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Public health

Health

• The World Health Organisation defines Health (of an individual) as the state of complete physical mental and social well-being and not merely the absence of disease or infirmity.

• World Health Organisation, however, does not define Public Health.

Death

• Death, on the planet Earth, is inevitable.

• A large number of deaths are premature.

• A substantial proportion of deaths can be avoided.

• Public Health is related to preventing premature and unavoidable deaths.

A Model of Health

Exposure to Risk Factors

Body resistance

Poor Health

Manifestation

Disease Condition

Disability Death

Public Health

• If the disease condition is avoided, the probability or the chance of death or disability can be reduced.

• Public Health is therefore described as the science and art of preventing diseases, prolonging life and promoting health (of individuals) through organised efforts and informed choices.

Public Health

• Public Health deals with the group of people rather than individuals.

• Dimensions of public health– Health promotion– Disease prevention– Early diagnosis and prompt treatment– Disability limitation– Rehabilitation

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• Public health is as old as the

man itself.

• In primitive time ,since the knowledge was limited, man attributed disease to the wrath of gods, the invasion of body by evil spirits and the malevolent influence of stars and planets.

Introduction

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It was based on– Supernatural theory of

disease

– Disease and human sufferings & calamities were attributed to the wrath of god

– Influence of evil spirits, stars & planets

Primitive medicine(6000BC)

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• After the fall of Rome, Christian faith entered the world

• Implicit faith on Christ was the only method of treatment of disease

• Christ was the supreme healer, the savior of body & soul

CHRISTIAN ERA

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• Because of this the enquiry into the diseases became unnecessary & even culpable.

• A doctor curing patients by rational methods was considered to be committing sin & using medicine was seemed to be lack of faith in God.

• The scientific medicine suffered greatly & was fully dormant.

• All classes of people were treated alike.

CHRISTIAN ERA

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• Crowding, poor nutrition and sanitation, lack of water sources and drainage, unpaved streets, keeping of animals in towns, and lack of organized waste disposal created conditions for widespread infectious diseases

• All these were threat for the public health• Although physicians provided services for those

able to pay but medical knowledge was a mix of pragmatism, mysticism and sheer lack of scientific knowledge

Christian medicine & PH

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• The practice of separating people with disease from the healthy population is an ancient one.

• By the 7th century, China had a well-established

policy of detaining sailors and foreign travellers suffering from plague.

• The term “quarantine” dates back to the late 14th century

Quarantine

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• From the 14th century, European doctors visiting plague victims wore– protective clothing– mask and– a beak

containing strong-smelling herbs.

Plague and quarantine

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• Smallpox is one of the oldest known human diseases.

• There are evidences that during the 18th century, Smallpox killed every seventh child born in Russia, and every 10th child born in France and Sweden

Smallpox & Immunization

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• Edward Jenner’s experiment in 1796brought hope that the disease could be controlled.He carried out the first vaccination with cowpox virus in 1796

Smallpox & Immunization

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• Following 1500 AD• Fracastorius envisaged the transfer of infection via

minute invisible particles and explained the cause of epidemics(Theory of contagion)

• He became the founder of epidemiology.• Sydenhem made differential diagnosis of scarlet

fever, malaria, dysentery ,cholera. • He is also regarded as the first distinguished

epidemiologist.

Dawn of scientific medicine

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• A milestone in the history of public health is great Sanitary awakening which took place in England in mid-nineteenth century and gradually spread to other countries.

• Industrial revolution of the 18th century sparked of numerous problems, i.e. creation of slums, overcrowding with all its ill effects.

Sanitary awakening

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• Great cholera epidemic of 1832 led the birth of public health in England around 1940.

• John Snow, studied the epidemiology of cholera in London from 1848 to 1854 and established the role of polluted drinking water in its spread.

• The great cholera epidemic of 1832 drew attention of the people and govt. on urgent need to improve public health……led to enactment of the Public Health Act of 1848, in England.

Rise of Public health

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• A comprehensive piece of legislation was brought into force in England, the Public Health Act of 1875, for the control of man’s physical environment.

• By the beginning of 20th century, the broad foundation of public health …..clean water, clean surroundings ,wholesome condition of houses, control of offensive trades etc., were laid in all the countries of the western world.

Rise of Public health

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• Preventive medicine really dates back to the 18th century.

• It developed as a branch of medicine distinct from Public Health.

• Preventive Medicine got a firm foundation after the discovery of causative agents of disease and establishment of the Germ Theory of disease.

Birth of preventive medicine

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• Modern Preventive Medicine:

defined as… “ the art and science of

health promotion, disease prevention, disability

limitation and rehabilitation”

Birth of preventive medicine

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Curative Medicine Public Health /Preventive Medicine

Modern medicine

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• Term Public Health came in to general use around 1840’s

• It arose from need to protect the public from the spread of communicable diseases

• In1848 the Public Health Act in England crystallized the efforts organized by the society to protect, promote & restore the public health

Public health

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• C.E.A. Winslow (1920) gave definition of public health: “the science & art of preventing disease, prolonging life & promoting health & efficiency through organized community efforts”

• This summarizes the philosophy of public health, which remains largely true even today

Public health

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• Disease control phase (1880-1920)

• Health promotional phase (1920-1960)

• Social engineering phase (1960-1980)

• Health for All phase (1981-2000AD)

Changing concepts in PH

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• 1880-1920• Sanitary legislation and sanitary reforms• Less available technical knowledge • Aimed at the control of man’s physical environment

(water supply, sewage disposal) & not at the control of any specific disease

• Improvement in the health of people due to disease and death control

Disease control phase

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• (1920-1960)• In addition to disease control activities one more

goal was added to public health i.e. health promotion of the individuals

• It was initiated as personal health services such as Introduction of Mother & Child health servicesSchool health servicesIndustrial health services Mental healthRehabilitation services

Health promotional phase

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• Two great movements were initiated for human development :

a) provision of basic health services through the medium of PHCs & Sub-centers

b) community development programme to promote village development through active participation of whole community

Health promotional phase

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• 1960-1980• Change in pattern of disease • Public Health entered in new phase called “social

engineering phase”• It moved towards preventive & rehabilitative

aspects of chronic diseases & behavioral problems

Social engineering phase

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• Goals of public health & preventive medicine which had already considered overlapping became identical, namely prevention of disease, promotion of health & prolongation of life

Social engineering phase

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• 1981-2000 AD• Health gap between rich & poor, within & between

countries Health for all phase

• Include provision of health care to all by reducing the inequalities within & between the population so that individual will lead a socially & economically productive life

Health for all phase

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• With the adoption of Health for All (1978), a new concept of Public Health became evident worldwide, which may be defined as….

“the organized application of local, state, national & international resources to achieve health for all, i.e. attainment by all the people of the world by the year 2000 of a level of health that will permit them to lead a socially & economically productive life”

Modern Public Health

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• During 20th century the dramatic increase in average span of life is credited to public health achievements such as vaccination programs, control of infectious diseases, better safety policy such as motor vehicle and worker safety, improved family planning, emphasis on safe drinking water.

• Now the focus is shifting more towards chronic diseases such as cancer, AIDS, diabetes and heart diseases

Modern Public Health

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• Vaccination• Safer workplaces• Control of infectious diseases• Decline in deaths from coronary heart disease

and stroke • Motor vehicle safety

Great Public Health Achievements of This Century

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

Great Public Health Achievements of This Century

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• CARE-Co-operative for Assistance And Relief Everywhere• UNICEF – United Nation International Children Emergency

Fund• WHO – World Health Organization• WORLD BANK• GOARN- Global Outbreak Alert and Response Network

International agencies of public health importance

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• UNDP-United Nations Development Programme• FAO – Food and Agriculture Organization• UNFPA - United Nation Fund for Population Activities.• Global fund to fight AIDS, TB, Malaria• Bill and Melinda Gates Foundation

International agencies of public health importance

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• USAID :United States Agency for International Development

• SIDA: Swedish International Development Agency• DANIDA: Danish International Development Agency• GAVI: The Global Alliance for Vaccines and Immunization

• INTERNATIONAL RED CROSS

International agencies of public health importance

Essential Public Health Functions

Essential Public Health Functions in India

Health situationEpidemiological surveillance

Health promotionRegulation

ParticipationPolicy and planning

EvaluationHuman resources

QualityResearch

Management capacityEmergencies and Distasters

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