1500 B.C.

Leviticus

Leviticus 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 and the Isolation of lepers.

The Code of Hammurabi

The Code of Hammurabi, created by the King of Babylon is one of the earliest sets of laws found.It shows rules and punishments if those rules are broken. It focuses on theft, farming (or shepherding), property damage, women's rights, marriage rights, children's rights, slave rights, murder, death, and injury. The punishment is different for different classes of offenders and victims. The laws do not accept excuses or explanations for mistakes or fault: the Code was openly displayed for all to see, so no man could plead ignorance of the law as an excuse. Few people, however, could read in that era (literacy mainly being the domain of scribes).The document a code of conduct for physicians and health practices. Before 500 BC there was also evidence of bathrooms and drains in homes as well as written medical precriptions.

Hippocrates

Hippocrates (460 BC-380 BC) was the founder of Western medicine. He manifested an amazingly modern perspective in his treatise entitled On Airs, Waters, and Places that was published in the fifth century. Here are some excerpts:

Whoever wishes to investigate medicine properly, should proceed thus: in the first place to consider the seasons of the year, and what effects each of them produces. We must also consider the qualities of the waters 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.

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.

500-1500 A.D.

THE MIDDLE AGES

The Middle Ages were also known as "The Dark Ages. During this time, there was an ending of Roman ideology. Health problems were considered to have spiritual causes and solutions. Illness was considered to be the result of sin thus stigmatizing the victim. Bloodletting and alchemy were common practices. Most importantly, this failure to consider the role of the environment in health led to epidemics and the inability to control them.

The Black Plague

The black Plague or Black Death was also known as the bubonic plague. It reappeared in Europe in 1348 after nearly a 1000 year absence. Up to 2/3rds of the population in major European cities succumbed in the first two years of the pandemic. The pandemic was approached by both scientists and the religious community and by 1350 A.D. there were many new public health initiatives developed to stop the spread of the deadly disease.

An interesting historical footnote is that some scholars contend that corpses were used for biological warfare.

1500-1700 A.D.

THE RENAISSANCE

During the Renaissance, there was rebirth of thinking about nature and humans. Careful accounts of disease outbreaks showed that saints as well as sinners got sick and critical observations led to more accurate descriptions of symptoms and outcomes. World exploration led to exposure to different world views on health. The rise of mercantilism highlighted the value of a healthy and productive population, leading to advances in occupational health.There was also an increased concern about infant mortality as a threat to long term availability of a productive working society.

John Graunt

The period saw an increased understanding of the need to collect qualitative data for the purpose of defining the state. This was known at the time as Political Arthmetic. The first solid use of data collection for the purpose of understanding health status came from John Graunt (1620-1674), the father of demography and descriptive epidemiology. In 1662, Graunt published, Natural and Political Observation, Upon the Bills of Mortality. By studying London death data for the previous 75 years, Graunt found certain predictability of mortality with respect to natural events and phenomenon. Using this data, Graunt developed the first life table.

Anthoni van Leeuwenhoek

Anthoni van Leeuwenhoek (1632-1723) was the first to observe bacteria and other microscopic organisms using a rudimentary microscope.

Bernardino Ramazzini

In 1700 Bernardino Ramazzini (1633-1714)published first comprehensive occupational health treatise. This the birth of occupational health.

Epidemics, Migration and Discovery

The 18th Century saw a growth in industrialization that brought more and more people to cities in search of work, While this led to overcrowding, poor sanitation and subsequent epidemics, there was a growing recognition of the nature of disease. There were two prevailing views of the causes of epidemics – Miasmic and Contagion. Both have public health implications.

Miasmic: This theory held that epidemics stemmed from certain atmospheric conditions and from miasmas rising from organic materials.

Contagion: This theory held that epidemics resulted from transmission of germs.

In the United States,governmental agencies were created to address: mounting health problems, sanitation and the protection of water supply.

Denis Diderot

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.

Germ Warfare

In 1763 in the New World, smallpox infected blankets were distributed to Native Americans starting an epidemic which killed thousands. Controversy still exists as to whether this was deliberate bioterrorism or a tragic mistake, though there were several instances of this happening.

Edward Jenner

1n 1796, Edward Jenner (1749-1843) published his first paper on the potential for inoculation, which led to the development of the small pox vaccine.

Marine Hospital Service

In 1798 the U.S. federal government created the to address health issues relating to maritime trade, such as yellow fever, scurvy and health threats brought to the U.S. from other countries on ships. The Marine Hospital Service later became the Public Health Service.

The 19th Century brought tremendous advances in the understanding of health and medicine. There was an acceptance of link between environment and health. There was an understanding of germ theory and there were growing efforts at social reform as a way of improving the health of the population. Industrialization led to increase in city populations.

America expanded Westward. Among the many hazards of going west was disease and injury.

Health quackery thrived

There was a laissez faire approach to health problems with few health regulations.

In Victorian England there were continued problems with sanitation and overcrowding that led to periodic outbreaks. Still there some major public health advances during that time. In 1837 the National Vaccination Board was developed in England.

Public Health Milestones

Edwin Chadwick (1800-1890)

In 1842 social reformer, 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.

Lemual Shattuck (1793-1859)

In 1850 in Boston, Shattuck released what was to be another seminal public health report. This report outlined the public health needs in the state of Massachusetts and included recommendations to create the first state board of health.

Cholera

Cholera first came to Sunderland, England in 1831-32. Several epidemics appeared overtime throughout England eventually killing more people than the Black Plague. This could be directly attributed to the conditions of poverty and rapid urbanization. London took on the name the Great Stink. It was not until the epidemic of 1854 that John Snow began to unravel the mystery of transmission.

John Snow (1813-1858)

John Snow was the first to link the cholera epidemic in London to one 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

Professionalization of Nursing: Nightingale, Seacole and Wald

Florence Nightingale (1820-1910)

The century also saw the rise of nursing as a profession. Like her friend, the public health reformer Edwin Chadwick, Florence Nightingale (1820-1910) believed that infection arose spontaneously in dirty and poorly ventilated places. This mistaken belief nevertheless led to improvements in hygiene and healthier living and working environments. Florence Nightingale also advised and supported William Rathbone in the development of district nursing in Liverpool and many Nightingale trained nurses became pioneers in this field.

Mary Seacole (1805-1881)

Mary Secole, the "black Florence Nightingale", was once one of the best-known women in England. She was a Caribbean doctress who had traveled widely, and was able to put her skills to good use in the Crimean War. Due to her race, she was denied the opportunity to work with Florence Nightingale. She traveled to Crimea on her own to minister to wounded British soldiers. There she established the British Hotel. Thousands of them remembered her with gratitude and affection. When she returned to England, she was once again shunned by the white nursing establishment, yet at the time of her death, she was the most famous woman in England. Queen Victoria even commissioned a bust of her for the palace. She published her memoirs, The Wonderful Adventures of Mrs. Seacole in Many Lands.

Lillian Wald (1867-1940)

Lilian Wald is considered to be the mother of public health nursing. At the end of the century, In the United States, Wald was beginning her public health crusade. She was a nurse, social worker and feminist. She discovered first-hand the squalid conditions in which many immigrants suffered, and in 1895, Wald created the Henry Street Settlement, determined to live among the poor to better provide a variety of volunteer services. Nursing was central to Wald's idea of neighborhood service, and she introduced the pioneering concept of "public health nursing," which placed medical care within the reach of the poor. By, 1940, nearly 300 nurses worked from 20 branches throughout New York City.

Robert Koch (1843-1910)

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. Koch asserted thatfour criteria must be fulfilled to establish a causal relationship between a parasite and a disease. These criteria are known as Koch’s Postulates.Koch was awarded the Nobel Prize for Physiology or Medicine in 1905.

Louis Pasteur (1822-1895)

French microbiologist, Louis Pasteur ,conducted experiments that supported the germ theory and effectively debunked the theory of spontaneous generation. His work involved the development of systems of innoculation including the first vaccine for rabies. He is best known, however, for his work in studies on fermenting beverages. He found that micro-organizisms could develop during this process. He invented a process in which liquids such as milk were heated to kill all bacteria and moulds. This was firsted test on April 20, 1862. This process was soon afterwards known as pasteurization.

In 1863, New York City conducted the first sanitary survey. New York's Association for the Improvement of the Condition of the Poor (est. 1844) finds "dark, contracted, ill constructed, badly ventilated and disgustingly filthy" housing. Some 18,000 people live in cellar apartments whose floors are putrid mud.

The American Public Health Association

In 1872, the American Public Health Association was was founded. APHA is now the oldest and largest organization of public health professionals in the world.

In 1878, The passage of the National Quarantine Act began the transfer of quarantine functions from the states to the federal Marine Hospital Service. In 1891 passage of immigration legislation, assigning to the Marine Hospital Service the responsibility for medical examination of arriving immigrants.

In 1879 the National Board of Health was established. Unfortunately it is dispanded in 1883 when there was increasing.

How the Other Half Lives, a study of live in New York’s tenements published in 1890, which like other reports, demonstrated the horrific conditions of tenement areas. Septic tanks for sewage treatment appeared in 1895.

The Western world in the early 20th Century was faced with the same public health challenges as the previous century. Life expectancy was 50 years old. Many public health advances grew out of social reforms. Thirty eight states created health departments.

Yellow Fever Understood

In 1900, the United States Army Yellow Fever Commission (often called simply "The Reed Commission" after its leader, Walter Reed (1857-1902) 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" objects and focused the people’s efforts on the eradication of the mosquito.

The Public Health Service

In 1902, the Marine Hospital Service became the Public Health and Marine Hospital Service in recognition of its expanding activities in the field of public health. In 1912, the name was shortened to the Public Health Service.

Epidemics

In the early twentieth century, the most common cause of death was from contagious diseases. Bubonic plague hit San Francisco and persisted until 1909. The influenza outbreak of 1918 killed over 600,000 people and did not subside until the 1950s. It has recently been discovered to have been an avian flu strain.

A Healthy Carrier

Fear of infectious diseases led to public health hysteria at times. In 1907 in New York City, cook Mary Mallon, an Irish immigrant, was identified as the first healthy carrier of typhoid. Dubbed Typhoid Mary, Mallon spent the rest of her life in and out of quarantine on New Brother Island. Her case exemplified the confrontation of public health, law, ethics, the media and anti-immigrant attitudes.

Childhood Diseases

Major childhood diseases included polio as well as bone deformity due to poor nutrition leading to pellagra and rickets.

Public Health and the Birth of School Nursing

Public Health Nursing is now widespread due in part to the work that Lillian Wald began late in the previous century and continued into the early Twentieth Century. Wald's most innovative experiment was a Public School Nursing Service designed to increase school attendance by having Henry Street nurses provide care at public schools. This was so successful that the New York City Board of Health soon organized a public school nursing program, the first such service offered anywhere in the world.

Meat Inspection

The The Jungle by Upton Sinclair graphically depicts conditions in the meat packing industry. Partly as a result of this book and the work of reformers, the U.S. Meat Inspection Act of 1906 was established. The act was authorized the Secretary of Agriculture to order meat inspections and condemn any found unfit for human consumption.

Child Labor

By 1911 approximately 2 million American children under 16 were working in hazardous and unhealthy conditions, often 12 hours a day, six days a week. Reformers worked tirelessly to address these dangerous child labor conditions with periodic successes. In 1912 President Theodore Roosevelt's first White House Conference urged creation of the Children's Bureau to combat exploitation of children. Still much of the success would be in raising awareness of the hazards and conditions under which children were working. Legal reform would not come until the 1930s.

Family Planning

In 1916, Margaret Sanger (1879-1966) published What Every Girl Should Know. It not only provided basic information about such topics as menstruation, but also acknowledged the reality of sexual feelings in adolescents. It was followed in 1917 by What Every Mother Should Know. That year, Sanger was sent to the workhouse for "creating a public nuisance." Sanger was a tireless pioneer for birth control, though her career is clouded in controversy due to her association with eugenisists and for racist writings early in her career.

Reform, Depression and War

In the United States in 1920-1940 there were continued efforts at social reform. There war also 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 of on charities for health care.

Penicillin

In 1928, Scottish physician Alexander Fleming (1881-1955) inadvertently discovered Penicillin while studying moulds. Fleming had served as a physician during WWI and had seen the horrific effect of infection in military hospitals. This discovery would be one of the most important discoveries of the Twentieth Century for its ability to kill backeria and fight infectious disease.

Native American Health

In 1921, The Bureau of Indian Affairs Health Division was created, the forerunner to the Indian Health Service. The provision of health services to members of federally-recognized tribes grew out of the special government-to-government relationship between the federal government and Indian tribes.The IHS currently provides health services to approximately 1.5 million American Indians and Alaska Natives who belong to more than 557 federally recognized tribes in 35 states.

The New Deal

FDR's New Deal created numerous agencies and public works projects, bringing an end to the Great Depression. In 1935, FDR created a limited form of the Social Security program began as a measure to implement "social insurance" during the Great Depression when poverty rates among senior citizens exceeded 50 percent.

The Tuskegee Syphilis Study

In 1932, the Public Health Service, working with the Tuskegee Institute, began a study in Macon County, Alabama, to record the natural history of syphilis. The study involved 600 African American men--399 with syphilis and 201 who did not have the disease. Researchers told the men they were being treated for "bad blood," a local term used to describe several ailments, including syphilis, anemia, and fatigue. In truth, they did not receive the proper treatment needed to cure their illness, so that the progression of the disease could be studied. In exchange for taking part in the study, the men received free medical exams, free meals, and burial insurance. Although originally projected to last 6 months, the study actually went on for 40 years. Some believe it only ended because a investigative reporter, James Jones, learned of the project and made it public. Since then great efforts have been made to stop unethical treatment of human subjects.

Centers for Disease Control and Prevention (CDC)

What we now know to be the Centers for Disease Control and Prevention (CDC) was established in 1946 in Atlanta as the Communicable Disease Center. It occupied only one floor of the Volunteer Building on Peachtree Street and had fewer than 400 employees, most of whom were engineers and entomologists. Until the previous day, they had worked for Malaria Control in War Areas, the predecessor of CDC, which had successfully kept the southeastern states malaria-free during World War II.

The World Health Organization

The World Health Organization (WHO) was established by the United Nations on April 7, 1948. The WHO inherited much of the mandate and resources of its predecessor, the Health Organization (HO), which had been an agency of the League of Nations.

Flouridation of Water

Water flouridation began in 1948. Fluoridation is the act of adding fluoride ions to water in order to reduce tooth decay in the general population. Many North American municipalities fluoridate their water supplies, citing effectiveness in reducing tooth decay, safety of floridation, and the low cost to do so.

The Polio Vaccine

The first effective polio vaccine was developed by Jonas Salk (1914-1995), although it was the vaccine developed by Albert Sabin (1906-1993) that was used for mass inoculation. The first inoculations of children against polio began in Pittsburgh, Pennsylvania on February 23, 1954. Through mass immunization, the disease was wiped out in the Americas.

The Pill

In 1960, Searle receives FDA approval to sell Enovid as a birth control pill. The development of the first highly effective contraceptive transforms women's lives around the world and opens the door to the sexual revolution. Searle was the first and only pharmaceutical company to sell an oral contraceptive and it had a lucrative monopoly. Other pharmaceutical companies quickly jumped on the band wagon.

Growth of Environmentalism

In 1962, Rachel Carson (1907-1964)'s Silent Spring led to greater awareness of the dangers of chemical pesticides to humans. Silent Spring played in the history of environmentalism roughly the same role that Uncle Tom's Cabin played in the abolitionist movement. That same year the Migrant Health Act was passed, providing support for clinics serving agricultural workers.

Tobacco Declared a Hazard

On January 11, 1964, Luther L. Terry, M.D. 1911-1985), Surgeon General 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.

War on Poverty

The War on Poverty (1964-1968) was a campaign of legislation and social services aimed at reducing or eliminating poverty in the United States of America. The term was first introduced by Lyndon B. Johnson during his State of the Union address on January 8, 1964. The legislation was designed in response to the poverty affecting over 35 million Americans as of 1964. 1965 The Johnson Administation created Medicare and Medicaid. Also in 1965, The Older Americans Act created the nutritional and social programs now run by DHHS. In addition, The Head Start Program was created. Head Start is a program of the U.S. government's Department of Health and Human Services which focuses on assisting low-income children, through five years of age; so that they are prepared for school. In 1966 the Community and Migrant Health Centers programs was launched.

The Civil Rights Movement

The Civil Rights Movement sought to end segregation of all facilities including universities and health care facilities. While the end of Jim Crow laws did lead to desegregation of the facilities, putting an end to unequal treatment would be a long time coming. This could be seen in the longevity of the Tuskegee experiment.

The Global Impact of Vaccines

International Smallpox Eradication Program was established in 1966. It was led by the U.S. Public Health Service. The wordwide eradication of smallpox was accomplished in 1977.

The Environmental Protection Agency

In 1970, the Environmental Protection Agency (EPA) was established under the Nixon Administration. The EPA is charged with protecting human health and with safeguarding air, water, and land.

The WIC Program

The Special Supplemental Nutrition Program for Women, Infants, and Children, commonly referred to as WIC, is a Federally funded nutrition-intervention program administered by the food and Nutrition Service of the U.S. Department of Agriculture. WIC began as a two-year pilot program in 1972 under an amendment to the Child Nutrition Act of 1966, and was made permanent in 1974. Its mission is to provide supplemental food, nutrition education, and health-care referrals to low-income pregnant or postpartum women, their infants, and children up to the age of five, to improve their health outcomes.

Legionnaires Disease

1976, 221 Legionnaires at a conference in Philadelphia fall sick and 34 die. The mysterious disease was called Legionnaires Disease.

The Health Care Financing Administration

In 1977, the Health Care Financing Administration was created to manage Medicare and Medicaid separately from the Social Security Administration. It would later become the Center for Medicare and Medicaid Services.

A Deadly New Virus

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.

The Future of Public Health

In 1988, the Institute of Medicine published its landmark report,The Future of Public Health. The book detailed the breakdown of the U.S. public health system and framed the importance of public health through defining its three core functions and ten essential services. Public Health's ten essential services are to:

The Human Genome Project Begins

In 1990, the Human Genome Project was formally established. The project endeavored to map the human genome down to the nucleotide (or base pair) level and to identify all the genes present in it. Once achieved this information was have major public health ramifications.

Food Labeling

In 1990, the Nutrition Labeling Education Act was signed into law. The act required food manufacturers to disclose the fat (saturated and unsaturated), cholesterol, sodium, sugar, fiber, protein and carbohydrate content in their products. This gave consumers new ways of monitoring their nutritional intake.

The Ryan White Comprehensive AIDS Resources Emergency Act

In 1990,the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act led to laws protecting those with HIV/AIDS from discrimination and established increased federal funding for AIDS research and treatment. The act was named for Ryan White (1971-1990) a teenage boy who died of AIDS after contracting the virus through treatment for hemophilia. His and his family's experience facing stigmitization brought national attention to the discrimination and fear surrounding the illness. At the time this act was established, there were 150,000 reported AIDS cases in the U.S.

Healthy People 2000

In 1990, CDC published Healthy People 2000. Healthy People 2000 was the blueprint for improving the health of Americans by the end of the century.The document contains 319 unduplicated main objectives grouped into 22 priority areas.

The Tobacco Settlement

In 1998 the Master Settlement Agreement was signed with the tobacco industry. 46 states settled lawsuits in which they sought to recover tobacco-related health care costs and to hold the tobacco companies accountable for decades of wrongdoing.

Top Ten Public Health Achievements of the Twentiethy Century

• Vaccination
• Motor vehicle safety
• Safer workplaces
• Control of infectious diseases
• Decline in deaths from coronary heart disease and stroke
• Safer, healthier food
• Healthier mothers and babies
• Family planning
• Fluoridation of drinking water
• Recognition of tobacco as a hazard

2000-2005

Despite the public health achievements of the previous century, the Twenty-First Century ushers in new global health challenges. The 9-11 tragedy makes very real the dangers of terrorism in the U.S. and highlights the pressing needs to strengthen public health departments in order for them to be prepared to respond to chemical, radiological or biological terrorist attacks. There are also new and emerging diseases.

Healthy People 2010

In January 2000, CDC published Healthy People 2010, the follow-up to Healthy People 2000. This would be the blueprint for the public health infrastructure in the new century.

HIV/AIDS

More than 23 million people with AIDS have died since 1981. Millions more are living with HIV. Poor countries, especially in Africa, are hardest hit. While there are now effective treatments, there is still not cure and the treatment when available is very expensive.

Bioterrorism

One month after the September 11th tragedy, anthrax contaminated letters were mailed to the New York Post, NBC's offices in New York 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 of CBS and ABC also indicating that the anthrax was transmitted by mail. Twenty-three people contracted anthrax, five of whom died. Many more people were exposed.

The Future of the Public's Health

In November 2002, the Institute of Medicine revisited its landmark report, The Future of Public Health and released a critical follow-up report, The Future of the Public's Health in the Twenty-First Century. The report outlined the state of the current public health infrastructure upon the heels of major bioterrorism attacks and provided recommendations for strengthening and preparing the infrastructure through increased public and private sectoral cooperation.

SARS

Severe Acute Respiratory Syndrome (SARS), an atypical form of pneumonia, first appeared in in China in 2002. SARS is now known to be caused by the SARS coronavirus (SARS-CoV), a novel highly contagious coronavirus. After China suppressed news of the outbreak, the disease spread rapidly, reaching neighboring countries in late February 2003, and then to other countries via international travellers. Toronto had a serious SARS outbreak, which fully tested its public health readiness. The last case in this outbreak occurred in June 2003.

Human Genome Project Completed

In 2003, the Human Genome Project was completed after 13 years of work. There were clear practical results even before the work was complete. The field of public health gemonics appeared. This emerging field assesses the impact of genes and their interaction with behavior, diet, and the environment on the population's health.

Foul Weather

In August 2005, Hurricane Katrina devastates the U.S. Gulf Coast. The levees in New Orleans broke leading to massive flooding destroying much of the city. The accompanying contamination of the water from decaying bodies and other organic matter as well as chemical toxins leaves the largest public health disaster the U.S. has ever seen. Federal cuts in funding for public health infrastructure leave the city and the rest of the Gulf coast unable to adeguately respond.