Rise of public health

PowerPoint Presentation

Rise of Public HealthPost-graduate seminar presentation

Dr. Aniruddh K. Menon1st year MD Community MedicineSIMS, Shimoga

Sunday, 16 March 2014Department of Community Medicine, SIMS, Shimoga1

1

BackgroundThe history of the world has broadly been a history of the healthGlobal transition in the perception of life and deathHealth is a hallmark of modernityEconomic and political progress are mere subordinates to securing health

Sunday, 16 March 20142Department of Community Medicine, SIMS, Shimoga

2

Rise of public health in the developed countriesAn approach through the different themes in the history of public healthSunday, 16 March 20143Department of Community Medicine, SIMS, Shimoga

Themes in the history of public healthThree relatively distinct missions:Public health as a reaction to epidemicsReactiveClosing borders, fumigation, shutting down piggeries, isolation of victimsPublic health as a form of policeCommunity standards becoming medicalControl of food-adulteration, prostitutionPublic health as a means of bettermentA proactive political visionMass vaccination, comprehensive urban water and sewerage systemsChange in the public health threatsSunday, 16 March 20144Department of Community Medicine, SIMS, Shimoga

The public health of epidemic crisis: reaction

Belief that we can the prerequisite for public healthWill-of-God explanations were always a discouragementNaturalistic explanations that mysterious element in the atmosphereSunday, 16 March 20145Department of Community Medicine, SIMS, Shimoga

1. Plague of Athens, 430 BC

The first European account of a widely fatal epidemicPlague outbreak after the Spartan invasion of AthensWorlds oldest available epidemic dataAccepting ones fate was the main responseIslamic doctors called it Allahs willSunday, 16 March 20146Department of Community Medicine, SIMS, Shimoga

2. Leprosy in the medieval Christian Latin countries

Activist response Jesus cleansing the ten lepersConfidence that certain diseases could be controlled Concepts in the Old and New Testaments Focus on community welfare Sunday, 16 March 20147Department of Community Medicine, SIMS, Shimoga

3. The great plague of three centuries

The prototypical institutional response to an epidemicThe Great Plague, a 1665 paintingSunday, 16 March 20148Department of Community Medicine, SIMS, Shimoga

The devastating plagueBlack 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 processPrecipitation of a social crisisFalse accusations on JewsSunday, 16 March 20149Department of Community Medicine, SIMS, Shimoga

Public response to plagueItaly took the earliest measures to control the epidemic40-day quarantine on ships coming from potentially infected placesAir-purification and decontaminationIsolationA responsive committed civil societyAtmospheric and miasmal theoriesSunday, 16 March 201410Department of Community Medicine, SIMS, Shimoga

4. The cholera pandemics, 1830

Accusations and loss of faithPrinted cholera notice, 1866Sunday, 16 March 201411Department of Community Medicine, SIMS, Shimoga

The cholera pandemics, 1830The poor accused that the rich were poisoning themThe rich accused that the poor wantonly persisted in unhygienic areasSuccessful attempts at disinfection, quarantine and isolationSunday, 16 March 201412Department of Community Medicine, SIMS, Shimoga

Cholera and dr. john snow, town soho, london


5. Syphilis and venereal diseases

Typhus, typhoid and relapsing feverVladimir Lenin died of syphilisSunday, 16 March 201414Department of Community Medicine, SIMS, Shimoga

14

Syphilis and other venereal diseasesSyphilis was rampant during the 16th century; lustseucheAssociation with wars and brothelsA serious epidemic; adventure for young menFrance and U.K. initiated the first prevention strategies; the Contagious Diseases Act, 1862Some control was gained by 1885


Typhus, typhoid, relapsing fever, yellow feverEpidemics arrived in the aftermath of Black DeathRelapsing fever and social catastrophesRudolph Virchow and Sebastian Neumann investigated typhus in Silesia, 1848Public response was comprehensive improvement of living conditionsSunday, 16 March 201416Department of Community Medicine, SIMS, Shimoga

6. The war against smallpox

Vaccination victoryEdward Jenner vaccinating James PhippsSunday, 16 March 201417Department of Community Medicine, SIMS, Shimoga

Smallpox Al-Razis naturalistic theory, 9th centuryIncreasing virulence in 15th to 18th century EuropeContagious disease of childhoodSurvivors were immuneState governments slow to respond Edward Jenner, 1798 vaccination with cowpoxCompulsory vaccination in U.K., 1853Sunday, 16 March 201418Department of Community Medicine, SIMS, Shimoga

The public health of communal life: medical policePolice actions taken at all levels of government Functions included:SanitationCaring for the desolateLabour rulesMarkets and commerceMarriage and midwiferyCattleMilitary, travel and prostitutionBurial of the deadDisaster and injury preventionForensicsBio-statistic recordsRegulation of medical practice


The medical police

Health promotion depublicizedThe responsible authoritiesConsumerism and technical advancementNuisances Removal Act, 1847Sunday, 16 March 201420Department of Community Medicine, SIMS, Shimoga

Public health as a means of betterment: public health of human potential

Goal reduce the preventable mortality and morbidity ratesFocus shifted towards analysing vital statistics

More efficient prevention strategies

The great sanitary campaign against urban filth


Phases of public healthPublic 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:Age of liberalism (1790 - 1880)Golden age of Public health (1880 - 1970)Return to liberalism (1970 onwards)Sunday, 16 March 201422Department of Community Medicine, SIMS, Shimoga

The age of liberalism: health in the name of the people - 1790 to 1880Age of the anti-slavery movement and rise of Methodism

Liberty develops a biosocial visionSir Edwin Chadwick laws of sanitationSunday, 16 March 201423Department of Community Medicine, SIMS, Shimoga

The golden age of public health: 1880 to 1970

State took up the responsibility of health of the peopleGerm Theory of Disease by Louis PasteurEffective treatment of infectious diseasesPublic health a distinct division of medicineSunday, 16 March 201424Department of Community Medicine, SIMS, Shimoga

Holocaust and EugenicsJews victimized by misinterpreted theoriesRise of nutritional and agricultural sciencesImproved methods of cure and prevention 3 new fears:The invisible germs that can transmit through the most casual contact (viruses)Mysterious genes (mutations)Deficiencies in food that doesnt improve with better consumption (trace nutrients)Health consciousness met new standardsImproved techniques of disinfection and sanitationDoctors opinion about critical issuesSunday, 16 March 201425Department of Community Medicine, SIMS, Shimoga

The return of liberalism: 1970 to presentMission statement of WHO: Health is the birth-right of all;States had to deliver that rightDeadly effects of good livingInternational coordination for healthSunday, 16 March 201426Department of Community Medicine, SIMS, Shimoga

Rise of public health in the developing countriesHistorical development of comprehensive public healthSunday, 16 March 201427Department of Community Medicine, SIMS, Shimoga

Development of public health in the developing countriesEarly public health

Empirical public healthColonial public healthFoundation of international public health

International health institution the WHODisease prevention and control campaignsSunday, 16 March 201428Department of Community Medicine, SIMS, Shimoga

Empirical public healthTeachings in the holy scriptures of the EastKautilyas treatisesEpidemics along Chinese trade routesSunday, 16 March 201429Department of Community Medicine, SIMS, Shimoga

Colonial public healthMassive intercontinental population shiftHealth establishments of the colonies:Indian Medical Service of the East India CompanyGold Coast Medical Department in GhanaMissionaries and their medical establishmentsCalcutta School of Tropical Medicine and HygieneAll-India Institute of Hygiene and Public Health, CalcuttaHaffkine Institute, BombayKing Institute of Preventive Medicine, MadrasCentral Vaccine Research Institute, KasauliNational Institute of Communicable Diseases, DelhiIndian Research Fund Association, DelhiNational Institute of Nutrition, Hyderabad


Calcutta school of tropical medicine and hygieneKolkata


All india institute of hygiene and public health

Kolkata Sunday, 16 March 201432Department of Community Medicine, SIMS, Shimoga

Haffkine institute (for biopharmaceutical sciences)

Mumbai


King institute of preventive medicineChennai


Central research instituteKasauli


National institute for communicable diseasesNew Delhi


National institute of nutrition

Hyderabad Sunday, 16 March 201437Department of Community Medicine, SIMS, Shimoga

Foundation of international public health18th century: European legislations to preventimportation of epidemics

First International Sanitary Conference,Paris, 1851: 12 countries

The Inter-governmental Conference of Far-Eastern Countrieson Rural Health, Bandung, 1937


OIHP, Paris (Pasteur Institute)

1923

League of Nations Health OrganizationInternational health officesSunday, 16 March 201439Department of Community Medicine, SIMS, Shimoga

world health organization: implementationPost-WWIIConference of the Brazilian and Chinese delegations of the UNConstitution of the WHO drafted, 22nd July 1946; came into force on 7th April 19487th April 1948: the day WHO officially came into beingConstitutional mandate: Attainment by all people of the highest possible level of healthSunday, 16 March 201440Department of Community Medicine, SIMS, Shimoga

Functions of w.h.o.Directing and coordinating international health work2.Providing advice and advocacy on international health development3.Adoption of international regulations4.Set international standards for biological and pharmaceutical agents, as well as other diagnostic procedures and products5.Adoption of international conventions and agreementsSunday, 16 March 201441Department of Community Medicine, SIMS, Shimoga

W.H.O.: Then and after194 member countries and territoriesWorked for over 65 years6 regional organizations and headquartersUNICEF and other health systems infrastructuresThe Beveridge model of national health and social welfare policySunday, 16 March 201442Department of Community Medicine, SIMS, Shimoga

W.H.O.: Then and afterTraining of different categories of health auxiliariesSecond conference on rural health, New Delhi, 1957, under the auspices of W.H.O. focus on MCHUnited Nations International Womens Decade: 1976-1985Global efforts at popularizing contraception


W.H.O.: Then and afterGreen Revolution of 1960s: fight against anaemia and IDDsVitamin A supplementation programmeInternational Conference on Nutrition, Rome, 1992: a W.H.O. F.A.O. coordination effortEnvironmental sanitation and safe drinking waterSunday, 16 March 201444Department of Community Medicine, SIMS, Shimoga

Disease prevention and control campaignsRockefeller FoundationSave the Children fund

Global disease control campaignsSunday, 16 March 201445Department of Community Medicine, SIMS, Shimoga

yawsArsenic and bismuth compounds pro-WWIIMass treatment campaigns using long-acting penicillinOnly a scattered foci persistedSunday, 16 March 201446Department of Community Medicine, SIMS, Shimoga

malariaInitial efforts with DDT a dramatic successResistance among the vectorsSunday, 16 March 201447Department of Community Medicine, SIMS, Shimoga

othersLeprosySyphilisCholera Sunday, 16 March 201448Department of Community Medicine, SIMS, Shimoga

Success story of public healthSMALLPOX


Ancient india and public healthSunday, 16 March 201450Department of Community Medicine, SIMS, Shimoga

The tradition of indian healthConceptualized on spiritualityAyurveda: the science of life


The tradition of indian healthEarliest protagonists of Indian medicine:Sage AtreyaCharakaSushrutaSage KashyapaBhela

Sanitation played a major role in the planning of cities like Harappa and Mohenjadaro. Sunday, 16 March 201452Department of Community Medicine, SIMS, Shimoga

Public health milestonesPersonalities and eventsSunday, 16 March 201453Department of Community Medicine, SIMS, Shimoga

Pioneers of public health

Sunday, 16 March 201454Edward Jenner (1749-1823)

A fascination that led to eradication of a pandemicDepartment of Community Medicine, SIMS, Shimoga

Sunday, 16 March 201455

Dr. John Snow (1813-1858)

A surgeons anesthesia apprentice who epidemiologized choleraDepartment of Community Medicine, SIMS, Shimoga


Dr. James Lind (1716-1794)

British naval doctor who discovered the treatment for scurvyDepartment of Community Medicine, SIMS, Shimoga


Robert Koch (1843 - 1910)

A microbiologist who discovered the agents of tuberculosis, leprosy, cholera, plague, sleeping sickness and tick feverDepartment of Community Medicine, SIMS, Shimoga


Dr. Joseph Lister (1827-1912)

A British surgeon who revolutionized antisepsisDepartment of Community Medicine, SIMS, Shimoga


Dr. John Simon (1816-1904)

British physician who pioneered public sanitationDepartment of Community Medicine, SIMS, Shimoga


Lemuel Shattuck (1793-1859)

American political analyst who emphasized on vital statisticsDepartment of Community Medicine, SIMS, Shimoga


Edwin Chadwick (1800-1890)

British Commissioner who legalized sanitation reformsDepartment of Community Medicine, SIMS, Shimoga


Sir Ronald Ross (1857 -1932)

A Garrison Surgeon posted at Bangalore who developed malaria prevention measures and introduced mathematical concepts to epidemiological studiesDepartment of Community Medicine, SIMS, Shimoga


Dr. William Farr (1807-1883)

British doctor who went on to become the Father of modern epidemiological surveillanceDepartment of Community Medicine, SIMS, Shimoga


Sir Joseph William Bhore (1878-1960)

Indian Civil Servant who conceptualized comprehensive primary health careDepartment of Community Medicine, SIMS, Shimoga


Dr. Sushila Nayyar (1914-2000)

Gandhian doctor who is aptly called as the founder of Indian Community MedicineDepartment of Community Medicine, SIMS, Shimoga


Dr. Alexander Duncan Langmuir(1910-1993)

Community physician who is known as the founder of 20th century epidemiology and public health surveillanceDepartment of Community Medicine, SIMS, Shimoga

5-point summary of what was spokenPublic health is health in the name of people, for and untoHealth is not rocket-science; best measures emerged from common senseResponsibility of individual health is with the individual, the countrys with the governmentAll religions are pro-health; scriptures spoke science, superstitions were a misinterpretationDeveloped and developing countries have separate issues to addressSunday, 16 March 201467Department of Community Medicine, SIMS, Shimoga

Glimpse at the way ahead . . . Universal access to affordable and effective health careA 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 Sunday, 16 March 201468Department of Community Medicine, SIMS, Shimoga

bibliographyOxford Textbook of Public Health. 4th edition

Textbook of Public Health and Community Medicine. Armed Forces Medical Services. 1st editionSunday, 16 March 201469Department of Community Medicine, SIMS, Shimoga

Thank you![Hygeia and Asclepius engraved in an arch over the Nyam door, Venice]

Sunday, 16 March 2014Department of Community Medicine, SIMS, Shimoga70

Rise of public health

Health & Medicine

Transcript of Rise of public health