The History of Public Health

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The History ofPublic Health

• Kristine M. Gebbie, DrPH, RN
• Columbia University School of Nursing
• Center for Health Policy
• 630 West 168th Street, Mail Box 6
• New York, NY 10032
• [phone]
• kmg24_at_columbia.edu

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Developed as part of an Enhanced AHEC Community
Partnership for Health Professions Workforce and
Educational Reform project funded by the Health
Resource and Service Administration (HRSA)
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OBJECTIVES

• Describe mission, responsibilities and core
  functions of public health systems
• Identify essential services
• Identify important historical figures

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Definition of Health

• The state of complete physical, mental and social
  well-being and not merely the absence of disease
  or infirmity WHO, 1947

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Definition of Public Health

• Activities that society undertakes to assure the
  conditions in which people can be healthy,
  including organized community efforts to prevent,
  identify and counter threats to the health of the
  public.

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Public Health System Activities

• Health promotion
• Disease prevention

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Prevention Triangles
Tertiary Medical Care
Tertiary Prevention
Secondary Medical Care
Secondary Prevention
Primary Medical Care
Clinical Preventive Services
Primary Prevention
Population Oriented Prevention
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Ethical Valuesof Public Health

• Beneficence
• Non-malfeasance
• Autonomy
• Social justice
• Truth-telling

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Balancing Ethical Conflicts

• Public health practice is always struggling to
  find the correct balance between respect for
  individual autonomy and decision-making and the
  need for limitations on individuals in order to
  achieve social justice.

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Key Eventsin theHistory of Public Health
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Key EventsDid you know that . . .

• South Carolina had the first provincial health
  officer in America, in 1712?
• South Carolina had its first water protection
  regulations in 1671?

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Key EventsSnow and Cholera

• Epidemiology mapping cases of cholera and
  household use of water sources revealed pattern
  involving a single water pump
• Removing the handle from the Broad Street pump
  ended the epidemic

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Death Rates From Cholera 1853-54
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Did you know that . . .

• In an 1881 report the SC Board of Health
  identified swamp drainage as an important tool in
  stopping malaria, 10 years before the mosquito
  was identified as the specific vector of the
  disease?

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Massachusetts and the Shattuck Report

• Massachusetts and the Shattuck Report
• 1850 review of sanitation practices and the
  potential for improving health status by
  enforcement of a sanitary code led to creation of
  local board of health in Massachusetts. This
  movement spread to other localities.
• SC State Board of Health
• Established in 1898.

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US Public Health Service

• Marine Hospital Service
• Created from concern for protection against
  imported infectious diseases and need to care for
  sick seamen
• US Public Health Service
• Uniformed service on call for local, national or
  international service in the protection of the
  publics health

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The Muckrakersand New Agencies

• Food and Drug Administration created to
  administer Pure Food, Drug and Cosmetic Act
• Superfund administered by the Environmental
  Protection Agency
• U.S. Department of Agriculture
• Occupational Safety Health Act

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Great Public Health Achievements of This Century

• Vaccination
• Motor vehicle safety
• Safer workplaces
• Control of infectious diseases
• Decline in deaths from coronary heart disease and
  stroke

• Safer, healthier food
• Healthier mothers and babies
• Family planning
• Flouridation of drinking water
• Recognition of tobacco as a hazard

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Discussion Time

• What has been your personal awareness of public
  health?
• Have you ever visited a public health program?
  Used a public health service?
• What are current public health issues in your
  community?

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Summary

• Public Health
• Services were developed to address the health
  needs of communities.
• Has developed a world view of health.
• Focuses on populations rather than individuals.