HISTORY OF PUBLIC HEALTH
Recurring Issues
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Movement of people(s)
Influence of war on disease and public health
concerns
• Early historical examples
– Mongol invasions from the East
– Crusades in Middle Ages
• Colonization invasions
• Civil War in the United States
• Spanish-American War
• World War II
HISTORY OF PUBLIC HEALTH
Recurring Issues (cont’d.)
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Influence of colonization/immigration on disease and
public health concerns
Influence of commercial trade on disease and public
health concerns
HISTORICAL PERSPECTIVE
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Primitive societies
Classical Cultures
Middle Ages
Renaissance and the Age of Reason
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Development of Public Health in the United States
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English Influence
Colonial America
19th Century in America
The Shattuck Report (1850)
Creation of Federal and State Environmental
Agencies
HISTORICAL PERSPECTIVE (cont’d.)
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Children’s Bureau (1912)
Food and Drug Administration (FDA)
Social Security Act (1935)
Federal Security Agency (1939)
– Department of Heath, Education, and Welfare
– Department of Health and Human Services
• Hill-Burton Act (Hospital Survey and Construction
Act (1946)
• National Institutes of Health (NIH)
• Medicare and Medicaid
Roman Civilization -- Public
Health Achievements
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Roman civilization that succeeded the Athenian is
well known for its engineering and administrative
arrangements affecting public health
E.g., inspection and removal of dilapidated buildings,
elimination of dangerous animals and foul smells,
supervision of weights and measures, supervision of
public bars and taverns, supervision of houses of
prostitution, regulation of building construction, etc.
E.g., supply of good and cheap grain guaranteed to
the poor
Roman Civilization -- Public
Health Achievements (cont’d).
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E.g., many streets were paved and had gutters that
helped to drain by a network of underground
conduits
E.g., provision was made for the cleaning and repair
of streets and for removal of garbage and rubbish
E.g., public baths were constructed and extensively
used
E.g., an adequate and relatively safe water supply
was made available by construction of magnificent
aqueducts and water tunnels
• Many of these are still in use today, having been
incorporated into the present-day water and sewage
systems of Rome and other cities
MIDDLE AGES
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Negative reactions to Greek/Roman influence
Disregard of personal hygiene and sanitation
Rise of pandemics -- e.g., cholera
Leprosy
Laws to isolate affected individuals; lack of treatment
or care
The Black Death (Bubonic Plague)
HISTORICAL PERSPECTIVE
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Primitive societies
Classical Cultures
Middle Ages
Renaissance and the Age of Reason
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Development of Public Health in the United States
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•
•
•
•
•
English Influence
Colonial America
19th Century in America
The Shattuck Report (1850)
Creation of Federal and State Environmental
Agencies
FOUR ERAS IN THE DEVELOPMENT OF PUBLIC
HEALTH IN THE UNITED STATES
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Colonial Era  Early 19th Century: Characterized by
the appearance of boards of health, mainly in port
cities
The Shattuck Era (c. 1950) : Characterized by the
development of organized health departments and
the impact of the new biological sciences on health
Early 20th Century: Characterized by the
development of state and local health departments
serving most of the population of the United States
FOUR ERAS IN THE DEVELOPMENT OF PUBLIC
HEALTH IN THE UNITED STATES (cont’’d.)
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Late 20th Century: Characterized by the expansion
of public health concerns into medical care,
community mental health, chronic diseases, and
health behavior, and a new concern with the impact
of environment on health
Y2K  : Who knows? Likely, considerable wrestling
with a growing national awareness of limited
resources and nearly insatiable demands for
improved health
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1800-1850: Although the United States expanded
greatly in population, public health measures
remained essentially stationary
Life expectancy in Boston decreased from27.9 years
in 1820-1825 to 21.4 years in 1840-1845
In 1950, in Massachusetts the tuberculosis death rate
was over 300 per 100,000 population, and infant
mortality was about 200 per 1,000 live births
THE SHATTUCK REPORT -- Report of the
Sanitary Commission of Massachusetts
(1850)
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Report of a legislative committee on sanitation and
health problems in Massachusetts
A signal event in the development of public health in
the United States
In effect, it charted health pathways for future
generations
A remarkable document with considerable
contemporary relevance in its various
recommendations
Results started to appear in 1969, when
Massachusetts establish its first state board of health
RECOMMENDATIONS OF THE SHATTUCK REPORT
(1850)
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Establishment of state and local boards of health
System of sanitary police or inspectors
Collection and analysis of vital statistics
Routine system for exchanging data and information
on public health matters
Sanitation programs for towns and buildings
Studies of the health of school children
Studies of tuberculosis
Control of alcoholism
RECOMMENDATIONS OF THE SHATTUCK REPORT
(1850) [cont’d.]
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Supervision of mental disease
Sanitary supervision and study of problems of
immigrants
Erection of model tenements, public bath houses and
wash houses
Control of smoke nuisances
Control of food adulteration
Exposure of “nostrums” -- I.e., panaceas, elixirs,
eetc.
Preaching of health from pulpits
Establishment of nurses’ training schools
RECOMMENDATIONS OF THE SHATTUCK REPORT
(1850) [cont’d.]
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Teaching of sanitary science in medical schools
Inclusion of preventive medicine in clinical practice
Routine physical examinations and maintenance of
family records of illness
DEVELOPMENT OF PUBLIC HEALTH
AGENCIES AND LEGISLATION IN THE
UNITED STATES
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Local Health Departments
State Health Departments
Early Federal Health Agencies
• Marine Hospital Service (est. 1798) -- first national health
initiative
• Port Quarantine Act (1878)
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Public Health and Advances in Bacteriology
United States Public Health Service
• Stems from the Marine Hospital Service
• 1902 -- Renamed the Public Health & Marine Hospital
Service
• 1912 -- renamed the U.S. Public Health Service
DEVELOPMENT OF PUBLIC HEALTH
AGENCIES AND LEGISLATION IN THE
UNITED STATES
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American Public Health Association (est. 1872)
Pure Food and Drug Act (1906) -- FDA
Children’s Bureau (est. 1912)
Sheppard-Towner Act (Maternal and Infancy Act)
(1921)
Social Security Act (1935)
Hill-Burton Act (Hospital Survey and Construction Act
(1946)
National Institutes of Health
Medicare and Medicaid (1935)
Federal and State Environmental Agencies (1970s)
PUBLIC HEALTH AND ADVANCES IN
BACTERIOLOGY
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Between 1877 and the end of the 19th century, the
identity of numerous bacterial disease agents was
established
These agents included those causing gonorrhea,
typhoid fever, leprosy, tuberculosis, cholera,
diphtheria, tetanus, pneumonia, plague, and
dystentery
The subperiod (1875-1900) has been termed by
some as the bacteriological period of public health
Examples:
• 1862 -- In France, Louis Pasteur proposed his germ theory
of disease
PUBLIC HEALTH AND ADVANCES IN
BACTERIOLOGY (cont’d.)
• Prior to this, “miasmas” (bad vapors) were thought to be
thsource of many diseases
• 1890 -- Pasteurization of milk introduced
• 1891 -- Meat inspection inititiated
• 1895 -- Septic tanks for sewage treatment were introduced
SUMMARY OBSERVATIONS
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Public health services as last resort, safety net, etc.
Continuing separation of medical care and (1) public
health, and (2) mental health
Recent reorganization of responsibility fot
environmental health, with inception of the
Environmental Protection Agency (EPA)
To understand public health and its administration in
the United States, must understand our
intergovernmental system
Some disarray in public health, partly due to the
broad spectrum of concerns definable as “public” in
scope