DR.

Syeda Khaleda Ferdousi

Assistant Professor Department of
Community Medicine DMC
 Rise of Public Health
The industrial revolution of the 18th century
sparked off numerous problems

Creation of slums, over crowding with all its ill effects,

- Accumulation of filth in the cities and towns, high sick

ness and death rates especially among women and
children.

- Infectious diseases like tuberculosis, Industrial and

social problems, which deteriorated the health of the
people to lower ebb.

 Contd
- Frequent vegetation of cholera compounded the
misery of the people

- The great cholera epidemic of 1832 led Edwin

Chadwick (1800-1890), a lawyer in ENGLAND to
investigate the health of inhabitants of the large
towns with a view to improve the condition
under which they lived.
 Chadwicks report on The sanitary Conditions
of the Labouring Population in Great Britain a
land mark in the history of public health

Chadwicks report focussed the attention of

the people and government on urgent need to
improve public health.

The great sanitary awakening led to the

enactment of the Public Health Act of 1848in
England.
Contd

The early history of public health in India

of which Bangladesh was once a part.

India has one of the most ancient

civilizations in recorded history.
Contd

Thousands of years before the

Christian era, there existed practices
of environmental sanitation, by
ancient people as far back as 3000
B.C

Contd

Before the advent of British in Indian

subcontinent, the Ayurvedic system
of medicine in most areas and Unani-
Tibbi system in some cities and towns
were the means for catering the
medical and health needs of the vast
multitude in all regions of the
subcontinent.
Contd

The existence of public health

services in the past and its history is
not well documented, recording of
which began with the arrival of east
India Company in India for trade.
History of public health in Bangladesh
may be described in three phases.
Public health in British
India:
The British established their rule in
India in 1757 and initiated
organization of civil and military
services.
In England the state of public health
was far from satisfactory till the
middle of nineteenth century.
Contd

Edwin Chadwick (1842), Lord Simon

(1858) and many other social
scientist was the pioneer to develop
public health in England the urgency
of which were felt to reduce high
morbidity and mortality due to
epidemic of cholera, typhus, plague
and small pox.
Contd

The health services initiated by the

East India company were specially
meant for the protection of the health
for the military personnel and
European civilian.

The real development in public health

administration began 1n 1859.
Contd
On the back drop of the extremely
unsatisfactory condition of health and high
mortality among British troops Royal commission
was appointed in 1859 to inquire in to the cause
thereof.
The commission suggested the establishment of
commission of Public health in each presidency
and recommended protection of water a
civilization in the Indus Valley, known as the
Indus valley Civilization.
Contd

Excavation in the Indus valley ( e.g.

Mohenjodaro and Harappa), showed relics
of planned cities with drainage, houses
and public baths built of backed bricks
suggesting the supplies, construction of
drains and prevention of epidemics as the
measures of safe guard the health of
British Army .
Contd

. During the next eighty five years there

were slow but often significant progress in
public health services.
An important land mark in the
developmental history of public health was
development of health circle scheme
in1927 as proposed by chittaranjan Das in
Bengal.
Contd
Under this scheme the post of Health officers for the
district and sanitary inspector for each police station
(Thana) were created.

Socio political unrest and military involvement engulfed

the subcontinent for long eight years (1929-1947) and
witnessed the Second the World War, the great Bengal
famine of 1943, quit India movement, Pakistan
movement and some such upheavals, resulting in almost
a total break down of public health administration
Bore Committee:

The government of British India

having felt the need to improve the
health service of the country,
appointed in 1943, a commission
which was designated as health
survey and development committee
headed by Sir Joseph Bhore.
Important recommendations of the
Bhore Committee were
Contd
1). Integration of preventive and curative
services at all levels
2). Development of primary health centres in
two stages
a). A short -term measure for the establishment
of one primary health centre in the rural areas
to cover 40,000 population with a secondary
health centre to serve as a supervisory,
coordinating and referral institution
Contd

b) A long term programme of setting

up primary health centre unites with
75-bedded hospitals for each 10,000
to 20,000 population and secondary
unites,
Contd
3).Major changes in medical education which
includes 3months training in preventive and
social medicine.

Before implementation of the recommendations

of the Bhore committee the subcontinent was
partitioned with the emergence of India and
Pakistan as independent countries in August
1947.
Contd

However, the Bhore committee report

continues to be an important document
for national health development.
Contd
A chorological citation of the events in
the in the history of public health in
India during British rule is given below:

1859- Appointment of a Royal

commission to enquire into the cause of
illness and ill health in British Army
stationed in India.
Contd

1864- Appointment of Sanitary

commissioners in three presidencies
Bengal, Madras and Bombay. The Civil
Surgeons of all districts became ex-
officio District Health Officers of their
respective districts.
Contd

1869- Appointment of public Health

Commissioners and a Statistical officer
With the Government of India.

1873- Promulgation of Birth and Death

registration Act by Government of
India.
cond

1880- Promulgation of the Vaccination

Act.
1881- Promulgation of the first Indian
factory Act.
1888- Central Governments decision to
place the responsibilities of looking after
sanitation on the local bodies.
Contd

1896- Occurrence of a severe epidemic

of plague and appointment of a Plague
Commission.
1897- Promulgation of epidemic disease
Act.
1904- Recommendation of plague
commission.
1909- Establishment of Central Malaria
Bureau.
Cond

1911- Establishment of Indian Research

fund Association.
1930- Establishment of all India institute
of Hygiene and public health, Calcutta.
Child Marriage Restraint Act. (Sarda Act)
passed fixing the minimum age of
marriage at 14 for girls and 18 for boys.
Contd

1940- The Drug Act was passed.

1943- Appointment of the Health Survey
and Development committee (Bhor
committee)
1946- Submission of Bhore committees
Report
Public health in Pakistan era

The first all Pakistan Conference, held in

1947 at Lahore, adopted the bore
Committee Report and its
recommendations as the basis of planning
and development of health administration
in Pakistan
Cond

In 1947, with the exception of

international health, quarantine,
health legislation and research health
administration of Pakistan was
decentralized with maximum
authority given to the provincial
government.
Cond

The second the all Pakistan medical

conference, held in Dhaka in 1951,
approved a six year health plane which
envisaged increase of beds in existing
hospitals, increased number of rural
dispensaries, conversion of medical school
into colleges setting up new medical
colleges,
Contd

Establishment of institute of Hygiene

and Preventive medicine, Medical
research institute and drug testing
laboratories at both wings
amalgamation of curative and medical
services and organization of anti-
malarial operations.
Contd

Government of East Pakistan through

a Five-year development plan
initiated action for the improvement
of the health administration.
Contd

An ambitious scheme was prepared

for establishing Rural Health Centre
(RHC) with three Sub centre in each
Thana on the basis of report of
Bhore Committee.
Contd

Besides the RHC scheme, several

vertical projects Malaria eradication,
family planning, Smallpox control,
BCG vaccination campaign etc were
also launched in the East Pakistan
Contd

Along with the government health

services, District Board used to provide
health services by appointing District
Health Officers (DHO) whose activities
were limited to preventive medicine. e.g.
Control of epidemics, mass vaccination,
checking of food adulteration. DHO
function through Thana Sanitary
Inspector.
Contd

There was little co-operation between

curative health services headed by
Surgeon General and preventive
health services headed by Director of
Public Health and as well as between
government and non - government
Health Authority.
Contd

During the Pakistani Era, East Bengal,

latter on renamed East Pakistan, did not
receive equitable share of central
allocation and support for the
development of its health manpower and
health service
Contd

Four new medical colleges including

one exclusively for women
functioning in West Pakistan by 1952.
The first new medical college started
functioning at chittagong in its
Easretn wings in 1957.
Cont

The only institute of Hygiene and

Preventive Medicine was established in
Lahore .
More over in the developmental activities
the traditional stress on the curative
medicine continued and public health
activities for prevention of disease and
promotion of health did not receive the
desired attention .
Contd

In fifties creation of job opportunities

in Eastern wing was neglected.

While doctors in West Pakistan were

favoured with scholarships for higher
studies and absorbed in Arm Forces
Medical services in good number.
Contd

East Pakistani doctors were

conscripted under the General
Practitioners (National Service) Act
1950 and allocated to West Pakistan
provinces for serving in remort
underdeveloped parts.
Contd

The gross disparity in the development of

health services, like that in other spheres,
was not an insignificant reason for
developing a sense of deprivation among
the people which resulted in the birth of
Bangladesh as an independent sovereign.:
Contd

A chronological history of events in the

field of public health taking place during
Pakistani Era is given below:
Contd

1947- Partition of India and emergence

of Pakistan as an independent
country with four provinces in its
western wings and East Bengal as the
sole province in the eastern wing.
Contd

1947- Holding of First All Pakistan Health

conference at Lahore, which adopted the
recommendations of Bhore committee as
the basis of health development in
Pakistan.
Contd

1948- Setting up of the Medical Council of

Pakistan under the Medical council Act
with dual function of maintaining a
uniform standard of medical education in
the country and liaison with medical
councils of foreign countries on the issue
of mutual reciprocity in the matter of
recognition of medical degrees
Contd

1949- Anti-malaria Pilot Project in East

Bengal started by WHO Malaria Control
and demonstration team
1950- Port Health authority started
functioning at Chittagong port.
Contd

1951- Four new medical colleges

including one for women were
established in western wing.
1957- One new Medical college started
functioning at Chittagong.
 Contd

1960-70 150 Rural Health Centers were

established. Each having 6maternity
beds and 3 sub centers. Three vertical
projects namely Malaria Eradication,
Family planning and small pox
Eradication programmed was launched
Public Health in Post-
independence Bangladesh
On attainment of independence, the
Government of Bangladesh initiated
activities in the field of public health with
right earnest.

Particular stress was given on organizing

primary health care, maternal and child
health and family planning activities.
Contd

The issue of development of health man

power was given due to importance and
gradually several institutes namely
Contd
institute of Postgraduate medicine,
National Institute of Ophthalmology,
Institute Of Disease of Chest and Hospital,
Rehabilitation Institute and Hospital for
Disable, Institute of mental Health,
Bangladesh institute of Research and
Rehabilitation in Diabetes, Endocrine and
Metabolic Disorder and National institute
of Preventive and Social Medicine were
built and reorganized to run post
graduate courses in all most all disciplines
of curative and preventive Medicine
Contd

. PHC philosophy has been accepted by

the Government of Bangladesh and all Its
public health activities and efforts are now
aimed to realizing the goal of HFA.
Chronological mention of certain
development is made here under.
Contd
1972- Introduction of Thana Health
Complex Scheme(THC) upgrading
the rural health centre (RHC)

1972-Establishment of National Health

Library and Documentation
centre.
1972- Establishment of Bangladesh
Medical and Research Council .
Contd

Upgrading of Dhaka Medical School

and Milford Hospital into Sir
Solimullah Medical College and
Medford hospital.
Contd
1972- Establishment of Bangladesh
College of Physician and
Surgeon (attended in 1972 and
1976) for the post Graduate
medical education (FCPS,MCPS)in all
specialties

1973- Promulgation of medical council Act.

Contd
1974- Establishment of Instituted of Public
Health Nutrition, Dietetic, and Food
Science.
1975- Amendment of the Pharmacy Act 1957.
Promulgation of Children Act.
1976- Promulgation of Blind Relief (Donation
of Eye) Act.
1975 Establishment of National Nutrition
Council (NNC)
Contd
1975- Order of Bangladesh Red Cross Society
passed, amend 1975.
1976- Establishment of Institute of
Epidemiology, Disease Control and
Research(IEDCR)
1977- Thana Health complex Scheme with 31
beds each and 4 or 5 Sub-centers
approved.
1977- Modification and recognition of under
graduate teaching in Hygiene and
preventive Medicine. Department of
Community Medicine strengthened.
Contd
1977- Promulgation of Environmental Pollution
Control Ordinance.
1977- Creation of the Directorate of Nursing
Service s(DNS) by order of
President.
1978- Bangladesh becomes a signatory to
Alma Ata Declaration following
endorsement of World Health
Organization resolution on HFA
2000.
1978 - Establishment of National institute of
Opthalmology.
 contd
1978- Commencement of formal academic programmed
of NIPSOM with two courses: Diploma in Public Health
(DPH), Diploma in Community Medicine (DCM).

1979 - Establishment of National institute of

Cardiovascular diseases

1979 - Launcing of Expanded Programme of

Immunization (EPI).

1980 - The post of Director of Health Services upgraded

to Director General of Health Services (DGHS).
 1981- Palli-chikitsak Scheme introduced but
subsequently abandoned after a few years.
1981- In troduction of PHC pilot project in six
Upozilla Health complexes.
1982- Private Clinic and Laboratory Ordinances
adopter by GOB
1983- Promulgation of Drug Control Ordinance.
Contd

1986- Foundation of the Cancer Institute

and Research Hospital
1990- Narcotics Control Act
promulgated.
1998 - Establishment of Bangabandhu
Sheikh Mujib Medical University.
 Community medicine is a new comer

It is the successor of what was previously known

as public health, community health,
preventive and social medicine.

All these share common ground i.e. prevention

of disease and promotion of health.
 Contd

It has emerged as a new science, with a

new outlook, new approach, and a new
method of delivery of health care system
to the people or the community at large.
 Contd
Community medicine is a stage in the
evolution of medicine as that branch
of medical practice which is
concerned with promotion of health
of human communities
 Contd

It thus differs from clinical specialties

where primary concern is the health
of the individual. In which led to
further broadening of the out look of
public heath.
 The emergence of community
medicine is the result of
dissatisfaction both within the health
profession and the public at large

Because of the fact the modern scientific

medicine could not be translated into
community oriented patient practice.
Public Health:

The science and arts of preventing disease,

prolonging life and promoting health and
efficiency through organised community efforts
for the sanitation of the environment,control of
communicable infection, the education of the
individual in personal Hygiene the organization
of medical and nursing services for early
diagnosis and preventive treatment of disease
and the development of machinery to ensure for
. So organising