Origins & Evolution

Question 1

Public Health

Answer 1

science of protecting and improving the health of populations through education, promotion of healthy lifestyles, and prevention of diseases

Question 2

Who implements public health services?

Answer 2

government agencies or groups held accountable to community

Question 3

Colonial Period

Answer 3

Challenges: plague, cholera, smallpox

Disease View: a sign of poor moral and spiritual conditions

Treatment: meditation, piety, bloodletting, purging

LACK OF PUBLIC HEALTH EFFORT

Effort: European cities appointed public authorities to adopt and enforce isolation and quarantine measures normally on a ship for 40 days

Question 4

Humorism

Answer 4

4 Humors: blood (air), yellow bile (warm), black bile (Earth), phelgm (water/cold)

Imbalances of these humors could lead to illness and the treatment tried to restore the balance

Question 5

Blood Letting

Answer 5

• intentionally withdrawing blood from the patient’s body to restore the humors

Question 6

Methods of Blood Letting

Answer 6

Venesection: direct incision was made into a vein

Cupping: glass or metal cups were placed on the skin and a vacuum was created by heating the cup which drew blood to the surface

Leeching: medicinal leeches were applied to skin

BLOODLETTING IS STILL PRACTICED TODAY (hemochromatosis, polycythemia vera, porphyria cutanea)

Question 7

Purging

Answer 7

• aimed to eliminate excess humors through the use of laxatives or emetics

Question 8

Types of Purging Substances

Answer 8

• Tobacco Smoke enema device
• Lobelia inflata
• Calomel

Question 9

Sweating

Answer 9

• employed to expel humors through the skin

Question 10

Methods of Sweating

Answer 10

• saunas
• steam baths
• substances that would cause sweating

Question 11

18th Century

Answer 11

Smallpox Law: quarantine measures requiring ships arriving in port to fly a yellow flag if smallpox was present

Cities had established permanent councils to enforce quarantine and isolation rules

The Poor Law in 1601 meant that the physically and mentally ill were looked after by voluntary hospitals and houses –> US adopted these practices in 18th century and more formal arrangement was made in the colonies

1st VOLUNTARY HOSPITALS in PHILADELPHIA AND NEW YORK

At the end of the 18th centure, congress passed Relief of Sick and Disabled Seamen that led to the formation of US Marine Hospital Services and 1st temporary hospital

Question 12

19th Century

Answer 12

• The age of industrialization led to an increase in population and crowding that without running water and disposal systems, the waste was dumped onto the streets or in rivers which caused disease to become rampant
• Industrialization caused an overburdened workforce and a crowded dwelling producing a more susceptible population
• Edwin Chadwick conducted studies of the health of working-class and proposed the Sanitary Idea (build a drainage network to remove sewage and wastes to remove diseases) –> Public Health Act of 1848
• In 1869, Massachusetts set up a state board of health and used Lemuel Shattucks findings to shape the American Public Health System –> development of health departments

Question 13

John Snow (father of epidemiology)

Answer 13

• it was believed that disease was caused by miasma or foul air
• John Snow did not believe in the miasma theory
• Snow convinced the authorities to remove the handle of the pump stopping its use –> this led to a significant decrease in cholera cases

Question 14

Spanish Influenza

Answer 14

• it was called the Spanish flu because the country of Spain tracked its progress publicly compared to other nations
• the first wave was mild, but the second wave in the Autumn of 1918 was much worse
• quarantine and isolation could be effective but was often too late as the Spanish Flu was not a reportable disease
• Socialized Medicine (1920) was embraced with healthcare for all, free of charge at the point of care –> US chose a different approach favoring employer-based insurance plans

Question 15

Symptoms of Spanish Flu

Answer 15

• normal flu symptoms (fever, sore throat, headache)
• turned blue in the face
• difficulty breathing
• bleeding from noses and mouth

Question 16

Mental Health Awareness

Answer 16

• Dorothea Dix was a retired schoolteacher from Maine who led a crusade to publicize the inhumane treatment of mentally ill citizens –> resulted in the establishment of 32 public institutions that were state responsible
• if the communities could not take care of the mentally ill, they placed them in jails and almshouses
• it was believed that poor and foreign-born citizens were more likely to be mentally ill and that moral and spiritual care would recover them

Question 17

State and Local Health Department Laboratories

Answer 17

• health departments and state boards of health were established late in the 19th century by the Marine Hospital for Seafarers
• this also allowed for laboratories to be formed that concentrated on improving sanitation through the detection and control of bacteria
• Louis Pasteur proved that anthrax was caused by bacteria and was the father of the germ theory
• bacteriologic agents were discovered for contagious diseases like TB, diphtheria, typhoid, and yellow fever
• health departments then moved on to clinical care and health education as WWI showed that the proportion was unfit for service so they wanted to improve healthcare for individuals to make a better society

Question 18

20th Century

Answer 18

• Congress passed Food and Drug Act
• The National Institute of Health was founded after a rebrand
• The CDC was established during WWII and established public health infrastructure
• The Social Security Act of 1935 was passed
• Funding was allocated to public health measures
• Medicare and Medicaid was established

Question 19

Challenges of Public Health

Answer 19

Inequities and Health Disparities:
- factors such as race, ethnicity, socioeconomic status, and geographic location
- marginalized communities have limited access to healthcare, etc

Chronic Disease Burden
- such as heart disease, diabetes, and obesity
- burden on HC system leading to increased HC costs, reduced quality of life, and death

Mental Health Crisis
- such as anxiety, depression, substance abuse disorder,
- lacks adequate resources and access to care

Opioid Epidemic:
- high rates of opioid addiction, overdose deaths,
- requires multifaceted approach (prevention, treatment, harm reduction)

Infectious Diseases
- such as COVID-19 shows a need for robust preparedness and response systems

Vaccine Hesitancy:
- misinformation has led to decreased vaccination rates for preventable diseases
- risk of lack of community immunity and disease outbreaks

Climate Change:
- extreme weather, changing disease patterns, increasing temperatures, air pollution, water contamination

Aging Population:
- challenges to chronic diseases, long term care needs, and strain on resources

Healthcare Access & Affordability:
- lack of insurance coverage and high out-of-pocket costs can prevent individuals from getting timely care

Data Privacy and Security
- balance data-sharing for benefits but safeguarding individual rights

Workforce Shortages:
- hinder the delivery and quality of public health services

Public Health Infrastructure:
- underfunded and lack modern infrastructure limiting their ability to respond effectively