Public Health, History and Achievements Dr Faris Al Lami MBChB PhD FFPH
Objectives Define public health. Describe conditions that existed before the advent of modern public health. Describe important achievements of Public Health
What is Public Health? The science of protecting and improving the health of communities through education, promotion of healthy lifestyles, and research for disease and injury prevention. PH professionals analyze the effect of genetics and environment on health to protect community health. PH professionals try to prevent problems by implementing educational programs, developing policies, administering services, regulating health systems and conducting research. A large part of public health is the fight for health care equity, quality, accessibility and limiting health disparities Adapted from: www.whatispublichealth.org: http://www.whatispublichealth.org/what/index.html
What is Public Health? To promote health and quality of life by preventing and controlling disease, injury, and disability. CDC Mission Statement
10 Essential Public Health Services Monitor health status to identify community health problems. Diagnose and investigate health problems in the community. Inform, educate, and empower people about health issues. Mobilize community partnerships to identify and solve health problems. Develop policies and plans that support individual and community health efforts.
10 Essential Public Health Services Enforce laws and regulations that protect health and ensure safety. Link people to needed personal health services Assure a competent public health workforce. Evaluate effectiveness, accessibility, and quality of population-based health services. Research for new insights and innovative solutions to health problems.
Public Health Timeline Ancient Greece Roman Empire Middle Ages Birth of Modern Medicine Great Sanitary Awakening Modern Public Health
Personal hygiene Physical fitness Olympics Naturalistic concept Disease caused by imbalance between man and his environment Ancient Greeks (500-323 BC) Hippocrates (b. 460 BC) Father of Western medicine Causal relationships Disease and climate, water, lifestyle, and nutrition Coined the term epidemic
Roman Empire (23 BC 476 AD) Adopted Greek health values Great engineers Sewage systems Aqueducts Administration Public baths Water supply Markets
Middle Ages (476-1450 AD) Shift away from Greek and Roman values Physical body less important than spiritual self Decline of hygiene and sanitation Beginnings of PH tools Quarantine of ships Isolation of diseased individuals
The Plague (The Black Death) Death of 25% to 50% of population Killed at least 25 million people in Europe (1/3 of the population). and more than 60 million worldwide. Plague originated in Asia, and moved west with Mongol armies and traders. The plague traveled on trade routes.
Renaissance (1400-1600 AD) Global Exploration Disease spread by traders and explorers Killed 90% of indigenous people in New World
Age of Reason and Enlightenment (1650-1800 AD) Birth of Modern Medicine William Harvey 1628 theories of circulation Edward Jenner 1796 cowpox experiment Coined the term vaccine (vacca, Latin for cow )
Industrialization, Urbanization and Great Sanitary Awakening (1800s-1900s) Growth in scientific knowledge Humanitarian ideals Connection between poverty and disease Water supply and sewage removal Monitor community health status
Dr. John Snow (1813-1858)
Sanitation Revolution Clean water; water treatment Food inspection Soaps, disinfectants, and pharmaceuticals Personal hygiene Public works departments; garbage collection, landfills, and street cleaning Public health departments and regulation
Deaths per 1,000 18 17 16 15 14 13 12 10 11 9 8 1900 1925 Twentieth Century U.S. Mortality Rate: 1900-2001 1934 1939 1944 1949 1954 1959 Source: www.infoplease.com 1965 1970 1975 1980 1985 1990 1995 Year 2000
Ten Great Achievements in Public Health, 1900-1999 1. Vaccination. 2. Motor-vehicle safety. 3. Safer workplaces. 4. Control of infectious diseases. 5. Decline in deaths from coronary heart disease and stroke. 6. Safer and healthier foods. 7. Healthier mothers and babies. 8. Family planning. 9. Fluoridation of drinking water. 10. Recognition of tobacco use as a health hazard.
Control of Infectious Diseases Clean water - filtered, chlorinated, monitored Safe foods Sanitation - waste collection, treatment, disposal Immunization and vaccines Measures to control TB, STDs, AIDS Anti-microbial therapy Access to medical care
21
Vaccination Control of pertussis, diphtheria, tetanus, measles, mumps, rubella Global eradication of smallpox Global eradication of poliomyelitis (by 2014?) Measles control but not eradication New vaccines - Haemophilus influenzae type b, hepatitis A and B, varicella, influenza, and pneumococcal pneumonia New technology Combination cocktails No vaccines for AIDS, malaria
Coronary Heart Disease and Strokes Since 1972, death rates for coronary heart disease have decreased in Western societies by 51% Decline in deaths from coronary heart disease and stroke have resulted from: Life style modification Smoking cessation Blood pressure control Access to early detection and better treatment
24
Safer and Healthier Foods Decreased contamination and food-borne disease Improved food handling methods - refrigeration Improved nutritional value of foods, crops Identifying essential micronutrients and deficiency conditions Food-fortification programs eliminated major micronutrient deficiency diseases: rickets, goiter, pellagra
26
Healthier Mothers and Babies Better hygiene and nutrition Spacing of pregnancies Safe delivery in general hospitals Antibiotics, vaccines, blood transfusions Management of pregnancies Social benefits, maternity leave, standards of living Greater access to health care Advances in maternal and neonatal medicine
28
29
Family Planning Safe and effective methods Access to family planning and contraceptive services Altered social and economic roles of women Health benefits e.g. smaller family size, longer interval between childbirth, less abortion Pre-conceptional counseling and screening Fewer infant, child, and maternal deaths Barrier contraceptives to prevent pregnancy and transmission of HIV and other STDs
Fluoridation of Drinking Water Began in 1945 to prevent tooth decay safe and inexpensive Benefits for children and adults Reaches all regardless of SES or access to care Reduced decay by 40%-70% in children Reduced tooth loss in adults (40%- 60%) Effects in preventing osteoporosis (with exercise, Vit D and calcium)
Recognition of Tobacco Use as a Health Hazard 1964 report on health risks of smoking Public anti-smoking campaigns Goals To prevent initiation of tobacco use To promote cessation of use To reduce secondary environmental exposure Prevalence of smoking among adults decreased Millions of smoking-related deaths prevented Still enormous PH problem among poor and adolescents
34
Workplace Safety Work-related health problems, e.g. coal workers' pneumoconiosis (black lung), and silicosis -- common at the beginning of the century -- have come under better control Severe injuries and deaths related to mining, manufacturing, construction, and transportation also decreased Since 1980, safer workplaces have resulted in a reduction of approximately 40% in the rate of fatal occupational injuries
36
Motor Vehicle Safety Improved motor-vehicle safety from engineering efforts to make both vehicles and highways safer. Successful efforts to change personal behavior (e.g., use of safety belts, child safety seats, and motorcycle helmets and decreased drinking and driving). These efforts have contributed to large reductions in motor-vehicle-related deaths.
38
Contributions to Increase Life Expectancy
Population (in millions) World Population Growth 8000 2010 7000 6000 5000 4000 3000 1850 2000 1000 0-8000 -3000-1000 1 AD 1000 1200 1400 1600 1750 Year 1850 1910 1930 1950 1970 1990 2010
Globalization Emerging infectious diseases Reemerging infectious diseases Health disparities between industrial and nonindustrial countries