MARK D
CURRICULUM FOR THE HEALTH SCIENCES IN SOUTH EASTERN EUROPE
Number (unit, topic): U1-T1
Prior review – Status: D
Title
The History of Public Health
Author(s), degrees,
institution(s)
Jeffrey Levett, PhD
National School of Public Health
Athens, Greece
National School of Public Health
197, Leoforos Alexandras
Athens, Greece 115 27
E-mail: jelevett@compulink.gr
Phone: 301 03641607
Address for
correspondence
ECTS (suggested):
Keywords
Learning objectives
Synopsis (Abstract)
To obtain:
 An overview of historical course of disease, and its social
impact on individuals, populations and nations
 A historical perspective of medical and public health
development.
To summarize:
 The steps that have lead to the infrastructure of
contemporary public health services.
To examine:
 The development of state intervention in population
health from the industrial revolution onwards.
The history of public health is the story of man’s attempts to
protect himself and his community from disease. It provides a
useful chart of the history of disease on human beings, insights
into the attitudes of society towards the sick and diseased
throughout the time course of history as well as information as
to how protection of the community was organized. A
knowledge of public health as an organized function of society
from its mythological beginnings and its early practice in
isolated communities enables us to better understand the
presence of death and disease in the industrial revolution and the
diseases of development that we know today.
Teaching methods
Subject discussion and practical excersizes
Specific
recommendations
from teacher
Assessment of
students
Sharpen computer and Internet skills
Either a written essay type presentation of a relevant topic with
a small bibliography (1500words), or an Internet search that
reveals the historical dimension of a relevant topic with a small
bibliography and with each citation briefly summarized (250
words). In certain cases a historical case study can be
undertaken.
The History of Public Health
Jeffrey Levett, National School of Public Health
Athens, Greece
Introduction
The history of medicine and public health teaches us that permanent well-being for the individual or
for a society is not realistic in everyday life.
The history of disease and sickness serves to remind the world that health is far from a static state
and that human health either of the individual or population cannot be summed up as being either
health or illness. {qualy/daly/burden of disease}
There is no all or none (black or white) or symmetrical polarization or even a weighted one-way
(healthy/sick) polarization.
Overview
 Mythological past-component
History of disease
Hippocrates / Do no Harm
The correct nutrition, correct bodily exercise is the right road to health
Healthy in body, healthy in mind (Ancient Greece)
 Middle ages
Medieval Town Sanitation
Medicus Civitatus versus Physicus
Malaria, Black Death, cholera
Community action state intervention
Quarantine (30+10 days)
Population movements
Vulnerable groups
 Towards Today
Vaccinations
Development of public health structures
League of Nations, Rockefeller Foundation
Figures that have shaped public health
Contributions to Public Health
ASPHER
PH-SEE Network
ASPHER-OSI
WHO-Council of Europe
Primitive Small communities
Kept small by puerperal fever in childbirth, high infant mortality and endemic diseases
This prevented any rapid development of population
Life span was short-no cure for disease
High carbohydrate diet led to
Slow natural processes:
Population increases when life births > deaths
Population decreases when life births < deaths
Sometimes adequately fed and protected from major disaster but unable to cope with
sickness and hazards of childbirth
Disaster: Famine, war, epidemic disease
Attitudes of Society
 Isolate or destroy patient
Primitive communities –Middle Ages
Physical or mental
Victim blaming
 Heal the sick:
Prevent them for harming or infecting others
 Protection of healthy from dangers of disease:
Positive protection of the healthy
 Health Care
From privilege to a right
Disease and History
Impact of disease upon history
Disease may have a single cause
Some diseases have multiple causes
Historical changes usually have multiple and complex causes
Disease can be a primary cause for great historical change
Disease may be a contributing cause to historical change
Episodes in which disease has been of real importance in historical change
Disease can affect an individual with great influence and power
Disease can effect an entire population and change society
History seen as the story of great figures
History seen as the story of social conditions and human development
Theory

Alcmmaeon of Croton (500BC) concluded that health results from the harmonious
cooperation of all parts of the body. Some form of equilibrium was proclaimed to be
the ideal state of health. {Claude Bernard 19th C}.
 Living in harmony with nature-secundum naturam vivere (Stoic philosophy)
“Without health, wisdom cannot become evident, art cannot find expression, strength
cannot fight, wealth becomes meaningless and intelligence has no consequence”
Herophilus, Greek philosopher-physician
 The preservation of health from antiquity (the golden mean/ moderation in all things)
Until the 18th C was founded upon six qualities not automatically guaranteed by nature
(Res non naturales) namely clean air, temperance in eating and drinking, regulated
Change of waking and sleep (early to bed early to rise makes a child healthy, wealthy and
wise), rest and movement (healthy in body healthy in mind), correction of the humors,
regulated sexual life and control of the passions.
 In the middle ages “to live with fever, sharp pains, toothache and weakness of the
eyes” (Michelangelo) was part of everyday existence.



Pascal believed that illness enables the individual to examine the meaning of life
and death and above all God.
Life without suffering has been compared to a rudderless boat, that disease
provides the individual with time to refine the art of living and improve the mind,
that disease and artistic work are closely related. Indeed Graham Green asked,
“How can those who do not write, compose or paint, manage to flee the
melancholy and panic that are inherent to human nature?”
Health or its absence is complex human states dynamic in nature applicable at
the individual or aggregate population level.
Practical Exercises
I Contrast of the valuable contributions of medicine and public health between 1850 –1950
II Examine the use and misuse of public health between 1900-1990
III Discuss the similarities and differences between, hygiene, social medicine, public health and the
new public health
Bibliography
Frazer William (1950) History of English Public Health 1834-1939
Finer S. (1952) The Life and Times of Edwin Chadwick
Porter, Dorothy, (1997 )Health, Civilisation and State
Porter, Dorothy ed (1994) The History of Health and the Modern State
George Rosen (1958) The History of Public Health
René Sand (1952) The Advance to Social Medicine
Thomas McKeown (1976) The Role of Medicine-Dream, Mirage or Nemesis
W. McNeill (1976) Plagues and People
Barker T. and Drake M. (Editors) (1982) Population and Society in Britain (1850-1980)
Screter Simon ibid (1982)
Rosenberg Charles, Explaining Epidemics and Other Sudies in the History of Medicine (1992)
Hamlin Christopher (1997) Public Health and Social Justice in the Age of Chadwick
Harden, Victoria A (2002) A Short History of the National Institutes of Health
www.nih.gov/od/museum/exhibits/history
Porter, Dorothy, The History of Public Health: Current Themes and Approaches
Berridge Virginia, History in Public Health : A New Development for History?