Public health

One of the fields of research and practice in health that developed alongside the biomedical model was public health. We have evidence that public health was considered thousands of years ago. For example, the Babylonians in Mesopotamia embraced regulatory hygiene customs. Although primarily to encourage spirituality, these customs simultaneously reduced the occurrence and spread of disease.(10) The Romans built elaborate sewage systems, baths, and fresh water aqueducts in their cities across their empire. However, in the Middle Ages, there was a spate of diseases including leprosy, smallpox, measles, tuberculosis, and the bubonic plague in towns and cities. With growing urbanization and industrialization in the 1800s, overcrowding became a major issue in cities in Europe, with London and New York providing potent case studies. Denser living arrangements provided greater opportunity for pestilence, epidemics, and disease, which in turn provided the catalyst for the introduction of formal public health measures. In 1842, Edwin Chadwick published a report entitled The Sanitary Conditions of the Labouring Population. This highlighted the discrepancy in disease between the working class and the upper class, concluding that unsanitary environments were responsible for poor health.(11) Chadwick championed sanitary reform, which became the basis for public health activities in Great Britain and the United States. In 1848 the first Public Health Act was passed in England which created a general board of health. However, just 5 years later in 1854, parliament refused to renew it because of the perceived imposition and economic cost of improving drainage and water systems.

In the same year there was a major cholera outbreak in London. The cause of this outbreak initially mystified doctors, until doctor John Snow mapped the geographical location of the outbreak and traced its origins back to a water pump in Soho, which he suggested was contaminated. Despite initial opposition, the removal of the water pump led the outbreak to subside, with the recognition that it was a combination of social and biomedical factors that were influencing people’s health. This helped pave the way for new infrastructure projects providing clean water, rubbish removal, and improved sewerage systems in urban areas, as well as new legislation on standards of housing and overcrowding and a second compulsory Public Health Act in 1875.(12)

Consequently, public health, like the biomedical model, also focused on disease and was strengthened by similar developments such as germ theory. However, public health looked beyond the individual at the wider social environment that could be causing its development and spread, highlighting the importance of sanitation and other social and living conditions in the control of communicable diseases. Public health programmes today also focus on the prevention of non-communicable disease and health promotion. They set standards of health within societies and monitor their implementation; assess health hazards and plan for potential problems and emergencies; monitor health trends to shape research agendas; clarify the causes of health problems and inform health policy and strategies; and identify and implement the most appropriate interventions.

The History of Public Health and the Modern State explores in more detail how public health developed in countries around the world.(13)

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