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• Major historical figures and events that played a role in the evolution of public health and epidemiology
• Definition of public health
• Distinction between Public Health and Community Health
• Categories of community health care
• • Agricultural Revolution: shift from hunter-gatherer to agricultural living provided a more secure food supply but also introduced diseases carried by domesticated animals, led to diets lacking in nutrients, and increased disease transmission due to larger settled populations and waste accumulation attracting disease vectors
  • The Hippocratic Corpus: early attempt to think about diseases as imbalances of man with the environment, considered diseases not as punishment from gods but as environmental or dietary imbalances, opened up the possibility of intervening to prevent or treat diseases
• Early concepts of disease:

  • Hunter Gatherers: humans were hunter-gatherers ten thousand years ago, focused on finding enough food to eat, lived in small groups, hunted and foraged for food, had a balanced diet, and had few problems with waste or contaminated water or food
  • Mythology, Superstition, and Religion: early explanations of disease focused on superstition, myths, and religion, with beliefs in mischievous or vengeful natural spirits, and stories like Zeus cramming diseases, sorrows, vices, and crimes into a box given to Epimetheus
• • The Bubonic Plague (1347-1700s): an acute infectious disease caused by the bacterium Yersinia pestis, transmitted to rats by flea bites, with rats serving as a natural reservoir for the disease and fleas transmitting it
• Plague transmission:

  • Rats serve as a natural reservoir for the disease
  • Fleas are the vectors
  • Infected fleas can jump to humans and introduce the bacteria during a blood meal
  • Bacteria spreads to regional lymph nodes and multiplies, causing dark, tender, swollen nodules (buboes)
  • Symptoms include headache, high fever, delirium, and death in about 60% of cases
• Causes of the Plague and Prevention Strategies:

  • The cause of the plague was not known, but theories included miasmas (invisible vapors from swamps or cesspools), person-to-person contact, sun exposure, or intentional poisoning
  • The miasma theory was the most popular, but the primary mode of transmission was actually via flea bites
  • Real causes were increased population density and failure to dispose of garbage, leading to rat populations exploding
  • Rats harbored fleas and Yersinia pestis, leading to plague epidemics when humans came into proximity with rats, fleas, and Yersinia pestis
• Ideas about Health:

  • Systematic thinking about health determinants and disease evolved over centuries
  • John Graunt (1662) observed common causes of death, higher death rates in men, seasonal variations, and constant vs. varying death rates for diseases
  • Graunt estimated population size and rates of population growth, constructing life tables to address survival from birth
  • Anton van Leeuwenhoek (1670s) was the "father of microscopy," using microscopes to discover bacteria, yeast, protozoa, sperm cells, and red blood cells
• • John Pringle in the 1740s studied "Jail Fever" and served as physician general to British forces during the War of Independence
• John Pringle served as physician general to British forces during the War of the Austrian Succession (1740-1748)
• Pringle proposed measures to improve the health of soldiers, including improvements in hospital ventilation and camp sanitation, proper drainage, adequate latrines, and the avoidance of marshes
• Pringle wrote extensively on the importance of hygiene to prevent "typhus" or "jail fever", which was a common malady among soldiers and prisoners in jails
• Pringle coined the term "influenza"
• James Lind and Scurvy (1754):

  • Scurvy is due to a deficiency in vitamin C that results in weak connective tissue and abnormally fragile capillaries that rupture easily, causing bleeding, anemia, edema, jaundice, heart failure, and death
  • Scurvy was a huge problem in sailors several centuries ago due to the chronic lack of fresh fruit and vegetables during long sea voyages
  • James Lind, a Scottish naval surgeon, suspected that citrus fruits could prevent scurvy based on some anecdotal observations
• Francois Broussais & Pierre Louis (1832):

  • Francois Broussais used bloodletting to treat many diseases, including cholera
  • Pierre Louis, a contemporary of Broussais, believed in using numerical methods to evaluate treatment and found bloodletting ineffective, though many dismissed his conclusions
• Ignaz Semmelweis and Oliver Wendell Holmes (1840s):

  • Ignaz Semmelweis, a Hungarian physician, practiced in the maternity department of Vienna General Hospital in the 1840s and required attendants to wash hands with chlorinated water to control the spread of infection
  • Oliver Wendell Holmes, Sr., an American physician and advocate for medical reforms, believed that doctors and nurses could carry puerperal fever from patient to patient
• John Snow - The Father of Epidemiology:

  • John Snow, a physician in London, spent several decades studying cholera in a systematic way and is credited with solving an outbreak of cholera in London in 1854
• Edwin Chadwick and the Sanitary Idea:

  • In 1842, Sir Edwin Chadwick published a report proving that life expectancy was much lower in towns than in the countryside and was instrumental in creating a central public health administration that led to improvements in health and well-being
• Louis Pasteur (late 1800s):

  • Louis Pasteur, a French biologist and chemist, made enormous contributions to germ theory, prevention of food spoilage, and disease control
• Louis Pasteur studied fermentation in wine and beer, concluding that microorganisms were responsible
• Pasteur discovered that microbes in milk could be killed by heating to about 130 degrees Fahrenheit, a process known as pasteurization
• Some microorganisms require oxygen (aerobic organisms), while others reproduce in the absence of oxygen (anaerobic)
• Pasteur pioneered the idea of artificially generating weakened microorganisms as vaccines
• Edward Jenner demonstrated the principle with cowpox, which could be used to vaccinate against smallpox
• Pasteur artificially weakened strains of anthrax and cholera to generate vaccines
• Public health is the science and art of preventing disease, prolonging life, and promoting human health through organized efforts and informed choices of society, organizations, public and private, communities, and individuals
• Charles Edward - A. Winslow defined public health as the science and art of preventing disease, prolonging life, and promoting physical health and efficiency through organized community efforts, control of community infections, education of the individual in principles of personal hygiene, organization of medical and nursing service for early diagnosis and preventive treatment of disease, and the development of social machinery to ensure to every individual in the community a standard of living adequate for the maintenance of health
• Health depends on a complex interplay among an array of genetic, environmental, and lifestyle factors
• Public health is built on expertise and skills from many areas, including biology, environmental and earth science, sociology, psychology, government, medicine, statistics, communication, and many others
• The strategy employed by public health is to:

  • Identify and define health problems
  • Identify the determinants, i.e., the factors associated with the problem (risk factors)
  • Develop and test interventions to control or prevent the problem
  • Assess the effectiveness of interventions
  • Decline in death from cardiovascular disease
  • Improvements of maternal and child health
  • Family planning
  • Fluoridation of drinking water
  • Reduction in the prevalence of tobacco use
• Community health refers to a group of people who share a common place, experience, or interest
• People may consider themselves part of a community with others who have had similar experiences, such as racial or ethnic communities, religious communities, or communities of people with disabilities
• Community health is a major field of study within the medical and clinical sciences
• It focuses on the maintenance, protection, and improvement of the health status of population groups and communities
• It is a distinct field of study that may be taught with a separate school of public health or environmental health
• Public health includes community health
• It is concerned with threats to health based on population health analysis
• Public health incorporates interdisciplinary approaches of epidemiology, biostatistics, health services, environmental health, community health, behavioral health, health economics, public policy, insurance medicine, and occupational health