Rise of public health

RISE OF PUBLIC
HEALTH
Post-graduate seminar
presentation
Dr. Aniruddh K. Menon
1st year MD Community
Medicine
SIMS, Shimoga
Tuesday, 24 January 2017 DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA 1

BACKGROUND
The history of the world has broadly been a history of the
health
Global transition in the perception of life and death
Health is a hallmark of modernity
Economic and political progress are mere subordinates toTuesday, 24 January 2017 2DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA

RISE OF PUBLIC
HEALTH IN THE
DEVELOPED
COUNTRIES
An approach through
the different themes in
the history of public
health
Tuesday, 24 January 2017 3DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA

THEMES IN THE HISTORY OF
PUBLIC HEALTH
Three relatively distinct missions:
1. Public health as a reaction to epidemics
- Reactive
- Closing borders, fumigation, shutting down piggeries, isolation of victims
2. Public health as a form of police
- Community standards becoming medical
- Control of food-adulteration, prostitution
3. Public health as a means of betterment
- A proactive political vision
- Mass vaccination, comprehensive urban water and sewerage systems
- Change in the public health threats

THE PUBLIC HEALTH OF
EPIDEMIC CRISIS: REACTION
Belief that we ‘can’ – the prerequisite
for public health
‘Will-of-God’ explanations were always a
discouragement
Naturalistic explanations – that ‘mysterious’
element in the atmosphere

1. PLAGUE OF
ATHENS, 430 BC
- The first European
account of a widely
fatal epidemic
Plague outbreak after the Spartan invasion
of Athens
World’s oldest available epidemic data
Accepting one’s fate was the main
response
Islamic doctors called it
‘Allah’s will’

2. LEPROSY IN THE
MEDIEVAL CHRISTIAN
LATIN COUNTRIES
Activist response
Jesus cleansing the ten lepers
Confidence that certain diseases could be
controlled
Concepts in the Old and New
Testaments
Focus on community
welfare

3. THE GREAT PLAGUE OF
THREE CENTURIES
The prototypical
institutional response
to an epidemic
The Great Plague, a 1665 painting

THE DEVASTATING PLAGUE
Black Death, the first wave – 1347 to 1351, and every
two decades thereafter
Case fatality rates of 30-100% depending on the strain
Divine will and natural process
Precipitation of a social crisis
False accusations on Jews

PUBLIC RESPONSE TO
PLAGUE
Italy took the earliest measures to control the epidemic
40-day quarantine on ships coming from potentially
infected places
Air-purification and decontamination
Isolation
A responsive committed civil society
Atmospheric and miasmal theories

4. THE CHOLERA
PANDEMICS, 1830
Accusations and loss
of faith
Printed cholera notice,
1866

THE CHOLERA PANDEMICS,
1830
The poor accused that the rich were poisoning them
The rich accused that the poor wantonly persisted in
unhygienic areas
Successful attempts at disinfection, quarantine and

CHOLERA AND DR. JOHN SNOW,
TOWN SOHO, LONDON

5. SYPHILIS AND
VENEREAL DISEASES Typhus, typhoid and
relapsing fever
Vladimir Lenin died of syphilis

SYPHILIS AND OTHER
VENEREAL DISEASES
Syphilis was rampant during the 16th century; ‘lustseuche’
Association with wars and brothels
A serious epidemic; adventure for young men
France and U.K. initiated the first prevention strategies; the
Contagious Diseases Act, 1862
Some control was gained by 1885

TYPHUS, TYPHOID, RELAPSING
FEVER, YELLOW FEVER
Epidemics arrived in the aftermath of Black Death
Relapsing fever and social catastrophes
Rudolph Virchow and Sebastian Neumann investigated
typhus in Silesia, 1848
Public response was comprehensive improvement of
living conditions

6. THE WAR AGAINST
SMALLPOX
Vaccination victory
Edward Jenner vaccinating James Phipps

SMALLPOX
Al-Razi’s naturalistic theory, 9th century
Increasing virulence in 15th to 18th century Europe
Contagious disease of childhood
Survivors were immune
State governments – slow to respond
Edward Jenner, 1798 – vaccination with cowpox
Compulsory vaccination in U.K., 1853

THE PUBLIC HEALTH OF
COMMUNAL LIFE: MEDICAL
POLICE
‘Police’ – actions taken at all levels of government
Functions included:
1. Sanitation
2. Caring for the desolate
3. Labour rules
4. Markets and commerce
5. Marriage and midwifery
6. Cattle
7. Military, travel and prostitution
8. Burial of the dead
9. Disaster and injury prevention
10.Forensics
11.Bio-statistic records
12.Regulation of medical practice

THE MEDICAL POLICE
Health promotion depublicized
The responsible authorities
Consumerism and technical
advancement
Nuisances Removal Act,
1847

PUBLIC HEALTH AS A MEANS OF
BETTERMENT: PUBLIC HEALTH
OF HUMAN POTENTIAL
Goal – reduce the preventable mortality and
morbidity rates
Focus shifted towards analysing vital
statistics
More efficient prevention strategies
The great sanitary campaign against urban
filth

PHASES OF PUBLIC HEALTH
Public health has undergone changes in the developed
countries mainly in the last two centuries. These can be
divided into three phases under the evolution of
concepts into:
1. Age of liberalism (1790 - 1880)
2. Golden age of Public health (1880 - 1970)
3. Return to liberalism (1970 onwards)

THE AGE OF LIBERALISM: HEALTH IN THE
NAME OF THE PEOPLE - 1790 TO 1880
Age of the anti-slavery movement and rise of
Methodism
Liberty develops a biosocial vision
Sir Edwin Chadwick – laws of
sanitation

THE GOLDEN AGE OF PUBLIC
HEALTH: 1880 TO 1970

Holocaust and Eugenics
Jews victimized by misinterpreted
theories
Rise of nutritional and agricultural
sciences
Improved methods of cure and
prevention
3 new fears:
1) The invisible germs that can transmit through the most casual
contact (viruses)
2) Mysterious genes (mutations)
3) Deficiencies in food that doesn’t improve with better
consumption (trace nutrients)
Health consciousness met new standards
Improved techniques of disinfection and sanitation
Doctors opinion about critical issues

THE RETURN OF LIBERALISM:
1970 TO PRESENT

RISE OF PUBLIC
HEALTH IN THE
DEVELOPING
COUNTRIES
Historical development
of comprehensive
public health

DEVELOPMENT OF PUBLIC
HEALTH IN THE DEVELOPING
COUNTRIES
Early public health
Empirical public health
Colonial public health
Foundation of international
public health
International health
institution – the WHO
Disease prevention and
control campaigns

EMPIRICAL PUBLIC HEALTH
Teachings in the holy scriptures of
the East
Kautilya’s treatises
Epidemics along Chinese trade
routes

COLONIAL PUBLIC HEALTH
Massive intercontinental population shift
Health establishments of the colonies:
 Indian Medical Service of the East India Company
 Gold Coast Medical Department in Ghana
Missionaries and their medical establishments
 Calcutta School of Tropical Medicine and Hygiene
 All-India Institute of Hygiene and Public Health, Calcutta
 Haffkine Institute, Bombay
 King Institute of Preventive Medicine, Madras
 Central Vaccine Research Institute, Kasauli
 National Institute of Communicable Diseases, Delhi
 Indian Research Fund Association, Delhi
 National Institute of Nutrition, Hyderabad

CALCUTTA SCHOOL OF
TROPICAL MEDICINE
AND HYGIENE
Kolkata

ALL INDIA INSTITUTE
OF HYGIENE AND
PUBLIC HEALTH
Kolkata

HAFFKINE INSTITUTE
(FOR
BIOPHARMACEUTICAL
SCIENCES)
Mumbai

KING INSTITUTE OF
PREVENTIVE
MEDICINE
Chennai

CENTRAL RESEARCH
INSTITUTE
Kasauli

NATIONAL INSTITUTE
FOR COMMUNICABLE
DISEASES
New Delhi

NATIONAL INSTITUTE
OF NUTRITION
Hyderabad

FOUNDATION OF
INTERNATIONAL PUBLIC
HEALTH
18th century: European legislations to prevent
importation of epidemics
First International Sanitary Conference,
Paris, 1851: 12 countries
The Inter-governmental Conference of Far-Eastern Countries
on Rural Health, Bandung, 1937

OIHP, Paris (Pasteur Institute)
1923
League of Nations Health Organization
INTERNATIONAL HEALTH
OFFICES

WORLD HEALTH
ORGANIZATION:
IMPLEMENTATION
Post-WWII
Conference of the Brazilian and Chinese delegations of
the UN
Constitution of the WHO drafted, 22nd July 1946; came
into force on 7th April 1948
7th April 1948: the day WHO officially came into being
Constitutional mandate: Attainment by all people of the
highest possible level of healthTuesday, 24 January 2017 40DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA

FUNCTIONS OF W.H.O.
1. Directing and coordinating international health work
2. Providing advice and advocacy on international health
development
3. Adoption of international
regulations
4. Set international standards for biological and
pharmaceutical agents, as well as other diagnostic procedures
and products
5. Adoption of international conventions and
agreements

W.H.O.: THEN AND AFTER
194 member countries and territories
Worked for over 65 years
6 regional organizations and headquarters
UNICEF and other health systems infrastructures
The Beveridge model of national health and social
welfare policy

Training of different categories of health auxiliaries
Second conference on rural health, New Delhi, 1957,
under the auspices of W.H.O.  focus on MCH
United Nations’ International Women’s Decade: 1976-
1985
Global efforts at popularizing contraception

Green Revolution of 1960s: fight against anaemia and
IDDs
Vitamin A supplementation programme
International Conference on Nutrition, Rome, 1992: a
W.H.O. – F.A.O. coordination effort
Environmental sanitation and safe drinking water

DISEASE PREVENTION AND
CONTROL CAMPAIGNS
W.H.O
U.N.I.C.E.F.
Other UN
agencies
Rockefell
er
Foundati
on
Save the
Children
fund
Global disease control campaigns

YAWS
Arsenic and bismuth compounds pro-WWII
Mass treatment campaigns using long-acting penicillin
Only a scattered foci persisted

MALARIA
Initial efforts with DDT – a dramatic success
Resistance among the vectors

OTHERS
Leprosy
Syphilis
Cholera

Success story of
public health
SMALLPOX

ANCIENT INDIA AND PUBLIC
HEALTH

THE TRADITION OF INDIAN
HEALTH
Conceptualized on spirituality
Ayurveda: the science of life
Dehashudhi
(clean body)
Manashudhi
(clean mind)
Jalashudhi
(clean water)
Aharashudhi
(clean food)
Deshashudhi
(clean
environment)

THE TRADITION OF INDIAN
HEALTH
Earliest protagonists of Indian medicine:
-Sage Atreya
-Charaka
-Sushruta
-Sage Kashyapa
-Bhela
Sanitation played a major role in the planning of cities
like Harappa and Mohenjadaro.

PUBLIC HEALTH
MILESTONES
Personalities and
events

PIONEERS OF PUBLIC
HEALTH
Tuesday, 24 January 2017 54
Edward Jenner (1749-1823)
A fascination that led to
eradication of a pandemic
DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA

Dr. John Snow (1813-1858)
A surgeon’s anesthesia
apprentice who
epidemiologized cholera

Dr. James Lind (1716-1794)
British naval doctor who
discovered the treatment for
scurvy

Robert Koch (1843 - 1910)
A microbiologist who
discovered the agents of
tuberculosis, leprosy, cholera,
plague, sleeping sickness and
tick fever

Dr. Joseph Lister (1827-
1912)
A British surgeon who
revolutionized antisepsis

Dr. John Simon (1816-1904)
British physician who
pioneered public sanitation

Lemuel Shattuck (1793-1859)
American political analyst
who emphasized on vital
statistics

Edwin Chadwick (1800-1890)
British Commissioner who
legalized sanitation reforms

Sir Ronald Ross (1857 -1932)
A Garrison Surgeon posted at
Bangalore who developed
malaria prevention measures
and introduced mathematical
concepts to epidemiological
studies

Dr. William Farr (1807-1883)
British doctor who went on to
become the Father of modern
epidemiological surveillance

Sir Joseph William Bhore (1878-
1960)
Indian Civil Servant who
conceptualized comprehensive
primary health care

Dr. Sushila Nayyar (1914-
2000)
Gandhian doctor who is aptly
called as the founder of
Indian Community Medicine

Dr. Alexander Duncan
Langmuir
(1910-1993)
Community physician who is
known as the founder of 20th
century epidemiology and
public health surveillance

5-POINT SUMMARY OF WHAT
WAS SPOKEN
Public health is health in the name of people, for and unto
Health is not rocket-science; best measures emerged from
common sense
Responsibility of individual health is with the individual, the
country’s with the government
All religions are pro-health; scriptures spoke science,
superstitions were a misinterpretation
Developed and developing countries have separate issues
to address

GLIMPSE AT THE WAY AHEAD .
. .
Universal access to affordable and effective health care
A new vision for public health, where truth and equity
propel the decisions and common sense frames the
priorities
“ Those who fail to read history
are destined to suffer the
repetition of its mistakes ”

BIBLIOGRAPHY
1. Oxford Textbook of Public Health. 4th edition
2. Textbook of Public Health and Community Medicine.
Armed Forces Medical Services. 1st edition

THANK YOU!
[Hygeia and Asclepius
engraved in an arch
over the Nyam door,
Venice]
Tuesday, 24 January
2017
DEPARTMENT OF COMMUNITY MEDICINE, SIMS, SHIMOGA 70

Rise of public health

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