In 1920 Charles-Edward A. Winslow defined public health as "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 service for the early diagnosis and preventive treatment of disease, and the development of the social machinery - which will ensure to every individual in the community a standard of living adequate for the maintenance of health." While most would include mental health as an important aspect of public health today, Winslow's definition is still relevant.
Health is dependent on a complex interplay among an array of genetic, environmental, and lifestyle factors. As a result, public health is built on expertise and skills from many areas, including biology, environmental and earth science, sociology, psychology, government, medicine, statistics, communication, and many others. This complexity makes it difficult for the general public to understand exactly what public health is and what it does.
In addition, public health has been so successful that some in the general population may not be aware of the expertise and hard work that is required to ensure the health and safety of their community. The life of a person who develops severe heart disease might be prolonged by a dramatic and very expensive medical procedure such as heart surgery.
However, public health is about interventions that prevent disease from occurring, so the benefits tend to be less obvious. In addition, prevention of disease both prolongs life and improves the quality of life. In a sense, public health is the heart disease that never developed, the epidemic that didn't happen, the outbreak of foodborne illness that never occurred, the child that would have developed asthma, but didn't. Public health is the disaster that didn't happen.
Time line of the History of Public Health in the United States:
In 1798 Congress passed the Act for the Relief of Sick and Disabled Seamen, alongside authorizing the formation of the US Marine Hospital Service (MHS), which was the forerunner of the Public Health Service. Seamen often became ill while at sea and often were unable to find adequate health care in port cities. Their health was viewed as essential to the developing country, and a network of marine hospitals, mainly in port cities, was established by Congress in 1798 to care for sick and disabled seamen. Seamen were taxed 20 cents a month in order to raise funds to pay physicians and support the network of hospitals. This tax was abolished in 1884. From 1884 to 1906 funds were raised by a levy on merchant ships, and after 1906 funds were allocated by the US Congress.
In 1799 Castle Island in Boston Harbor was chosen as the temporary site for the first marine hospital. Dr. Thomas Welsh, a Harvard College graduate and participant in the Revolutionary War battles at Lexington and Bunker Hill, was appointed as the physician in charge.
In 1799, Boston establishes the first board of health and the first health department in the United States. Paul Revere is named as the first health officer.
In 1804, the Boston Marine Hospital is established in the Charlestown section of Boston. Dr. Benjamin Waterhouse was appointed the physician in charge from 1807-1809.
In 1800, Dr. Benjamin Waterhouse introduced smallpox vaccination to the United States.
In 1842, Lemuel Shattuck, a Massachusetts legislator, established the first US system for recording births, deaths and marriages. Largely through his efforts Massachusetts legislation became the model for all the other states in the Union. Among Shattuck's many contributions were his proposal for a standard nomenclature for disease; establishment of a system for recording mortality data by age, sex, occupation, socioeconomic level, and location; the application of data to programs in immunization, school health, smoking, and alcohol abuse.
In 1849, the Massachusetts legislature appointed a Sanitary Commission 'to prepare and report to the next General Court a plan for a sanitary survey of the State', with Shattuck as Chief Commissioner and author of its report. The report (1850) was enthusiastically received by the New England Journal of Medicine, but the 50 recommendations in the report were otherwise ignored. Twenty years later the Secretary of the Board of Health of Massachusetts based his plans for public health on Shattuck's recommendations.
In 1874, the Massachusetts State Board of Health instituted a voluntary plan for weekly reporting of disease by physicians.
In 1884, Massachusetts passed legislation requiring the reporting of "diseases dangerous to the public health" and imposed fines for not reporting.
In 1887, a small "Hygienic Laboratory" was established at the marine hospital on Staten Island to aid in the diagnosis of infectious diseases among passengers of incoming ships. The laboratory later moved to Washington, D.C., and eventually evolved into the National Institutes of Health.
In 1891, The Immigration Act of 1891 required that all immigrants entering the US be given a health examination by PHS physicians. The law stipulated the exclusion of "all idiots, insane persons, paupers or persons likely to become public charges, persons suffering from a loathsome or dangerous contagious disease," and criminals. The largest inspection center was on Ellis Island in New York Harbor.
In 1894, the first epidemic of polio strikes the United States.
In 1900, some estimates indicate that HIV was transmitted from monkeys to humans as early as 1884-1924, but was either unrecognized or failed to initiate human to human transmission until later.
In 1902, the US Congress expanded the scientific research work at the Hygienic Laboratory and gave it a definite budget. The legislation required the Surgeon General to organize conferences of local and national health officials in order to coordinate state and national public health activities. The Marine Hospital Service was renamed the Public Health and Marine Hospital Services (PHMHS) to reflect its broader scope.
In 1906, Congress passed the Federal Meat Inspection Act requiring the Department of Agriculture to inspect meats entering interstate commerce. They also passed the Food and Drugs Act. The law forbade adulteration and misbranding of foods, drinks, and drugs in interstate commerce, but contained few specific requirements to insure compliance.
In 1912, the PHMHS was renamed the United States Public Health Service, and it was authorized to investigate human diseases such as, tuberculosis, hookworm, malaria, and leprosy, sanitation, water supplies and sewage disposal.
In 1916, Johns Hopkins University founds the first school of public health in the United States with a grant of $267,000 from the Rockefeller Foundation. The Rockefeller Foundation later supported schools of public health at Harvard and the University of Michigan.
In 1918, the influenza pandemic of 1918 struck. It is believed to have caused at least 25-50 million deaths worldwide.
In 1925, all states begin participating in national reporting of disease.
In 1938, Congress passed the Federal Food, Drug, and Cosmetic Act of 1938, and major amendments to the law were made in 1954, 1958, and 1960. Today the law requires manufacturers to provide scientific proof of a new drug's safety. The law also makes dangerous or falsely labeled cosmetics and therapeutic devices illegal. Enforcement of these laws is the mission of the Food and Drug Administration (FDA), which is tasked with ensuring that foods are safe and wholesome. It also ensures that drugs and medical devices are safe and effective, and that cosmetics are harmless. Provisions are also made to ensure accurately labeling and that radiofrequency emissions from electronic devices is not hazardous to consumers.
In 1948, Richard Doll and Bradford Hill conducted a landmark epidemiologic investigation of the cause of the remarkable increase in lung cancer that had occurred during the 20th century. They identified lung cancer patients in 20 London hospitals and enrolled a comparison group of non-cancer patients and conducted a case-control study. Somewhat to the surprise of Doll and Hill, the study found that the one consistent difference between lung cancer patients and the non-cancer controls was that the cancer patients were more frequently smokers, and they were heavier smokers. It initially stirred much controversy, even among the medical community because smoking was extremely prevalent, even in physicians, and many refused to believe that it could be a cause of cancer.
In 1948, the Framingham Heart Study began with the goal of identifying the factors that contribute to cardiovascular disease by following its development over a long period of time in a large group of disease-free participants.
In 1952, Polio cases surge in the US. Early testing of the vaccine developed by Jonas Salk is encouraging.
In 1953, Under President Eisenhower, Congress created the Department of Health, Education, and Welfare (HEW).
In 1954, a large scale clinical trial of the Salk vaccine begins.
In 1959, Rene Dubos published a landmark book entitled "The Mirage of Health" in which he convincingly argued that the decline in mortality since 1850 was not primarily due to laboratory medicine; it was due to control of infectious disease as a result of sanitation and improvements in nutrition. He also pointed out that Western health was not optimal and that life expectation at age 45 had improved little. He said that disease is complex and tends to be rooted in social, physical, and cultural environment in which people lived.
In 1970, The Occupational Safety and Health Act was passed by Congress, and the Occupational Safety and Health Administration was founded in 1971.
In 1970, The Environmental Protection Agency (EPA) was established to consolidate federal research, monitoring, standard-setting and enforcement activities to ensure environmental protection.
In 1979, HEW's educational tasks were transferred to the new Department of Education and responsibility for health was given to the newly organized Department of Health and Human Services (HHS).
In 1979, Smallpox is declared eradicated by the World Health Organization. The eradication of smallpox, one of the deadliest and most dreaded diseases, was the result of a massive global effort utilizing case finding and vaccination. The last known case occurred in 1977 in Somalia.
In 1980, President Jimmy Carter signed into law the Comprehensive Environmental Response, Compensation and Liability Act (CERCLA or Superfund). This historic new statute gave EPA the authority to clean up uncontrolled hazardous waste sites and spills.
In 1981, Dr. Michael Gottlieb and his associates report on four previously healthy young men who had developed Pneumocystis carinii pneumonia. They hypothesized that this was a new syndrome of acquired immunodeficiency cause by a sexually transmitted infectious agent.
In 2002 The Institute of Medicine issued a report entitled "Who Will Keep the Public Healthy?" The report concluded that "... public health professionals must have a framework for action and an understanding of the forces that impact on health, a model of health that emphasizes the linkages and relationships among multiple determinants affecting health. Such an ecological model, the committee believes, is key to effectively addressing the challenges of the 21st century."
Some Major Achievements of Public Health During the 20th Century
Vaccination to reduce epidemic diseases
Eradication of smallpox
Improved motor vehicle safety
Safer workplaces
Control of infectious diseases
Decline in death from cardiovascular disease
Improvements in maternal and child health
Family planning
Fluoridation of drinking water
Reductions in prevalence of tobacco use