Session 3 - The History & Development of PH

7/30/2019 Session 3 - The History & Development of PH

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The History & Developmentof Public Health

Dept. of Public Health & Preventive Medicine

Padjadjaran University Medical School


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INTRODUCTION

Historical reviews: provide valuable insightsthat can contribute to the solution of present &future health problems

Barton (1979):development the healthsciences over 5 major area.

- empirical health

- basic science- clinical science

- public health science

- political science


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Institute of Medicine (IOM), 1988:

Growing demand for Public Health, as:

a profession

a governmental activity

a commitment to society

The goals of PH (in broad terms):

To identify problems that affect entirecommunities or populations

To marshal support to address these problems

To ensure that the solutions are implemented


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Detels & Breslow (1997):

Public Health: the process of mobilizing local,state, national & international resources toensure the conditions in which people can behealthy

Historically, public health efforts meant healthdevelopment to be undertaken by thegovernment as a public sector activity

Public health cover promotive, preventive,

curative, & rehabilitative health measuresLater, the connotation of the term public was

widened to encompass the involvement ofpeople together with the government in health

development efforts


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EARLY PUBLIC HEALTH

EMPIRICAL PUBLIC HEALTH

The concept of disease had been postulatedwithin the limited scientific knowledgeavailable

Traditional medicine focused on management ofillnesses at the individual rather than the publiclevel. However, the spread of diseases due tocontact amongst people or due to hereditary

transmission was recognized centuries ago.

Quarantine & prohibition were major measuresused historically to protect the transmission ofdiseases


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EMPIRICAL PUBLIC HEALTH (contd)

Among figures:

Sir Jeremy Bentham

Thomas Southwood Smith

Edwin Chadwick

Sir John Simon

John Snow

William Farr

Max von Pettenkoffer

Question:

What are health-related concepts hold or discoveries

during this empirical public health era?


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Colonial public health

Trading around the world during the 18

th

& 19

th

centuries for the exploration & exploitation ofnatural resources led to the discovery of newterritories in different parts of the world

The colonials established their ownadministrative, legal, & medical care systemswith varying degrees of autonomy & authority

To protect the health of their own people & the

workers, colonial rulers established laws similarto those in their home countries, e.g. the PublicHealth Acts, Local Government Act, CivilRegistration Act, Factory Acts, Food

Adulteration Act, Vaccination Act, & ContagiousDiseases Acts


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Colonial public health (contd)

European & American religious missionaries also embarked onexpeditions around the world along with the colonial powers.Many of them established medical care institutions, as well asgeneral educational systems including nursing & medical schools.

However, the actual development of public health & medical care

services for the general public remained rudimentary Moving millions of people to totally unfamiliar areas had led to a

high incidence of death & disability

died due to: smallpox, malaria, yellow fever, typhus, typhoid

disabled due to: yaws, leprosy, & syphilis

The development of in the areas of physics, microbiology,biochemistry, pharmacology & other diagnostics led to anexplosion of its application in public health practices


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Foundation of international public health

Intl public health efforts intensified in the early 18th century when

European nations applied protective legislative measures toprevent importation of epidemic diseases by trading ships

The First Intl Sanitary Conference (1851): the first attempt to reacha consensus on drafting intl quarantine regulations. For the next50 years, a series of similar intl sanitary conference were held

but failed to produce an intl sanitary code

partly due to:

- the non-availability of a sound scientific basis for theprevention & control of epidemics

- the vested political & commercial interests of each colonialpower

The 11thIntl Sanitary Conference (1903): the first sanitaryconvention for the prevention & control of three epidemics:

plague, cholera, & yellow fever


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Foundation of international public health(contd)

Based on the convention, L Office International d Hygiene Publique(OIHP)was established in 1907 as the first intl health office

objective:

- to protect Europe against three notifiable diseases (at the

beginning)

- to monitor & report the outbreaks of the three notifiablediseases

- to provide general public health information on measures

taken to combat these diseases through monthly bulletin

In Bandoeng (1937) Conference of far eastern countries on Ruralhygiene.


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Around the time of the establishment of the League of Nations:

- major epidemics were rampant in various parts of the world

- some infectious diseases, e.g. cholera & plague, were

threatening to become pandemics

The League had to cope with many other postwar rehabilitation problems& the Paris-based OIHP was unable to deal with such pandemicseven with its originally assigned tasks

Based on the proposal of the Brazilian delegation, the League of Nationsagreed, in 1920, to the establishment of an intl health organizations

The League of Nations Health Organizations was formed in 1923,originally assigned to handle intl health matters relating to bothtechnical assistance & clearing-house functions


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The League of Nations Health Organizations organized the intl healthconferences in the early 1930s, provided a forum for sharingexperiences on public health development in the countries undercolonial rule

The Intergovernmental Conference of Far-Eastern Countries on RuralHygiene held in 1937 in Bandung, West Java, Indonesia

Studied the public health interventions of the participating countries,defined the central role of health in development, & emphasized theneed for integrating health care & intersectoral action

However, the onset of the devastating Second World War delayed

effective follow-up of the Bandung Conference principles

After the 2nd world war, the WHO Constitution was approved on 22 July1946, initiating the establishment of the Organization as a specializedagency of the United Nations


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The WHO constitutional mandate:Attainment by all people of the highest possible level of health

The WHOs main functional roles:

Directing & coordinating intl health work & providing advice &advocacy on intl health development

The WHOs authority:

- To adopt intl regulations

- To set intl standards for biological & pharmaceutical agents, aswell as other diagnostic procedures & products

- To adopt intl conventions & agreements


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SCIENCE-ORIENTED

PUBLIC HEALTH The age of opportunity that saw remarkable

scientific & technological advancements which

opened up limitless vistas & unlimitedpossibilities for solving the age-old problems ofpoverty & disease

Inventions & innovations:

quinine, DDT, penicillin, sulphonamide,vaccines, birth-control pills & injectables,imaging diagnostic technologies


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After the 2nd world war, developing countriesstarted to building up health systems

infrastructures based on a network of hospitals& health centers

During the early 1950s most countries adoptedthe Beveridge model of national health & social

welfare policy & they initiated free healthservices for all

Training of different categories of healthauxiliaries, e.g. health assistants, medical

assistants, health visitors, nurses, midwives,vaccinators, sanitary workers, communityworkers, laboratory technicians, pharmacists,was initiated by the establishment ofparamedical training institutes


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Intl rural health conference in New Delhi (1937):

The concepts & functioning of rural health services

The training & use of multipurpose village workers

The enhancement of prevention & control of epidemic &

endemic diseases

The utilization of local resources & promoting

intersectoral action,

The participation of local people, incl. formation of

village health committees

The rural health centers as the basic units where

comprehensive health care could be provided to the

rural population was recognized


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Science-oriented PH.Cont

1960most countries started population

policy/ family planning.

1960s Green revolution started

1970 WHO survey :Only 29% of rural and

50% of urban population have access toa save drinking water.


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Science oriented PH..cont

Disease prevention and control campaign

- yaws-start 1948 ;mass treatment withlong acting penicillin.

-malaria-->start with DDT in 1950s.

Result dramatic ;after that facedproblem of resistence of mosquito toDDT and parasite to drug.


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Disease preventioncont

-Leprosy in 1943 discovered Diamino-diphenyl

sulphon(DDS)-global leprosy

control program

- Sexual transmitted disease: 1948 in Europe.

1992 who used long acting penicillin.

- Cholera: eltor appear in Indonesia in 1961.


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Public health sucesses

Smallpox eradication

Session 3 - The History & Development of PH

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