CHANGING CONCEPTS IN

PUBLIC HEALTH

Dr SAKSHI KAUR CHHABRA

2nd YR PG STUDENT

DEPARTMENT OF PUBLIC HEALTH DENTISTRY

PACIFIC DENTAL COLLEGE AND HOSPITAL, DEBARI

CONTENTS

INTRODUCTION

DEFINITION

PHASES OF PUBLIC HEALTH

NOTABLE FIGURES IN PUBLIC HEALTH

REFERENCES

INTRODUCTION

Public health refers to all organized measures (whether public or

private) to prevent disease, promote health, and prolong life among

the population as a whole.

Its activities aim to provide conditions in which people can be

healthy and focus on entire populations, not on individual patients or

diseases.

Thus, public health is concerned with the total system and not only

the eradication of a particular disease. 

DEFINITION

Public health, as defined by C. E. A, Winslow, a leading figure in the history of

public health is defined as ‘the science and art of preventing disease, prolonging

life, and promoting health and efficiency through organized community efforts

for the sanitation of the environment, the control of community infections, the

education of the individual in personal health, the organization of medical and

nursing services for the early diagnosis and preventive treatment of disease, and

the development of the social machinery which will ensure to every individual in

community a standard of living adequate for the maintenance or improvement of

the health’.

PHASES OF PUBLIC HEALTH In the history of public health, four distinct phases may be demarcated :

1. Disease control phase (1880 – 1920)

2. Health promotional phase (1920 – 1960)

3. Social engineering phase (1960 – 1980)

4. ‘Health for All’ phase (1981 – 2000 AD)

[1] DISEASE CONTROL PHASE (1880-1920) Public health during the 19th century was largely a matter of sanitary

legislation and sanitary reforms aimed at the control of man's physical environment, e.g., water supply, sewage disposal, etc.

Clearly these measures were not aimed at the control of any specific disease, for want of the needed technical knowledge.

However, these measures vastly improved the health of the people due to disease and death control.

[2] HEALTH PROMOTIONAL PHASE (1920-1960) At the beginning of the 20th century, a new concept, the concept of

"health promotion" began to take shape. It was realized that public health had neglected the citizen as an

individual, and that the State had a direct responsibility for the health of the individual. Consequently, in addition to disease control activities, one more goal was added to public health, that is, health promotion of individuals.

It was initiated as personal health services such as mother and child health services, school health services, industrial health services, mental health and rehabilitation services.

Public health nursing was a direct offshoot of this concept. Public health departments began expanding their programs towards health promotional activities.

C.E.A. Winslow - one of the leading figures in the history of public, health, in 1220 defined public health as "the science and art of preventing disease, prolonging life and promoting health and efficiency through organized community effort". This definition summarizes the philosophy of public health, which remains largely true even today.

Since the State had assumed direct responsibility for the health of the individual, two great movements were initiated for human development during the first halt of the present century, namely

(a) Provision of "basic health services" through the medium of primary health centres and sub centres for rural and urban areas evolution of health centres is an important development in the history of public health. (b) The second great movement was the Community Development Programme to promote village development through the active participation of the whole community and on the initiative of the community.

[3] SOCIAL ENGINEERING PHASE (1960-1980) With the advances in preventive medicine and practice of public

health, the pattern of disease began to change in the developed world. Many of the acute illness problems have been brought under control.

However, as old problems were solved, new health problems in the form of chronic diseases began to emerge, e.g., cancer, diabetes, cardiovascular diseases, alcoholism and drug addiction etc. especially in the affluent societies.

A new concept, the concept of "risk factors" as determinants of these diseases came into existence.

The consequences of these diseases, unlike the swift death brought by the acute infectious diseases, was to place a chronic burden on the society that created them. These problems brought new challenges to public health which needed reorientation more towards social objectives.

Public health entered a new phase in the 1960s, described as the "social engineering" phase

NEW PRIORITY WERE GIVEN TO

Social and behavioural aspects of disease and health .

Public health moved into the preventive and rehabilitative aspects of chronic diseases and behavioural problems.

In short, although the term "public health" is still used, its original meaning has changed.

In view of its changed meaning and scope, the term "community health" has been preferred by some leaders in public health.

[4] ‘HEALTH FOR ALL’ PHASE (1981 -2000 AD) As the centuries have unfolded, the glaring contrasts in the picture of

health in the developed and developing countries came into a sharper focus, despite advances in medicine.

Most people in the developed countries, and the elite of the developing countries, enjoy all the determinants of good health - adequate income, nutrition, education, sanitation, safe drinking water and comprehensive health care.

In contrast, only 10 to 20 per, cent of the population in developing countries enjoy ready access to health services of any kind

Death claims 60-250 of every 1000 live births within the first year of life, and the life expectancy is 30 per cent lower than in the developed countries .

John Bryant in the introduction to his book: "Health and the Developing World" presented a gloomy picture and a challenge of inequalities in health by saying: "Large numbers of the world's people, perhaps more than half, have no access to health care at all, and for many of the rest the care they receive does not answer the problems they have".

The global conscience was stirred leading to a new awakening that the health gap between rich and poor within countries and between countries should be narrowed and ultimately eliminated.

It is conceded that the neglected 80 per cent of the world's population too have an equal claim to health care, to protection from the killer diseases of childhood, to primary health care for mothers and children, to treatment for those ills that mankind has long ago learnt to control, if not to cure.

Against this background, in 1981, the members of the WHO pledged themselves to an ambitious target to provide Health for All by the year 2000, that is attainment of a level of health that will permit all peoples "to lead a socially and economically productive life" .

5 FAMOUS PUBLIC HEALTH OFFICIALS WHO CHANGED THE WORLD

Below are mentioned some of the known health care officials who under their supervision paid to the cause of public health.

1) Mc Namara

2) Lee Jong WooK

3) Dr. Mirta Roses Periago

4) Sir Edwin Chadwick

5) Dr. Margarat Chan

Mc Namara

Robert Strange McNamara  was an American business executive and the eighth Secretary of defence.

Following that, he served as President of THE WORLD BANK from 1968 to 1981. McNamara was responsible for the institution of systems analysis in public policy, which developed into the discipline known today as policy analysis.

Lee Jong WooK

LEE Jong-wook was nominated on 28

January 2003 by the World Health

Organization's Executive Board for the

post of Director-General of the agency

and elected to the post on 21 May by the

Member States of WHO for a five-year

term.

Dr. Mirta Roses Periago

Dr Mirta Roses Periago, from Argentina, took office as Director of the Pan American Health Organization (PAHO) and WHO Regional Director for the Americas (AMRO) in 2003 and is currently in her second term.

Director of the Pan American Health Organization (PAHO)

Sir Edwin Chadwick

He was an English social reformer, noted for his work to reform the Poor Laws and improve sanitary conditions and public health.

Dr. Margarat Chan

Dr Margaret Chan is the Director-General of WHO and was first appointed by the World Health Assembly on 9 November 2006. The Assembly appointed Dr Chan for a second five-year term at its sixty-fifth session in May 2012. Dr Chan's current term began on 1 July 2012 and will continue until 30 June 2017.

16 SURPRISING FACTS ABOUT PUBLIC HEALTH

1. Public health systems are typically divided into three major categories: epidemiology, biostatistics and health services. The health services arena is the one most of us are most familiar with.

2. Subfields of these major categories include environmental, social, behavioral and occupational health are subfields of the major categories.

3. The focus of public health intervention should always be the prevention of disease before the treatment of it.

4. The UN’s World Health Organization is the world’s most recognized health organization that seeks to improve public health throughout the world.

5. The head of the public health system in the US is the Surgeon General.

6. In 2000, the US government spent $4500 per capita on public health.

7. In contrast, in many African nations, government spending on public health is less than $10 per person.

8. The Centers for Disease Control and Prevention in Atlanta, Georgia is one of the most widely recognized public health organizations. Many people do not realize that they work on health problems all over the world – not just US health problems.

9. One of the earliest examples of a public health system was during the Roman times, when a system for disposing of diversion of human waste was developed in order to prevent the population from disease.

10. One of the biggest accomplishments of worldwide public health programs is immunizations, and the eradication of diseases like polio because of immunization.

11. One of the first examples of immunization came as early as 100 BC in China. Children were “inoculated” against smallpox by putting the pus from a lesion of an infected individual into a scratch on their arm to prevent them from contracting the disease.

12. Another example of early public health programs was in the 14th century during the “Black Death” in Europe. Officials found that they could stem the spread of the disease by burning portions of the cities where infestations had been so prevalent. We now know that the disease was rodent borne. So, burning the cities killed off the infestations of rats that were spreading the disease.

13. The idea of quarantining those with infectious diseases came about during the medieval period. This was also an early example of a public health measure.

14. Even the development of regular garbage collection programs as cities grew is an example of a public health program. Scientists quickly discovered how dangerous garbage was to public health.

15. One of the primary reasons that average life expectancy across much of the world has increased so dramatically in the last few years is the development of public health systems, which have brought vaccinations, public health departments and health education programs to the masses.

16. Today’s public health departments focus their efforts on broadening public health’s reach through education in addition to the work they’ve always performed. For example, newer public health programs often educating the public about risky behaviors, such as obesity, alcoholism and unsafe sex. These programs seek to reduce the number of health issues related to behavior.

REFERENCES Marion Willard Eavans Jr, Chapter – 2, Basic concepts in public health, Jones

and Barlett.

WHO website.

www.googleimages.com

Park K (2015). Park’s Text book of Preventive and Social Medicine. 23RD

ed. M/s Banarasidas Bhanot publishers. Jabalpur.

The Healthy Public 2016