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Evolution of public health- Dr Subraham Pany

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Evolution of public health- Dr Subraham Pany

  1. 1. presented by: DR. SUBRAHAM PANY
  2. 2. Dr. Lipilekha Pattanaik- For presenting the idea of the topic Dr. E. Venkat Rao – For guiding me for the presentation. I thankmy H.O.D. & all the facultymembers for being a great helpto me in my seminar. My senior colleagues have providedme a great boost in completing my seminar
  3. 3. DEFINING PUBLIC HEALTH: “The science and art of preventing disease, prolonging life and promoting physical health and efficiency through organized community efforts for the sanitation of the environment, the control of community infections, the education of the individual in principles of personal hygiene, the organization of medical and nursing services for the early diagnosis and preventive treatment of diseases and the development of social machinery which will ensure every individual in the community, a standard of living adequate for maintenance of health” :by Winslow [REF.:TEXT BOOK OF PUBLIC HEATH AND COMMUNITY MEDICINE:AFMC:PG 7]
  4. 4. In studying history, we are able to understand how our predicament is similar to someone else's who came prior to us. We might also be able to examine what they did and assess if this is a path that we want to take or something we wish to avoid. Studying history connects us to something larger than merely subjective consciousness. [REF:K. PARK’S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICINE.]
  5. 5. From time immemorial man has been interested in trying to control disease. The medicine man, the priest, the herbalist and the magician, all undertook in various ways to cure man's disease and/or to bring relief to the sick. It has been truly said that medicine was conceived in sympathy and born out of necessity; and that the first doctor was the first man, and the first woman, the first nurse.
  6. 6. As centuries rolled on , civilisations' emerged in various regions , each civilisation having its own characteristic culture and life style. Every civilisation had a different hypothesis on health. Health was considered as a state of balance between various humors of human body, variously defined by various cultures. Disease were believed to result from a state of imbalance caused by disturbance in the relative proportion of these humors.
  7. 7. FATALISTIC THEORY * God rewards or punishes indivisuals on basis of their good and evil deeds DEMONISTIC THEORY *Indivisuals suffering from disease were possessed by demons *Demons were usually evil CHARMS THEORY *Good spirits bring health & prosperity *Evils spirits bring upon wrath
  8. 8. Dhanvantari : Hindu god of medicine. Ayurveda: meaning “the science of life” is the indigenous system of Indian medicine Ayurveda originated from Atharvaveda. Siddha: practiced in Tamil speaking areas of south India. Yoga: the key to a longer and healthy life is and was a basic component of health care
  9. 9. WORKING HYPOTHESIS Tri – dosa: Vata (wind) Pita (gall) kapha (mucus) LEADING PERSONALITIES Atreya : first Indian physician & teacher Charaka : Composed charaka samhita. Known as “father of Indian medicine” Sushuruta : composed sushuruta samhita (which describes various operative procedures & techiniques of plastic surgery). Known as “father of Indian Surgery”
  10. 10. WORKING HYPOTHESIS Five fold system : EARTH, METAL, WATER, WOOD & FIRE (Each related to five firm organs : Heart, Spleen, Lungs, liver and Kidney) 3 Celestial emperors:  Huang Ti : developed medical facilities  Nei Ching : a classic master of internal medicine LEADING PERSONALITIES
  11. 11. WORKING HYPOTHESIS They believed that the natural history of disease starts with the food consumed by an individual  Imhotep : was considered a master in all fields of learning and medicine. He developed a deep sense of sanitation among the Egyptians. [Ref : Foundations of community medicine: Elsevier publications 4th edition & K. Park’s Textbook of Preventive and Social Medicine 19th edition] LEADING PERSONALITIES
  12. 12. WORKING HYPOTHESIS 4 fold system : Blood, Phlegm, Black bile & Yellow bile (Each possessing properties of Heat, cold, moisture and dryness respectively) LEADING PERSONALITIES APPOLO AESCULAPIUS HYGEIA PANACEA Greek God of medicine The staff of Aesculapius -> CADUCACEUS HYGEIA : Goddess of Hygiene -> PREVENTIVE MEDICINE PANACEA : Goddess of Treatment -> CLINICAL MEDICINE
  13. 13. WORKING HYPOTHESIS BILE & PHLEGM (Describing Warmth and cold)  Galen : He produced some 500 treatise which were studied for around 14 centuries.  Celsus : A surgeon who developed method for control of Hemorrhage and Infection [Ref : Foundations of community medicine: Elsevier publications 4th edition] LEADING PERSONALITIES
  14. 14. Arabian MEDICINE They developed UNANI system of medicine  Rhazes : produced over 200 medical and philosophical treatise  Avicenna: Compiled the “canon of medicine” for general practitioners  Ibn. An. Nafis : Investigator and writer. He is known to conceive the idea of pulmonary circulation. LEADING PERSONALITIES
  15. 15. Mesopotamian MEDICINE WORKING HYPOTHESIS Liver was considered as the seat of life. There were interpretations of dreams relating them to disease. Prescription were written on tablets, in cuneiform writing. The oldest medical prescription comes to us from Mesopotamia, dating back to 2100 B.C. MAJOR WORK DONE [Ref : Foundations of community medicine: Elsevier publications 4th edition & K. Park’s Textbook of Preventive and Social Medicine 19th edition]
  16. 16. Miasmic: Toxic vapor or miasma emanated from decaying animal & vegetable matter are diffused into the surrounding and spread al sort of disease. Contagion/GERM : This theory held that epidemics resulted from transmission of germs. Spontaneousgeneration: Or Abiogenesis was originally propounded by Aristotle, who believed that living organisms directly emerged from non living organisms. Later the theory was displaced by theory of biogenesis, i.e., “Life originates from life” – by Louis Pasteur
  17. 17. It is believed to be the first written health code in world. The book dealt with personal and community responsibilities and included guidance regarding the cleanliness of body, sexual health behaviors & protection against contagious diseases. [REF:JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION IN 1920 AND IN THE NEW ENGLAND JOURNAL OF MEDICINE]
  18. 18. Created by the King of Babylon, is one of the earliest sets of laws found. It focuses on theft, farming, Human rights, murder, death, and injury. There was also a documented code for physicians and health practices.  There was also evidence of bathrooms and drains in homes as well as written medical prescriptions
  19. 19. (460 – 375 B.C. ) Introduced Scientific methods to the study of medicine His famous oath, the "Hippocratic oath" has become the keystone of medical ethics. Hippocrates will always be regarded as one of the “masters of the medical art”.
  20. 20. Also during this period, Greeks were active in the practice of community sanitation. Romans improved upon Greek engineering in the building of aqueducts to protect water supplies.  They also created the first hospital. [REF : FOUNDATIONS OF COMMUNITY MEDICINE: ELSEVIER PUBLICATIONS 4TH EDITION & K. PARK’S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICINE 19TH EDITION & GENEVA: WORLD HEALTH ORGANIZATION; 2008. ]
  21. 21. The Middle Ages, also known as "The Dark Ages”. Health problems were considered to have spiritual causes and solutions. Bloodletting and alchemy were common practices. Most importantly, the failure was to consider the role of the environment in health that led to epidemics and thus resulting in inability to control them.
  22. 22.  Black Plague or Black Death or bubonic plague.  It reappeared in Europe in 1348 after nearly a 1000 year absence. Up to 2/3rds of the succumbed in the first two years of the pandemic.  The pandemic was approached by scientists and by 1350 A.D.  An interesting historical footnote is that some scholars contend that corpses were used for “biological warfare.”
  23. 23.  This Era highlighted the value of a healthy and productive population, leading to advances in occupational health.  A milestone in the history of public health is the Great Sanitary awakening which took place in England & gradually spread to other countries.  Term Public Health came in to general use around 1840’s. It arose from need to protect the public from the spread of communicable diseases In 1848 (Cholera in London).  A comprehensive piece of legislation was brought into force in England, the Public Health Act of 1875 , for the control of man’s physical environment.  Preventive medicine really dates back to the 18th century. It developed as a branch of medicine distinct from Public Health. Preventive Medicine got a firm foundation after the discovery of causative agents of disease and establishment of the Germ Theory of disease.
  24. 24. PREVENTIVE MEDICINE: “The science and art of preventing disease, prolonging life, promoting physical and mental health and efficiency..” Definition: (By Leavell and Clark) • James Lind conclusively showed in 1748 that scurvy can be prevented by the use of fresh citrus fruits and vegetables. • Edward Jenner discovered small pox vaccine. • Thus the concept of ‘Preventive Medicine’ came. • And the scope of Preventive Medicine was broadened from the general measures of health promotion (hygiene) to specific measures of disease prevention (immunization).
  25. 25. COMMUNITY MEDICINE:  With the emergence of Non-communicable diseases and due to their multifactorial etiology, the concept of “MULTIFACTORIAL DISEASE CAUSATION” came into vogue.  So, measures like early diagnosis, identification of risk factors, limiting the development of disability and rehabilitation of handicapped persons were included into the subject.  Thus the scope was broadened from –  HYGIENE  PUBLIC HEALTH PREVENTIVE AND SOCIAL MEDICINE  COMMUNITY MEDICINE
  26. 26. (1620-1674) The father of demography and descriptive epidemiology. The first solid use of data collection for the purpose of understanding health status came from John Graunt.. In 1662, He published, Natural and Political Observation, Upon the Bills of Mortality. By studying London death data for the previous 75 years.
  27. 27. He was the first to observe bacteria and other microscopic organisms using a light microscope. In 1700 Bernardino Ramazzini (1633-1714) published first comprehensive occupational health treatise. He is known as the father of occupational health. [REF : FOUNDATIONS OF COMMUNITY MEDICINE: ELSEVIER PUBLICATIONS 4TH EDITION & K. PARK’S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICINE.
  28. 28.  French philosopher, Denis Diderot (1713- 1784) in his article on Man, emphasized the importance of infant mortality on the growth or decline of a population.  In his article The Hospital, Diderot outlined a public assistance scheme including old age insurance and medical care.
  29. 29. (1716 - 1794) While serving as surgeon on HMS Salisbury, he carried out experiments to discover the cause of scurvy. He established the superiority of citrus fruits above all other ‘remedies’. In 1753, he published ‘A Treatise of the Scurvy’ and in 1757 ‘An Essay on the Most Effectual Means of Preserving the Health of Seamen in the Royal Navy’.
  30. 30. In 1763 in the New World, smallpox infected blankets were distributed to Native Americans starting an epidemic which killed thousands. Now, Controversy still exists as to whether this was deliberate bioterrorism or a tragic mistake.
  31. 31. In 1796, Edward Jenner published his first paper on the potential for inoculation, which led to the development of the small pox vaccine. So successful was Jenner’s discovery, that in 1840 the government of the day banned any other treatment for smallpox other than Jenner’s (1749-1843)
  32. 32. Yellow Fever appeared in the U.S. in the late 17th century. The deadly virus continued to strike cities, mostly eastern seaports and Gulf Coast cities, for the next two hundred years, killing hundreds, sometimes thousands in a single summer.
  33. 33. The 19th Century brought tremendous advances in the understanding of health and medicine. There was an acceptance of link between environment and health & there were growing efforts at social reform as a way of improving the health of the population.
  34. 34.  In 1842, Edwin Chadwick, published his landmark report, “Report on the Inquiry into Sanitary Conditions of the Laboring Population of Great Britain”. This report outlined the major public health challenges facing England at the time leading to the beginnings of reform.  Chadwick campaigned for changes in the law. This included the reform of sanitation, education and transportation. [REF : National Commission on Macroeconomics and Health. Report of the National Commission on Macroeconomics and Health 2005. MOHFW, GOI. 2005]
  35. 35. In 1850 in Boston, Shattuck released a report. This report outlined the public health needs in the state of Massachusetts . Shattuck proposed the establishment of health offices at the state and local levels in order to gather statistical information on public health conditions. (1793-1859)
  36. 36. Cholera first came to Sunderland, England in 1831-32. It was not until the epidemic of 1854 that John Snow began to unravel the mystery of transmission
  37. 37. John Snow was the first to link the cholera epidemic in London to a particular water source—the Broad Street Pump. When the pump handle was removed the disease incidence drastically decreased. This was the birth of “applied epidemiology”. (1813-1858)
  38. 38. The century also saw the rise of nursing as a profession. Florence Nightingale believed that infection arose spontaneously in dirty and poorly ventilated places. She led to improvements in hygiene and healthier living and working environments. Florence Nightingale also advised and supported the development of district nursing in Liverpool. (1820-1910)
  39. 39.  These criteria are known as Koch’s Postulates.  Koch was awarded the Nobel Prize for Physiology in 1905.  German scientist, Robert Koch, was one of the founders of bacteriology.  In the process of discovering the causes of anthrax, cholera and tuberculosis (1882- 1883) He developed methods and technical procedures still used by epidemiologists.
  40. 40. French microbiologist Louis Pasteur conducted experiments that supported the germ theory. His work involved the development of systems of inoculation including the first vaccine for rabies. He invented the process of pasteurization.
  41. 41.  Ross studied malaria between 1881 and 1899. He worked on malaria in Calcutta at the Presidency General Hospital.  He demonstrated that malaria is transmitted from infected birds to healthy ones by the bite of a mosquito, a finding that suggested the disease’s mode of transmission to humans.  In 1902, Ross was awarded the Nobel Prize in Physiology / Medicine for his remarkable work. (1857 -1932)
  42. 42. In 1900 “The Reed Commission" after its leader, WALTER REED proved that the Aedes aegypti mosquito was the vector for yellow fever. This ended the belief that yellow fever spread by direct contact with infected people or "contaminated"
  43. 43. Her case exemplified the confrontation of public health, law, ethics, the media and anti-immigrant attitudes. In 1907 in New York City, cook Mary Mallon, was identified as the first healthy carrier of typhoid. She was then known as Typhoid Mary, Mallon spent the rest of her life in and out of quarantine on New Brother Island.
  44. 44. In 1916, published What Every Girl Should Know. It provided basic information about topics such as menstruation & acknowledged the reality of sexual feelings in adolescents. It was followed in 1917 by What Every Mother Should Know.  Sanger was a tireless pioneer for birth control and family planning measures.
  45. 45.  There were two prevailing forces shaping health and human services--the World War I and the Great Depression.  There was no health insurance and people were dependent on charities for health care.
  46. 46. In 1928, Scottish physician ALEXANDER FLEMING (1881-1955) discovered Penicillin while studying moulds. This discovery would be one of the most important discoveries of the Twentieth Century for its ability to kill bacteria and fight infectious disease.
  47. 47. Centers for Disease Control and Prevention (CDC) It was established in 1946 in Atlanta as the Communicable Disease Center. The World Health Organization (WHO) was established by the United Nations on April 7, 1948. Water Fluoridation began in 1948.
  48. 48. It was developed by JONAS SALK and ALBERT SABIN. The first mass inoculations of children against polio began in Pennsylvania on February 23, 1954. This Indian Civil Servant was responsible for the initial concepts of comprehensive health care. Bhore committee was set up by the Government of India in 1943 to investigate and recommend improvements to the Indian Public Health system. [REF : GOVERNMENT OF INDIA. NATIONAL HEALTH POLICY. MINISTRY OF HEALTH AND FAMILY WELFARE, GOVERNMENT OF INDIA, NEW DELHI: 2002 & KISHORE J. NATIONAL HEALTH PROGRAMS OF INDIA. NEW DELHI: CENTURY PUBLICATIONS; 2009.]
  49. 49. In 1960, Searle receives FDA approval to sell “Enovid” as an effective birth control pill. It transformed women's lives around the world. SEARLE: first pharmaceutical company to sell an oral contraceptive.
  50. 50. On January 11, 1964, LUTHER L. TERRY, Surgeon of the U.S. Public Health Service, released the report of the Surgeon General's Advisory Committee on Smoking and Health. That landmark document, now referred to as the First Surgeon General's Report on Smoking and Health, was America's first widely publicized official recognition that cigarette smoking is a cause of cancer and other serious diseases.
  51. 51.  Dr Sushila Nayyar, was the younger sister of Pyarelal Nayyar, personal secretary to Mahatma Gandhi.  She had set up the Mahatma Gandhi Institute of Medical Sciences in Wardha, in 1969 and remained committed to confine her energies to developing and extending it.  Dr. Nayyar also headed the Gandhi Memorial Leprosy Foundation.  She was also a campaigner for family planning.
  52. 52. 1981 a mysterious epidemic was identified as Acquired Immune Deficiency Syndrome (AIDS).  It was found to be caused by the Human immunodeficiency virus (HIV).  It is now a global pandemic. More than 23 million people with AIDS have died since 1981. Millions more are living with HIV. GENEVA: WORLD HEALTH ORGANIZATION; 2014.
  53. 53. In 1990, the Human Genome Project was formally established. The project endeavored to map the human genome down to the nucleotide level and to identify all the genes present in it.
  54. 54. 1. Vaccination 2. Motor vehicle safety 3. Safer workplaces 4. Control of infectious diseases 5. Decline in deaths from coronary heart disease and stroke 6. Safer, healthier food 7. Healthier mothers and babies 8. Family planning 9. Fluoridation of drinking water 10. Recognition of tobacco as a hazard
  55. 55. CARE- Co-operative for Assistance And Relief Everywhere UNICEF – United Nation International Children Emergency Fund WHO – World Health Organization WORLD BANK GOARN - Global Outbreak Alert and Response Network INTERNATIONAL HEALTH ORGANISATION International Federation Of RED CROSS ROTARY INTERNATIONAL BILL & MELINDA GATES FOUNDATION
  56. 56.  In January 2000, CDC published Healthy People 2010  This was considered to be the blueprint for the public health infrastructure in the new century.
  57. 57. One month after the 9-11 tragedy, anthrax contaminated letters were mailed to the New York Post offices and the U.S. Senate. Letters to Senator Tom Daschle and Senator Patrick Leahy, carried a more potent form of anthrax. The CDC confirmed anthrax cases at American Media, in Florida, and at the New York offices. 23 people contracted anthrax, 5 of whom died & many more exposed.
  58. 58. China 2002 Spread to 37 countries through Air travel 8000 infected & 800 dead A Global Problem By 2010, 219 million infected world wide & 6,60,000 died Most common in Africa, Asia Native America 1918 Kansas : 50 million affected [REF:NATIONAL MUSEUM OF HEALTH & MEDICINE, ARMED FORCES INSTITUTE OF PATHOLOGY ] 2009 Major pandemic in Asian Sub continent Annual epidemics :3 to 5 Million severe illness & 2,50,000 to 5,00,000 deaths around the world. REF:WHO 2015
  59. 59. By 2012 : 8.3 million people fell ill & 1.3 million dead Out break in West Africa : March 2014  Avian Influenza A(H7N9) virus : March 2013
  60. 60. PREVENTIVE & PROMOTIVE HEALTH CARE  Mission Indradhanush PROGRAMMES FOR COMMUNICABLE DISEASES  Revised National Tuberculosis programme  National Leprosy Eradication programme  National vector borne disease control programme  National AIDS control programme  Pulse Polio Programme PROGRAMME FOR NON-COOMUNICABLE DISEASE  National Tobacco control programme  National programme for prevention & control of cancer, Diabetes, Cardiovascular Diseases & stroke  National programme for control treatment of occupational diseases  National programme for prevention & control of Deafness  National Mental Health programme  National programme for Blindness NATIONAL NUTRITION PROGRAMME  Integrated Child development Services  National Iodine Deficiency disease control programme  Mid – day meal programme  Programmes related to system strengthening / welfare  National programme for the heath care of the Elderly  RMNCH  The National health Mission  National Urban health Mission MISCELLANEOUS  Voluntary blood donation programme  Universal immunisation programme  Integrated Disease surveillance project  Pradhan Mantri Swasthya Suraksha Yojana  Janani sishu surakshya Karyakram  Rashtriya kishore Swastha Karyakram REF: NATIONAL HEALTH PORTAL; WWW.NHP.GOV.IN
  61. 61. THANK YOU !

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