The History & Development of Public Health

Dept. of Public Health & Preventive Medicine Padjadjaran University Medical School

INTRODUCTION
Historical reviews: provide valuable insights that can contribute to the solution of present & future health problems Barton (1979): development the health sciences over 5 major area.
- empirical health - basic science

- clinical science
- public health science - political science

Institute of Medicine (IOM), 1988:

Growing demand for Public Health, as: a profession

a governmental activity
a commitment to society

The goals of PH (in broad terms): To identify problems that affect entire communities or populations To marshal support to address these problems To ensure that the solutions are implemented

Detels & Breslow (1997):

Public Health: the process of mobilizing local, state, national & international resources to ensure the conditions in which people can be healthy Historically, public health efforts meant health development to be undertaken by the government as a public sector activity Public health cover promotive, preventive, curative, & rehabilitative health measures

Later, the connotation of the term public was widened to encompass the involvement of people together with the government in health development efforts

EARLY PUBLIC HEALTH

EMPIRICAL PUBLIC HEALTH The concept of disease had been postulated within the limited scientific knowledge available Traditional medicine focused on management of illnesses at the individual rather than the public level. However, the spread of diseases due to contact amongst people or due to hereditary transmission was recognized centuries ago. Quarantine & prohibition were major measures used historically to protect the transmission of diseases

EMPIRICAL PUBLIC HEALTH (contd)

Among figures: Sir Jeremy Bentham Thomas Southwood Smith Edwin Chadwick Sir John Simon

John Snow
William Farr Max von Pettenkoffer

Question: What are health-related concepts hold or discoveries during this empirical public health era?

Colonial public health

Trading around the world during the 18th & 19th centuries for the exploration & exploitation of natural resources led to the discovery of new territories in different parts of the world The colonials established their own administrative, legal, & medical care systems with varying degrees of autonomy & authority To protect the health of their own people & the workers, colonial rulers established laws similar to those in their home countries, e.g. the Public Health Acts, Local Government Act, Civil Registration Act, Factory Acts, Food Adulteration Act, Vaccination Act, & Contagious Diseases Acts

Colonial public health (contd)

European & American religious missionaries also embarked on expeditions around the world along with the colonial powers. Many of them established medical care institutions, as well as general educational systems including nursing & medical schools. However, the actual development of public health & medical care services for the general public remained rudimentary Moving millions of people to totally unfamiliar areas had led to a high incidence of death & disability died due to: smallpox, malaria, yellow fever, typhus, typhoid disabled due to: yaws, leprosy, & syphilis The development of in the areas of physics, microbiology, biochemistry, pharmacology & other diagnostics led to an explosion of its application in public health practices

Foundation of international public health

Intl public health efforts intensified in the early 18th century when European nations applied protective legislative measures to prevent importation of epidemic diseases by trading ships

The First Intl Sanitary Conference (1851): the first attempt to reach a consensus on drafting intl quarantine regulations. For the next 50 years, a series of similar intl sanitary conference were held but failed to produce an intl sanitary code partly due to:
- the non-availability of a sound scientific basis for the prevention & control of epidemics - the vested political & commercial interests of each colonial power The 11th Intl Sanitary Conference (1903): the first sanitary convention for the prevention & control of three epidemics: plague, cholera, & yellow fever

Foundation of international public health (contd)

Based on the convention, L Office International d Hygiene Publique (OIHP) was established in 1907 as the first intl health office

objective:
- to protect Europe against three notifiable diseases (at the beginning)

- to monitor & report the outbreaks of the three notifiable diseases

- to provide general public health information on measures taken to combat these diseases through monthly bulletin

In Bandoeng (1937) Conference of far eastern countries on Rural hygiene.

Foundation of international public health (contd)

Around the time of the establishment of the League of Nations: - major epidemics were rampant in various parts of the world

- some infectious diseases, e.g. cholera & plague, were

threatening to become pandemics The League had to cope with many other postwar rehabilitation problems & the Paris-based OIHP was unable to deal with such pandemics even with its originally assigned tasks Based on the proposal of the Brazilian delegation, the League of Nations agreed, in 1920, to the establishment of an intl health organizations The League of Nations Health Organizations was formed in 1923, originally assigned to handle intl health matters relating to both technical assistance & clearing-house functions

Foundation of international public health (contd)

The League of Nations Health Organizations organized the intl health conferences in the early 1930s, provided a forum for sharing experiences on public health development in the countries under colonial rule The Intergovernmental Conference of Far-Eastern Countries on Rural Hygiene held in 1937 in Bandung, West Java, Indonesia Studied the public health interventions of the participating countries, defined the central role of health in development, & emphasized the need for integrating health care & intersectoral action However, the onset of the devastating Second World War delayed effective follow-up of the Bandung Conference principles

After the 2nd world war, the WHO Constitution was approved on 22 July 1946, initiating the establishment of the Organization as a specialized agency of the United Nations

Foundation of international public health (contd)

The WHO constitutional mandate:
Attainment by all people of the highest possible level of health

The WHOs main functional roles:

Directing & coordinating intl health work & providing advice & advocacy on intl health development

The WHOs authority:

- To adopt intl regulations - To set intl standards for biological & pharmaceutical agents, as well as other diagnostic procedures & products - To adopt intl conventions & agreements

SCIENCE-ORIENTED PUBLIC HEALTH

The age of opportunity that saw remarkable scientific & technological advancements which opened up limitless vistas & unlimited possibilities for solving the age-old problems of poverty & disease Inventions & innovations: quinine, DDT, penicillin, sulphonamide, vaccines, birth-control pills & injectables, imaging diagnostic technologies

 After the 2nd world war, developing countries started to building up health systems infrastructures based on a network of hospitals & health centers During the early 1950s most countries adopted the Beveridge model of national health & social welfare policy & they initiated free health services for all
Training of different categories of health auxiliaries, e.g. health assistants, medical assistants, health visitors, nurses, midwives, vaccinators, sanitary workers, community workers, laboratory technicians, pharmacists, was initiated by the establishment of paramedical training institutes

Intl rural health conference in New Delhi (1937):

The concepts & functioning of rural health services The training & use of multipurpose village workers

The enhancement of prevention & control of epidemic & endemic diseases

The utilization of local resources & promoting intersectoral action, The participation of local people, incl. formation of village health committees The rural health centers as the basic units where comprehensive health care could be provided to the rural population was recognized

Science-oriented PH.Cont
1960most countries started population policy/ family planning.

1960s Green revolution started

1970 WHO survey :Only 29% of rural and 50% of urban population have access to a save drinking water.

Science oriented PH..cont

Disease prevention and control campaign - yaws-start 1948 ;mass treatment with long acting penicillin. -malaria-->start with DDT in 1950s. Result dramatic ;after that faced problem of resistence of mosquito to DDT and parasite to drug.

Disease preventioncont
-Leprosy in 1943 discovered Diamino-diphenyl sulphon(DDS)-global leprosy control program - Sexual transmitted disease: 1948 in Europe. 1992 who used long acting penicillin.

- Cholera: eltor appear in Indonesia in 1961.

Public health sucesses

Smallpox eradication