Instructor Guide for Module 1
A Brief History of Public Health
Introductions and Pretest
A Brief History of Public Health
Modern Public Health: Tools and Functions
Organization and Legal Basis of Public Health
Public Health Ethics
Posttest and Course Evaluation
Developed by:
Continuing Education, School of Public Health, University at Albany and the
Professional Development Program, Rockefeller College, University at Albany
Instructor’s Guide
A Brief History of Public Health
Acknowledgements
The development of these training materials was made possible by support from the New York
State Department of Health and the New York New Jersey Public Health Training Center, which
is funded through a grant from the Health Resources and Services Administration (HRSA) of the
U.S. Department of Health and Human Services.
Project Coordinator
Carol Young, PhD, Continuing Education, School of Public Health, University at Albany
Content Experts

Robert Burhans
NYSDOH

David O. Carpenter
UAlbany

Andrew Doniger
Monroe Co. (NY) DOH

William Leavy
UAlbany

Patrick Trapp
NYSDOH

Carol D. Young
UAlbany

Vicki Zeldin
NYSDOH

NYNJ Public Health Training Center Team

Pennsylvania and Ohio Public Health Training Center
Research, Design, and Editing
Cheryl Reeves, MS/MLS, Continuing Education, School of Public Health, University at Albany
Instructional Technologies Unit, Professional Development Program, Rockefeller College,
University at Albany
Contact Information
New York New Jersey Public Health Training Center
http://www.nynj-phtc.org/
Carol Young, PhD
School of Public Health, University at Albany
One University Place
Rensselaer, NY 12144-3456
Phone: (518) 402-0330
Fax: (518) 402-1137
E-mail: cyoung@albany.edu
Web: http://www.albany.edu/sph/
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Instructor’s Guide
A Brief History of Public Health
How To Use This Guide
This Instructor Guide accompanies the MS PowerPoint slides for Module 1: A Brief History of
Public Health. It contains the slides, notes, key points, and additional references for the
instructor’s presentation of Module 1.
Instructors are encouraged to modify the material to suit the specific audience and/or location of
instruction. Specific instructions on how to modify PowerPoint presentations can be found in the
Course Guide, which should be used in conjunction with each of the Instructor Guides.
All materials may be downloaded from the comprehensive curriculum source page at
http://www.nynj-phtc.org/intro/.
The entire course (Modules 0-4) is intended to be presented in six-hours. Module 1 is designed
to take 60 minutes.
Before you Begin


Read the Course Guide for Instructors, which explains how to
o
Organize the entire day’s presentation
o
Create student guides
o
Use PowerPoint software
Teaching tips, preparation checklists, and many other details are also provided. The
Course Guide is found under “Other Materials” on the source page.
Read the Instructor Guide for each module to become familiar with the content and flow.

Look for notes and slides that require examples specific to your own training situation
(i.e., audience, health department, location).

Determine whether a module’s generic presentation should be modified for your specific
audience. Additional slides may be found under “Other Materials” in the file “Additional
Slides.”

Review all activities in this module. Make sure you have materials to hand out to
participants.
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Instructor’s Guide
A Brief History of Public Health
Module 1: A Brief History of Public Health
Slide 1
Slide 2
Key Points:
 Module 0 established where PH is today

o
“What is Public Health?”
o
Multidisciplinary workforce, etc.
This module answers
o
Slide 3
How did we get to this point?
Key Points:
 To understand roots of public health

A very fast run-through of history
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A Brief History of Public Health
Slide 4
Key Points:
 Public health is the most ancient of human
activities

From the beginning of human history, human
beings have needed to ensure the survival of the
larger community or the tribe

Historically focuses beyond the individual to the
whole population
o
Slide 5
EXAMPLE, early tribes understood the
need to protect mothers and infants.
Ensuring maternal and child health
continues to be a major focus of Public
Health today.

Societies that survive develop “public health
measures” -- strong rules/ regulations/ taboos/
powers to protect the community’s health:

PH is imbedded in the belief system (religion,
superstitions, and in the case of modern public
health, science)

PH is imposed by the political system.
Key Points:
 Populations must protect conditions related to
these requirements for survival:

o
Air – poor quality can cause sickness or
death, often in minutes
o
Water – poor quality or lack of water can
cause sickness or death in days
o
Food – can sustain or injure; poor quality
or lack of food can cause sickness or
death in days or weeks
o
Shelter – must have, at least on a
seasonal basis
o
Care and mutual support – especially
around birthing and protecting the new
generation
All these requirements continue to be essential
for group survival and success
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Instructor’s Guide
A Brief History of Public Health
Slide 6
Key Points:
 Powerful codes and regulations have existed in
multiple cultures, in virtually all civilizations,
Eastern and Western

Health codes are based on the society’s belief
system and the society’s understanding of
health/disease

Salus populi: suprema lex esta = “Let the welfare
of the people be the supreme law”

Requirements and prohibitions (tribal rules) are
passed on through oral traditions, for example:

Slide 7
o
Don’t camp in damp, swampy places
o
Don’t use still or unclear water
o
Don’t allow animal waste inside shelters
o
Avoid certain foods, plants or animals
o
Assist with feeding of infants
Oral traditions eventually become part of written
codes (e.g., in China, Middle East, North Africa,
South and Central America)
o
EXAMPLE: The Bible, the book of
Leviticus spells out the rabbi’s power to
evict lepers and demolish their housing
(based on fear of the disease and the
misperception that it was communicable).
o
EXAMPLE: Both the Koran and the Bible
have detailed food codes
Key Points:
 Very quick overview of major historical
developments related to public health

Focus on (bias toward) Western History
NOTE: This slide is an advanced organizer; a preview
of the time periods examined in this presentation.
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Instructor’s Guide
A Brief History of Public Health
Slide 8
Slide 9
Slide 10
Key Point:
 Public health messages haven’t changed all that
much
o
The Greeks understood the importance
of washing hands, taking a bath,
exercising and eating good food.
o
Naturalistic concept – ill health was
caused by an imbalance between man
and environment.
Key Points:
 Hippocrates – father of Western medicine

Believed that illness had a physical and rational
explanation

Looked for and described causal relationship
between disease and factors such as climate,
soil, water, lifestyle and nutrition
Key Points:
 Built aqueducts to bring water into the city

o
Plumbing technology was very advanced
o
Replaced leaky clay pipes with lead
pipes (unfortunately, Romans suffered
from lead poisoning)
Collected taxes to support public services such
as:
o
Public baths
o
Water and sewage systems
o
Restaurant inspection
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Instructor’s Guide
A Brief History of Public Health
Slide 11
Slide 12
Key Point:
 Le Pont du Gard in southern France
o
Romans constructed it between 500 and
523 B.C.
o
An aqueduct to carry fresh water to the
city of Nimes
Key Points:
 Europe during the Middle Ages (also called the
“Dark Ages”)

o
Decline of hygiene and sanitation -general abandonment of the Greek and
Roman values of hygiene and sanitation.
o
Faith and prayer were the accepted
treatment for illness.
Even during the Middle Ages, some important
public health tools developed:
o
An understanding that isolating ships and
diseased individuals could help prevent
the spread of disease.
o
Quarantine of ships and travelers for 40
days.
o
Persons denied entry to infected ships.
See “Background Materials” at the end of this Instructor Guide.
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Instructor’s Guide
A Brief History of Public Health
Slide 13
Key Points:
 Epidemic disease in Western Europe between
1348 and 1530+ AD (the end of the Middle Ages
through the Renaissance)

The Plague (The Black Death)
o
Worst from 1348-1352
o
Killed at least 25 million people in Europe
(1/3 of the population)
o
Killed more than 60 million worldwide
o
Boccaccio said that the victims, "ate
lunch with their friend and dinner with
their ancestors in paradise."
Map graphic courtesy of “The Black Death, 1348,"
EyeWitness to History, www.eyewitnesstohistory.com
(2001)
See “Background Materials” at the end of this Instructor Guide.
Slide 14
Key Points:
 Renaissance -- arts and literature and
exploration flourished

Explorers and traders unknowingly spread
diseases like smallpox, measles, and typhoid.
o
This method of the spread of disease still
exists today (e.g., spread of SARS
across countries, albeit in a very
accelerated form).
See “Background Materials” at the end of this Instructor Guide.
Slide 15
Key Point:
 A renewed interest in Reason & Enlightenment
laid foundation for more scientific explorations
Graphic: statue of Edward Jenner vaccinating eightyear-old James Phipps
See “Background Materials” at the end of this Instructor Guide.
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Instructor’s Guide
A Brief History of Public Health
Slide 16
Key Points:
 Industrialization and urbanization in the 19th
Century produced a new set of public health
problems:
o
Slums
o
Poverty
o
Disease

Worse than 1000 years before

At this time, English working class had a life
expectancy of 7 years
See “Background Materials” at the end of this Instructor Guide.
Slide 17
Key Points:
 The great sanitary awakening is the birth of
modern public health:
o
Great strides in scientific knowledge to
help understand the origin and treatment
of disease.
o
Interest in humanitarian ideals
o
Acknowledgement of the connection
between poverty and disease.

Even today, poverty is the single best
predictor of poor health.

Returning to what the Romans had figured out,
new infrastructure for clean water and sewage
removal

Birth of a system to monitor the health status of
communities
See “Background Materials” at the end of this Instructor Guide.
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Instructor’s Guide
A Brief History of Public Health
Slide 18
Key Points:
 John Snow

o
Considered the “George Washington” of
public health
o
Well-educated despite being raised in a
working class family
o
Man of many interests, a physician to
Queen Victoria, and a mathematician
o
Became very concerned about the
cholera outbreaks in London that were
devastating the population. He made
careful observations of the disease, who
caught it, where the deaths occurred.
John Snow and the Broad Street Pump
o
Classic tale of basic epidemiology, the
core science of public health.
o
Before people understood the role of
bacteria in causing disease and without
any of the modern laboratory supports or
computer analysis, Snow developed a
theory of the source of the outbreak
See “Background Materials” at the end of this Instructor Guide.
Slide 19
Key Points:
 EPIDEMIOLOGY

o
The study of the distribution and
determinants of disease in populations,
to seek the causes of both health and
disease.
o
(see Module 2: Modern Mission of Public
Health)
John Snow and the Broad Street Pump
o
Dr. Snow devised a simple map
identifying the number and distribution of
cases of the disease in the community
and the specific water company serving
each house in which disease occurred.
o
With close observation and mathematical
calculations, he hypothesized that one
water pump (on Broad Street) was
responsible for transmission of much of
the disease.
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Instructor’s Guide
A Brief History of Public Health
Slide 20
Key Points:
 Snow took the handle off the Broad Street pump,
and the cholera outbreak subsided.

Slide 21
Using epidemiologic practices, Snow identified
(and stopped) the source of the disease.
Key Points:
 Early Epidemiology
o
Example of early Geographic Information
Systems (or GIS)
o
Like J. Snow, trying to understand a
disease by studying the location of its
spread.
Picture caption: map showing deaths from Diphtheria in
the City Of New York from May 1st 1874 to December
31st 1875. Made under the direction of W. De F. Day,
M.D., sanitary superintendent, Health Dept.
Slide 22
Key Points:
 Tremendous growth in scientific knowledge
made modern public health possible



Relationship between germs and disease:
o
Until the late 1800s, NO CONCEPT of
bacteria and germs
o
Theories of “miasma” or bad air were
thought to cause disease
Procedural and behavioral changes:
o
Use of disinfectants
o
Improved obstetrical care
o
Use of inoculation
o
Introduction of anesthetics in surgery
o
Revival of sanitary measures
Decline in maternal and infant mortality
See “Background Materials” at the end of this Instructor Guide.
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Instructor’s Guide
A Brief History of Public Health
Slide 23
Key Points:
 During the 1800s changes occurred after the
rise of industrialization and nationalism.
o

1842 Chadwick Report
o

1837 first modern sanitation legislation
was enacted.
Chadwick’s Report led to reforms in
sanitation, health care, and treatment of
poor and working classes
Charles Dickens’ novels brought public attention
to the desperate position of the poor and the
squalid conditions in which they were living
o
Pauper children
o
Child labor (indentured workers in mines
and factories)
o
More than half of working class children
died before their fifth birthday
o
Average age of death for common
laborers was 16
See “Background Materials” at the end of this Instructor Guide.
Slide 24
Key Points:
 Lemuel Shattuck (Teacher, historian, statistician,
publisher, and visionary)

o
Developed the original plan that led to
the establishment in 1869 of the nation’s
first Board of Health in Massachusetts.
o
First local health department in the U.S.
were along the East Coast in the late
1700s.
Shattuck identified major public health issues for
Massachusetts that could be applied to the
entire nation:
Source: Photograph from Lemuel Shattuck Hospital,
Boston, MA at http://www.shattuckhospital.org/
See “Background Materials” at the end of this Instructor Guide.
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Instructor’s Guide
A Brief History of Public Health
Slide 25
Slide 26
Slide 27
Key Points:
 The Sanitary Reform Movement

Example of a society no longer accepting the
squalid living conditions such as found in
tenements.

Lead in to activity on the next slide
Group Activity:
 May be done in small groups or 2-person teams
– ask each team to report one item.

If class is small, accept answers from individuals
and write list on a blackboard or flip chart.

“Things” can be conditions, behaviors, diseases,
physical states, maladies, circumstances, etc.

Some answers include:
o
Child labor
o
Smoking in the workplace, restaurants,
etc.
o
AIDS in Africa – Is just starting to be
unacceptable?
Key Points:
 The death rate in children drops and the average
life span increases over the years from less than
40 to 74.

By 1900 -- Greater acceptance of the germ
theory of disease begins to shift the job of
garbage removal from health departments to
public works departments. Health officers, it is
felt, should spend their time battling infectious
diseases, not cleaning up "public nuisances"
such as garbage.
See “Background Materials” at the end of this Instructor Guide.
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Instructor’s Guide
A Brief History of Public Health
Slide 28
Key Points:
 Look at the BIG PICTURE to summarize
accomplishments of PH in the 20th Century

Ask this question:
o

WHAT DO YOU THINK IS THE
REASON FOR THE GREAT DROP IN
MORTALITY FROM 1900-1940?
Answer: clean water is the primary contributor
to people living longer. American life expectancy
has increased from 45 to 75 years over the past
century. Only 5 of those additional years can be
attributed to the medical care system.
Source: M.J. Schneider, Intro to Public Health, p. 7; Life
expectancy data from J.P. Bunker et al., “Improving
Health: Measuring Effects of Medical Care,” Milbank
Quarterly 72(1994):225-258.
Slide 29
Key Points:
 Nursing
o
Nurses are the single largest group
employed in PH
o
Public health nurses visited families to
help them understand how to promote
good health and prevent disease.
o
Informing, educating, and empowering
people about health issues is one of the
10 essential services of public health.
Credits: DHEW book. Department of Health, City of
New York
Pictures in this slide:
 Photos show nurses boiling milk for babies,
showing mothers how to care for their babies

Bottom left: Visiting nurse shows mother how to
sterilize bottles. Courtesy of the National Library
of Medicine. www.nlm.nih.gov

Top right: Photograph of Philadelphia’s Visiting
Nurses. (calendar from Visiting Nurse
Association of Greater Philadelphia).
Philadelphia’s Visiting nurses of 1909 prepare to
leave their headquarters at 1340 Lombard Street
to begin their daily rounds.
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Instructor’s Guide
A Brief History of Public Health
Slide 30
OPTIONAL
 This is the CDC’s list of the 10 great
achievements in public health of the last century.

Can be debated / discussed (EXAMPLE: clean
water not included? fluoridation included?)
Slide 31
Slide 32
Key Points:
 Actual causes behind the diseases
o
Half of all 1990 deaths are due to these
10 factors
o
Total of 38% from tobacco, diet, and
exercise (still on the list, centuries after
the Greeks recognized the importance)
and alcohol. These are facets of lifestyle.
o
Top 3 causes are self-inflicted.

What kills people has changed – shift from
infectious diseases to behavior-related deaths
and chronic disease. What are the ramifications?

Science for 21st century may be behavioral and
political. (social sciences)
o

The social and behavioral sciences,
working with communities for change,
have become as important tools as the
“hard” sciences (chemistry, biology).
CHALLENGE AHEAD: Acknowledge that
behavior (lifestyle) affects health. (e.g., tobacco
causes heart disease).
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A Brief History of Public Health
Slide 33
Slide 34
Key Points:
 World Population Challenge Ahead
o
In public health, we stand back to look at
aggregate numbers to understand trends
that are not immediately apparent.
o
This big picture look at the population of
our planet has implications for every
aspect of public health – environmental
health, communicable disease, safe and
adequate food and water etc.
Key Points:
 Challenge Ahead: Disparities in health access
and outcomes
o

“Differences in the incidence,
prevalence, mortality, and burden of
diseases and other adverse health
conditions that exist among specific
population groups.”
DHHS selected these six focus areas in which
racial and ethnic minorities experience serious
disparities in health access and outcomes.
See “Background Materials” at the end of this Instructor Guide.
Slide 35
Key Points:
 Describe the PH model in the slide
o
Modern public health education is now
based on an “ecological model” for
understanding health outcomes –
o
EMPHASIZE THE LINKAGES &
INTERRELATEDNESS OF THESE
FACTORS
o
Collaborations that link public health and
medicine in disease prevention and
chronic care

Emerging areas: informatics, genomics,
communication, competence and sensitivity to
cultural differences, community-based learning
and research, global health, policy and law, and
ethics

CHALLENGE: Who will keep the public healthy?
See “Background Materials” at the end of this Instructor Guide.
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Instructor’s Guide
A Brief History of Public Health
Slide 36
Key Points:
 Ask for examples of "emerging" infectious
diseases


Slide 37
o
New infections resulting from changes or
evolution of existing organisms
o
Previously unrecognized infections
appearing in areas undergoing ecologic
transformation
o
Answer: HIV/AIDS, Lyme disease and
hepatitis C.
What are examples of “re-emerging"
infectious diseases?
o
Known infections spreading to new
geographic areas or populations
o
Old infections reemerging as a result of
antimicrobial resistance in known agents
or breakdowns in public health measures
o
Answer: Cholera, Dengue fever,
Diphtheria: Meningococcal meningitis,
Yellow fever
What are examples of international health
disparities?
o
Mortality rate of children under five
o
Percentage of children who are
moderately or severely underweight
o
Access to primary schooling
o
Risks from armed conflict
o
Risks from HIV/AIDS
o
Total health care expenditure
o
Vaccination programs
Key Points:
 Healthy People 2010 builds on initiatives
pursued over the past two decades.

Healthy People 2010 is a comprehensive set of
disease prevention and health promotion
objectives for the nation to achieve over the first
decade of the new century. Created by scientists
both inside and outside of Government, it
identifies a wide range of public health priorities
and specific, measurable objectives.

Optional Handout 1.2: Healthy People 2010
Fact Sheet
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Instructor’s Guide
A Brief History of Public Health
Background Materials and References
Slide 12 Background

http://www.bbc.co.uk/education/medicine/nonint/middle/ph/maphcs1.shtml
Slide 13 Background
The plague spread when people fled to other cities. It is believed the plague originated in Asia,
and moved west with Mongol armies and traders. The plague traveled on trade routes and
caravans. In 1348 a ship docked at in Dorset, England. On this ship were flea-infested black
rats that carried a disease, which was to wipe out almost 33% of the British population. The
disease would plague Britain's shores for 300 years, triggering repeated epidemics.
Two main types of fatal plague in this period: pneumonic and bubonic. Pneumonic plague was
spread by sneezing and bubonic plague by flea bites. The fleas that delivered the deadly bite
would leap from dead rats to humans and could survive in any warm place. Pneumonic fever
was more contagious because it was air-based. Symptoms of bubonic plague would start with a
high temperature, headaches and vomiting, followed by lumps appearing in the groin and
armpits. Eventually the victim would be covered all over with black bruises; death would shortly
follow.
Such a devastating disease was bound to bring huge changes to medieval society. Some
writers complained the disease had brought out the worst in people. In other cases, because so
many had died, labor was in short supply.

http://www.eyewitnesstohistory.com

http://www.iath.virginia.edu/osheim/

http://www.learner.org/exhibits/renaissance/index.html

http://www.cdc.gov/ncidod/dvbid/plague/

http://www.insecta-inspecta.com/fleas/bdeath/

http://www.bbc.co.uk/history/society_culture/welfare/black_01.shtml
Slide 14 Background
Global disease spread
“The Spanish inadvertently owe much of their success in conquering the Aztecs and Incas in
Mexico in the 16th century to smallpox. Unlike the Spanish, the native Indians had no immunity
to the disease, having never encountered it before. It wiped out huge numbers of them. A
century later the North American Indians suffered a similar devastation. In the 18th century
smallpox decimated the aborigines when it reached Australia, the last corner of the world to
have escaped its ravages.”
 Source: http://www.bbc.co.uk/history/discovery/medicine/smallpox_01.shtml
Born to Die : Disease and New World Conquest, 1492-1650
by Noble David Cook (1998)
Explains how the conquest of the New World was achieved by a handful of Europeans--not by
the sword, but by deadly disease. The Aztec and Inca empires were destroyed by a few
page 19 of 26
Instructor’s Guide
A Brief History of Public Health
hundred Europeans whose most important weapons, though the conquerors did not realize it at
the time, were diseases previously unknown in the Americas. The end result of the colonizing
experience in the Americas, whether of the Portuguese, Dutch, Spanish, English, or French,
was the collapse of native society.
Age of Exploration
 Latter half of the fifteenth through the sixteenth centuries

Genoese navigator, Christopher Columbus (1451–1506)

First English voyage around the world by Sir Francis Drake (ca. 1540–1596)

Vasco da Gama's (ca. 1460–1524) voyage to India, making the Portuguese the first
Europeans to sail to that country and leading to the exploration of the west coast of
Africa

Bartolomeu Dias' (ca. 1450–1500) discovery of the Cape of Good Hope

Ferdinand Magellan's (1480–1521) voyage to find a route through the Americas to the
East, which ultimately led to discovery of the passage known today as the Strait of
Magellan
Sources:
 http://www.metmuseum.org/toah/hd/expl/hd_expl.htm

http://www.bbc.co.uk/history/discovery/exploration/
Slide 15 Background
William Harvey (English physician, 1578 - 1657)
 Demonstrated function of the heart and circulatory system

1628 publication of his theories in “An Anatomical Study of the Motion of the Heart and
of the Blood in Animals”

First to suggest that humans and other mammals reproduced via the fertilization of an
egg by sperm.

Used dissection (no microscope) to create theories

http://www.bbc.co.uk/history/historic_figures/harvey_william.shtml
Edward Jenner (English physician, 1749 - 1823)
 1796 vaccination of eight-year-old James Phipps proved that cowpox or swinepox
provided immunity against smallpox (age-old tradition that people who had earlier caught
the mild disease of cowpox did not catch the normally fatal disease of smallpox – on
May 14, 1796 Jenner inoculated Phipps with swinepox and on July 1 he inoculated
Phipps with smallpox)

Coined the word vaccine from the Latin vacca for cow,

Laid the foundation of modern immunology as a science

http://www.jennermuseum.com/

http://www.bbc.co.uk/history/discovery/medicine/smallpox_02.shtml

http://www.whonamedit.com/doctor.cfm/1818.html
Slide 16 Background
Lower East Side Tenement Museum, New York City
page 20 of 26
Instructor’s Guide
A Brief History of Public Health
Virtual Tour: “It was easy to overlook 97 Orchard Street. The building was but one of the
thousands of tenements that sprouted up on the Lower East Side during the nineteenth century.
However, for Lukas Glockner, 97 Orchard Street wasn't just another tenement; it was a ticket to
prosperity. When the German immigrant opened his tenement in 1863, he was hoping to turn a
profit by providing cheap homes to the immigrants who were flooding into Manhattan. The
tenement fulfilled Glockner's dreams: people filled the building and swelled his pocketbook.
Indeed, between 1863 and 1935, 7000 tenants lived in 97 Orchard Street. The lives of some of
these residents are the basis of our Virtual Tour.”
 Source: http://www.tenement.org
Slide 17 Background
Ashton (1990) describes four phases of the development of modern-day public health:
 An initial environmentally-focused phase which addressed infectious diseases related to
“urbanization, poverty and squalor”. This phase lasted from the 1840s to the late 19th
century.

A second phase of personal preventive medical services related to immunization, family
hygiene, health education and family planning which began with the development of
vaccines in the late 19th century and lasted until the 1930s.

A therapeutic era that began with the development of insulin and antibiotics in the 1930s
and persists until today. Its focus is on improving population health through the provision
of organized medical services deploying effective therapeutic technologies.

A recognition that the ‘environment’ is also social, economic and psychological and that
‘healthy public policy’ (Hancock, 1982) is an appropriate part of this new public health.




Slide 18 Background
More information from UCLA School of Public Health at
http://www.ph.ucla.edu/epi/snow.html
Slide 22 Background
NOTE: A vibrio is a type of bacteria whose natural environment is water.
Louis Pasteur, 1822–95.
o
French chemist.
o
His early research consisted of chemical studies of the tartrates, in which he
discovered (1848) molecular dissymmetry.
o
His experiments with bacteria (1862) conclusively disproved the theory of
spontaneous generation and led to the germ theory of infection.
o
His work on wine, vinegar, and beer resulted in the development of the process
of pasteurization.
o
Of great economic value also was his solution for the control of silkworm disease,
his study of chicken cholera, and his technique of vaccination against anthrax,
which was successfully administered against rabies in 1885.
o
In 1888 the Pasteur Institute was founded in Paris, with Pasteur as its director, to
continue work on rabies and to provide a teaching and research center on
virulent and contagious diseases.
o
From The Columbia Encyclopedia, Sixth Edition. 2001
Robert Koch, 1843-1910.
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A Brief History of Public Health


o
Showed that anthrax is caused by a specific organism
o
Koch's postulates for proving that a particular micro-organism is the cause of a
particular disease greatly advance the Germ Theory of Disease. They are still
used today in a slightly modified form.
o
Biography available at: http://www.nobel.se/medicine/laureates/1905/kochbio.html
Slide 23 Background
Edwin Chadwick, 1800-1890
o
Researched and published three-volume "Survey into the Sanitary Condition of
the Labouring Classes in Great Britain,“ which was a landmark in social history,
with graphic descriptions of how the filth in air, water, soil and surroundings was
a major factor in the spread of disease, especially in urban areas.
o
This led to reforms in sanitation, health care and treatment of poor and working
classes.
o
Chadwick, who was appointed Sanitation Commissioner, had several ideas on
how public health could be improved. This included a constant supply of fresh
clean water, water closets in every house, and a system of carrying sewage to
outlying farms, where it would provide a cheap source of fertilizer.
o
Attempts to introduce public health reforms were resisted successfully by people
with vested interests, for example, landlords and water companies, in maintaining
the present system.
o
Source: http://www.spartacus.schoolnet.co.uk/PHchadwick.htm
Charles Dickens (1812 - 1870)
o
Oliver Twist (1838)
o
A Christmas Carol (1843)
o
Bleak House (1853)
o
Hard Times (1854)
o
DICKENS: “Jo lives - that is to say, Jo has not yet died - in a ruinous place,
known to the likes of him by the name of Tom-all-Alone's. It is a black, dilapidated
street, avoided by all decent people; where the crazy houses were seized upon,
when their decay was far advanced, by some bold vagrants, who, after
establishing their own possession, took to letting them out in lodgings. Now,
these tumbling tenements contain, by night, a swarm of misery. As, on the ruined
human wretch, vermin parasites appear, so, these ruined shelters have bred a
crowd of foul existence that crawls in and out of gaps in walls and boards; and
coils itself to sleep, in maggot numbers, where the rain drips in; and comes and
goes, fetching and carrying fever, and sowing more evil in its every footprint than
Lord Coddle, and Sir Thomas Doddle, and the Duke of Foddle, and all the fine
gentlemen in office, down to Zoddle, shall set right in 500 years - though born
expressly to do it.” (from Bleak House)
o
Source:
http://www.bbc.co.uk/history/society_culture/welfare/source_smell_01.shtml
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A Brief History of Public Health

Slide 24 Background
Shattuck identified major public health issues for Massachusetts that could be applied to
the entire nation:
o
Establish the accurate keeping of health records and vital public health statistics
to use as tools to fight disease
o
Improve public sanitary conditions by developing a system of sanitary inspection
o
Develop a vaccination program
o
Study tuberculosis
o
Disseminate public health information to all citizens
o
Control potentially dangerous products; control food adulteration
o
Establish nursing schools
o
Mental disease supervision
o
Control alcoholism
o
Medical school courses in sanitary science
o
Educate immigrants about sanitation
o
Introduce preventive medicine in clinical practice and offer routine physical
examinations

http://hsc.usf.edu/~kmbrown/shattuck.htm

http://www.healthbenchmarks.org/news/timelines/PubHealth.cfm

Slide 27 Background
http://www.cleaninglink.com/Cleaning_Library/history_of_sanitation.htm

http://www.nyc.gov/html/dos/html/history/history.html

http://www.astc.org/exhibitions/rotten/timeline.htm
Slide 34 Background
DHHS selected these six focus areas in which racial and ethnic minorities experience serious
disparities in health access and outcomes:


1. Infant Mortality
o
U.S. national average -- 7.2 deaths per 1,000 live births (1996 data) -- U.S. ranks
24th compared with other industrialized nations
o
Rate for white infants -- 6.0 per 1,000 (1996)
o
Rate for black infants -- 14.2 per 1,000 (1996) -- nearly 2.5 that of white infants
o
Rate for American Indian infants -- 9.0 per 1,000 (1995) -- some Indian
communities approach rates that are twice the national rate
o
Rate for Hispanic infants -- 7.6 per 1,000 (1995) -- 8.9 per 1,000 among Puerto
Rican subgroup (1995)
2. Cancer Screening and Management
o
Second leading cause of death in the U.S. (accounts for more than 544,000
deaths each year)
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A Brief History of Public Health
o
The chances of developing cancer in a lifetime are nearly 50 percent for men and
nearly 40 percent for women
o
About half of those who develop the disease will die from it.
o
Many minority groups suffer disproportionately from cancer:
o
For men and women combined, blacks have a cancer death rate about 35
percent higher than that for whites (171.6 vs. 127.0 per 100,000).
o
The death rate for cancer for black men is about 50 percent higher than it is for
white men (226.8 vs. 151.8 per 100,000).
o
The death rate for lung cancer is about 27 percent higher for blacks than for
whites (49.9 vs. 39.3 per 100,000).
o
The prostate cancer mortality rate for black men is more than twice that of white
men (55.5 vs 23.8 per 100,000).
o
The incidence rate for lung cancer in black men is about 50 percent higher than
in white men (110.7 vs. 72.6 per 100,000).
o
Native Hawaiian men have elevated rates of lung cancer compared with white
men.
o
Alaska Native men and women suffer disproportionately higher rates of cancers
of the colon and rectum than do whites.
o
Vietnamese women in the U.S. have a cervical cancer incidence rate more than
five times greater than white women (47.3 vs. 8.7 per 100,000). Hispanic women
also suffer elevated rates of cervical cancer.

3. Cardiovascular Disease

4. Diabetes

5. HIV Infection/AIDS

6. Immunizations
For More Information:
 http://healthdisparities.nih.gov/whatare.html

http://www.ama-assn.org/ama/pub/category/7639.html

http://ncmhd.nih.gov/

http://www.cpca.org/health/

http://www.worldbank.org/poverty/health/library/jun1401.htm

Slide 35 Background
Refer to Who Will Keep the Public Healthy? Educating Public Health Professionals for
the 21st Century (2003) on the NAP website http://www.nap.edu/catalog/10542.html.

Optional Handout 1.1 (A guide to thinking about the determinants of population health.)
Taken from p. 6 of Educating Public Health Professionals for the 21st Century at
http://books.nap.edu/books/030908542X/html/6.html (gives another point of view)

Public Health must address all factors and determinants
o
Individual behaviors and environmental factors are responsible for about 70
percent of all premature deaths in the United States
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A Brief History of Public Health
o
Developing and implementing policies and preventive interventions that
effectively address these determinants of health can reduce the burden of illness,
enhance quality of life, and increase longevity.
o
Individual biology and behaviors influence health through their interaction with
each other and with the individual’s social and physical environments.
o
In addition, policies and interventions can improve health by targeting factors
related to individuals and their environments, including access to quality health
care.

Social environment includes interactions with family, friends, coworkers, and others in
the community. It also encompasses social institutions, such as law enforcement, the
workplace, places of worship, and schools.

Policies and interventions can have a powerful and positive effect on the health of
individuals and the community. Examples include health promotion campaigns to
prevent smoking; policies mandating child restraints and safety belt use in automobiles;
disease prevention services, such as immunization of children, adolescents, and adults;
and clinical services, such as enhanced mental health care.

Poverty is one of the greatest threats to health. It frustrates people's ambitions for
building a better future, undermines their self-care actions and creates a sense of
powerlessness and loss of control over their lives and the determinants of health.
Measures that reduce poverty and build capacity are effective in creating an enabling
environment for promoting health. Health promotion uses different strategies and
approaches to develop capacity and change people’s social circumstances and health
behaviors. These interrelated strategies aim to:

o
Build healthy public policy.
o
Create a supportive environment for health.
o
Strengthen community action.
o
Develop personal skills.
o
Reorient health services.
Source: http://www.icn.ch/matters_healthpromo.htm
Slide 36 Background

http://www.cdc.gov/ncidod/eid/about/background.htm

http://www.niaid.nih.gov/publications/eid.htm

http://www.who.int/inf-fs/en/fact097.html

http://www.apha-ih.org

http://www.apha.org/

http://www.globalhealth.org/

What causes emergence or re-emergence of infectious diseases?
o
Several factors contribute to the emergence and re-emergence of infectious
diseases, but most can be linked with the increasing number of people living and
moving in the world: rapid and intense international travel; overcrowding in cities
with poor sanitation; substantially increased international trade in food, mass
distribution of food and unhygienic food preparation practices; increased
exposure of humans to disease vectors and reservoirs in nature; and alteration of
the environment and climatic changes which have a direct impact on the
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A Brief History of Public Health
composition and size of the population of insect vectors and animal reservoirs.
Other factors include a deteriorating public health infrastructure which is unable
to cope with the needs of the population.

What new technologies combat emerging diseases?
o
Genetic immunization, which involves injecting DNA encoding a pathogen protein
directly into muscle tissue, is a new approach that may have important
implications for controlling emerging disease outbreaks. DNA vaccines, as they
are known, have shown promise in several disease models.
Handouts for Module 1

1.1 Optional: “A guide to thinking about the determinants of population health” (PDF
document)

1.2 Optional: Healthy People 2010 Fact Sheet (PDF document)
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