Public Health Lecture

Public Health

Interdisciplinary science and art of disease, disability, injury prevention and control in the human
population. -Holmes 2009

It refers to the health status of a defined group of people and the governmental actions and
conditions to promote, protect, and preserve their health. - McKenzie, Ringer, Kotecki 2002

Public Health
Is the science and art of 1) preventing disease, 2) prolonging life, and 3) promoting health and
efficiency through organized community effort for:
A. The sanitation of the environment
B. The control of communicable infections
C. The education of the individual in personal hygiene
D. The organization of health services for the early diagnosis and preventive treatment of disease
E. The development of social machinery to ensure everyone a standard of living adequate for the
maintenance of health,
So organizing these benefits as to enable every citizen to enjoy his birth right of health and longevity.
- Institute of Medicine, 1988

Public health is what we, as a society, do collectively ensure that people can be healthy.

Public Health vs. Medicine

Public Health Medicine
It is concerned with the community or population It is concerned with individual patients.
It focuses on preventing illness, disabilities, and It focuses on the treatment of individual patients.
injuries.

Standards for Public Health Services

Vision Healthy People in Healthy Communities
Mission Promote health and prevent disease
Goals  Prevent epidemics and spread of diseases
 Protect against environmental hazards
 Prevent injuries
 Promote and encourage healthy behaviours
 Respond to disasters and assist
communities in recovery
 Assure the quality and accessibility of health
services

Essential Public Health Services

1. Monitoring and identifying community health needs.
2. Informing, educating, and empowering people about health issues.
3. Diagnosing and investigating health problems and health hazards in the community.
4. Mobilizing community partnerships to identify and solve health problems.
5. Enforcing laws and regulations that protect and ensure safety.
6. Linking people with needed personal health services and ensure the provision of health care.
7. Ensuring a competent public health and personal health care workforce.
8. Evaluating the effectiveness, accessibility and quality of health services.
9. Researching new insights and innovative solutions to health problems.

Principles of the Ethical Practice of Public Health

1. Public health should address principally the fundamental causes of disease and requirements for
health, aiming to prevent adverse health outcomes.
2. Public health should achieve community health in a way that respects the rights if individuals in the
community.
3. Public health policies, programs, and priorities should be developed and evaluated through
processes that ensure an opportunity for input from community members.
4. Public health should advocate and work for the empowerment of disenfranchised community
members, aiming to ensure that the basic resources and conditions necessary for health are
accessible to ALL.
5. Public health should seek the information needed to implement effective policies and programs
that protect and promote health.
6. Public health institutions should provide communities with the information they have that is
needed for decisions on policies or programs and should obtain the community’s consent for their
implementation.
7. Public health institutions should act in a timely manner on the information they have within the
resources and mandate given to them by the public
8. Public health programs and policies should incorporate a variety of approaches that anticipate and
respect diverse values, beliefs and cultures in the community.
9. Public health programs and policies should be implemented in a manner that most enhances the
physical and social environment.
10. Public Health institutions should protect the confidentiality of information that can bring harm to
an individual or community if made public.
11. Public health institutions should ensure the professionals competence of their employees
12. Public health and their employees should engage in collaborations and affiliations in ways that
build the public’s trust and the institution’s effectiveness.

Key Assumptions
1. Humans have a right to the resources necessary for health.
2. Humans are inherently social and independent.
3. The effectiveness of institutions depends heavily on the public’s trust.
4. Collaboration is the element to public health.
5. People and their physical environment are interdependent.
6. Each person in a community should have an opportunity to contribute.

Bases For Action

1. Knowledge is important and powerful.
2. Science is the basis for much of our public health knowledge.
3. People are responsible to act on the basis of what they know.
4. Action is not based on information alone.

History of Public Health

The Ancient World

 Diseases were more common than health longevity.
 Empirical and religious traditions were mixed.
 Medical Practice was based on belief in the supernatural.

Chinese
 had latrines and sewers and used protective measures for drinking water and destruction of rats
and rabid animals.
 Medical care emphasized diet, herbal medicine, hygiene, and massage and acupuncture.

Indians
 Cities were planned with building codes, street paving and covered sewers.
 Indian medicine originated in herbalism associated with mythical gods.
 Used drugs and surgery and established schools and public hospitals as a part of state medicine.

Egyptians
 Widespread parasitic disease
 Drainage and hygiene was highly emphasized.
 Developed surgical skills and organization of medical care. 4

Hebrews
 Mosaic Law stressed the prevention of disease through regulation of personal and community
hygiene, reproductive and maternal health, isolation lepers and family and personal conduct as
part of religious practice.
 Mandatory rest day, protection of water supplies, sanitation of communities, waste disposal,
and food protection.

Greeks
 Much emphasis on the prevention of disease as on the treatment of those diseases
 The rile of the physician began to take a more defined shape
 Scientific view of medicine emerged
 Preservation of health was seen as a balance of forces: exercise and rest, nutrition and excretion
etc.
*Hippocrates

Romans
 Extremely skilled in engineering of water supply, sewage and drainage systems, public baths,
latrines, town planning, sanitation and medical care
 Aqueducts
 Marshlands were drained to reduce malarial threat
 Dissected living humans to further their knowledge in anatomy.

The Early Medieval Period

 Lack of fresh water and sewage removal was the major problem
 Pagan and Christian beliefs were integrated
 Possession by the devil and with craft were accepted as causes of disease
 Prayer, penitence and exorcism were considered as treatment
 Living in filth was evidence of sanctity
 Most newborns die before five
 Bubonic plague

The Early Medieval Period Outside Church Domination

 Muslim medicine flourished
 Piped water supplies in Cairo
 Cordova Medical Academy
 Beginnings of western medicine in anatomy, physiology and descriptive clinical medicine.

The Late Medieval Period

 Monastery hospitals were established to provide charity and ease the suffering of the sick and
dying.
 Most physicians were monks
 Leprosy became widespread disease.
 Growth exacerbated public health problems
 Crowding
 Poor Nutrition
 Sanitation
 Lack of adequate water sources and drainage
 Unpaved streets
 Keeping animals in town
 Lack of organized waste disposal
The Renaissanse
 Trade and exploration spread epidemics across Europe
 Careful accounting of disease outbreaks revealed that diseases killed saints and sinners alike.
 More critical observations of the sick led to more accurate descriptions of symptoms and
outcomes of diseases.
 Control Measures
- Examination and registration of prostitutes
- Closure of communal bath houses
- Isolation in special hospitals
- Reporting of Disease
- Expulsion of sick prostitutes.
 Antonie Van Leewenhoek - discovered the microscope

Science emerged as a legitimate field of injury and numerous scientific advancements

were made.

Age of Enlightenment
 Improvements in agriculture created greater productivity and nutrition
 Higher birth rates and falling death rates
 Urban areas suffered from crowding, poor housing, sanitation and nutrition
 Harsh working conditions

Modern Times
 Observation of microorganism
 Germ theory
 Artificial vaccine
 Increase in average lifespan
 Lowing infant mortality
 Increase in obesity and diabetes
 Terrorism and bioterrorism preparedness
 Natural disaster preparedness

Modern Functions and Accomplishments of Public Health

 Health surveillance, monitoring and analysis
 Disease outbreak investigation, epidemic and disease risk factors
 Establishing, designing and managing health promotion and disease prevention programs
 Enabling and empowering communities to promote health and reduce inequalities
 Developing and maintaining well-educated and well trained multidisciplinary public health task
force
 Increasing quality assurance in public health functions

The Late Medieval Period

Fear of Diseases, lack of knowledge, speculation and rumors

Public and religious ceremonies and burials were

promoted
Jews were persecuted

Excommunication