CPH - Unit 1

• Presentation of Contents


  • COMMUNITY & PUBLIC HEALTH: YESTERDAY,TODAY, AND TOMORROW
  • A BRIEF HISTORY OF COMMUNITY AND PUBLIC HEALTH
• Early Civilizations


  • Ancient Societies (before 500 B.C.)
  • Classical Cultures (500 B.C. - 500 C.E.)
• Prior to 2000 B.C.


  Archeological findings provide evidence of sewage disposal and written medical prescriptions
• Circa 1900 B.C.


  Perhaps the earliest written record of public health was the Code of Hammurabi; included laws for physicians and health practices
• Circa 1500 B.C.


  Bible's Book of Leviticus was written; includes guidelines for personal cleanliness and sanitation
• Fifth and sixth centuries B.C.

  • Evidence that Greek men participated in games of strength and skill and swam in public facilities
  • Greeks were involved in practice of community sanitation; involved in obtaining water from far away sources and not just local wells
• Romans


  • Improved on community sanitation of Greeks; built aqueducts to transport water from miles away; built sewer systems; created regulation for building construction, refuse removal, and street cleaning and repair; created hospitals as infirmaries for slaves
• A.D 476


  Roman Empire fell and most public health activities ceased
• Middle Ages (A.D 500 –1500)


  • A.D 500–1000 (Dark Ages)
  • A.D 1200
• A.D 500–1000 (Dark Ages)


  • Growing revulsion for Roman materialism and a growth of spirituality; health problems were considered to have both spiritual causes and spiritual solutions, a time referred to as the spiritual era of public health
• Failure to take into account the role of the physical and biological environment in the causation of communicable diseases

  • Resulted in many unrelenting epidemics in which millions suffered and died
• Deadliest epidemics of the period

  • Plague ("Black Death")
  • Smallpox
  • Diphtheria
  • Measles
  • Influenza
  • Tuberculosis
  • Anthrax
  • Trachoma
• A.D 1492


  Syphilis epidemic was last epidemic of the period
• Renaissance and Exploration (1500–1700)


  • Rebirth of thinking about the nature of world and humankind
  • Belief that disease was caused by environmental, not spiritual factors
  • Observation of ill led to more accurate descriptions of symptoms and outcomes of diseases
  • 1662: John Graunt published the Observations on the Bills of Mortality, which was the beginning of vital statistics
  • Epidemics (e.g., smallpox, malaria, and plague) still rampant
  • Explorers, conquerors, and merchants and their crews spread disease to colonists and indigenous people throughout the New World
• Timeline and Highlights of Community and Public Health from 1700–2010

  • Eighteenth Century (1700s)
  • First Half of Nineteenth Century (1800–1848)
  • Second Half of Nineteenth Century (1848–1900)
  • Twentieth Century
• Eighteenth Century (1700s)


  • Period characterized by industrial growth; workplaces were unsafe and unhealthy (Cities were overcrowded, and water supplies were inadequate and often unsanitary. Streets were usually unpaved, filthy, and heaped with trash and garbage. Many homes had unsanitary dirt floors)
  • 1793: yellow fever epidemic in Philadelphia
  • 1796: Dr. Edward Jenner successfully demonstrated smallpox vaccination
  • 1798: Marine Hospital Service (forerunner to U.S. Public Health Service) was formed
  • By 1799: several of America's largest cities, including Boston, Philadelphia, New York, and Baltimore, had municipal boards of health
• 1796


  Dr. Edward Jenner successfully demonstrated smallpox vaccination by inoculating a boy with material from a cowpox (Vaccinia) pustule. When challenged later with material from a smallpox (Variola) pustule, the boy remained healthy.
• 1798


  Marine Hospital Service (forerunner to U.S. Public Health Service) was formed
• First Half of Nineteenth Century (1800–1848)

  • U.S. government's approach to health was laissez faire (noninterference)
  • 1813: first visiting nurse in United States
• Second Half of Nineteenth Century (1848–1900)

  • 1849: London cholera epidemics
  • Dr. John Snow studied the epidemic and hypothesized that the disease was being caused by the drinking water from the Broad Street pump. Snow's action was remarkable because it led to the discovery that microorganisms can cause disease.
  • 1850: Modern era of public health begins
  • 1850: Lemuel Shattuck's report included recommendations for the establishment of boards of health, the collection of vital statistics, the implementation of sanitary measures, and research on diseases.
  • 1863: Louis Pasteur proposed germ theory
  • 1872: American Public Health Association founded
  • 1875–1900: Bacteriological period of public health
  • 1876: Robert Koch established relationship between a particular microbe and a particular disease
  • 1900: Major Walter Reed announced that yellow fever was transmitted by mosquitoes
• Miasmas theory


  According to this theory, vapors, or miasmas, were the source of many diseases
• Twentieth Century


  • Health Resources Development Period (1900–1960)
  • The Great Depression and World War II
  • Postwar Years
  • Period of Social Engineering (1960–1973)
  • Period of Health Promotion (1974–present)
• Health Resources Development Period (1900–1960)

  • The Reform Phase (1900–1920)
  • 1902: First national-level voluntary health agency created
  • 1906: Upton Sinclair's The Jungle was published
  • 1910: First International Congress on Occupational Diseases in Chicago
  • 1911: First local health department established
  • 1913: American Cancer Society founded
  • 1917: United States ranked 14th of 16 in maternal death rate
  • 1918: Birth of school health instruction
  • 1918: First school of public health established in John Hopkin's University in Baltimore
  • 1923: Establishment of another school at Harvard University
• 1922


  Thomas D. Wood created first professional preparation program for health educators
• 1930


  Life expectancy in the United States was 59.7 years
• The Great Depression and World War II


  • 1933: Franklin D. Roosevelt created numerous agencies and programs for public works as part of his New Deal; Much of the money was used for public health, including the control of malaria, the building of hospitals and laboratories, and the construction of municipal water and sewer systems included unsuccessful attempt at national health care program
• 1946


  National Hospital Survey and Construction (Hill-Burton) Act passed. The goal of the legislation was to improve the distribution of medical care and to enhance the quality of hospitals.
• 1952


  Development of polio vaccine
• Period of Social Engineering (1960–1973)

  • 1965: Medicare and Medicaid bills passed
• Medicare and Medicaid


  Medicare assists in the payment of medical bills for the elderly and certain people with disabilities, and Medicaid assists in the payment of medical bills for the poor.
• Period of Health Promotion (1974–present)


  • 1974: A New Perspective on the Health of Canadians published
  • 1976: Health Information and Health Promotion Act passed
  • 1979: Healthy People published
  • 1980: Promoting Health/Preventing Disease: Objectives of the Nation published
  • 1990: Healthy People 2000 published
  • 2000: Healthy People 2010 published
  • 2010: Affordable Care Act becomes law
• Healthy People 2020 Vision


  A society in which all people live long, healthy lives.
• Healthy People 2020 Mission

  • Identify nationwide health improvement priorities
  • Increase public awareness and understanding of the determinants of health, disease, and disability and the opportunities for progress
  • Provide measurable objectives and goals that are applicable at the national, state, and local levels
  • Engage multiple sectors to take actions to strengthen policies and improve practices that are driven by the best available evidence and knowledge
  • Identify critical research, evaluation, and data collection needs

  
• Healthy People 2020 Goals

  • Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death
  • Achieve health equity, eliminate disparities, and improve the health of all groups
  • Create social and physical environments that promote good health for all
  • Promote quality of life, healthy development, and healthy behaviors across all life stages
• History of Community and Public Health in the Philippines

  • Pre-Colonial Period
  • Spanish Occupation
  • US Occupation (1898-1946)
  • Bureau of Health
  • Creation of the Department of Health
• Pre-Colonial Period


  • Many existing beliefs and practices in the Philippines, includes: Magic religious elements, e.g., beliefs in spirits and sorcery as causes of illness; Empirical aspect e.g., use of medicinal plants
  • Archaeological sites in the Philippines have yielded skeletal remains showing intricate ornamental dental work and the use of trephination
• Spanish Occupation


  • Spain laid the foundation for a feudal health care system
  • Religious orders built hospitals, often next to churches
  • Medical education was not extended to the indio until late in the 9th century, through the University of Santo Tomas
• US Occupation (1898-1946)


  • United States established economic system giving the colonizers full right's to use the countries resources
  • Spanish feudal system was not dismantled- tenancy became more widespread
  • US also introduced western models of educational and health care system which reinforced elitism and a colonial mentality, mixed with the Spanish feudal patron-client relationship
  • September 29, 1898- Americans established a military Board of Health with Dr. Frank S. Bourns as president
  • Civilian Board of Health was established in 1901 whom Dr. L. M. Maus as the first health commissioner
  • Americans organized and erected several institutions, including the Bureau of Governmental Laboratories, built in 1901 for medical research and vaccine production
  • Americans, led by Dean Worcester built the UP College of Medicine and Surgery in 1905, with Johns Hopkins University serving as a blueprint
  • By 1909, nursing instruction begun at the Philippine Normal School
  • In terms of public health, the Americans improved on the sewer system and provide a safer water supply
• Bureau of Health


  • 1915- Bureau of Health was organized and renamed into the Philippine Health Service
  • A number of health institutions were already being given to Filipinos, in accordance with the Organic Act of 1916
  • January 1, 1919- Dr Vicente De Jesus became the first Filipino to head the health portfolio
  • 1933- Philippine Health Services reverted to being known as the Bureau of Health
  • it pursued its official journal, The Health Messenger
  • established Community Health and Social Centers, precursors to todays Barangay Health Centers
  • 1936- Governor General Frank Murphy assumed the post of US High Commissioner, he remarked that the Philippines led all oriental countries in terms of health status
  • When the Commonwealth of the Philippines was inaugurated, Dr. Jose Fabella was named Chief of the Bureau of Health
  • 1936- Dr. Fabella reviewed the Bureau of Health's organization and made an inventory of its existing facilities
  • 1940s- Bureau of Health was reorganized into Department of Health and Public Welfare under Dr. Fabella
  • Major priorities of the agency: TB, malnutrition, malaria, GI disease and high infant mortality
  • Health was relegated to the Department of Education, Health and Public Welfare under Commissioner Claro M. Recto
• Creation of the Department of Health

  • 1947- President Manuel Roxas signed E.O. No. 94 into law, calling for the creation of the Department of Health
  • Dr. Antonio C. Villarama - appointed secretary
  • A new Bureau of Hospitals and Bureau of Quarantine were created under DOH
  • Under E.O. 94, the Institute of Nutrition was created in 1948 to coordinate various nutrition activities of the different agencies
  • February 20, 1958- E.O. No. 288 provided for the reorganization of the Department of Health - entailed a partial decentralization of powers and created 8 Regional Offices
  • Marcos administration- one of the priorities is health maintenance
  • 1975-mid-eighties- 4 specialty hospitals were built in succession: the Philippine Heart Center, Philippine Children's Medical Center, National Kidney and Transplant Institute, Lung Center of the Philippines
  • Department of Health- transformed into the Ministry of Health on June 2, 1978 with Dr. Clemente S. Gatmaitan as the first health minister
  • April 13, 1987- Department of Health was created from the previous Ministry of Health