DISCUSS THE MAJOR MEDICAL AND PUBLIC HEALTH MEASURES

DEVELOPED IN THE 20
th
CENTURY THAT WERE INSTRUMENTAL FOR
CONTROLLING THE SPREAD OF INFECTIOUS DISEASES IN DEVELOPED
COUNTRIES
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 disease and the development of social machinery which will ensure
to every individual in the community a standard of living adequate for the maintenance of
health.
SHEQ3122 : PUBLIC HEALTH MICROBIOLOGY
MATRIC NO : SEQ 110003
TITLE :




ublic health is an organized efforts in order to improve the health communities. The
main component of public health component is focusing on efforts on communities
rather than to individuals. In addition, public health practice is a global combination
of science and social expertise and did not rely on a specific body of knowledge or
expertise. According to C.E.A. Winslow (1920), the definition of public health
practice is;





According to Centre for Disease Control, public health measures are non-pharmaceutical
interventions to reduce transmission of infectious diseases. They can be implement at individual,
community and social levels. At an individual level, the example of public health measures are
hand-washing and cough etiquette and these two examples can be useful in limiting influenza
infection. At a societal or community level, public health interventions, school closures and
managing mass gatherings are examples of public health measures. Therefore, they are many
public health measures (PHMs) had been proposed by World Health Organization (refer to WHO
pandemic plan guidance on public health measures) in order to combat the infectious diseases.
The primary objective of developing the measures is; to restricted and lowering the transmission
and therefore reduce the global number of cases especially the deaths.
P
1. Educational setting and day care-based interventions
They are two rational reasons on the implementation of this kind of intervention. First,
respiratory infections are always observed to spread easily in day care and school settings and
second, one of the three pandemics in 20
th
century showed a particular focus on transmission in
children. According to WHO, they are two action plans that being developed based on this
intervention. They are reactive school and day care closures and proactive school and day care
closures. The reactive school and day care closures is the planned closure of schools when it seen
that there is transmission taking place in school. The objective and rational of this plan is to
reduce the anticipated amplification of influenza (one of the infectious diseases) transmission in
schools. The proactive school and day care closures plan is the early planned closure of schools
when it is judged that the transmission of the disease (mainly influenza diseases) is approaching
a school but before it starts in the school itself.

2. Public education
The idea of public education is to deliver the clear, consistent and accurate information to the
public in order to help them to be prepared for a pandemic and reduce their risk. Public education
includes 3 main components.
First component: The individual infection prevention and control measures, including education
about hand hygiene, respiratory/cough etiquette (including covering ones mouth when coughing
or sneezing), proper tissue disposal, and other personal protective measures to avoid droplet and
contact spread. In addition, it is important to delivered information to public about the
importance of fresh air and how to increase air circulation in buildings.
Second component: Social distancing, including messages advising people. It is advisable for
public to stay home from day-care, school and public events if they have influenza-like-illness
(ILI) symptoms or have had contact with someone with ILI. Plus, they have to avoid large
gatherings or crowds, reduce non-essential travel and know about the emergency preparedness
supplies they should have in their homes (food and water).
Third component: Influenza care including information about how to access health care advice,
where and how to seek medical care and self-care procedures (how to care for others who are ill
at home).

3. Immunization
The immunization against smallpox introduced by Edward Jenner in 1796 is the pioneer program
and become one of the most successful program listed by CDC MMWR (Morbidity and
Mortality Weekly Report) in the 20
th
century. This is based on the infectious diseases case in
USA, one of the developed country in world. In 1900, 21064 smallpox cases (894 died); in 1920,
469 924 measles cases (7575 patients died) were reported and for the diphtheria, 147 991 cases
(13170 died) were reported. In 1922, 107473 pertussis cases were reported with 5099 patients
were died. Even though, the small pox vaccine had been developed early in 1796 and other four
vaccines (to combat rabies, typhoid, cholera and plague) were developed in the late 19
th
century,
but all these vaccines were not widely used in USA in the early 1900. Since 1900, many more
vaccines had been developed and licensed in USA in order to fight many infectious diseases such
as diphtheria, tetanus, meningitis and other 23 kind of diseases. 14 of these vaccines (rabies,
typhoid, cholera, plague, tuberculosis, influenza, yellow fever, meningitis, pneumonia,
adenovirus, anthrax, Japanese encephalitis, Hepatitis A and Lyme disease) were used at a
selected populations at high risk and others ( smallpox, diphtheria, pertussis, tetanus,
poliomyelitis, measles, mumps, rubella, Hepatitis B, Haemophilus influenza type B, Varicella
and Rotavirus) had been recommended and used in all US children. During the 20
th
century, the
great achievements have been made in the control of many vaccine-preventable diseases. The
last case of smallpox in the United States occurred in 1949 and another three diseases are had
showed the dramatically decreased in term of number of cases. They are poliomyelitis caused by
wild-type virus (fully eliminate), measles and Haemophilus influenza type b (the number of
cases reported are very low in number). The achievement in eradication of disease will not be a
reality if the cooperation between the scientist and authorities could not be established. The
Vaccination Assistance Act that being introduced by United States in 1962 show that the
authorities are fully support he purchase and administration of a full range of childhood vaccines.
4. Sanitation and Hygiene
The industrialization era that started in the 19
th
century shift the population and lifestyle of
people from country to city. In addition, introduction of immigration to support the
industrialization process led to overcrowding in poor housing served by inadequate or
nonexistence of public water supplies and proper waste-disposal systems. These two factors led
to the increasing of the number of cases that related to the water-borne, water-washed, water-
based and water-related diseases such as yellow fever, cholera, dysentery, typhoid fever and
malaria. However, in 1900 the incidence of many diseases (that been state) had decline (in the
number of reported cases) because of the improvement in the public health awareness and still
continued into the 20
th
century. The authorities had developed systems based on the idea that
they can prevent infection by providing clean drinking water. The examples of disease
prevention actions that had been taken by the authorities are introduction of the organized solid
waste disposal, sewage disposal, water treatment and chlorination (treatment for drinking water).
In addition, they are also had organized a public education about the hygiene practices (such as
food handling and hand washing) and awareness about the food safety. Furthermore, US had also
developed an organized municipal water system in order to provide a better water treatment. The
first large-scale municipal water system in the US was built in Philadelphia in the late of 19
th

century and this water system had been continued to build for entire states in US in 20
th
century.
All these actions had been monitored and controlled by local and state health departments. These
progressive actions had shown a positive results towards the decrease of many water-related
diseases. As example, in 1900, 194 of every 100 000 US residents died from TB. But in 1940,
TB still remained a leading cause of death but the death rate had decreased to 46 per 100 000
persons. This is due to the implementation of TB-control programs in every household in US
especially that in urban areas.





5. Animal and pest control programmes
The animal and pest control also contributes to the reduction of the number of disease. As
example, the animal control programmes that is fully supported by the United States nation and
state-coordinated vaccination had fully eliminated the dog-to-dog transmission of rabies in 20
th

century. Malaria was also reduced to the negligible levels by the late 1940s through the
mosquito-control programmes by the US. The effort form US Marine Hospital Service that
introduced the quarantine and ship inspection activities and rodent and vector-control operations
led to diminish of the plague diseases. The last plague diseases outbreak that cause from rat
reported in US is around 1924-1925 that occurred in Los Angeles.

6. Closing of the Public Amusements
The idea of closing the public places arose from the epidemic of Spanish flu that struck United
States of America in fall of 1918. The state that fully implemented this type of intervention is
Chicago. In Chicago, new movie theatres, church and vaudeville halls were closed or restricted
during the epidemic happened. In that time the public health practitioner were active in finding
means to limit the impact of disease. The evidence that manifested that Chicago are fully
implemented this intervention is the order from the Archdiocese of Chicago (the Roman
Catholics movement in Chicago). It clearly stated that:
In compliance with the directions of the state and city Departments of Healthall evening
services are suspendedthere are no public devotions in the afternoons or eveningslong
sermons were prohibitedthe church is to be thoroughly ventilated for ten to fifteen minutes
while the people are out of the building and was to be cleaned with disinfectantsparishioners
who coughed, sneezed or showing the indications of having contracted the disease were asked to
leave.
This evidence shows that the public buildings are seriously being monitored and restricted when
the pandemic happened.


7. Invention of Public Health Stations
In 20st century, the United States nation had created the Public Health Stations. The station
provided the pasteurized milk, settlement houses that provided emergency shelter, visiting nurses
and educational programmes for mothers and their children. The creation of the stations had
eventually created a public awareness about the important of taking a good hygiene and also
improved the chances of childhood survival.
8. School Nurse Program
In fall 1918 and winter 1919, as the influenza pandemic spread across the US nation, the
majority of urban schools were closed for weeks or months. But then, they are states that
diverged from the prevailing patterns by keeping their public school open. They are New York
City, New Haven and Connecticut. They have their own designation program in order to limit
the spread of the disease. One of the remarkable program is the invention of School Nurse
Program. The first school nurse program began in 1902 when New Yorks board of education
and its health commissioner asked the nursing expert Lillian Wald to design a demonstration
program. Through this program, nurses are placed in four of the city school. The nurses began
the routine inspection on 10000 children with home visits for any needing follow-up treatment.
At school, the nurses went from class to class, lining up the children to examine eyes, hands,
throats and hair and provided a written report of their findings to the physician in charge.
Through this program, the children have their extra care about their health instead of being at
home.
9. School Medical Inspection program
The School Medical Inspection (SMI) program started in late of 19
th
century. In this program, the
medical doctors were making prescribed visits to assigned districts to examine the pupils. The
objective of this program was the surveillance for the many contagious disease of childhood and
if discovered, their rapid containment in the form of quarantine. In addition, the doctors, nurses,
social workers cooperated by learning and facilitate the methods of disease control under this
program. Plus, this intervention focused on the children in K-12 schools as they are many
children in that kind environment.

References
Miller G. & Cutler D. (2004). The Role of Public Health Improvements in Health Advance:
The 20th Century United States. United States: Harvard University.

ECDC. (2009). Guide to public health measures to reduce the impact of influenza
pandemics in Europe. Stockhold, Sweden: European Control for Disease
Prevention and Control.

Borkowski, L. (2010). Public Health 101 : Ten Great Achievements. Retrieved from
http://scienceblogs.com/thepumphandle/2010/09/03/public-health-101-ten-
great-ac/

CDC. (1999). Achievements in Public Health, 1900-1999: Control of Infectious Diseases.
MMWR Weekly, 48(29), 621-629.

CDC. (1999). Achievements in Public Health, 1900-1999 Impact of Vaccines Universally
Recommended for Children -- United States, 1990-1998. MMWR Weekly, 48(12),
243-248.

CDC. (2002). Notice to Readers: 25th Anniversary of the Last Case of Naturally Acquired
Smallpox. MMWR Weekly, 51(42), 952.

Schlipkter U, Flahault A. (2010). Communicable diseases: achievements and challenges
for public health. Public Health Reviews, 32, 90-119.

Rosner, D. (2010). Public Health in the Early 20th Century (Vol. 125, pp. 38-47). NY, USA:
Mailman School of Public Health, Columbia University.

Alenxandra Minna Stern, M. B. R., Martin Cetron & Howard Markel. (2010). Better Off in
School: School Medical Inspection as a Public Health Strategy During the 1918
1919 Influenza Pandemic in the United States (Vol. 125, pp. 63-70). MI, USA:
Center for the History of Medicine, 100 Simpson Memorial Institute.




DISCUSS THE MAJOR MEDICAL AND PUBLIC HEALTH MEASURES
DEVELOPED IN THE 20
th
CENTURY THAT WERE INSTRUMENTAL
FOR CONTROLLING THE SPREAD OF INFECTIOUS DISEASES IN
DEVELOPED COUNTRIES












SHEQ 3122: PUBLIC HEALTH MICROBIOLOGY

TITLE:









NAME : HIKMAL FIZAR BIN JAMALUDIN
MATRIC NO : SEQ 110003
LECTURERS NAME : PROF. DR. THONG KWAI LIN