Prehistory
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.
1500 BC
Leviticus
Leviticus is believed to be the first written health code in world. The
book dealt with personal and community responsibilities and
included guidance regarding the cleanliness of body, sexual health
behaviors, protection against contagious diseases and the Isolation of
lepers.
The Code of Hammurabi
The Code of Hammurabi, created by the King of Babylon is one of the
earliest sets of laws found.It shows rules and punishments if those
rules are broken. It focuses on theft, farming (or shepherding),
property damage, women's rights, marriage rights, children's rights,
slave rights, murder, death, and injury. The punishment is different
for different classes of offenders and victims. The laws do not accept
excuses or explanations for mistakes or fault: the Code was openly
displayed for all to see, so no man could plead ignorance of the law
as an excuse. Few people, however, could read in that era (literacy
mainly being the domain of scribes).The document a code of conduct
for physicians and health practices. Before 500 BC there was also
evidence of bathrooms and drains in homes as well as written
medical prescriptions.
500 BC-500 AD
Hippocrates
Hippocrates (460 BC-380 BC) was the founder of Western medicine.
He manifested an amazingly modern perspective in his treatise
entitled On Airs, Waters, and Places that was published in the fifth
century. Here are some excerpts:
Whoever wishes to investigate medicine properly, should proceed
thus: in the first place to consider the seasons of the year, and what
effects each of them produces. We must also consider the qualities of
the waters and the mode in which the inhabitants live, and what are
their pursuits, whether they are fond of drinking and eating to excess,
and given to indolence, or are fond of exercise and labor, and not
given to excess in eating and drinking.
Also during this period, Greeks were active in the practice of
community sanitation. Romans improved upon Greek engineering in
the building of aqueducts to protect water supplies. They also
created the first hospital.
500-1500
The Middle Ages
The Middle Ages were also known as "The Dark Ages. During this
time, there was an ending of Roman ideology. Health problems were
considered to have spiritual causes and solutions. Illness was
considered to be the result of sin thus stigmatizing the victim.
Bloodletting and alchemy were common practices. Most importantly,
this failure to consider the role of the environment in health led to
epidemics and the inability to control them.
The Black Plague
The black Plague or Black Death was also known as the bubonic
plague. It reappeared in Europe in 1348 after nearly a 1000 year
absence. Up to 2/3rds of the population in major European cities
succumbed in the first two years of the pandemic. The pandemic was
approached by both scientists and the religious community and by
1350 A.D. there were many new public health initiatives developed to
stop the spread of the deadly disease. An interesting historical
footnote is that some scholars contend that corpses were used for
biological warfare.
1500-1700
The Renaissance
During the Renaissance, there was rebirth of thinking about nature
and humans. Careful accounts of disease outbreaks showed that
saints as well as sinners got sick and critical observations led to more
accurate descriptions of symptoms and outcomes. World exploration
led to exposure to different world views on health. The rise of
mercantilism highlighted the value of a healthy and productive
population, leading to advances in occupational health. There was
also an increased concern about infant mortality as a threat to long
term availability of a productive working society.
John Graunt
The period saw an increased understanding of the need to collect
qualitative data for the purpose of defining the state. This was known
at the time as Political Arthmetic. The first solid use of data collection
for the purpose of understanding health status came from John
Graunt (1620-1674), the father of demography and descriptive
epidemiology. In 1662, Graunt published, Natural and Political
Observation, Upon the Bills of Mortality. By studying London death
data for the previous 75 years, Graunt found certain predictability of
mortality with respect to natural events and phenomenon. Using this
data, Graunt developed the first life table.
Anthoni van Leeuwenhoek
Anthoni van Leeuwenhoek (1632-1723) was the first to observe
bacteria and other microscopic organisms using a rudimentary
microscope.
Bernardino Ramazzini
In 1700 Bernardino Ramazzini (1633-1714)published first
comprehensive occupational health treatise. This the birth of
occupational health.
1700-1800
Epidemics, Migration and Discovery
The 18th Century saw a growth in industrialization that brought more
and more people to cities in search of work, While this led to
overcrowding, poor sanitation and subsequent epidemics, there was
a growing recognition of the nature of disease. There were two
prevailing views of the causes of epidemics – Miasmic and Contagion.
Both have public health implications.
Miasmic: This theory held that epidemics stemmed from certain
atmospheric conditions and from miasmas rising from organic
materials.
Contagion: This theory held that epidemics resulted from
transmission of germs.
In the United States, governmental agencies were created to address:
mounting health problems, sanitation and the protection of water
supply.
Denis Diderot
French philosopher, Denis Diderot (1713-1784) in his article on Man,
emphasized the importance of infant mortality on the growth or
decline of a population. In his article The Hospital, Diderot outlined a
public assistance scheme including old age insurance and medical
care.
Germ Warfare
In 1763 in the New World, smallpox infected blankets were
distributed to Native Americans starting an epidemic which killed
thousands. Controversy still exists as to whether this was deliberate
bioterrorism or a tragic mistake, though there were several instances
of this happening.
Edward Jenner
1n 1796, Edward Jenner (1749-1843) published his first paper on the
potential for inoculation, which led to the development of the small
pox vaccine.
Yellow Fever
Yellow Fever appeared in the U.S. in the late 17th century. The deadly
virus continued to strike cities, mostly eastern seaports and Gulf
Coast cities, for the next two hundred years, killing hundreds,
sometimes thousands in a single summer.
In 1793, Philadelphia was the scene of one of the worst outbreaks.
The city was the capitol then and the epidemic forced the evacuation
of many of most prominent citizens, including George Washington,
Thomas Jefferson and Alexander Hamilton.
Marine Hospital Service
In 1798 the U.S. federal government created the to address health
issues relating to maritime trade, such as yellow fever, scurvy and
health threats brought to the U.S. from other countries on ships. The
Marine Hospital Service later became the Public Health Service.
1800-1900
The 19th Century brought tremendous advances in the
understanding of health and medicine. There was an acceptance of
link between environment and health. There was an understanding of
germ theory and there were growing efforts at social reform as a way
of improving the health of the population. Industrialization led to
increase in city populations.
America expanded Westward. Among the many hazards of going
west was disease and injury.
Health Quackery Thrived
There was a laissez faire approach to health problems with few
health regulations.
In Victorian England there were continued problems with sanitation
and overcrowding that led to periodic outbreaks. Still there some
major public health advances during that time. In 1837 the National
Vaccination Board was developed in England.
Public Health Milestones
Edwin Chadwick (1800-1890)
In 1842 social reformer, Edwin Chadwick, published his landmark
report,Report on the Inquiry into Sanitary Conditions of the Laboring
Population of Great Britain. This report outlined the major public
health challenges facing England at the time leading to the
beginnings of reform.
Lemual Shattuck (1793-1859)
In 1850 in Boston, Shattuck released what was to be another seminal
public health report. This report outlined the public health needs in
the state of Massachusetts and included recommendations to create
the first state board of health.
Cholera
Cholera first came to Sunderland, England in 1831-32. Several
epidemics appeared overtime throughout England eventually killing
more people than the Black Plague. This could be directly attributed
to the conditions of poverty and rapid urbanization. London took on
the name the Great Stink. It was not until the epidemic of 1854 that
John Snow began to unravel the mystery of transmission.
John Snow (1813-1858)
John Snow was the first to link the cholera epidemic in London to one
particular water source—the Broad Street Pump. When the pump
handle was removed the disease incidence drastically decreased. This
was the birth of applied epidemiology
Professionalization of Nursing: Nightingale, Seacole and
Wald
Florence Nightingale (1820-1910)
The century also saw the rise of nursing as a profession. Like her
friend, the public health reformer Edwin Chadwick, Florence
Nightingale (1820-1910) believed that infection arose spontaneously
in dirty and poorly ventilated places. This mistaken belief
nevertheless led to improvements in hygiene and healthier living and
working environments. Florence Nightingale also advised and
supported William Rathbone in the development of district nursing in
Liverpool and many Nightingale trained nurses became pioneers in
this field.
Mary Seacole (1805-1881)
Mary Seacole, the "black Florence Nightingale", was once one of the
best-known women in England. She was a Caribbean doctor who had
traveled widely, and was able to put her skills to good use in the
Crimean War. Due to her race, she was denied the opportunity to
work with Florence Nightingale. She traveled to Crimea on her own to
minister to wounded British soldiers. There she established the
British Hotel. Thousands of them remembered her with gratitude and
affection. When she returned to England, she was once again
shunned by the white nursing establishment, yet at the time of her
death, she was the most famous woman in England. Queen Victoria
even commissioned a bust of her for the palace. She published her
memoirs, The Wonderful Adventures of Mrs. Seacole in Many Lands.
Lillian Wald (1867-1940)
Lillian Wald is considered to be the mother of public health nursing.
At the end of the century, In the United States, Wald was beginning
her public health crusade. She was a nurse, social worker and
feminist. She discovered first-hand the squalid conditions in which
many immigrants suffered, and in 1895, Wald created the Henry
Street Settlement, determined to live among the poor to better
provide a variety of volunteer services. Nursing was central to Wald's
idea of neighborhood service, and she introduced the pioneering
concept of "public health nursing," which placed medical care within
the reach of the poor. By, 1940, nearly 300 nurses worked from 20
branches throughout New York City.
Robert Koch (1843-1910)
German scientist, Robert Koch , was one of the founders of
bacteriology. In the process of discovering the causes of anthrax,
cholera and tuberculosis (1882-1883) he developed methods and
technical procedures still used by epidemiologists. Koch asserted that
four criteria must be fulfilled to establish a causal relationship
between a parasite and a disease. These criteria are known as Koch’s
Postulates.Koch was awarded the Nobel Prize for Physiology or
Medicine in 1905.
Louis Pasteur (1822-1895)
French microbiologist, Louis Pasteur ,conducted experiments that
supported the germ theory and effectively debunked the theory of
spontaneous generation. His work involved the development of
systems of inoculation including the first vaccine for rabies. He is best
known, however, for his work in studies on fermenting beverages. He
found that micro-organizisms could develop during this process. He
invented a process in which liquids such as milk were heated to kill all
bacteria and moulds. This was first test on April 20, 1862. This
process was soon afterwards known as pasteurization.
In 1863, New York City conducted the first sanitary survey. New
York's Association for the Improvement of the Condition of the Poor
(est. 1844) finds "dark, contracted, ill constructed, badly ventilated
and disgustingly filthy" housing. Some 18,000 people live in cellar
apartments whose floors are putrid mud.
The American Public Health Association
In 1872, the American Public Health Association was was founded.
APHA is now the oldest and largest organization of public health
professionals in the world.
In 1878, The passage of the National Quarantine Act began the
transfer of quarantine functions from the states to the federal Marine
Hospital Service. In 1891 passage of immigration legislation, assigning
to the Marine Hospital Service the responsibility for medical
examination of arriving immigrants.
In 1879 the National Board of Health was established. Unfortunately
it is disbanded in 1883 when there was increasing.
How the Other Half Lives, a study of live in New York’s tenements
published in 1890, which like other reports, demonstrated the
horrific conditions of tenement areas. Septic tanks for sewage
treatment appeared in 1895.
1900-1920
The Western world in the early 20th Century was faced with the
same public health challenges as the previous century. Life
expectancy was 50 years old. Many public health advances grew out
of social reforms. Thirty eight states created health departments.
Yellow Fever Understood
In 1900, the United States Army Yellow Fever Commission (often
called simply "The Reed Commission" after its leader, Walter Reed
(1857-1902) proved that the Aedes aegypti mosquito was the vector
for yellow fever. This ended the belief that yellow fever spread by
direct contact with infected people or "contaminated" objects and
focused the people’s efforts on the eradication of the mosquito.
The Public Health Service
In 1902, the Marine Hospital Service became the Public Health and
Marine Hospital Service in recognition of its expanding activities in
the field of public health. In 1912, the name was shortened to the
Public Health Service.
Epidemics
In the early twentieth century, the most common cause of death was
from contagious diseases. Bubonic plague hit San Francisco and
persisted until 1909. The influenza outbreak of 1918 killed over
600,000 people and did not subside until the 1950s. It has recently
been discovered to have been an avian flu strain.
A Healthy Carrier
Fear of infectious diseases led to public health hysteria at times. In
1907 in New York City, cook Mary Mallon, an Irish immigrant, was
identified as the first healthy carrier of typhoid. Dubbed Typhoid
Mary, Mallon spent the rest of her life in and out of quarantine on
New Brother Island. Her case exemplified the confrontation of public
health, law, ethics, the media and anti-immigrant attitudes.
Childhood Diseases
Major childhood diseases included polio as well as bone deformity
due to poor nutrition leading to pellagra and rickets.
Public Health and the Birth of School Nursing
Public Health Nursing is now widespread due in part to the work that
Lillian Wald began late in the previous century and continued into the
early Twentieth Century. Wald's most innovative experiment was a
Public School Nursing Service designed to increase school attendance
by having Henry Street nurses provide care at public schools. This was
so successful that the New York City Board of Health soon organized a
public school nursing program, the first such service offered
anywhere in the world.
Meat Inspection
The The Jungle by Upton Sinclair graphically depicts conditions in the
meat packing industry. Partly as a result of this book and the work of
reformers, the U.S. Meat Inspection Act of 1906 was established. The
act was authorized the Secretary of Agriculture to order meat
inspections and condemn any found unfit for human consumption.
Child Labor
By 1911 approximately 2 million American children under 16 were
working in hazardous and unhealthy conditions, often 12 hours a day,
six days a week. Reformers worked tirelessly to address these
dangerous child labor conditions with periodic successes. In 1912
President Theodore Roosevelt's first White House Conference urged
creation of the Children's Bureau to combat exploitation of children.
Still much of the success would be in raising awareness of the hazards
and conditions under which children were working. Legal reform
would not come until the 1930s.
Family Planning
In 1916, Margaret Sanger (1879-1966) published What Every Girl
Should Know. It not only provided basic information about such
topics as menstruation, but also acknowledged the reality of sexual
feelings in adolescents. It was followed in 1917 by What Every
Mother Should Know. That year, Sanger was sent to the workhouse
for "creating a public nuisance." Sanger was a tireless pioneer for
birth control, though her reputation was severaly tarnished due to
her association with eugenisists and for racist writings early in her
career.
1920-1940
Reform, Depression and War
In the United States in 1920-1940 there were continued efforts at
social reform. There war also two prevailing forces shaping health
and human services--the World War I and the Great Depression.
There was no health insurance and people were dependent of on
charities for health care.
Penicillin
In 1928, Scottish physician Alexander Fleming (1881-1955)
inadvertently discovered Penicillin while studying moulds. Fleming
had served as a physician during WWI and had seen the horrific effect
of infection in military hospitals. This discovery would be one of the
most important discoveries of the Twentieth Century for its ability to
kill bacteria and fight infectious disease.
Native American Health
In 1921, The Bureau of Indian Affairs Health Division was created, the
forerunner to the Indian Health Service. The provision of health
services to members of federally-recognized tribes grew out of the
special government-to-government relationship between the federal
government and Indian tribes.The IHS currently provides health
services to approximately 1.5 million American Indians and Alaska
Natives who belong to more than 557 federally recognized tribes in
35 states.
The New Deal
Franklin Roosevelt's New Deal created numerous agencies and public
works projects, bringing an end to the Great Depression. In 1935, FDR
created a limited form of the Social Security program began as a
measure to implement "social insurance" during the Great
Depression when poverty rates among senior citizens exceeded 50
percent.
The Tuskegee Syphilis Study
In 1932, the Public Health Service, working with the Tuskegee
Institute, began a study in Macon County, Alabama, to record the
natural history of syphilis. The study involved 600 African American
men--399 with syphilis and 201 who did not have the disease.
Researchers told the men they were being treated for "bad blood," a
local term used to describe several ailments, including syphilis,
anemia, and fatigue. In truth, they did not receive the proper
treatment needed to cure their illness, so that the progression of the
disease could be studied. In exchange for taking part in the study, the
men received free medical exams, free meals, and burial insurance.
Although originally projected to last 6 months, the study actually
went on for 40 years. Some believe it only ended because a
investigative reporter, James Jones, learned of the project and made
it public. Since then great efforts have been made to stop unethical
treatment of human subjects. Jones's book is entitled, Bad Blood.
1940-1960
Centers for Disease Control and Prevention (CDC)
What we now know to be the Centers for Disease Control and
Prevention (CDC) was established in 1946 in Atlanta as the
Communicable Disease Center. It occupied only one floor of the
Volunteer Building on Peachtree Street and had fewer than 400
employees, most of whom were engineers and entomologists. Until
the previous day, they had worked for Malaria Control in War Areas,
the predecessor of CDC, which had successfully kept the
southeastern states malaria-free during World War II.
The World Health Organization
The World Health Organization (WHO) was established by the United
Nations on April 7, 1948. The WHO inherited much of the mandate
and resources of its predecessor, the Health Organization (HO), which
had been an agency of the League of Nations.
Fluoridation of Water
Water Fluoridation began in 1948. Fluoridation is the act of adding
fluoride ions to water in order to reduce tooth decay in the general
population. Many North American municipalities fluoridate their
water supplies, citing effectiveness in reducing tooth decay, safety of
fluoridation, and the low cost to do so.
The Polio Vaccine
The first effective polio vaccine was developed by Jonas Salk (19141995), although it was the vaccine developed by Albert Sabin (19061993) that was used for mass inoculation. The first inoculations of
children against polio began in Pittsburgh, Pennsylvania on February
23, 1954. Through mass immunization, the disease was wiped out in
the Americas.
1960-1980
The Pill
In 1960, Searle receives FDA approval to sell Enovid as a birth control
pill. The development of the first highly effective contraceptive
transforms women's lives around the world and opens the door to
the sexual revolution. Searle was the first and only pharmaceutical
company to sell an oral contraceptive and it had a lucrative
monopoly. Other pharmaceutical companies quickly jumped on the
band wagon.
Growth of Environmentalism
In 1962, Rachel Carson (1907-1964)'s Silent Spring led to greater
awareness of the dangers of chemical pesticides to humans. Silent
Spring played in the history of environmentalism roughly the same
role that Uncle Tom's Cabin played in the abolitionist movement.
That same year the Migrant Health Act was passed, providing support
for clinics serving agricultural workers.
Tobacco Declared a Hazard
On January 11, 1964, Luther L. Terry, M.D. 1911-1985), Surgeon
General of the U.S. Public Health Service, released the report of the
Surgeon General's Advisory Committee on Smoking and Health. That
landmark document, now referred to as the first Surgeon General's
Report on Smoking and Health, was America's first widely publicized
official recognition that cigarette smoking is a cause of cancer and
other serious diseases.
War on Poverty
The War on Poverty (1964-1968) was a campaign of legislation and
social services aimed at reducing or eliminating poverty in the United
States of America. The term was first introduced by Lyndon B.
Johnson during his State of the Union address on January 8, 1964.
The legislation was designed in response to the poverty affecting over
35 million Americans as of 1964. 1965 The Johnson Administration
created Medicare and Medicaid.
Also in 1965, The Older Americans Act created the nutritional and
social programs now run by DHHS. In addition, The Head Start
Program was created. Head Start is a program of the U.S.
government's Department of Health and Human Services which
focuses on assisting low-income children, through five years of age;
so that they are prepared for school. In 1966 the Community and
Migrant Health Centers programs was launched.
The Civil Rights Movement
The Civil Rights Movement sought to end segregation of all facilities
including universities and health care facilities. While the end of Jim
Crow laws did lead to desegregation of the facilities, putting an end
to unequal treatment would be a long time coming. This could be
seen in the longevity of the Tuskegee experiment.
The Global Impact of Vaccines
International Smallpox Eradication Program was established in 1966.
It was led by the U.S. Public Health Service. The worldwide
eradication of smallpox was accomplished in 1977.
The Environmental Protection Agency
In 1970, the Environmental Protection Agency (EPA) was established
under the Nixon Administration. The EPA is charged with protecting
human health and with safeguarding air, water, and land.
The WIC Program
The Special Supplemental Nutrition Program for Women, Infants, and
Children, commonly referred to as WIC, is a Federally funded
nutrition-intervention program administered by the food and
Nutrition Service of the U.S. Department of Agriculture. WIC began as
a two-year pilot program in 1972 under an amendment to the Child
Nutrition Act of 1966, and was made permanent in 1974. Its mission
is to provide supplemental food, nutrition education, and health-care
referrals to low-income pregnant or postpartum women, their
infants, and children up to the age of five, to improve their health
outcomes.
Legionnaires Disease
In 1976, 221 attendees at a convention of the Amerian Legion in
Philadelphia fell sick and 34 died. The mysterious disease was named
Legionnaires disease or legionellosis.
The Health Care Financing Administration
In 1977, the Health Care Financing Administration was created to
manage Medicare and Medicaid separately from the Social Security
Administration. It would later become the Center for Medicare and
Medicaid Services.
1980-2000
A Deadly New Virus
1981 a mysterious epidemic was identified as Acquired Immune
Deficiency Syndrome (AIDS). It was found to be caused by the Human
immunodeficiency virus (HIV). It is now a global pandemic. More than
23 million people with AIDS have died since 1981. Millions more are
living with HIV.
The Future of Public Health
In 1988, the Institute of Medicine published its landmark report,The
Future of Public Health. The book detailed the breakdown of the U.S.
public health system and framed the importance of public health
through defining its three core functions and ten essential services.
Public Health's ten essential services are to:
Monitor health status to identify community health problems

Diagnose and investigate health problems and health hazards
in the community
 Inform, educate, and empower people about health issues
 Mobilize community partnerships to identify and solve health
problems
 Develop policies and plans that support individual and
community health efforts
 Enforce laws and regulations that protect health and ensure
safety
 Link people to needed personal health services and assure the
provision of health care when otherwise unavailable
 Assure a competent public health and personal health care
workforce
 Evaluate effectiveness, accessibility, and quality of personal
and population-based health services
 Research for new insights and innovative solutions to health
problems
The Human Genome Project Begins
In 1990, the Human Genome Project was formally established. The
project endeavored to map the human genome down to the
nucleotide (or base pair) level and to identify all the genes present in
it. Once achieved this information was have major public health
ramifications.
Food Labeling
In 1990, the Nutrition Labeling Education Act was signed into law.
The act required food manufacturers to disclose the fat (saturated
and unsaturated), cholesterol, sodium, sugar, fiber, protein and
carbohydrate content in their products. This gave consumers new
ways of monitoring their nutritional intake.
The Ryan White Comprehensive AIDS Resources Emergency
Act
In 1990,the Ryan White Comprehensive AIDS Resources Emergency
(CARE) Act led to laws protecting those with HIV/AIDS from
discrimination and established increased federal funding for AIDS
research and treatment. The act was named for Ryan White (19711990) a teenage boy who died of AIDS after contracting the virus
through treatment for hemophilia. His and his family's experience
facing stigmatization brought national attention to the discrimination
and fear surrounding the illness. At the time this act was established,
there were 150,000 reported AIDS cases in the U.S.
Healthy People 2000
In 1990, CDC published Healthy People 2000. Healthy People 2000
was the blueprint for improving the health of Americans by the end
of the century.The document contains 319 unduplicated main
objectives grouped into 22 priority areas.
The Tobacco Settlement
In 1998 the Master Settlement Agreement was signed with the
tobacco industry. 46 states settled lawsuits in which they sought to
recover tobacco-related health care costs and to hold the tobacco
companies accountable for decades of wrongdoing.
Top Ten Public Health Achievements of the Twentieth
Century


Vaccination
 Motor vehicle safety
 Safer workplaces
 Control of infectious diseases
Decline in deaths from coronary heart disease and stroke
 Safer, healthier food
 Healthier mothers and babies
 Family planning
 Fluoridation of drinking water
 Recognition of tobacco as a hazard
2000-2005
Despite the public health achievements of the previous century, the
Twenty-First Century ushers in new global health challenges. The 911 tragedy makes very real the dangers of terrorism in the U.S. and
highlights the pressing needs to strengthen public health
departments in order for them to be prepared to respond to
chemical, radiological or biological terrorist attacks. There are also
new and emerging diseases.
Healthy People 2010
In January 2000, CDC published Healthy People 2010, the follow-up to
Healthy People 2000. This would be the blueprint for the public
health infrastructure in the new century.
HIV/AIDS
More than 23 million people with AIDS have died since 1981. Millions
more are living with HIV. Poor countries, especially in Africa, are
hardest hit. While there are now effective treatments, there is still
not cure and the treatment when available is very expensive.
Bioterrorism
One month after the September 11th tragedy, anthrax contaminated
letters were mailed to the New York Post, NBC's offices in New York
and the U.S. Senate. Letters to Senator Tom Daschle and Senator
Patrick Leahy, carried a more potent form of anthrax. The CDC
confirmed anthrax cases at American Media, in Florida, and at the
New York offices of CBS and ABC also indicating that the anthrax was
transmitted by mail. Twenty-three people contracted anthrax, five of
whom died. Many more people were exposed.
The Future of the Public's Health
In November 2002, the Institute of Medicine revisited its landmark
report, The Future of Public Health and released a critical follow-up
report, The Future of the Public's Health in the Twenty-First Century.
The report outlined the state of the current public health
infrastructure upon the heels of major bioterrorism attacks and
provided recommendations for strengthening and preparing the
infrastructure through increased public and private sectoral
cooperation.
SARS
Severe Acute Respiratory Syndrome (SARS), an atypical form of
pneumonia, first appeared in in China in 2002. SARS is now known to
be caused by the SARS coronavirus (SARS-CoV), a novel highly
contagious coronavirus. After China suppressed news of the
outbreak, the disease spread rapidly, reaching neighboring countries
in late February 2003, and then to other countries via international
travelers. Toronto had a serious SARS outbreak, which fully tested its
public health readiness. The last case in this outbreak occurred in
June 2003.
Human Genome Project Completed
In 2003, the Human Genome Project was completed after 13 years of
work. There were clear practical results even before the work was
complete. The field of public health genomics appeared. This
emerging field assesses the impact of genes and their interaction
with behavior, diet, and the environment on the population's health.
Foul Weather
In August 2005, Hurricane Katrina devastates the U.S. Gulf Coast. The
levees in New Orleans broke leading to massive flooding destroying
much of the city. The accompanying contamination of the water from
decaying bodies and other organic matter as well as chemical toxins
leaves the largest public health disaster the U.S. has ever seen.
Federal cuts in funding for public health infrastructure leave the city
and the rest of the Gulf coast unable to adequately respond.