Thursday, October 29, 2009

The History of Public Health

On the Monday before Thanksgiving, Research!America and leading public health organizations take time to recognize public health professionals who work tirelessly every day to protect us. From the ordinary to the extraordinary, these heroes keep our drinking water safe, air clean and children healthy. Read about the work some public health heroes are doing around the country.

In anticipation of Public Health Thank You Day, I’m doing a series of posts on the history of public health and medicine. Beginning next week, we’ll post three entries highlighting different eras in history: one focusing on ancient times, another on the 1800s, and one about the 20th century.

To provide some context, I’ve created a short timeline about public health and medical history. It is based primarily on the 1993 edition of George Rosen’s A History of Public Health, and will hopefully give you a sense of the underlying principles of public health as well as how far we’ve come.

The Ancient Era (800s BCE-500s CE)
A focus on cleanliness, sanitary measures including public baths, and the availability of public hospitals and city physicians helped to keep ancient societies healthy. Doctors also developed methods for diagnosing disease and determining how it spread.

The Middle Ages (400s-1500s)
High population densities resulting from the urbanization of Europe during this time led to sanitation problems and hastened the spread of disease, especially among the poor. In response to these problems, societies introduced public health improvements that included greater numbers of hospitals, hospices, and bathhouses; better treatments for disease were also sought.

The Renaissance (1300s-1500s)
Greater interest in science generated advancements in medicine and public health. Work by people like Andreas Vesalius, who studied human anatomy, and William Harvey, who discovered circulation of the blood, increased society’s knowledge about the body’s structure and functions. The transmission of disease to new places with military explorations, trade, and travel provided new information about how disease spreads. Statistics emerged as a useful tool for investigation.

Early Modern Period (1500s-1700s)
Public welfare became increasingly entwined with state welfare as governments connected the health of their country with the state’s power. Statistics were first used to calculate mortality rates, life expectancy, and fertility, providing a better picture of the health of populations.

The Enlightenment (Mid-1600s to 1790s)
The championing of reason over traditional sources of authority and a deeper interest in science were crucial to the evolution of public health. With a greater focus on self-improvement, people became more interested in ways to improve wellness and image, often leading to interesting (and not always particularly effective) ideas about what was best for one’s health.

The Industrial Era (1800s)
Concerns about the spread of cholera and revolutions across Europe led to a renewed focus on sanitary conditions in Europe and statistics were used more widely to understand the connection between health and living conditions. These general improvements were effective in lowering overall mortality. John Snow’s study of the cholera outbreak on Broad Street in London marked the founding of epidemiological science.

Bacteriological Era (1880-1900)
Discoveries by Pasteur, Koch, and Lister define this period. Germ theory offered new explanations for the spread of disease leading scientists to conclude that microbes, rather than miasmas (bad air), cause disease. This improved understanding aids in prevention and treatment.

20th Century Improvements

Many advances are made in public health including immunizations, motor-vehicle safety, control of infectious diseases, safer and healthier foods, the fluoridation of drinking water, and more.

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