History of Public Health

Methods of preventing disease go back many centuries. Concepts of disease were crude and often based on anecdote. Some recommendations and practices were ineffective, if not even harmful to health such as bloodletting.

In the mid-1800's there was a hygiene movement, particularly in the UK, with focus of improvements of cleanness and well-being of the poor. Additionally, at the end of the 19th century germ theory became accepted.

Learning Objectives:

  1. Explain the evolution of concepts about cause and prevention of disease
  2. Understand the importance of studying the factors associated with outcomes in a systematic way in human populations.
  3. Discuss some of the major historical figures and events that played a role in evolution of public health and epidemiology
  4. Describe the overall structure of the public health system in the US today

Early Concepts of Disease

10,000 years ago when humans were hunter-gatherers and lived in small, nomadic groups accumulating waste and contamination wasn't a problem. Early concepts of disease revolved around superstition, myths and religion (bad spirits, Pandora's box, etc).

The agricultural revolution provided more secure supply of food and enable expansion of population. People often lived off one or two crops, often lacking protein and vitamins. The domesticated animals provided food and labor, but also carried diseases that could be transmitted to humans. Waste accumulation attracted rodents and insect vectors and with people living in larger groups there was a greater opportunity for transmission of diseases.

The first concept of disease not founded on superstition was the Hippocratic corpus; A Greek concept that disease is caused by an unbalance of the environment or natural forces, and Blood, Bile, Phlegm, and Melancholy must be kept equal within the body. Although the concept clearly incorrect by today's medical standards, Greek doctors would prescribe changes in diet and lifestyle. It also became the rational for bloodletting, which continued for many centuries despite lack of evidence.

The Bubonic Plague

The bubonic plague caused by a bacteria that lives in the intestines of fleas. Fleas were the vector and rats were a reservoir for the bacteria that could easily transmit the disease. Occasionally, an infected flea could jump to a human and infect them directly. Causing dark, tender, swollen nodules. Symptoms also included headache, and delirium and was fatal in about 60% of cases.

Starting in 1347 Europe experienced waves of the plague which lasted until the late 1700's. It was believed to have originated in Asia and traveled along trade routes to the black sea.

One might blame the lack of preventative measures and knowledge about transmission on the primitive understanding of medicine, however this wasn't due to a lack of technology but the fact that humans had not come up with a structured way to think about disease. There were theories about how the plague spread and how to prevent it, but no tests were ever done through observation of large groups of people. The idea of studying groups of people to identify risk factors and disease outcomes had not yet evolved. The lack of a systematic way of testing possible associated between exposures and outcomes was the major factor that prevented advances in understanding the causes of disease and development of effected treatment/prevention.

The black plague still exists today, and kills a few thousand people every year due to anti-biotic resistant strains. However, when identified early it is curable.

Quarantine and Isolation

The concept of quarantine dates back to the early 1400's and the black death. In Italian Qaurintina means 40 days. Travelers and merchandise thought to have been exposed would isolate for a set period of time. This practice persisted until the 19th and 20th century. Isolation is separating someone who has the disease from the rest of the population, which was useful in cases like SARS where the infected is only contagious when symptoms are present. Quarantine is separating someone from the population who might have been exposed, e.g. COVID-19 since one could be contagious without symptoms.

Public Health in the US

Events in the US paralleled those of the UK as the population moved from an agricultural to an urban and industrial way of living.

Timeline 1800s

Timeline 1900s

Ideas About Health

Examples of a few key players who influenced how we think about health and disease and it's determinites:

John Snow: Father of Epidemiology

In the 1800s there were large outbreaks of Cholera in America and Europe killing thousands of people. John Snow was a physician from London who studied Cholera for many years, and is credited with solving a outbreak in 1854. The theory on Cholera transmission was measimas or person to person contact. Snow began examining the victims and found symptoms were always related to the gastroinstestinal tract and reasoned that if it were spread by bad air there would by pulmonary symptoms so transmission was more likely to occur by food or water consumption.

Many Londoners received their water from hand pump wells that were located throughout the city and two private companies in particular pumped water from the Thames river to the areas primary effected by cholera. Of course, few people believed Snow since he couldn't actually prove there was something in the water. He ended the epidemic in 1854 by removing the handle to the infected water pump himself. Cholera remains a problem in countries with underdeveloped sanitation and water routes, such as Haiti. In these locations it is more realistic to vaccinate for cholera than fix the entire system.

The Sanitary Idea

In a way modern public health, i.e. as a function of government, comes from France and Britian around 1850-1875 in the wake of the consequences industrial revolution. However the circumstances that propelled the development of public health as a discipline, such as the importance of the size of a population in measuring the influence and power of a state. This crude notion made the idea of "numbering the people" important. John Graunt's office was the first of it's kind to mandate the recording of births, marriages, deaths. William Farr was the first Chief Statistician. The General Registrar's Office established the importance of surveillance with respect to health.

Another contributing factor was the start of the enlightenment, which embraced democracy, citizenship, reason, rationality and the social value of intelligence. One theme was the reduction of mortality and improvements to health had an economic value to society, healthy workers were able to contribute more. Utilitarianism, or the idea that one can measure the amount of evil by the misery created or relieved by an action, provided underpinnings for public health.

Health and Class

In 1842 Sir Edwin Chadwick, a social reformer, published a report entitled "Report into the Sanitary Conditions of the Laboring Populations of Great Britain proving that life expectancy is much lower in towns than in the countryside. He argued that it was possible for government to improve people's lives through reform and a healthier population would work harder and cost less to support. He concluded what was really needed was not more doctors but civil engineers to provide drainage of the streets and more efficient ways of delivering clean water and removing sewage. These ideas contributed to the idea that public health was a legitimate concern of government and led to the creation of legislation and government offices.


Revision #18
Created 9 June 2022 12:35:19 by Elkip
Updated 7 August 2022 19:01:00 by Elkip