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I. The meanings of “public health” in history
- The health of populations rather than individuals
- Control of disease requiring the authority of “public” bodies
rather than “private” choice. Public authority
expressed through religious leaders (e.g. priesthood
in Leviticus) or through secular leaders, usually local/regional
government (from town leaders to agents of the king
or officers of a nation state). Measures are often
taken only in times of crisis.
- Surveillance, intervention and control by the state
in the lives of individuals for reasons of the health
of the whole or to protect those considered vulnerable
to health risks.
II. Public health before the 19 th century – primarily
port cities and large towns
- Responses to epidemics: quarantine, pest houses,
disposal of the dead
- Regulations about “nuisances”: smelly
crafts, some concern for refuse, cemeteries
III. The Industrial Revolution – technological
progress and new environmental stresses
- Control over “nature” – the
agricultural revolution of the 17th-18th centuries
and improved nutrition
- Inventions of transformation
- sources of energy
for work
- heat -> steam engine (1760s-1780s)
- electricity -> electric
motors (physics - 1830s-40s; applications
1880s - 1910)
- petroleum products -> internal combustion
engine (1880s -)
- the production of goods –> reorganization
of labor –> new urbanization
- travel –> the railroad (from the 1820s)
- communication –> telegraph (c. 1850s),
telephone (c. 1880s)
- The new urbanization and
health: sewage, water supplies, crowding and
common hygiene
IV. Medicine and the new public health of epidemics
- the contagionists – person
to person causation – e.g.
smallpox
was the classic disease model
- inoculation comes to Europe in the early 18th
century
- inoculation = direct transmission of active
smallpox under controlled conditions
- Edward Jenner and vaccination = inoculation
with cowpox, a mild disease that confers immunity
to smallpox
- compulsory vaccination
- eradication of “wild” smallpox
(WHO, 1975....)
- a medical model -- treat the individual
in order to treat the population
- the sanitarians – environmental
contaminants caused disease “infection” with
"bad" or "contaminated" air - e.g. malaria, typhus
were classic disease models
- rise of state surveillance - collecting quantitative
data about populations (birth, death,
causes of death) for reasons other than taxation
and military induction
- e.g. London Bills of Mortality begun in 1603,
first UK census in 1801
- Government funded investigations
into health conditions – 1830s
to 1860s - a “machinery” of surveillance
over inhabitants
- Asiatic cholera and class conflict – 1832
- John Snow (early 1850s) and the water pump
in London
- Government legislation and funding for metropolitan
water and sewer systems – sanitary engineering
- Coercive authority and the public good
- a social-context model -- treat the environmental
conditions in order to treat the population
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