public health

2. CHANGING
CONCEPTS IN
PUBLIC HEALTH
 Dr SAKSHI KAUR CHHABRA
 2nd YR PG STUDENT
 DEPARTMENT OF PUBLIC HEALTH DENTISTRY
 PACIFIC DENTAL COLLEGE AND HOSPITAL, DEBARI

3. CONTENTS
INTRODUCTION
DEFINITION
PHASES OF PUBLIC HEALTH
NOTABLE FIGURES IN PUBLIC HEALTH
REFERENCES

4. INTRODUCTION
 Public health refers to all organized measures (whether public or
private) to prevent disease, promote health, and prolong life among
the population as a whole.
 Its activities aim to provide conditions in which people can be
healthy and focus on entire populations, not on individual patients or
diseases.
 Thus, public health is concerned with the total system and not only
the eradication of a particular disease.

5. DEFINITION
 Public health, as defined by C. E. A, Winslow, a leading figure in the history of
public health is defined as ‘the science and art of preventing disease, prolonging
life, and promoting health and efficiency through organized community efforts
for the sanitation of the environment, the control of community infections, the
education of the individual in personal health, the organization of medical and
nursing services for the early diagnosis and preventive treatment of disease, and
the development of the social machinery which will ensure to every individual in
community a standard of living adequate for the maintenance or improvement of
the health’.

6. PHASES OF PUBLIC HEALTH
 In the history of public health, four distinct phases may be demarcated :
1. Disease control phase (1880 – 1920)
2. Health promotional phase (1920 – 1960)
3. Social engineering phase (1960 – 1980)
4. ‘Health for All’ phase (1981 – 2000 AD)

7. [1] DISEASE CONTROL
PHASE (1880-1920)
 Public health during the 19th century was largely a matter of sanitary
legislation and sanitary reforms aimed at the control of man's physical
environment, e.g., water supply, sewage disposal, etc.
 Clearly these measures were not aimed at the control of any specific disease, for
want of the needed technical knowledge.
 However, these measures vastly improved the health of the people due to
disease and death control.

8. [2] HEALTH PROMOTIONAL
PHASE (1920-1960)
 At the beginning of the 20th century, a new concept, the concept of
"health promotion" began to take shape.
 It was realized that public health had neglected the citizen as an
individual, and that the State had a direct responsibility for the health
of the individual. Consequently, in addition to disease control
activities, one more goal was added to public health, that is, health
promotion of individuals.
 It was initiated as personal health services such as mother and child
health services, school health services, industrial health services,
mental health and rehabilitation services.

10.  Public health nursing was a direct offshoot of this concept. Public
health departments began expanding their programs towards health
promotional activities.
 C.E.A. Winslow - one of the leading figures in the history of public,
health, in 1220 defined public health as "the science and art of
preventing disease, prolonging life and promoting health and
efficiency through organized community effort". This definition
summarizes the philosophy of public health, which remains largely
true even today.

11.  Since the State had assumed direct responsibility for the health of the
individual, two great movements were initiated for human
development during the first halt of the present century, namely
(a) Provision of "basic health services" through the medium of primary
health centres and sub centres for rural and urban areas evolution of
health centres is an important development in the history of public
health.
(b) The second great movement was the Community Development
Programme to promote village development through the active
participation of the whole community and on the initiative of the
community.

12. [3] SOCIAL ENGINEERING
PHASE (1960-1980)
 With the advances in preventive medicine and practice of public
health, the pattern of disease began to change in the developed
world. Many of the acute illness problems have been brought under
control.
 However, as old problems were solved, new health problems in the
form of chronic diseases began to emerge, e.g., cancer, diabetes,
cardiovascular diseases, alcoholism and drug addiction etc.
especially in the affluent societies.

13.  A new concept, the concept of "risk factors" as determinants of these
diseases came into existence.
 The consequences of these diseases, unlike the swift death brought by
the acute infectious diseases, was to place a chronic burden on the
society that created them. These problems brought new challenges to
public health which needed reorientation more towards social
objectives.

14. Public health entered a new phase
in the 1960s, described as the
"social engineering" phase

15.  NEW PRIORITY WERE GIVEN TO
Social and behavioural aspects of disease
and health .
Public health moved into the preventive and
rehabilitative aspects of chronic diseases and
behavioural problems.

16. In short, although the term "public
health" is still used, its original
meaning has changed.
In view of its changed meaning and
scope, the term "community
health" has been preferred by some
leaders in public health.

17. [4] ‘HEALTH FOR ALL’ PHASE
 (1981 -2000 AD)
 As the centuries have unfolded, the glaring contrasts in the picture of
health in the developed and developing countries came into a sharper
focus, despite advances in medicine.
 Most people in the developed countries, and the elite of the
developing countries, enjoy all the determinants of good health -
adequate income, nutrition, education, sanitation, safe drinking water
and comprehensive health care.
 In contrast, only 10 to 20 per, cent of the population in developing
countries enjoy ready access to health services of any kind

18.  Death claims 60-250 of every 1000 live births within the first year of
life, and the life expectancy is 30 per cent lower than in the developed
countries .
 John Bryant in the introduction to his book: "Health and the
Developing World" presented a gloomy picture and a challenge of
inequalities in health by saying: "Large numbers of the world's people,
perhaps more than half, have no access to health care at all, and for
many of the rest the care they receive does not answer the problems
they have".

19.  The global conscience was stirred leading to a new awakening that the
health gap between rich and poor within countries and between
countries should be narrowed and ultimately eliminated.
 It is conceded that the neglected 80 per cent of the world's population
too have an equal claim to health care, to protection from the killer
diseases of childhood, to primary health care for mothers and children,
to treatment for those ills that mankind has long ago learnt to control,
if not to cure.

20. Against this background, in 1981, the members of the
WHO pledged themselves to an ambitious target to
provide Health for All by the year 2000, that is
attainment of a level of health that will permit all
peoples "to lead a socially and economically productive
life" .

21. 5 FAMOUS PUBLIC HEALTH OFFICIALS
WHO CHANGED THE WORLD
 Below are mentioned some of the known health care officials who
under their supervision paid to the cause of public health.
1) Mc Namara
2) Lee Jong WooK
3) Dr. Mirta Roses Periago
4) Sir Edwin Chadwick
5) Dr. Margarat Chan

22. Mc Namara
 Robert Strange McNamara was an
American business executive and the eighth
Secretary of defence.
 Following that, he served as President of
THE WORLD BANK from 1968 to 1981.
McNamara was responsible for the institution
of systems analysis in public policy, which
developed into the discipline known today
as policy analysis.

23. Lee Jong WooK
 LEE Jong-wook was nominated on 28
January 2003 by the World Health
Organization's Executive Board for the
post of Director-General of the agency
and elected to the post on 21 May by the
Member States of WHO for a five-year
term.

24. Dr. Mirta Roses Periago
Dr Mirta Roses Periago, from
Argentina, took office as Director
of the Pan American Health
Organization (PAHO) and WHO
Regional Director for the Americas
(AMRO) in 2003 and is currently
in her second term.
Director of the Pan American
Health Organization (PAHO)

25. Sir Edwin Chadwick
He was an English social reformer,
noted for his work to reform the Poor
Laws and improve sanitary conditions
and public health.

26. Dr. Margarat Chan
Dr Margaret Chan is the Director-General of
WHO and was first appointed by the World
Health Assembly on 9 November 2006. The
Assembly appointed Dr Chan for a second five-
year term at its sixty-fifth session in May 2012.
Dr Chan's current term began on 1 July 2012
and will continue until 30 June 2017.

27. 16 SURPRISING FACTS ABOUT PUBLIC
HEALTH
1. Public health systems are typically divided into three
major categories: epidemiology, biostatistics and
health services. The health services arena is the one
most of us are most familiar with.
2. Subfields of these major categories include
environmental, social, behavioral and occupational
health are subfields of the major categories.

28. 3. The focus of public health intervention should
always be the prevention of disease before the
treatment of it.
4. The UN’s World Health Organization is the
world’s most recognized health organization that
seeks to improve public health throughout the
world.
5. The head of the public health system in the US is
the Surgeon General.

29. 6. In 2000, the US government spent $4500 per capita on
public health.
7. In contrast, in many African nations, government
spending on public health is less than $10 per person.
8. The Centers for Disease Control and Prevention in
Atlanta, Georgia is one of the most widely recognized
public health organizations. Many people do not realize
that they work on health problems all over the world –
not just US health problems.

30. 9. One of the earliest examples of a public health system was
during the Roman times, when a system for disposing of
diversion of human waste was developed in order to prevent the
population from disease.
10. One of the biggest accomplishments of worldwide public
health programs is immunizations, and the eradication of
diseases like polio because of immunization.
11. One of the first examples of immunization came as early as
100 BC in China. Children were “inoculated” against smallpox
by putting the pus from a lesion of an infected individual into a
scratch on their arm to prevent them from contracting the
disease.

31. 12. Another example of early public health programs was in the 14th
century during the “Black Death” in Europe. Officials found that they
could stem the spread of the disease by burning portions of the cities
where infestations had been so prevalent. We now know that the disease
was rodent borne. So, burning the cities killed off the infestations of rats
that were spreading the disease.
13. The idea of quarantining those with infectious diseases came about
during the medieval period. This was also an early example of a public
health measure.
14. Even the development of regular garbage collection programs as cities
grew is an example of a public health program. Scientists quickly
discovered how dangerous garbage was to public health.

32. 15. One of the primary reasons that average life expectancy
across much of the world has increased so dramatically in the
last few years is the development of public health systems,
which have brought vaccinations, public health departments and
health education programs to the masses.
16. Today’s public health departments focus their efforts on
broadening public health’s reach through education in addition
to the work they’ve always performed. For example, newer
public health programs often educating the public about risky
behaviors, such as obesity, alcoholism and unsafe sex. These
programs seek to reduce the number of health issues related to
behavior.

33. REFERENCES
 Marion Willard Eavans Jr, Chapter – 2, Basic concepts in public health, Jones
and Barlett.
 WHO website.
 www.googleimages.com
 Park K (2015). Park’s Text book of Preventive and Social Medicine. 23RD
ed. M/s Banarasidas Bhanot publishers. Jabalpur.
 The Healthy Public 2016