Topics

 History of Community and Public Health

 Community and Public Health in the
Philippines
Objective
 To be oriented with the historical aspect of
community and public health in general and in
the Philippines in particular
History of Community and Public Health
 Early Concepts of Disease
 About 10,000 years ago:
 Hunted and foraged for food
 Had a short lifespan, not because of epidemics
 Primary problem was finding enough food to eat

 Mixed diet was probably fairly balanced and nutritionally

complete
 Lived in small groups and traveled frequently
 Did not encounter problems like accumulating waste or
contaminated water or food
For many centuries, explanations for the occurrence of disease
were not based on science, but on religion, superstition, and
mythology

 Primitive peoples believed in natural

spirits
 Examples:
 In the Philippines
 In India: Hinduism
 In ancient Greece: Pandora’s Box
 The Agricultural Revolution

 Ensured a more secure supply of food and enabled the

population to expand

 Problems:
 Rely heavily on one or two crops so their diets were often
lacking in protein, minerals, and vitamins
 Domesticated animals carried diseases that could be
transmitted to humans
 Problems during Agricultural Revolution
 People began living in larger
groups and staying in the same
place
 Faster transmission of diseases
 Accumulation of garbage

 The picture above shows a

woman emptying her bedpan
into the street
The Hippocratic Corpus - looked at disease as an imbalance in natural forces or humors or fluids
An excess of the humor (e.g. blood) became
the rationale for bloodletting
Period of Epidemics
 The Bubonic Plague (1347-1700s)
 caused by the bacterium Yersinia pestis
 live in the intestines of fleas
 transmitted to rats by flea bites
 Rats - natural reservoir
 Fleas – vectors
 Occasionally, an infected flea would jump to a human and
introduce the bacteria when a blood meal was taken
 Black Death

 Two kinds of plagues:  Pneumonic

 Bubonic  spread by coughs and
 from infected fleas spit of the infected
 kills more than half of its  victims died within 24
victims within a week hrs.
 Theories on the cause of the Plague:
 spread by person-to-person
contact
 by too much sun exposure
 intentional poisoning

 "miasmas“
 most popular explanation
 invisible vapors that emanated
from swamps or cesspools and
floated around in the air, where
they could be inhaled
 Crude treatments were
developed:
 theriac, smoke, aromatic herbs
 Ineffective because primary
mode of transmission was flea
bites, not miasmas
Quarantine and Isolation

 Dated back in the 4th century

 Used to combat plague

 Quarantine
 Italian word quarantena (40 day period)
 Separation of a person who may have been
exposed to the disease

 Isolation
 Separation of a person who has the disease
Ideas About Health
Girolamo Fracastoro
Italian physician, poet, astronomer, and
(1546)

geologist
 Proposed the germ theory of disease more
than 300 years before its formal articulation by
Louis Pasteur and Robert Koch
 Each disease was caused by a different type of
rapidly multiplying 'seed' that these could be
transmitted by direct contact, through the air,
or on contaminated clothing and linens
 1592
 Parish clerks in London began
recording deaths
 The Bills of Mortality
 1662
 John Graunt
 Founding member of the Royal
Society of London
 Summarized this data in a
publication
 "Natural and Political
Observations Mentioned in a
Following Index, and Made Upon
the Bills of Mortality."
Anton van Leeuwenhouk (1670s)

 The Father of Microscopy

 Apprentice in a dry
goods store where
magnifying glasses
were used to inspect
the quality of cloth
 Experimented with new
methods for grinding
and polishing more
powerful lenses
 First person to see
bacteria, yeast, protozoa,
sperm cells, and red
blood cells.
 John Pringle
 Scottish physician general to the
British forces during the War of
the Austrian Succession (1740–
48)
 Became physician to the Duke of
Cumberland and to King George
III
 Published "Observations on the
Diseases of the Army" in 1752
 Emphasized importance of
hygiene to prevent typhus or "jail
fever," which was a common
malady among soldiers and
prisoners in jails
 Thought to be caused by filth
 Also coined the term 'influenza'
 James Lind and Scurvy (1754)
 Scurvy
 Deficiency in vitamin C .Results in weak connective tissue and
fragile capillaries that rupture easily, causing bleeding, anemia,
edema, jaundice, heart failure, and death
 James Lind, a Scottish naval surgeon. In 1754, conducted the
world's first controlled clinical trial on 12 sailors with scurvy
 Divided the 12 sailors into pairs, each group received different
treatment (sea water, various other concoctions, and lemons
and oranges) .The two who received lemons and oranges were
cured, but the others were not
 Francois Broussais & Pierre Louis (1832)
 Francois Broussais
 Prominent Parisian
physician and strong
proponent of bloodletting
with leeches

 Pierre Louis
 A contemporary of
Broussais who believed in
using numerical methods
to evaluate treatment
 Studied bloodletting and
found it ineffective, but
many dismissed his
conclusions
The Industrial Revolution
The Enlightenment (1700-1850)

 Period that saw an embrace of:

 Democracy
 Citizenship
 Reason
 rationality
 Social value of intelligence (value of information
gathering)

 These ideas provided important foundations for

public health
 Utilitarianism

 Developed by Jeremy Bentham and his disciples (the theoretical

radicals) in the early 1800s
 Maximizing total benefit and reducing suffering
 Provided a theoretic structure for health policy and wider social
policies

 Reducing mortality and improving health had an economic value

to society

 Healthy workers were more able to contribute to the economy of

the state

 One could measure 'evil' by the degree of misery that was

 
Ignaz Semmelweis (1840s)
 A Hungarian physician

 “Father of Handwashing”
 Two maternity wards in the hospital
 One was where births were attended by medical students, another
where births were attended by midwives
 Medical students often came directly from dissecting rooms where they
were working on corpses with their bare hands
 Puerperal fever (postpartum sepsis) was much more common in the
ward tended by the medical students
 Semmelweis began to wonder whether contagion could be carried on
the hands and transferred to the women during childbirth
 Required all birth attendants to wash their hands in chlorinated lime
water before attending to a birth
 Rate of infection plummeted
 Findings were initially ignored even by his superiors
Oliver Wendell Holmes (1840s)
 American physician, professor,
lecturer, and literary author
 The Autocrat of the Breakfast-
Table (1858)
 In 1843, he presented a paper
entitled "The Contagiousness
Of Puerperal Fever" at the
Boston Society for Medical
Improvement
 Advocated for medical reforms
 A strong proponent of the idea
that doctors and nurses could
carry puerperal fever from
patient to patient
 John Snow - The Father of Epidemiology

 1800s - epidemics of
cholera in Europe and
America that killed
thousands of people
 Prevailing opinion of
the time was that
cholera was spread
either by miasmas or
by person-to-person
contact
 He believed that it was
transmitted by water
or food consumption
 Snow made several important contributions
to the development of epidemiologic thinking
 Proposed a new hypothesis for how cholera
was transmitted
 Tested this hypothesis systematically by
making comparisons between groups of
people
 Provided evidence for an association between
drinking water from the Broad Street well and
contracting cholera
 Argued for an intervention which prevented
additional cases (removal of the pump handle)
 The Sanitary Idea (1850-1875)
 Public health as we think of it today took shape in
London and Paris in the wake of the devastating
health consequences of the Industrial Revolution

 Development of public health as a discipline had

many contributing factors:

 Importance of the monarchy and the power of the

state
 Emergence of the Enlightenment in the 18th century
 Recognition that poor health was a burden that fell
disproportionately on the poor
 John Graunt’s study on the importance of
numbering the people led to the creation of
the General Registrar's Office in 1837

 Recorded births, deaths, and marriages in

England and Wales

 Office established the importance of

surveillance with respect to health
William Farr
 Trained at the Royal
Academy of Medicine
in Paris

 Appointed as Chief
Statistician of
General Registrar's
Office
 Louis-René Villermé

 French physician
 Noticed that mortality rates varied widely
among the districts of Paris
 Used tax rates as an indicator of wealth
 Found a striking correlation with mortality
rates
 Edwin Chadwick
 “The Report into the Sanitary Conditions of the Laboring
Population of Great Britain” (1842)
 Life expectancy was much lower in towns than in the
countryside
 Believed that a healthier population would be able to work
harder and would cost less to support
 Contributed to the emerging idea that the public's health was a
legitimate interest of government
 Instrumental in creating a central public health administration
that paved the way for drainage, sewers, garbage disposal,
regulation of housing
 Concluded that what was really needed was not more
physicians, but civil engineers to provide drainage of streets
and to devise more efficient ways of removing sewage and
Louis Pasteur (late 1800)

 French biologist and chemist

 “Germ Theory of Disease”
 Began studying fermentation in wine and beer and
concluded that microorganisms were responsible
 Discovered that microbes in milk could be killed by heating
to about 130 degrees Fahrenheit (54 degrees Celsius)
 Discovered that some microorganisms require oxygen while
others reproduce in the absence of oxygen
 Pioneered the idea of artificially generating weakened
microorganisms as vaccines
 Community and Public Health in the U.S.
 1799
 Boston established the first Board of
Health and the first health department in
the United States
 Paul Revere is named as the first Health
Officer
 1800
 Dr. Benjamin Waterhouse introduced
smallpox vaccination to the US
Lemuel Shattuck
 Massachusetts legislator
 Established the first US system for recording births, deaths and
marriages (1842)
 Established a system for recording mortality data by age, sex,
occupation, socioeconomic level, and location and the
application of data to programs in immunization, school health,
smoking, and alcohol abuse
 Proposed a standard nomenclature for disease
Immigration Act of 1891

 Required that all immigrants entering the US be given a

health examination by Public Health Service (PHS)
physicians
 Stipulated exclusion of :
1. all idiots, insane persons, paupers or persons likely to
become public charges
2. persons suffering from a loathsome or dangerous
contagious disease
3. criminals
 Largest inspection center was on Ellis Island in New York
Harbor
 1894 - The first epidemic of polio struck the United States

 1900 - Some estimates indicate that HIV was transmitted from

monkeys to humans as early as 1884, but was either unrecognized
or failed to initiate human to human transmission until later

 1906
 Congress passed the Federal Meat Inspection Act requiring the US
Department of Agriculture (USDA) to inspect meats entering
interstate commerce
 Also passed the Food and Drug Act which forbade adulteration and
misbranding of foods, drinks, and drugs in interstate commerce,
but contained few specific requirements to ensure compliance
 1912 - The Public Health and Marine Hospital Services
(PHMHS) was renamed the United States Public Health
Service, and was authorized to investigate human diseases
(tuberculosis, hookworm, malaria, and leprosy), sanitation,
water supplies and sewage disposal

 1916 - Johns Hopkins University founded the first School of

Public Health in the United States with a grant of $267,000
from the Rockefeller Foundation

 1952 - Polio cases surged in the US encouraging the early

testing of the vaccine developed by Jonas Salk

 1954 - A large-scale clinical trial of the Salk polio vaccine

began
 1953 - Under President Eisenhower, Congress created
the Department of Health, Education, and Welfare (HEW)

 1970 - The Occupational Safety and Health Act was

passed by Congress, and the Occupational Safety and
Health Administration (OSHA) was founded in 1971

 1970 - The Environmental Protection Agency (EPA) was

established to consolidate federal research, monitoring,
standard-setting and enforcement activities to ensure
environmental protection

 1979 - Smallpox was declared eradicated by the World

Health Organization (WHO) as a result of massive global
effort utilizing case-finding and vaccination. The last
known case occurred in 1977 in Somalia
 1981 - Dr. Michael Gottlieb and his associates
report on four previously healthy young men
who had developed Pneumocystis carinii
pneumonia

 Hypothesized that this was a new syndrome of

acquired immunodeficiency caused by a
sexually transmitted infectious agent
Some of the Major Achievements of Public Health in the 20th Century

 Vaccination to reduce  Decline in death rate from

epidemic diseases cardiovascular disease
 Eradication of smallpox  Improvements in maternal and child
health
 Improved motor vehicle
safety  Family planning
 Safer workplaces  Fluoridation of drinking water
 Control of infectious  Reductions in the prevalence of tobacco
diseases use
Community and Public Health in the Philippines
 1901
 Act No. 157 of the Philippine Commission
 Created a Board of Health of the Philippines which
also acted as the Board of Health for the City of
Manila
 Act No. 309 created Provincial and Municipal Boards
of Health

 1905
 Act. No. 1407 (Reorganization Act)
 Abolished the Board of Health
 It’s function and activities were taken over by the
Beareau of Health under the Department of Interior
and Local Government
 1906 – District Health Offices headed by District
Health Officers had jurisdiction over health districts

 1912
 The Fajardo Act (Act No. 2156)
 Created Sanitary Divisions
 The President, Sanitary Division (forerunners of the
present Municipal health officers) took charge of
two or three municipalities

 1915
 The Bureau of Health was renamed Philippine
Health Service with a Director of Health as its Head
 The Service was placed under the Department of of
Public Instruction with the Vice-Governor General as
the Department Secretary
 1940 – The Manila Health Department was
created by virtue of the new charter of the
city of Manila

 1948
 The first training center of the Bureau of
Health was organized in cooperation with the
Pasay City Health Department
 Tabon Health Center was located in a
marginalized part of the city, later on it was
renamed Doña Marta Health Center
 1950
 Organization of Rural Health Demonstration and
Training Center(RHDTC) by the Department of
Health through the initiative of Dr. Hilario Lara,
Dean, Institute of Hygiene (now College of Public
Health, U.P.)

 The WHO and UNICEF assisted project used health

centers of the Quezon City Health Department,
which were located in the rural areas of the city

 The RHDTC was used as a laboratory for the field

experiences of graduate and basic students in
medicine, nursing, health education, nutrition &
social work
 1953
 Philippine Congress approved Republic Act No.
1082 or the Rural Health Law
 It created the first 81 Rural Health Units
 Each unit had a physician, a public health
nurse,a midwife, a sanitary inspector and a
clerk driver
 They were provided with transportation by
UNICEF
 1959
 The Reorganization Act with implementing details
emdodied in Executive order 288, series of 1959
decentralized and integrated health services
 It created 8 Regional Health Offices in the country,
which were later increased to 11 and eventually to
16
 The reorganization of 1959 also merged two
Bureaus in the Department of Health
 The Bureau of Health (in charge of preventive
programs- Maternal & Child Health, Dental Health,
Industrial or Occupational Health) was merged with
the Bureau of Hospitals ( in charge of curative
programs and regulatory and licensing functions) to
form the Bureau of Health and Medical Services
 1987 to1989 - Executive Order No. 119
reorganized the Department of Health which
created several offices and services within the
Department of Health

 1990 to 1992
 The Local Government Code of 1991 (R.A.
7160) was passed and implemented
 This resulted in devolution, which transferred
the power and authority from the national to
the local government units
 It was aimed to build their capabilities for self-
government and develop them fully as self-
reliant communities
 May 24, 1999 – Executive Order No. 102 was
signed by President Estrada, redirecting the
functions and operations of the Department of
Health