PATHFINDERS on the ROAD to HEALTH

John Last

University of Ottawa, Canada

THREE GIANT STEPS

• Fire to cook meat (?750-500k BCE)• Planting & harvesting crops• Animal husbandry (10-12k BCE)

HUMAN SETTLEMENTS

• Origins of culture – history, tradition, myths, legends, religious beliefs, science

• Ecosystem changes – human influences on natural environment due to agriculture, waste disposal, etc

• Ecological origin of diseases – fecal/oral, vector-borne, parasitic, trans-species, etc

• Population surge

AIRS, WATERS, PLACES

Seasons, Winds (hot, cold)

Water

Place – Aspect to winds, sun

(sheltered or exposed)

Life of the people –

Hard working, eat & drink wisely,

Indolent, eat and drink a lot

James Lind1716-1794

Edward Jenner1749-1823

Lady Mary Wortley Montague

John Snow1813-1858

Cholera in South London, 1854in Relation to Water Supply

Southwark

& Vauxhall

Water Company

40,046 houses 286 deaths

71 per 10,000

houses

Lambeth

Water Company

26,107 houses

14 deaths

5 per 10,000

houses

All other Water

Companies

287,345 houses

277 deaths

9 per 10,000

houses

IDENTIFYING,CLASSIFYING BACTERIA

VACCINES, SERA(Late 19th century onward)

Contributions of Bacteriology to Public Health

Louis Pasteur1822-1895

19th Cent. Public Health Heroes

Snow, Farr, Nightingale

Henle, Koch, Virchow, Pasteur

Semmelweiss, O.W. Holmes

Chadwick, Shattuck

Mayhew, Kingsley

Newspaper editors, cartoonists

Politicians

THE SANITARY REVOLUTION

Late 19th-Early 20th Century

Clean, pure, safe waterSanitation

(sanitary disposal of human waste)

Improved household and personal hygiene

Essential Ingredients

1. AWARE THAT THE PROBLEM EXISTS

Health Information System

Public perception

(Role of media)

Essential Ingredients

• Aware problem exists

2. KNOW WHAT CAUSES IT

(Don’t necessarily need complete understanding, just enough to be able to take action)

Essential Ingredients

• Aware problem exists

• Know what causes it

3. ABILITY TO CONTROL THE CAUSE

(Don’t always need to understand a cause

in order to be able to control it)

Essential Ingredients

• Aware problem exists• Know what causes it• Able to control cause4. BELIEF THAT IT IS IMPORTANT This requires a sense of values – a moral

imperative, the public health ethic, the concept of ‘Redefining the Unacceptable’

(Geoffrey Vickers)

Essential Ingredients

• Aware problem exists

• Know what causes it

• Able to control cause

• Believe it is important

5. POLITICAL WILL

Advocacy, lobby (pressure) groups

ESSENTIAL INGREDIENTS

• Aware that the problem exists

• Know what causes the problem

• Ability to control the cause

• Believe it is important (Values)

• Political will

21st CENTURY CHALLENGES(Huge public health impacts)

• Human disruption of global ecosystems – Atmosphere: global warming, ozone attenuation, smog; resource depletion (fresh water, ocean fisheries); loss of biodiversity, species extinctions

• Violent armed conflicts• HIV/AIDS pandemic• Tobacco addiction pandemic• Petroleum fuel addiction pandemic

PROMOTING HEALTH

• SAFE ENVIRONMENT

• ENHANCED IMMUNITY

• SENSIBLE BEHAVIOUR

• GOOD NUTRITION

• WELL-BORN CHILDREN

• PRUDENT TREATMENT

ESSENTIAL CONCEPTS

• Food and nutrition science

• Environmental management

• Contagion and its control

• Behavioural and social determinants

• Counting, measuring, surveillance

• Multi-sectoral, trans-disciplinary commitment to control health problems