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What is Public Health? Public Health is Healthy People in Healthy Communities 1 of 51 Definition of Public Health • Public health is the science and art of • Preventing disease. • Prolonging life. • Organizing community efforts for the: • Sanitation of the environment. • Control of communicable diseases. • Education of the individual in personal hygiene. • Organization of medical and nursing services for the early diagnosis and preventive treatment of disease. • Development of the social machinery to ensure everyone a standard of living adequate for the maintenance of health. (Winslow, 1923) 2 of 51 “On Airs, Waters, and Places” “ These things one ought to consider most attentively, and concerning the waters which the inhabitants use, whether they be marshy and soft, or hard, and running from elevated and rocky situations, and then if saltish and unfit for cooking; and the ground, whether it be naked and deficient in water, or wooded and well watered, and whether it lies in a hollow, confined situation, or is elevated and cold; and the mode in which the inhabitants live, and what are their pursuits, whether they are fond of drinking and eating to excess, and given to indolence, or are fond of exercise and labor, and not given to excess in eating and drinking.” Hippocrates, 400 BC, translated by Francis Adam 3 of 51 Plague in Marseilles, 1720 4 of 51 Death Rates 1860 – 1970 3500 Deaths per 100,000 Tuberculosis 3000 Whooping Cough 2500 Measles 2000 1500 1000 500 0 1860 1870 1880 1890 1900 1910 1920 1930 1940 1950 1960 1970 5 of 51 Leading Causes of Death, 1990 Developed Nations 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Heart disease Cerebrovascular disease Cancer – lung, trachea Lower respiratory infections Chronic Obstructive Pulmonary Disease Cancer – colon, rectum Cancer – stomach Traffic accidents Self-inflicted injuries Diabetes Developing Nations 1. 2. 3. 4. 5. 6. 7. Lower respiratory infections Heart disease Cerebrovascular disease Diarrhoeal diseases Perinatal conditions Tuberculosis Chronic Obstructive Pulmonary Disease 8. Measles 9. Malaria 10. Traffic accidents 6 of 51 Twentieth Century • Governmental Reform • 1908 First Bureau of Child Hygiene, New York City Health Dept. • Dr. Josephine Baker • Appointed Bureau chief. • Established school nurse program. 7 of 51 Representations (1800s) Dickens Daumier 8 of 51 What are the Requirements for Survival? • Write down a list of critical things that humans need. 9 of 51 Mortality Rates U.S. vs % GNP Spent on Medical Care, 1900-1970 8.5% Total Mortality Percent GNP on Medical Care 15 7.5% 12.5 6.5% 10 5.5% 7.5 Mortality Minus 11 Infectious Diseases 3.5% 5 % GNP on Medical Care Mortality rates per 1,000 17.5 4.5% 1900 1910 1920 1930 1940 1950 1960 1970 J. McKinley and S. McKinley, “The Questionable Contribution of Medical Measures to the Decline of Mortality in the Twentieth Century.” Millbank Memorial Fund Quarterly 55 (1977): 413 Millbank Memorial 10 of 51 New York State Courts 11 of 51 Legal Hierarchy U.S. Constitution U.S. Congress Federal Agencies State Constitution State Legislatures Local Health Dept. Municipal Home Rule State Agencies 12 of 51 Legal Functions Legislative Branch Laws, Statutes, Ordinances Executive Branch Rules, Regulations Judicial Branch Interpretations 13 of 51 Examples Host Agent Environment Human Human Bacteria, Virus Energy Water, Food, Air Automobile 14 of 51