2. history of community and public health

7/25/2019 2. History of Community and Public Health

1/49

Topics

History of Community and Public Health Community and Public Health in the

Philippines

Objective

To be oriented with the historical aspect ofcommunity and public health in general and inthe Philippines in particular


2/49

History of Community and Public Health


3/49

Early Concepts of Disease About 10,000 years ago:

Hunted and foraged for food

Had a short lifespan, not because of epidemics

Primary problem was nding enough food to eat

Mixed diet was probably fairly balanced and nutritionallycomplete

i!ed in small groups and tra!eled fre"uently

#id not encounter problems li$e accumulating waste orcontaminated water or food


4/49

For many centuries, explanations for the occurrence of disease

were not based on science, but on religion, superstition, andmythology

Primitive peoples believed in naturalspiritsExamples:

In the PhilippinesIn India: Hinduism In ancient Greece: Pandoras !ox


5/49

The Agricultural Revolution

Ensured a more secure supply of food and enabled thepopulation to expand

Problems:

"ely heavily on one or two crops so their diets were often

lac#ing in protein$ minerals$ and vitamins %omesticated animals carried diseases that could be

transmitted to humans


6/49

Problems during Agricultural Revolution

People began living in largergroups and staying in the sameplace

&aster transmission of diseases

'ccumulation of garbage

The picture above shows awoman emptying her bedpaninto the street


7/49

The Hippocratic Corpus -looked at disease as an imbalance in natural forces or humors or fluids

'n excess of the humor (e)g) blood* becamethe rationale for bloodletting


8/49

Period of Epidemics %he &ubonic Plague '1()*+1*00s

caused by the bacterium Yersinia pestis

live in the intestines of +eas

transmitted to rats by +ea bites

"ats , natural reservoir

&leas - vectors

.ccasionally$ an infected +ea would /ump to a human andintroduce the bacteria when a blood meal was ta#en


9/49

Black Death

Two #inds of plagues:

!ubonic

from infected +eas

#ills more than half of itsvictims within a wee#

Pneumonic

spread by coughs andspit of the infected

victims died within 01hrs)


10/49


11/49

Theories on the cause of the Plague: spread by person,to,person

contact

by too much sun exposure

intentional poisoning

2miasmas3

most popular explanation invisible vapors that emanated

from swamps or cesspools and+oated around in the air$ wherethey could be inhaled

Crude treatments weredeveloped:

theriac$ smo#e$ aromatic herbs

Ine4ective because primarymode of transmission was +ea

bites$ not miasmas


12/49

Quarantine and Isolation

%ated bac# in the 1th

century 5sed to combat plague

6uarantine Italian word quarantena (17 day period* 8eparation of a person who may have been

exposed to the disease

Isolation 8eparation of a person who has the disease


13/49

Ideas About Health

-irolamo .racastoro'1/)

Italian physician$ poet$ astronomer$ andgeologist

Proposed the germ theory of disease morethan 977 years before its formal articulation byouis Pasteur and "obert ;och

Each disease was caused by a di4erent type ofrapidly multiplying


14/49

=>?0

Parish cler#s in ondon beganrecording deaths

The !ills of @ortality

=AA0 Bohn Graunt

&ounding member of the "oyal8ociety of ondon

8ummaried this data in a

publication 2Datural and Political

.bservations @entioned in a&ollowing Index$ and @ade 5ponthe !ills of @ortality)2


15/49

Anton van Leeuwenhouk (1670s)

The &ather of @icroscopy

'pprentice in a drygoods store wheremagnifying glasseswere used to inspect

the uality of cloth Experimented with new

methods for grindingand polishing more

powerful lenses &irst person to see

bacteria$ yeast$ protooa$sperm cells$ and redblood cells)


16/49

John Pringle 8cottish physician general to the

!ritish forces during the Far of

the 'ustrian 8uccession (=17-1*

!ecame physician to the %u#e ofCumberland and to ;ing George

III Published 2.bservations on the

%iseases of the 'rmy2 in =>0

Emphasied importance of

hygiene to prevent typhus or 2/ailfever$2 which was a commonmalady among soldiers andprisoners in /ails

Thought to be caused by lth

'lso coined the term


17/49

James Lind and Scurvy (1754) 8curvy

%eciency in vitamin C )"esults in wea# connective tissue and

fragile capillaries that rupture easily$ causing bleeding$ anemia$edema$ /aundice$ heart failure$ and death

Bames ind$ a 8cottish naval surgeon) In =>1$ conducted theworld


18/49

Francois Broussais & Pierre Louis (1832)

&rancois !roussais

Prominent Parisianphysician and strongproponent of bloodlettingwith leeches

Pierre ouis

' contemporary of!roussais who believed inusing numerical methodsto evaluate treatment

8tudied bloodletting andfound it ine4ective$ butmany dismissed his

conclusions


19/49

The Industrial Revolution


20/49

The Enlightenment (1700-1850)

Period that saw an embrace of: %emocracy Citienship

"eason

rationality 8ocial value of intelligence (value of information

gathering*

These ideas provided important foundations forpublic health


21/49

Utilitarianism

%eveloped by Beremy !entham and his disciples (the theoreticalradicals* in the early =77s

@aximiing total benet and reducing su4ering

Provided a theoretic structure for health policy and wider socialpolicies

"educing mortality and improving health had an economic valueto society

Healthy wor#ers were more able to contribute to the economy ofthe state

.ne could measure


22/49

Ignaz Semmelweis (1840s) ' Hungarian physician

3&ather of HandwashingJ

Two maternity wards in the hospital

.ne was where births were attended by medical students$ anotherwhere births were attended by midwives

@edical students often came directly from dissecting rooms where theywere wor#ing on corpses with their bare hands

Puerperal fever (postpartum sepsis* was much more common in theward tended by the medical students

8emmelweis began to wonder whether contagion could be carried onthe hands and transferred to the women during childbirth

"euired all birth attendants to wash their hands in chlorinated limewater before attending to a birth

"ate of infection plummeted

&indings were initially ignored even by his superiors


23/49

Oliver Wendell Holmes (1840s)

'merican physician$ professor$lecturer$ and literary author

The 'utocrat of the !rea#fast,Table (=>* In =19$ he presented a paper

entitled 2The Contagiousness.f Puerperal &ever2 at the!oston 8ociety for @edicalImprovement

'dvocated for medical reforms

' strong proponent of the ideathat doctors and nurses couldcarry puerperal fever frompatient to patient


24/49

John Snow - The Father of Epidemiology

=77s , epidemics ofcholera in Europe and'merica that #illedthousands of people

Prevailing opinion ofthe time was thatcholera was spreadeither by miasmas or

by person,to,personcontact

He believed that it wastransmitted by water

or food consumption


25/49


26/49


27/49

Snow made several important contributions

to the development of epidemiologic thinking

Proposed a new hypothesis for how cholerawas transmitted

Tested this hypothesis systematically byma#ing comparisons between groups ofpeople

Provided evidence for an association betweendrin#ing water from the !road 8treet well andcontracting cholera

'rgued for an intervention which preventedadditional cases (removal of the pump handle*


28/49

The Sanitary Idea (1850-1875)

Public health as we thin# of it today too# shape in

ondon and Paris in the wa#e of the devastatinghealth conseuences of the Industrial "evolution

%evelopment of public health as a discipline had

many contributing factors:

Importance of the monarchy and the power of thestate

Emergence of the Enlightenment in the =th century "ecognition that poor health was a burden that fell

disproportionately on the poor


29/49

Bohn Graunts study on the importance ofnumbering the people led to the creation ofthe General "egistrar


30/49

William Farr

Trained at the "oyal'cademy of @edicinein Paris

'ppointed as Chief8tatistician ofGeneral "egistrar


31/49

Louis-Ren Villerm

&rench physician Doticed that mortality rates varied widely

among the districts of Paris

5sed tax rates as an indicator of wealth

&ound a stri#ing correlation with mortalityrates


32/49

Edwin Chadwick 3The "eport into the 8anitary Conditions of the aboring

Population of Great !ritainJ (=10*

ife expectancy was much lower in towns than in the

countryside !elieved that a healthier population would be able to wor#

harder and would cost less to support

Contributed to the emerging idea that the public


33/49

Louis Pasteur (late 1800)

&rench biologist and chemist 3Germ Theory of %iseaseJ

!egan studying fermentation in wine and beer andconcluded that microorganisms were responsible

%iscovered that microbes in mil# could be #illed by heatingto about =97 degrees &ahrenheit (>1 degrees Celsius*

%iscovered that some microorganisms reuire oxygen whileothers reproduce in the absence of oxygen

Pioneered the idea of articially generating wea#ened

microorganisms as vaccines


34/49


35/49

Lemuel Shattuck @assachusetts legislator

Established the rst 58 system for recording births$ deaths andmarriages (=10*

Established a system for recording mortality data by age$ sex$occupation$ socioeconomic level$ and location and theapplication of data to programs in immuniation$ school health$smo#ing$ and alcohol abuse

Proposed a standard nomenclature for disease

Community and Public Health in the U.S.

=??

!oston established the rst !oard ofHealth and the rst health department in

the 5nited 8tates

Paul "evere is named as the rst Health.Kcer

=77

%r) !en/amin Faterhouse introduced

smallpox vaccination to the 58


36/49

Immigration Act of 1891

"euired that all immigrants entering the 58 be given ahealth examination by Public Health 8ervice (PH8*

physicians 8tipulated exclusion of :

=) all idiots$ insane persons$ paupers or persons li#ely tobecome public charges

0) persons su4ering from a loathsome or dangerouscontagious disease

9) criminals

argest inspection center was on Ellis Island in Dew Lor#Harbor


37/49

=?1 , The rst epidemic of polio struc# the 5nited 8tates

=?77 , 8ome estimates indicate that HIM was transmitted frommon#eys to humans as early as =1$ but was either unrecogniedor failed to initiate human to human transmission until later

=?7A

Congress passed the &ederal @eat Inspection 'ct reuiring the 58%epartment of 'griculture (58%'* to inspect meats enteringinterstate commerce

'lso passed the &ood and %rug 'ct which forbade adulteration andmisbranding of foods$ drin#s$ and drugs in interstate commerce$but contained few specic reuirements to ensure compliance


38/49

=?=0 , The Public Health and @arine Hospital 8ervices(PH@H8* was renamed the 5nited 8tates Public Health8ervice$ and was authoried to investigate human diseases(tuberculosis$ hoo#worm$ malaria$ and leprosy*$ sanitation$

water supplies and sewage disposal

=?=A , Bohns Hop#ins 5niversity founded the rst 8chool ofPublic Health in the 5nited 8tates with a grant of N0A$777from the "oc#efeller &oundation

=?>0 , Polio cases surged in the 58 encouraging the earlytesting of the vaccine developed by Bonas 8al#

=?>1 , ' large,scale clinical trial of the 8al# polio vaccinebegan


39/49

=?>9 , 5nder President Eisenhower$ Congress createdthe %epartment of Health$ Education$ and Felfare (HEF*

=?7 , The .ccupational 8afety and Health 'ct waspassed by Congress$ and the .ccupational 8afety andHealth 'dministration (.8H'* was founded in =?=

=?7 , The Environmental Protection 'gency (EP'* was

established to consolidate federal research$ monitoring$standard,setting and enforcement activities to ensureenvironmental protection

=?? , 8mallpox was declared eradicated by the ForldHealth .rganiation (FH.* as a result of massive globale4ort utiliing case,nding and vaccination) The last#nown case occurred in =? in 8omalia


40/49

=?= , %r) @ichael Gottlieb and his associatesreport on four previously healthy young menwho had developed Pneumocystis cariniipneumonia

Hypothesied that this was a new syndrome ofacuired immunodeciency caused by a

sexually transmitted infectious agent


41/49

Some of the Major Achievements of Public Health in the 20thCentury

Vaccination to reduce

epidemic diseases

Eradication of smallpox

Improved motor vehicle

safety

Safer workplaces

Control of infectious

diseases

Decline in death rate from

cardiovascular disease

Improvements in maternal and child

health

Family planning

Fluoridation of drinking water

Reductions in the prevalence of toacco

use


42/49

Community and Public Health in the Philippines

=?7=

'ct Do) => of the Philippine Commission

Created a !oard of Health of the Philippineswhichalso acted as the !oard of Health for the City of@anila

'ct Do) 97?created Provincial and @unicipal !oardsof Health

=?7>

'ct) Do) =17 ("eorganiation 'ct* 'bolished the !oard of Health

Its function and activities were ta#en over by the!eareau of Health under the %epartment of Interior

and ocal Government

=?7A %i t i t H lth .K h d d b %i t i t


43/49

=?7A - %istrict Health .Kces headed by %istrictHealth .Kcers had /urisdiction over health districts

=?=0The &a/ardo 'ct ('ct Do) 0=>A*

Created 8anitary %ivisions

The President$ 8anitary %ivision (forerunners of the

present @unicipal health oKcers* too# charge oftwo or three municipalities

=?=>

The !ureau of Healthwas renamed PhilippineHealth 8ervicewith a %irector of Health as its Head

The 8ervice was placed under the %epartment of ofPublic Instruction with the Mice,Governor General asthe %epartment 8ecretary


44/49

=?17 - The @anila Health %epartment wascreated by virtue of the new charter of thecity of @anila

=?1

The rst training center of the !ureau of

Health was organied in cooperation with thePasay City Health %epartment

Tabon Health Centerwas located in amarginalied part of the city$ later on it was

renamed %oOa @arta Health Center


45/49

=?>7

.rganiation of "ural Health %emonstration andTraining Center("H%TC*by the %epartment of

Health through the initiative of %r) Hilario ara$%ean$ Institute of Hygiene(now College of PublicHealth$ 5)P)*

The FH. and 5DICE& assisted pro/ect used healthcenters of the 6ueon City Health %epartment$which were located in the rural areas of the city

The "H%TC was used as a laboratory for the eldexperiences of graduate and basic students inmedicine$ nursing$ health education$ nutrition social wor#


46/49

=?>9

Philippine Congress approved "epublic 'ct Do)=70or the "ural Health aw

It created the rst = "ural Health 5nits

Each unit had a physician$ a public healthnurse$a midwife$ a sanitary inspector and a

cler# driverThey were provided with transportation by

5DICE&


47/49

=?>?

The "eorganiation 'ct with implementing detailsemdodied in Executive order 0$ series of =?>?

decentralied and integrated health services It created "egional Health .Kces in the country$

which were later increased to == and eventually to=A

The reorganiation of =?>? also merged two!ureaus in the %epartment of Health

The !ureau of Health (in charge of preventiveprograms, @aternal Child Health$ %ental Health$

Industrial or .ccupational Health*was merged withthe !ureau of Hospitals ( in charge of curativeprograms and regulatory and licensing functions*toform the !ureau of Health and @edical 8ervices


48/49

=? to=?? , Executive .rder Do) ==?reorganied the %epartment of Healthwhichcreated several oKces and services within the

%epartment of Health

=??7 to =??0

The ocal Government Code of =??= (")')=A7*was passed and implemented

This resulted in devolution$ which transferredthe power and authority from the national to

the local government units It was aimed to build their capabilities for self,

government and develop them fully as self,reliant communities


49/49

@ay 01$ =??? - Executive .rder Do) =70 wassigned by President Estrada$ redirecting thefunctions and operations of the %epartment of

Health

2. history of community and public health

Documents