Contemporary public health has evolved through various historical stages. Its development as a discipline has been shaped throughout many years from the ancient times to the present day and different pioneers from different countries tremendously contributed to its historical evolution.
Furthermore, public health evolution has been marked by several changes since its inception and these changes were influenced by the newly developed ideas and scientific evidences for the purpose of improving the health of the population (Porter, 1994).
The essay here, in its first part, will attempt to discuss in more details the most important changes that public health has undergone in the course of its evolution and why these changes occurred.
In the second part, the explicit meaning of essential components of public health will be discussed and the way these should be achieved will be proposed throughout.
MOST IMPORTANT CHANGES IN THE HISTORY OF PUBLIC HEALTH AND REASONS FOR THESE CHANGES
Throughout human race history, health problems have existed and have been concerned mainly with community well-being. Most of these health problems were mostly caused by communicable diseases related to poor physical environment, insufficiency supply of water and food of good quality and poor provision of medical care. Interventions to cope with the above health issues have changed over time but closely linked and this led to what is known today as modern public health (Rosen, 1993, p.1).
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1.1. Early history of public health
Available literature demonstrates that there are evidences of activities associated with the improvement of community health that have existed from the ancient times. Rosen (1993:1) outlines that, in the north India some 4000 years ago, archaeological findings have shown that there has been a developed urban planning system with great sanitation and housing. He further adds that other evidences have shown, in other Asian countries, that the same system was largely developed mostly in Egypt to mention but a few.
Apart from the above earliest development, public health continued its evolution over the centuries pioneered by several authors among them Hippocrates. This honored Greek physician, also known as the “father of medicine” because of his commendable contribution on the practice of medical ethics for physicians demonstrated how proper diet, fresh air, a moderate climate and attention to lifestyle and living conditions were important for healthy living (Schneider & Lilienfeld, 2008:5).
Later on, other societies inspired by the Greek civilisation, as it is the case for the Romans, continued to develop water and sanitation infrastructure and healthcare system. Schneider and Lilienfeld, (2008:5) reported that, further to the public health systems that were just introduced, Romans put in place governmental administration systems to overseeing the initiated changes. However, these early public health initiatives did not benefit all the population; vulnerable groups like slaves and those living in poverty did not have access to the safe drinking water and adequate sanitation and continuously suffered high rate of diseases as it is now noted in some parts of the world (Schneider & Lilienfeld, 2008:5).
1.2. Middle Ages
After these early development of public health, came the Medieval Ages (500-1500 A.D.) that were characterised by a decline of the Greco-Roman powers due to disintegration from within and invasions from outside that destroyed public health infrastructure(Rosen,1993:26).
During this period, health problems were thought to be having spiritual causes and the remedy as well. This belief was shared by both pagans and Christians. It was believed, for Christians, that there was a link between sin and the occurrence of disease and the latter was considered to be a punishment (Rosen, 1993:26). Biological and physical environment as the main factors in transmissible disease causation were ignored and this was the main implication of the spiritualism during this era and as a result it was difficult to control the epidemics that erupted leaving millions of people dead and others suffering from their sequels (International Health Sciences University, 2012).
Rosen (1993:35) states that the 2 devastating epidemics that may be considered which prevailed during this time are the Plague of Justinian and the Black Death in 543 and 1348 respectively. Moreover, other outbreaks between the above 2 dates ravaged Europe and other regions around Mediterranean Sea notably but not exhaustively: leprosy, smallpox, diphtheria, measles, tuberculosis, and scabies. Causes of these epidemics were not identified yet but it was thought that poor living conditions were highly associated.
After these horrific epidemics occurrence, various measures were put in place in Europe cities to fight against them and consequently improve public health. Establishment of butcheries and regulation about livestock possession, regulation of food at public market, food preservation and garbage disposal are the measures that proved to be effective in preventing disease transmission from animals to people or between people. Additionally, food preservation regulation played a key role in prevention of food borne diseases from damaged and expired food (International Health Sciences University, 2011).
1.3. Renaissance Era
The development of public health did not stop in Middle Ages. The followed period of renaissance (1500-1700 of Christian era) was marked by a rejection of older theories. However, the old theories helped in developing new ones. Spiritual theory about the cause of disease started to be doubtful as epidemics killed both sinners and saints. Environmental factors were uncovered to be the leading cause in the development of infectious diseases. Further critical observations of sick people, signs and symptoms they presented have shown that various illnesses were distinctly separate (International Health Sciences University, 2012).
It is worth to note that, during renaissance era, various authors brought new discoveries in the development of public health. Rosen (1993) reported that the Italian Giolamo Fracastoro brought in the theory of contagion where he showed the role of microorganisms in infectious diseases development and the way the communicable diseases are transmitted. The Dutchman Anton von Leeuwenhoek, the inventor of microscope, was the first man to confirm that the theory Giolamo Fracastoro developed was probably true after his observation of microbes agents.
Indeed, the contribution of other authors (Petty, John Graunt and Gottfried Achenwall) in this important era of public health evolution was significant. They introduced the concept of measurement in public health to quantify health problems like calculations of mortality, life expectancy and fertility (Rosen, 1993).
Despite this new era of rethinking and developing new ideas about public health, some diseases like malaria, smallpox and plague continued ravaging and killing many people in some European countries. Also, travels and movements between urban and rural areas dominated this era, explaining the spread of these illnesses to other areas causing suffering to their inhabitants.
1.4. The enlightenment epoch
This is the period from 1750 to mid-nineteenth century (Encyclopedia of Public Health, 2002).The enlightenment era is considered to be the era where public health discipline has known tremendous progress. Rosen (1993) states that enlightenment era was seen as “pivotal” in the development of public health.
Industrial development was the main turning point during this era. Likewise, social and political development has remarkably had a great impact on societal transformation and the knowledge about the way communicable diseases are spread has increasingly improved. (Encyclopedia of Public Health, 2002).
Despite the remarkable changes, it is stated that health conditions were still demanding due to the great number of people moving towards industrial areas in the cities, poor sanitation system and insufficiency in clean water supply. Additionally, working conditions were not conducive for those mainly working in mines and factories. All of these factors largely contributed to the spread of diseases (Rosen, 1993).
In England, Edwin Chadwick demonstrated the reality of poverty disease cycle and attempted to measure the association between poverty and disease. Also, Chadwick linked the disease with environmental factors. His report “The Report of a General Plan for the Promotion of Public and Personal Health (1850)” attracted attention and is considered by many as one of the important documents of modern public health (Encyclopedia of Public Health, 2002).
Chadwick’s evidences were later proved by John Snow’s work during the famous 1848 London cholera outbreak where he identified that the contamination of water pump was the probable origin of the epidemic (International Health Sciences University, 2012).
Towards 19th century, new discoveries in bacteriology emerged. The great work of the Frenchman Luis Pasteur collaboratively with other scientists showed that micro-organisms were responsible of diseases occurrence thus proving to be false the theory of “spontaneous generation” developed before; henceforth the “germ theory” was born. Later on, the Germany Robert Koch proved that one micro-organism causes specific disease (International Health Sciences University, 2012).
Following these remarkable findings, some medicaments were developed including some disinfectants which became popular in medical practice and as a result, mortality and morbidity rates declined significantly. Additionally, the identification of microbes as causative agents of diseases resulted in an establishment of immunology as a science and subsequently the vaccines were developed (International Health Sciences University, 2012).
1.5. Twentieth Century
Early on, decrease in mortality and morbidity rate was significant following the bacteriology emergence in later 19th Century. On the other hand, serious health problems did not disappear; infant mortality among others. It is reported that, for the time being, in Europe and in the United States of America health programs for improving maternal and child health were developed (Encyclopedia of Public Health, 2002).
Academic programs in public health were developed, given the growing scope and complexity of public health problems, to deal with research issues and to train public health personnel. Health organisations agencies and charities were established in tackling public health concerns for particular groups of population (Rosen, 1993).
Later on in twentieth century, expansion of public health roles continued and its horizon broadened. However, 1920’s and early 1930’s saw a slow development of public health. There was a decline in disease prevalence as a result of establishment of sanitary measures.
In the aftermath of World War II, there was an increasing growth of health infrastructure in the curative field but little attention was paid to planning
1960’s and early 1970’s marked what was named “period of social engineering”. The main characteristic of this period was the economic growth chiefly in the United States of America but part of the population were medically uncovered (International Health Sciences University, 2012).
Later 1970’s to 1980’s, health promotion initiatives, eradication of certain diseases that ravaged the world before and the emergence of new infectious disease were making headlines. Encyclopedia of public health (2002) states that the emergence of Human Immunodeficiency Virus infection, use of addictive drugs and air pollution were the main preoccupations of World Health Organisation and other international agencies.
As a final point, it is obvious that public health as a discipline has its own history which evolved over time from the early history of human race till today. The focus of public health enlarged as time advanced as health problems.
At the same time, the future of public health will be and will remain of an utmost importance in solving population’s health where everyone is invited to play his/her active role.
MEANING OF ESSENTIAL PUBLIC HEALTH COMPONENTS AND THE WAY THEY SHOULD BE ACHIEVED
2.1. Collective responsibility for health and the major role of the state in protecting and promoting health
Health sector is the main sector that deals with the health of populations. However, this does not mean that its activities are the only concerned with the promotion of community health.
World Health Organisation (2013) states that the health of populations is determined not only by the health sector but also by social and economic factors, and henceforth, policies and other actions other than of those of health sector. In developing health policies, governments should work collaboratively with other sectors involved in development process such as finance, education, agriculture, environment, housing and transport to see how their planning can reach their objectives while also improving health. Also, this intersectoral partnership helps in tackling other health related issues such as those activities that pollute environment or promote those activities aimed at having access to quality education or gender equality.
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2.2. Focus on the whole population
Public health activities are intended to promote the health of the whole population rather than individuals’ health. According to Riegelman (2010) the first thing to come to mind, in public health, is the health of the community and the society in general. Indeed, in public health the activities to improve the health are no longer individual-centered but rather population-centered.
To achieve this, collaboration between all development sectors is needed given the wide view of public health. The involvement of all development actors is seen as a comprehensive way of thinking about the scope of public health and it is an evidence-based approach for the analysis of health determinants and illnesses. This leads to evidence-based interventions to protect and improve health (Riegelman, 2010).
2.3. Emphasis upon prevention
Prevention constitutes a key component of public health practice. It has been said that “prevention is better than cure”; this statement shows how much prevention activities are of a paramount importance in public health. Health promotion and disease prevention activities play a key role in tackling health problems that the community faces which, in many cases, are preventable (World Health Organisation, 2002).
Strategies for prevention that aim to alleviate the risk factors by promoting healthy behaviours and reducing dangerous exposures need a collaboration between government and different stakeholders and active participation of the population(World Health Organisation,2002).
2.4. Recognizing underlying socio-economic determinants of health and disease
Socioeconomic determinants with other determinants of health (biological, environment, culture, personal behaviour, living and working conditions…) mostly influence the health status of population. Further, these health determinants may interact with other factors for better or worse.
Importantly, socioeconomic factors are thought to be major determinants of health. Washington State Department of Health (2007) reports that “Health impacts associated with lower socioeconomic position accumulate and persist throughout the lifespan”.
The partnership between public health professionals, community, nongovernmental organisations and governmental institutions is a major force to fix this issue (Washington State Department of Health, 2007).
2.5. Partnership with the population served
The collaboration with the community in addressing health issues is a core part of health promotion activities. Declaration of Alma Ata (1978) claims that the maximum involvement of community and individual self-reliance and the active participation in planning, organisation, operation and control of primary healthcare are the basis of success in health promotional activities. Therefore, policies, strategies and plan of action should be established by the government to ensure that primary healthcare is launched and sustained as a core part of health system in partnership with other sectors.
2.6. Multidisciplinary basis
Multidisciplinary feature of public health is unquestionable. According to Tzenalis & Sotiriadou (2010:50), the engagement of various stakeholders in the task of improving health of population shows that “promoting health does not belong to one group of professionals or sector of health services”.
The joint action from various professional groups at every level is reported to be effective and recommended in providing health promotion services (Solheim, Memory & Kimm 2007 cited in Tzenalis & Sotiriadou, 2010).
Altogether, the above described core components of modern public demonstrate how much wide the discipline of public health is. The active participation of all involved stakeholders is the key towards the success of public health practice.
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