Pharmacy in Public Health:

History of Public Health

 Public health practice is:
• Aimed at improving health or preventing
illness
• Intended for a population group
• Implemented by a government or group
accountable to a population group
 Treatment vs. Prevention
• Treatment of illness or disease
– Person is already ill
– Requires medical treatment
• Prevention
– Person is not yet ill
– Goal is to prevent exposure to the cause of illness
– May require very different actions than medical
treatment
 Vocabulary
• Disease
– Disease typically refers to the illness resulting
from a specific cause
– Before the late 19th century, specific causes could
not be identified
• Illness
– A more general term which includes a wide
variety of diseases and does not denote a specific
cause
 Historical Timeline
• Before 500 BC—written records inadequate
• 500 BC-500 AD—Greeks and Romans
• To 1500 AD—Medieval era
• 1775—American Revolution
• 1800 – 1875—Sanitary era
• 1875 – 1950—Infectious disease epidemiology
• 1950 – 2000—Chronic disease epidemiology
• 2000—Back to the future
 The Greek and Roman Eras
• Health issues included access to clean water
and nutritious food as well as general
environmental conditions
• Greeks specifically addressed these concerns
when establishing new settlements
• Romans used their engineering expertise to
assure access to clean water and ample food
 Greek and Roman Eras, cont’d
• Both Greeks and Romans defined a role for
government in public health
• Romans believed that access to foods, water,
and adequate sanitation were requirements of
civil life
• Romans developed administrative
departments and bureaucracies for assuring
that basic needs were met
Bubonic Plague in the Medieval Era
500-1500
• Bubonic plague is caused by bacteria carried
by fleas that live on rodents, esp. rats
• Humans are infected when rodents die and
fleas seek another animal to live on
• Bubonic plague epidemics occurred several
times during the medieval era
 Medieval Walled City
(Figure reprinted from Pounds N. The Medieval City. Westport, CT: Greenwood Press; 2005)
 Response to the Bubonic Plague
• Isolated persons with symptoms of plague
outside the city walls
• Quarantined persons suspected of having
plague or would not allow travelers into city
• Formed boards of health to address health
issues
• Established hospitals for the treatment of
poor sick people
 Smallpox: 1775

• Smallpox is an infectious disease that

produces pustules on the skin; mortality is
about 50%; survivors developed immunity
– Most Americans, including patriot soldiers, had no
immunity to smallpox
– The severity of the disease is decreased
substantially by inoculation (placing infectious
matter into a small cut or scratch)
 George Washington at Boston,
1775
• American soldiers were susceptible but British
soldiers were immune
• If smallpox spread through the American
army, the army could be incapacitated
• Smallpox was present in Boston in 1775
• If Washington was going to defeat the British,
he had to prevent American soldiers from
becoming ill with smallpox
Boston’s location on a peninsula
allowed the use of quarantine
(Figure courtesy of American Antiquities Society)
 Inoculation Hospitals
• At Washington’s winter camp, while no battles
were being fought, inoculation hospitals were
built
• All susceptible soldiers were inoculated
• Smallpox was no longer a threat to the
American army
• First public health campaign in America
 Cholera: 1848
• Cholera is an infectious disease caused by a
bacterium resulting in severe diarrhea and
dehydration that can result in death
– In 1848, cholera was thought to be caused by
miasma, a gas arising from garbage and filth
– No way of preventing cholera was known
– Did not understand the pathology of the disease
and what caused death
The mortality for cholera was very
high
(Figure courtesy of the National Library of Medicine.)
 John Snow and the Scientific
Method
• Snow was able to investigate a problem using
the scientific method, i.e. asking a question
then collecting and analyzing data to answer
the question
• Tested the hypothesis that cholera was
transmitted by contaminated water by
collecting data on the number of deaths in
homes served by one water company versus a
second water company
Example mortality data collected by John
Snow
Smoking as a cause of chronic
disease: Late 20th Century
Public Health Campaign: Smoking
(Figure courtesy of the National Library of Medicine.)
 Public health in the 21st century
• Infectious disease
– Avian (bird) flu
– Extensively drug resistant tuberculosis
• Environment
– Water, sanitation, and food supply
– Global climate change
• Role of Government
 Review
• Review each era based on the three parts to
the definition of public health:
– How government was involved
– Identify the population served
– Identify the purpose of the activity (promote
health or prevent disease)
 Historical Examples
• How public health practice helped George
Washington win the American Revolution
• Establishing cities in ancient Greece and in the
Roman Empire
• The Medieval Era and the bubonic plague
• John Snow and the cholera epidemic
• Tobacco use in the 20th century
• George and his environment in the 21st
century
Reference
• Carter, Jean et al. Pharmacy in Public Health:
Basics and Beyond. 2010