Changing concepts in Public health

Public Health

“The science and art of preventing disease, prolonging life and promoting health and efficiency through organized community effort.” –CEA Winslow, 1920

 “The process of mobilizing and engaging local, state, national, and international resources to assure the conditions in which people can be healthy” –The Oxford Textbook of Public Health

• national resources to assure the conditions in which people can be healthy” -The Oxford Textbook of Public Health

In the history of public health, four distinct phases may be demarcated:

1. Disease control phase (1880-1920)
2. Health promotional phase (1920-1960)
3. Social engineering phase (1960-1980)
4. Health for all phase (1981 -2000 AD)

1. Disease control phase (1880-1920)

Public health during the 19th century was largely a matter of sanitary legislation and sanitary reforms aimed at the control of man’s physical environment e.g. water supply, sewage disposal etc. Clearly these measures were not aimed at control of any specific disease, for want of the needed technical knowledge. However, these measures vastly improved the health of the people due to disease and death control.

2. Health promotional phase (1920-1960)

At the beginning of the 20th century, a new concept, the concept of “health promotion” began to take shape. It was realized that public health had neglected the citizen as an individual and the State had a direct responsibility for the health of the individual. Consequently, in addition to disease control activities, one more goal was added to public health, that is, health promotion of individuals. It was initiated as personal health services such as mother and child health services, school health services, industrial health services, mental health and rehabilitation services. Public health nursing was a direct offshoot of this concept. Public health departments began expanding their programs towards health promotional activities. C.E.A. Winslow – one of the leading figures in the history of public, health, in 1920 defined public health as “the science and art of preventing disease, prolonging life and promoting health and efficiency through organized community effort”. This definition summarizes the philosophy of public health, which remains largely true even today. Since the State had assumed direct responsibility for the health of the individual, two great movements were initiated for human development during the first half of the present century, namely;

• Provision of “basic health services” through the medium of primary health centers and sub centers for rural and urban areas evolution of health centers is an important development in the history of public health.
• The second great movement was the Community Development Programme to promote village development through the active participation of the whole community and on the initiative of the community.

3. Social engineering phase (1960-1980)

 With the advances in preventive medicine and practice of public health, the pattern of disease began to change in the developed world. Many of the acute illness problems have been brought under control. However, as old problems were solved, new health problems in the form of chronic diseases began to emerge, e.g., cancer, diabetes, cardiovascular diseases, alcoholism and drug addiction etc. especially in the affluent societies. A new concept, the concept of “risk factors” as determinants of these diseases came into existence. The consequences of these diseases, unlike the swift death brought by the acute infectious diseases, was to place a chronic burden on the society that created them. These problems brought new challenges to public health which needed reorientation more towards social objectives. Public health entered a new phase in the 1960s, described as the “social engineering” phase. Social and behavioral aspects of disease and health were given in a new priority. Public health moved into the preventive and rehabilitative aspects of chronic diseases and behavioral problems. In short, although the term “public health” is still used, its original meaning has changed. In view of its changed meaning and scope, the term “community health” has been preferred by some leaders in public health.

4. Health for all phases (1981 -2000 AD)

 As the centuries have unfolded, the glaring contrasts in the picture of health in the developed and developing countries came into a sharper focus, despite advances in medicine. Most people in the developed countries, and the elite of the developing countries, enjoy all the determinants of good health.  Adequate income, nutrition, education, sanitation, safe drinking water and comprehensive health care. In contrast, only 10 to 20 per, cent of the population in developing countries enjoy ready access to health services of any kind. Death claims 60-250 of every 1000 live births within the first year of life, and the life expectancy is 30 per cent lower than in the developed countries. John Bryant in the introduction to his book: “Health and the Developing World” presented a gloomy picture and a challenge of inequalities in health by saying: “Large numbers of the world’s people, perhaps more than half, have no access to health care at all, and for many of the rest the care they receive does not answer the problems they have”. The global conscience was stirred leading to a new awakening that the health gap between rich and poor within countries and between countries should be narrowed and ultimately eliminated. It is conceded that the neglected 80 per cent of the world’s population too have an equal claim to health care, to protection from the killer diseases of childhood, to primary health care for mothers and children, to treatment for those ills that mankind has long ago learnt to control, if not to cure. Against this background, in 1981, the members of the WHO pledged themselves to an ambitious target to provide Health for All by the year 2000, that is attainment of a level of health that will permit all peoples “to lead a socially and economically productive life.” 

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Additional sources: Park, K. A Textbook of Preventive and Social Medicine. 23th edition