19th Century in America • The Shattuck Report (1850) • Creation of Federal and State Environmental Agencies

4. HISTORICAL PERSPECTIVE (cont’d.) • Children’s Bureau (1912) • Food and Drug Administration (FDA) • Social Security Act (1935) • Federal Security Agency (1939) • Department of Heath, Education, and Welfare • Department of Health and Human Services • Hill-Burton Act (Hospital Survey and Construction Act (1946) • National Institutes of Health (NIH) • Medicare and Medicaid

5. Roman Civilization -- Public Health Achievements • Roman civilization that succeeded the Athenian is well known for its engineering and administrative arrangements affecting public health • E.g., inspection and removal of dilapidated buildings, elimination of dangerous animals and foul smells, supervision of weights and measures, supervision of public bars and taverns, supervision of houses of prostitution, regulation of building construction, etc. • E.g., supply of good and cheap grain guaranteed to the poor

6. Roman Civilization -- Public Health Achievements (cont’d). • E.g., many streets were paved and had gutters that helped to drain by a network of underground conduits • E.g., provision was made for the cleaning and repair of streets and for removal of garbage and rubbish • E.g., public baths were constructed and extensively used • E.g., an adequate and relatively safe water supply was made available by construction of magnificent aqueducts and water tunnels • Many of these are still in use today, having been incorporated into the present-day water and sewage systems of Rome and other cities

7. MIDDLE AGES • Negative reactions to Greek/Roman influence • Disregard of personal hygiene and sanitation • Rise of pandemics -- e.g., cholera • Leprosy • Laws to isolate affected individuals; lack of treatment or care • The Black Death (Bubonic Plague)

8. HISTORICALPERSPECTIVE • Primitive societies • Classical Cultures • Middle Ages • Renaissance and the Age of Reason • Development of Public Health in the United States • English Influence • Colonial America • 19th Century in America • The Shattuck Report (1850) • Creation of Federal and State Environmental Agencies

9. FOUR ERAS IN THE DEVELOPMENT OF PUBLIC HEALTH IN THE UNITED STATES • Colonial Era  Early 19th Century: Characterized by the appearance of boards of health, mainly in port cities • The Shattuck Era (c. 1950) : Characterized by the development of organized health departments and the impact of the new biological sciences on health • Early 20th Century: Characterized by the development of state and local health departments serving most of thepopulation of the United States

10. FOUR ERAS IN THE DEVELOPMENT OF PUBLIC HEALTH IN THE UNITED STATES (cont’’d.) • Late 20th Century: Characterized by the expansion of public health concerns into medical care, community mental health, chronic diseases, and health behavior, and a new concern with the impact of environment on health • Y2K  : Who knows? Likely, considerable wrestling with a growing national awareness of limited resources and nearly insatiable demands for improved health

11. 1800-1850: Although the United States expanded greatly in population, public health measures remained essentially stationary • Life expectancy in Boston decreased from27.9 years in 1820-1825 to 21.4 years in 1840-1845 • In 1950, in Massachusetts the tuberculosis death rate was over 300 per 100,000 population, and infant mortality was about 200 per 1,000 live births

12. THE SHATTUCK REPORT -- Report of the Sanitary Commission of Massachusetts (1850) • Report of a legislative committee on sanitation and health problems in Massachusetts • A signal event in the development of public health in the United States • In effect, it charted health pathways for future generations • A remarkable document with considerable contemporary relevance in its various recommendations • Results started to appear in 1969, when Massachusetts establish its first state board of health

13. RECOMMENDATIONS OF THE SHATTUCK REPORT(1850) • Establishment of state and local boards of health • System of sanitary police or inspectors • Collection and analysis of vital statistics • Routine system for exchanging data and information on public health matters • Sanitation programs for towns and buildings • Studies of the health of school children • Studies of tuberculosis • Control of alcoholism

14. RECOMMENDATIONS OF THE SHATTUCK REPORT(1850) [cont’d.] • Supervision of mental disease • Sanitary supervision and study of problems of immigrants • Erection of model tenements, public bath houses and wash houses • Control of smoke nuisances • Control of food adulteration • Exposure of “nostrums” -- I.e., panaceas, elixirs, eetc. • Preaching of health from pulpits • Establishment of nurses’ training schools

15. RECOMMENDATIONS OF THE SHATTUCK REPORT(1850) [cont’d.] • Teaching of sanitary science in medical schools • Inclusion of preventive medicine in clinical practice • Routine physical examinations and maintenance of family records of illness

16. DEVELOPMENT OF PUBLIC HEALTH AGENCIES AND LEGISLATION IN THE UNITED STATES • Local Health Departments • State Health Departments • Early Federal Health Agencies • Marine Hospital Service (est. 1798) -- first national health initiative • Port Quarantine Act (1878) • Public Health and Advances in Bacteriology • United States Public Health Service • Stems from the Marine Hospital Service • 1902 -- Renamed the Public Health & Marine Hospital Service • 1912 -- renamed the U.S. Public Health Service

17. DEVELOPMENT OF PUBLIC HEALTH AGENCIES AND LEGISLATION IN THE UNITED STATES • American Public Health Association (est. 1872) • Pure Food and Drug Act (1906) -- FDA • Children’s Bureau (est. 1912) • Sheppard-Towner Act (Maternal and Infancy Act) (1921) • Social Security Act (1935) • Hill-Burton Act (Hospital Survey and Construction Act (1946) • National Institutes of Health • Medicare and Medicaid (1935) • Federal and State Environmental Agencies (1970s)

18. PUBLIC HEALTH AND ADVANCES IN BACTERIOLOGY • Between 1877 and the end of the 19th century, the identity of numerous bacterial disease agents was established • These agents included those causing gonorrhea, typhoid fever, leprosy, tuberculosis, cholera, diphtheria, tetanus, pneumonia, plague, and dystentery • The subperiod (1875-1900) has been termed by some as the bacteriological period of public health • Examples: • 1862 -- In France, Louis Pasteur proposed his germ theory of disease

19. PUBLIC HEALTH AND ADVANCES IN BACTERIOLOGY (cont’d.) • Prior to this, “miasmas” (bad vapors) were thought to be thsource of many diseases • 1890 -- Pasteurization of milk introduced • 1891 -- Meat inspection inititiated • 1895 -- Septic tanks for sewage treatment were introduced

20. SUMMARY OBSERVATIONS Public health services as last resort, safety net, etc. Continuing separation of medical care and (1) public health, and (2) mental health Recent reorganization of responsibility fot environmental health, with inception of the Environmental Protection Agency (EPA) To understand public health and its administration in the United States, must understand our intergovernmental system Some disarray in public health, partly due to the broad spectrumof concerns definable as “public” inscope