Changing concepts Health and Public Health

Dr B Manoj Aravind

Health
Health is a state of complete physical, mental and social well-being and not merely absence of disease or infirmity - WHO (1948)

Public Health
Public health is the Science and Art of preventing disease, prolonging life, and promoting health and efficiency through organized community effort (C.E.A. Winslow, 1920)

Public Health
Public health is the Science and Art of preventing disease, prolonging life, and promoting health and efficiency through organized community effort (C.E.A. Winslow, 1920)

Public Health
Organized community effort for 1. Sanitation of the environment 2. Control of communicable disease 3. Education of the individuals in personal hygiene 4. Organization of medical and nursing services for early diagnosis and preventive treatment of disease 5. Development of the social machinery to insure everyone a standard of living adequate for maintenance of health
(C.E.A. Winslow, 1920)

History

Primitive medicine
ADAM and EVE Supernatural Theory of Disease
Wrath of Gods Invasion by evil spirits Stars and Planets

Healing by rituals, magic, witchcraft Traditional Healers still prevalent

Medicine of Ancient Civilizations

Indian Chinese Egyptian Mesopotamian Greek Roman

Indian Medicine
Ayurveda and Siddha Tridosha theory of disease
Disease is dysequilibrium

Manusmrithi code of personal hygiene Indus valley civilization (3300 1700 BC) advanced engineering systems for urban sanitation and water supply

Chinese Medicine
Two principles yang and yin Balance of the two opposing forces meant good health Early pioneers of immunization (variolation to prevent smallpox) Bare-foot doctors

Egyptian Medicine
Imhotep (2600 BC) description of diagnosis and treatment of over 200 diseases Prevalent specializations Eye, head and tooth Disease due to absorption from the intestines of harmful substances which gave rise to putrefaction of blood and formation of pus Planned cities, public baths and underground drains Innoculation against smallpox, value of mosquito nets, association of plague with rats

Mesopotamian Medicine
Religious concepts, magic, necromancy, geomancy, interpretation of dreams, medical astrology Herb doctors, knife doctors and spell doctors

Babylonian code of Hammurabi first codification of medical practice

Greek Medicine
Theory of four humors Legend of Aesculapius and his two daughters Father of Medicine Hippocrates an epidemiologist and master of medical art
Challenged the tradition of magic in medicine Radically new approach in medicine by application of clinical methods Airs, Water and Places Man and environment

Hippocratic Oath keystone of medical ethics

Roman Medicine
State was supreme Public Health was more robust fine roads, aqueducts bringing pure water to cities, drained marshes to combat Malaria, built sewerage systems, hospitals for sick Galen (130 -205 AD)
Predisposing, exciting and environmental factors Preserving health more important than cure

Dark Ages of Medicine 500 1500 AD

Fall of Roman Empire Europe fell into darkness ravaged by disease and pestilence Rise of Arabic medicine The Arabs lit a brilliant torch from the Greecian lamps Sir William Osler Abu Becr (aka Rhazes) 865 925 AD Sina (aka Avicenna) 980 1037 AD Pharmacology - in search of Elixir of life

Dawn of Scientific Medicine

Early revival Renaissance Sanitary awakening Rise of Public health Germ theory of disease Birth of preventive medicine Era of Modern Medicine

Early revival - Rennaisance (1453 1600 AD)

Paracelsus (1493 1541)

Publicly burnt works of Galen and Avicenna Attacked superstition and dogma Turned medicine towards rational research

Fracastorius (1483 1553)

Theory of Contagion Invisible particles spread infection causing epidemics Syphilis is sexually transmitted Founder of Epidemiology

Early revival - Rennaisance (1453 1600 AD)

Andreas Vesalius Science of Anatomy

Ambroise Pare
Father of Surgery
specially the art

th 17

and

th 18

Centuries

Period of exciting discoveries William Harvey Leeuwenhoek Edward Jenner Morgagni John Hunter Thomas Sydenham

Sanitary Awakening
Industrial revolution and its problems Great Cholera Epidemic of 1832 Edwin Chadwick s (1800-1890) Report
The Sanitary Conditions of the Labouring Population in Great Britain Recommended improved housing and working conditions

Great sanitary awakening : anti-filth crusade Enactment of the Public Health Act of 1848 State is responsible for the health of its people Birth of Public health concept

Rise of Public Health

Cholera - Father of Public Health John Snow (Cholera 1848 54) William Budd (Typhoid 1856) Clean drinking water: Felt need Demand

Rise of Public Health

Sir John Simon The State of Public Health in England Sanitary Act, 1866 Result: Comprehensive legislation - the Public Health Act of 1875

Disease Control Phase of Public Health (1880 1920)

Sanitary legislation and reforms aimed at control of man s physical environment General Cleanliness and clean water Garbage and refuse disposal Quarantine Great achievement in improving people s health without targeting any specific disease Broad foundations of public health laid
Clean Water Clean surroundings Improved housing Control of offensive trades

Supernatural Theory Theory of Humors Miasmatic Theory & Theory of Contagion Theory of Spontaneous generation

Germ Theory of Disease

Germ theory of disease

Louis Pasteur proposed in 1873 Robert Koch 4 postulates for explaining causation Golden age of bacteriology Simultaneous discoveries in immunology Birth of Preventive medicine

Preventive Medicine
Distinct from Public Health when developed Disease prevention by specific measures James Lind and Edward Jenner Early phase Discoveries in Bacteriology, Immunology, Parasitology, disease transmission & antibiotics Investigations for early detection of disease furthered the advances

Health Promotional Phase (1920-1960)

Concept of Health Promotion of individuals State s direct responsibility for the health of the individual
Provision of Basic health services Community Development programme

Personal Health services mother and child health, school health, industrial health Public health nursing

Modern Medicine
Curative Medicine Preventive Medicine Social Medicine Family Medicine Community Medicine

Social Engineering Phase (1960-1980)

Epidemiological transition Diseases of the civilization and the concept of risk factors Social and behavioural aspects of disease prioritized Goals of preventive medicine and public health became identical Emergence of community health population health

Health for All Phase (1981-2000)

Health inequalities Health & Developing World John Bryant Health for all by 2000: attainment of a level of health that will permit all peoples to lead a socially and economically productive life. WHO (1981) Primary Health Care approach

Now Towards MDGs (2000-2015)

September 2000 UN Millienium Declaration Road Map till 2015: goals and targets Health is one of the seven social areas targeted 3/8 Goals, 8 /18 targets, 18/48 indicators of progress are health related

Thank you