Public Health

Public Health


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One of the things that Romans noticed as they travelled the world was that people from different areas suffered from different diseases. For example, they discovered that people living near marshes and swamps often suffered from a disease we now call malaria.

From evidence such as this, the Romans, like the Greeks before them, became convinced that the physical environment was one of the main causes of disease. The Romans were therefore very careful where they built new towns. Before a decision was taken, animals that had been grazing in the area were killed. Their livers were inspected and if they were a greenish-yellow, the area was rejected as being too unhealthy.

The Romans suspected that the quality of the water people drank was an important factor in obtaining good health. For hundreds of years the Romans had used the River Tiber for washing, drinking and for dumping their waste. The Roman government decided that an attempt should be made to separate the water used for these different purposes.

In 312 BC work was started on the first Roman aqueduct. Within a hundred years, nine aqueducts were

supplying the Roman people with water from nearby mountain lakes. At certain points along the pipes, the water entered settling basins which filtered the sediment from the water.

When the water arrived in Rome it went into several large reservoirs. The best quality water went to the city's drinking fountains while the most polluted was used to water plants and flowers.

The Roman government also attempted to deal with the problem of sewage disposal. Public toilets were built all over Rome. They were connected to a system of underground drains that took the sewage from the toilets to the River Tiber.

Rich people in Rome were able to pay to have fresh water piped into their houses. They also had toilets installed that were connected to the underground sewage system. However, the vast majority of people in Rome had to walk to their nearest fountain or public toilet. Some people could not be bothered and, when it was more convenient, still obtained their water from the River Tiber.

Although Roman attempts to improve the health of the public were fairly successful, outbreaks of different diseases still took place fairly often.

Rome had a considerable number of doctors to treat people when they were ill. However, this treatment had to be paid for and many Romans could not afford it.

The government became concerned about the large numbers of people who died while they were still young.

Outbreaks of disease often led to serious labour shortages. It was therefore decided that medical treatment should be provided free of charge to those too poor to pay. By the 2nd century AD every city and town was expected to employ doctors to treat the poor when they were sick. These doctors also had

the responsibility of training future doctors.

The Romans were not the first people to realise that it was a good idea for the government to take responsibility for the health of its people. For example, cities in India had a good sewage system 2,000 years before the Romans. However, the Romans were more aware of the importance of public health than any other previous civilisation. Also, the Romans controlled a large empire. This meant that aqueducts, fountains, reservoirs, public toilets and sewage pipes were not only built in Rome but all over the world.

Those cracked or leaky pots that people toss out through windows. Look at the way they smash, the weight of them, the damage they do to the pavement!... You are a fool if you don't make your will before venturing out to dinner... Along your route at night may prove a death-trap: so pray and hope (poor you!) that the local housewives drop nothing worse on your head than a pailful of slops.

If the apartment is divided among several tenants, redress can be sought only against the one who lives in the part of the apartment from which the liquid was poured... When in consequence of the fall of one of these projectiles... the body of a free man shall have suffered injury, the judge shall award to the victim in addition to medical fees and other expenses incurred in his treatment, the total of the wages of which he has been or shall in future be deprived by the inability to work.

The improved health of Rome is a result of the greater number of reservoirs, aqueducts, fountains, and water basins... the appearance of Rome is cleaner and changed, and the causes of the unhealthy atmosphere, that gave Rome so bad a name among the ancients, are now removed.

When you build a town you need to choose a healthy site... A marshy area must be avoided. For when the morning breezes come... they bring the poisoned breaths of marsh animals... I agree with the old method. For the ancients sacrificed the beasts which were feeding in those places where towns were being placed, and then inspected their livers... If they found them faulty, they judged that the supply of food and water which was to be found in these places would be harmful.

You should avoid marshy areas... A marsh always sends out harmful poisonous vapours during the hot periods of the summer, and, at this time, gives birth to animals possessing mischief-making stings... thus unknown diseases are often contracted.

Precautions must be taken in the neighbourhood of swamps... because there are certain very small creatures which cannot be seen by the eyes, which float in the air and enter the body through the mouth and nose and there cause serious diseases.

1. What evidence is there in these sources that there was a long period of time when little was done about improving the unhealthy condition of Rome?

2. Describe the different ways that the Roman government attempted to improve the health of the Roman people.

3 Read source 2. Select another source from this unit that hetps to explain why the law mentioned in 2 was passed.

4. Comment on the value of the sources in this unit for a historian writing a book about the Roman government's attempts to improve the health of the Roman people.


20 th Century Public Health Achievements

According to the CDC, public health has been credited with adding 25 years to the life expectancy of people living in the U.S. in the 20 th century. But, how? Since it can be difficult for the general public to understand the impact of public health interventions, the CDC created Ten Great Public Health Achievements in the 20 th Century as a very helpful overview of all the great things public health has been able to achieve.

  • Vaccination to reduce epidemic diseases
    • At the beginning of the 20 th century, infectious diseases such as smallpox, measles, diphtheria, and pertussis were widely prevalent. Since there were few effective measures available, death tolls were high. Both the development and promotion of vaccinations against preventable diseases has resulted in dramatic declines in morbidity and mortality and even results in the eradication of smallpox.
    • Since 1925, there has been a 90% decrease in the annual death rate due to motor vehicle travel. This is particularly impressive given the number of motor vehicles, drivers, and miles traveled in motor vehicles have all increased dramatically since 1925.Some of the biggest interventions include regulations developed and enforced regarding safety belts, alcohol-impaired drivers, young drivers, pedestrians, and child safety and booster seats.
    • Data from CDC's National Institute for Occupational Safety and Health (NIOSH) National Traumatic Occupational Fatalities (NTOF) surveillance system indicate that the annual number of work-related deaths decreased 28% from 1980 to 1995 with a 43% decrease in occupational injuries during the same time.
    • The leading causes of death in 1900 were pneumonia, tuberculosis (TB), and diarrhea and enteritis whereas in 1997, 4.5% of deaths were attributable to pneumonia, influenza, and HIV infection. Sanitation and hygiene, vaccination, and antibiotics are among the control measures responsible for this marked decrease. Who knew handwashing could be so powerful!
    • While deaths due to infectious death have gone down dramatically, heart disease has been the leading cause of death for most of the 20 th century. Since 1950, age-adjusted death rates from cardiovascular disease have been cut by more than half. Some of the key public health factors contributing to this decline include the decline in tobacco use, changes in the U.S. diet, and better early detection and treatment of those at risk of cardiovascular disease (e.g. individuals with hypertension, high cholesterol, etc.)
    • Contaminated food and water resulted in many foodborne infections in early in the 20 th century. Advances, such as refrigeration, pasteurization, pest control, animal control, and food safety regulations that promoted better hygiene and sanitation practices all contributed to decreases in foodborne infections.
    • Childbirth use to come with great risk to many mothers and infants. Over the span of the century, the infant mortality rate declined greater than 90% and the maternal mortality rate declined almost 99%. Improvements in nutrition, standards of living, access to health care, and surveillance and monitoring of disease contributed to reducing risks to mothers and infants.
    • Better family planning interventions have resulted in longer intervals between births and smaller family sizes, both of which have been associated with improved maternal and child health outcomes.
    • At the beginning of the century, extensive dental caries was common in the U.S. with tooth extraction being the main treatment option available. Several studies have suggested that water fluoridation has contributed to reductions in dental caries when compared to communities without fluoridated water.
    • Smoking has been associated with a number of morbidities including cardiovascular disease, cancer, chronic obstructive pulmonary disease, and low birth weight. According to the CDC, it is the leading preventable cause of death and disability in the United States. Due to massive public health efforts that include smoking cessation interventions and regulation of the purchase and use of tobacco, there have been substantial reductions in smoking.

    Our History - Our Story

    Laboratory at 291 Peachtree Street, Atlanta, Georgia, 1945.
    Aimee Wilcox & Laboratory Director, Dr. Seward Miller.

    On July 1, 1946 the Communicable Disease Center (CDC) opened its doors and occupied one floor of a small building in Atlanta. Its primary mission was simple yet highly challenging: prevent malaria from spreading across the nation. Armed with a budget of only $10 million and fewer than 400 employees, the agency&rsquos early challenges included obtaining enough trucks, sprayers, and shovels necessary to wage war on mosquitoes.

    As the organization took root deep in the South, once known as the heart of the malaria zone, CDC Founder Dr. Joseph Mountin continued to advocate for public health issues and to push for CDC to extend its responsibilities to other communicable diseases. He was a visionary public health leader with high hopes for this small and, at that time, relatively insignificant branch of the Public Health Service. In 1947, CDC made a token payment of $10 to Emory University for 15 acres of land on Clifton Road in Atlanta that now serves as CDC headquarters. The new institution expanded its focus to include all communicable diseases and to provide practical help to state health departments when requested.

    Although medical epidemiologists were scarce in those early years, disease surveillance became the cornerstone of CDC&rsquos mission of service to the states and over time changed the practice of public health. There have been many significant accomplishments since CDC&rsquos humble beginnings. The following highlights some of CDC&rsquos important achievements for improving public health worldwide.

    Today, CDC is one of the major operating components of the Department of Health and Human Services and is recognized as the nation&rsquos premiere health promotion, prevention, and preparedness agency.

    A look at CDC's significant contributions to public health, from 1946 to now.


    Development of modern health insurance

    Development of modern health insurance

    National health insurance proposal

    Throughout the twentieth century, Progressive groups repeatedly called for national health insurance in the United States. The Progressive Party, also known informally as the Bull Moose Party, was formed in 1912 and nominated former President Theodore Roosevelt as its candidate for the presidential election. Its platform called for a National Health Service and public insurance for the elderly, unemployed, and disabled. The proposal for government health insurance was controversial and was opposed by influential organizations such as the American Federation of Labor, the American Medical Association, and fraternal organizations. Roosevelt finished second in the 1912 election, losing to Democratic candidate Woodrow Wilson. The Progressive Party performed poorly in the 1914 congressional elections and was dissolved in 1916 however, its idea of social insurance continued to influence reformers such as President Franklin Roosevelt. ⎸] ⎹]

    By 1920, 16 European countries had adopted public health insurance. In contrast, the United States rejected the European models and instead developed a system of private health insurance in which many employers provided plans to employees and their families. This system emerged in the late 1920s when hospitals began offering health plans to public school teachers. ⎺]

    Emergence of employer-sponsored insurance

    In 1929, the Dallas public schools entered into a contract with Baylor Hospital. Under the agreement, teachers would pay a monthly fee in exchange for guaranteed care at Baylor. The plan proved a success and was imitated by administrators around the country. The creator of one such plan illustrated his advertising posters with a picture of a blue cross. The American Hospital Association then adopted the blue cross as an insignia for plans they approved, while the American Medical Association adopted a blue shield for their approved plans. The Blue Cross/Blue Shield plans gave rise to a fee-for-service employer-sponsored insurance model, in which insurance companies reimbursed claims for services their enrollees received. According to one historian, "Blue Cross paid whatever the hospital charged. Blue Cross was not designed to monitor hospital costs." ⎻] ⎼] ⎽]

    In the 1930s, an industrialist named Henry Kaiser employed 5,000 workers on an aqueduct project in Southern California, with only one hospital nearby. Kaiser agreed to pay the hospital a fixed rate for each worker, and in exchange the hospital would provide all medical care for the workers' occupational injuries. The arrangement gave rise to the Kaiser Permanente Health Plan, a health insurance plan that operates its own hospitals and physicians' groups. The Kaiser system created managed care, which is the model for today's health maintenance organizations (HMOs) and preferred provider organizations (PPOs). Under the model of managed care, the insurance company involves itself more directly in medical care, often by owning hospitals, paying salaries to doctors, controlling referrals, or limiting the treatments covered. ⎾]

    Spread of employer-sponsored insurance and managed care

    The employer-sponsored model of health insurance spread during World War II, when a labor shortage prompted the federal government to institute wage controls with the intent of preventing inflation. In 1943, the War Labor Board ruled that wage controls did not apply to fringe benefits offered by employers, such as health insurance. In response, employers began offering greater health benefits rather than higher salaries in order to attract workers. The model grew more popular after the war when payments by employers toward employee health insurance were made tax-exempt. ⎿] ⏀] ⏁]

    By 1963, 77 percent of Americans had hospitalization coverage, and over 50 percent also had coverage for routine medical expenses. ⏂]

    In the 1980s, the RAND Corporation conducted a randomized study assigning people to different types of private health insurance, fee-for-service or managed care. The managed care organization in the study proved better at controlling costs, leading to public policies encouraging this type of private insurance. ⏃]


    Introduction

    Protecting and advancing the health of our nation's people and contributing to the delivery of health care world-wide is very important work and the main task of the Public Health Service (PHS). The PHS is a principal part of the Department of Health and Human Services (HHS) and the major health agency of the Federal Government. The PHS has about 5,700 Commissioned Corps officers and 51,000 Civil Service employees. Its budget in 1993 was approximately 17 billion dollars.

    In order to fulfill its very broad mission of promoting health in our nation and the world, the PHS has designed programs and created agencies which help control and prevent diseases conduct and fund biomedical research that will eventually lead to better treatment and prevention of diseases protect us against unsafe food, drugs, and medical devices improve mental health and deal with drug and alcohol abuse expand health resources and, provide health care to people in medically underserved areas and to those with special needs.

    The eight major agencies that make up the PHS and that do this work are the Centers for Disease Control and Prevention (CDC), the Agency for Toxic Substances and Disease Registry (ATSDR), the National Institutes of Health (NIH), the Food and Drug Administration (FDA), the Substance Abuse and Mental Health Services Administration (SAMHSA), the Health Resources and Services Administration (URSA), the Agency for Health Care Policy and Research (AUCPR), and the Indian Health Service (IHS).

    The Assistant Secretary for Health, with the assistance of the Surgeon General, heads the PHS, advises the HHS Secretary on health and health-related matters, and directs the activities of the major PHS agencies. Located in the Office of the Assistant Secretary for Health (OASH) are other important programs such as the National AIDS Program Office, the Office of International Health, and the President's Council on Physical Fitness and Sports.

    As the PHS gets ready to celebrate its bicentennial in 1998 it has a lot to be proud of. Its history has been one of growth and expansion, of ever-increasing Federal responsibility for health care, and of change in response to the evolving health needs of our nation. This then is the history of the Marine Hospital Service (1798-1902), the Public Health and Marine Hospital Service (1902-1912), and the Public Health Service (1912-present).

    The PHS grew out of a need for healthy seamen in our infant republic, which relied so much on the sea for trade and security. These seamen traveled widely, often became sick at sea, and then, away from their homes and families, could not find adequate health care in the port cities they visited or would overburden the meager public hospitals then in existence. Since they came from all the new states and former colonies, and could get sick anywhere, their health care became a national or Federal problem. A loose network of marine hospitals, mainly in port cities, was established by Congress in 1798 to care for these sick and disabled seamen, and was called the Marine Hospital Service (MHS).

    The Federal Government had only three executive departments then to administer all Federal programs -- State, Treasury, and War. The MHS was placed under the Revenue Marine Division of the Treasury Department. Funds to pay physicians and build marine hospitals were appropriated by taxing American seamen 20 cents a month. This was one of the first direct taxes enacted by the new republic and the first medical insurance program in the United States. The monies were collected from ship masters by the customs collectors in different U.S. ports.

    The President was granted the authority to appoint the directors of these hospitals, but later allowed the customs collectors to do it. The appointments thus became influenced by local politics and practices. Often times hospitals were built to meet political rather than medical needs. Each hospital was managed independently and the Treasury Department had no supervisory mechanism to centralize or coordinate their activity. For example, the report of a Congressional commission formed to investigate the MHS stated in 1851 that the "hospital at Mobile is as distinct and different from that at Norfolk or New Orleans as if it were a hotel and the other a hospital. "

    Lack of money, in addition to the lack of any supervisory authority, was another major problem for the MHS. The demand for medical services far exceeded the funds available. For that reason sailors with chronic or incurable conditions were excluded from the hospitals and a four-month limit was placed on hospital care for the rest. Additional funds had to be appropriated constantly from Congress in order to maintain the Service and to build the hospitals. Because of these problems Congress was forced to act and in 1870 reorganized the MUS from a loose network of locally-controlled hospitals to a centrally-controlled national agency with its own administrative staff, administration and headquarters in Washington, D.C.

    Through this reorganization, the MHS became a separate bureau of the Treasury Department under the supervision of the Supervising Surgeon, who was appointed by the Secretary of the Treasury. The title of the central administrator was changed to Supervising Surgeon General in 1875 and to Surgeon General in 1902. Additional money to fund the reorganized Service was appropriated by raising the hospital tax on seamen from twenty to forty cents per month. The money collected was deposited in a separate MHS fund.

    Taxing seamen to fund the MHS was abolished in 1884. From 1884 to 1906 the cost of maintaining the marine hospitals was paid from the proceeds of a tonnage tax on vessels entering the United States, and from 1906 to 1981, when the Public Health Service hospitals were closed, by direct appropriations from Congress.

    The 1870 reorganization also changed the general character of the Service. It became national in scope and military in outlook and organization. Medical officers, called surgeons, were required to pass entrance examinations and wear uniforms. In 1889, when the Commissioned Corps was formally recognized by legislative action, the medical officers were given titles and pay corresponding to Army and Navy grades. Physicians who passed the examinations were appointed to the general service, rather than to a particular hospital, and were assigned wherever needed. The goal was to create a professional, mobile, health corps, free as possible from political favoritism and patronage, and able to deal with the new health needs of a rapidly growing and industrializing nation.

    Epidemics of contagious diseases, such as small pox, yellow fever, and cholera, had devastating effects throughout the 19th century. They killed many people, spread panic and fear, disrupted government, and caused Congress to enact laws to stop their importation and spread. As a result of these new laws, the functions of the MHS were expanded greatly beyond the medical relief of the sick seamen to include the supervision of national quarantine (ship inspection and disinfection), the medical inspection of immigrants, the prevention of interstate spread of disease, and general investigations in the field of public health, such as that of yellow fever epidemics.

    To help diagnose infectious diseases among passengers of incoming ships, the MUS established in 1887 a small bacteriology laboratory, called the Hygienic Laboratory, at the marine hospital on Staten Island, New York. That laboratory later moved to Washington, D.C., and became the National Institutes of Health, the largest biomedical research organization in the world.

    To better consolidate these increased functions of the MHS, including medical research, and give them legal powers, Congress passed an act in 1902 which expanded the scientific research work at the Hygienic Laboratory and gave it a definite budget. The bill also required the Surgeon General to organize annual conferences of local and national health officials in order to coordinate better state and national public health activities, and changed the name of the MHS to the Public Health and Marine Hospital Services (PHMHS) to reflect its broader scope.

    The PHMHS was not the only government agency engaged in health-related work. The enforcement of the pure food and drugs law, passed in 1906, was placed in the hands of the Bureau of Chemistry of the Department of Agriculture. The Federal inspection of meats entering interstate commerce, also mandated by law in 1906, was done by the Bureau of Animal Industry of the Department of Agriculture. The Bureau of the Census was authorized in 1902 to collect vital statistics -- data relating to health and disease from around the country.

    Efforts were made during the early decades of the 20th century by both political parties and by people inside and outside of government concerned with the nation's health to combine public health-related work being done by various Federal agencies, but they were unsuccessful in Congress. The act of August 14, 1912 changed the name of the PHMHS to the Public Health Service and further broadened its powers by authorizing investigations into human diseases (such as, tuberculosis, hookworm, malaria, and leprosy), sanitation, water supplies and sewage disposal, but went no further.

    Real consolidation began in June 1939, when the PHS was transferred by President Franklin D. Roosevelt to the newly created Federal Security Agency (FSA), which combined a number of New Deal government agencies and services related to health, education, and welfare. Over 140 years of association between the PHS and the Treasury Department came to an end. All of the laws affecting the functions of the services were also consolidated for the first time in the Public Health Services Act of 1944.

    The FSA was a noncabinet-level agency whose programs grew to such size and scope that, in 1953, President Eisenhower submitted a reorganization plan to Congress which called for the dissolution of the FSA and the transfer of all its responsibilities to a newly created Department of Health, Education, and Welfare (HEW). A major objective of this reorganization was to ensure that the important areas of health, education, and social security be represented in the President's cabinet. In 1979, HEW's educational tasks were transferred to the new Department of Education and the remaining divisions of HEW were reorganized as the Department of Health and Human Services (HHS).

    Throughout all of these reorganizations which have shaped, defined, and established the PHS in its present place in the Federal Government, and which have spanned nearly two centuries, the PHS has never lost sight of its primary goal -- providing health care for those with special needs. From the care of sick and disabled sailors the PHS has extended its activities to other groups with special needs (such as, the American Indians, the Alaska Natives, migrant workers, Federal prisoners, and refugees), and to the nation as a whole.

    The duties and functions of the PHS have expanded to include disease control and prevention, biomedical research, regulation of food and drugs, mental health and drug abuse, health care delivery, and international health. These six themes provide the organizational structure for the images of the PHS that follow.


    5 Worst Public Health Outbreaks in U.S. History

    Throughout history, there have been similar outbreaks to the coronavirus, with some handled forcefully and cohesively, reducing continuous spread, while others completely rejected the science, which temporarily destroyed the economic and health state of the country.

    Major disease outbreaks have transformed how people live and how to mitigate the fear of co-existing with a deadly infection.

    Pandemics have left an imprint in history, as global public health experts are referring to past efforts of preventing further spread of serious diseases.

    The coronavirus pandemic has reported nearly seven million cases and killed almost two hundred thousand Americans since it struck the country earlier this year. The country has taken substantive measures to contain the spread of the virus, despite the lack of leadership and guidance from the federal government, including quarantining, limited interaction in big gatherings, the wearing of face masks and gloves when in public and maintaining strong personal hygiene.

    Throughout history, there have been similar outbreaks to the coronavirus, with some handled forcefully and cohesively, reducing continuous spread, while others completely rejected the science, which temporarily destroyed the economic and health state of the country.

    Here are some of the worst public health outbreaks in U.S. history.

    Cholera: 1832-1866

    Three waves of cholera infected the globe between 1832 and 1866, killing an estimated 150,000 Americans.

    The deadly, water-born disease infected the intestines and originated in India. Cholera is known to spread by consuming unsanitary water, which easily spread through trade routes as people traveled from India to Europe via steamboats and railroads, where immigrants then carried it to America.

    New York City was the first major city to really experience the impacts of the pandemic, similar to what happened with the coronavirus, as nearly five thousand people died of the infection. Between 5 and 10 percent of the total population died in major cities during the outbreak.

    As cholera struck the United States, thousands of more Americans reported to have the infection, which caused Ohio to postpone its first State Fair, contaminated migrants along the Oregon Trail to the Pacific Northwest and the Mormon Trail to Utah and reported nearly twelve thousand fatalities en route to the California Gold Rush, according to American Minute.

    By the early 1900s, the outbreaks subsided, but it still remains unclear what nixed the disease. Scientists suggest a change in climate or enforced quarantine rules.

    Currently, cholera is a cause of death for nearly ninety-five thousand people worldwide, according to the Centers for Disease Control and Prevention ( CDC). Although modern sewage and water treatment have helped prevent further spread of the infection, cholera is still a public health issue that’s infected thousands of people

    Yellow Fever: 1878

    One humid summer in the late 1700s brought the yellow fever epidemic from the Caribbean Islands and into Philadelphia. Nearly half a century later, the yellow fever swarmed Norfolk, Virginia in 1855, but the worst outbreak that infected the United States was in the Mississippi River Valley in 1878.

    In the spring of 1878, the Caribbean served as another epicenter for the outbreak, where thousands of refugees fled to America’s shores in hopes to avoid contact with the fever. President Rutherford B. Hayes signed the Quarantine Act of 1878, granting the Marine Hospital Service the authority to not allow migrants to enter the country’s shores via ships.

    During the spring and summer of 1878, the valley reported nearly 120,000 cases of the fever and roughly between 13,000 and 20,000 fatalities. The fever triggered a yellow-ish coloring of the skin and eyes, fever and bloody vomiting.

    The outbreak started in New Orleans and swiftly spread up the valley as more than one-fifth of the city’s population fled to avoid the deadly disease. Like the coronavirus, the yellow fever impacted different industries —residents fled cities that were infected, the economy contracted and thousands of people died. A vaccine was later developed and licensed for distribution.

    It wasn’t until 1900 that researchers confirmed that the fever spread by a species of a mosquito native to Africa and tropical climates.

    The Spanish Influenza: 1918

    The influenza pandemic, or the “Spanish flu” that entered the United States was the most severe pandemic in recent history, according to the CDC. The flu was caused by H1N1, but it didn’t have a universal agreement or conclusion as to where the virus had originated. The flu quickly spread worldwide from 1918 to 1919, infecting nearly one-third of the globe’s population.

    In the United States, there were 675,000 deaths —after the first identified case sprouted among military personnel—with the highest mortality rates among people younger than five years old, between the ages of twenty to forty and sixty-five years and up. Since there was no vaccine to prevent further spread, federal officials and public health experts encouraged people to isolate, quarantine, maintain strong personal hygiene, use disinfectants and limit gatherings.

    The Spanish flu also came at a time when the United States passed the 1918 Sedition Act—which followed the country’s participation in World War I as an Allied Power—a piece of legislation that dubbed it criminal to say anything that could harm or interfere negatively with the country or the war effort. Although it’s unclear how thoroughly the act was implemented, newspapers, the military and federal officials downplayed the risk of the flu.

    Then-President Woodrow Wilson also understated the threat of the virus since he was extensively interested in the country’s war efforts—despite contracting it and hiding it from the public in 1919. Wilson decided to “focus on the battlefronts of Europe, virtually ignoring the disease that ravaged the home front.”

    In recent weeks, President Donald Trump has publicly admitted to downplaying the coronavirus, an initiative from a president that the country’s clearly seen before.

    Wilson’s handling of the Spanish flu ranked him as a top candidate for the worst presidents during a disaster, as hundreds of thousands of Americans died under his control.

    Known as the most feared disease of the twentieth century, the polio epidemic infiltrated the United States several times throughout the 1900s, with the outbreak of 1952 being the year when the number of reported cases peaked across the country.

    During that year, more than fifty-seven thousand Americans were infected, with over three thousand deaths.

    Fear and general uncertainty made this epidemic so similar to the coronavirus, as it was unpredictable. Polio is a viral disease that impacts the nervous system, usually triggering paralysis. At the time, no one knew how it was transmitted or what had caused it, but it became known that it typically spreads through direct contact with an infected person.

    With the frequent outbreaks of the disease, life for Americans didn’t return back to normal for a number of years. Recreation facilities shuttered their doors and children didn’t go to playgrounds or spend time with friends.

    The country saw a vaccine for the disease in 1955, thanks to President Franklin Roosevelt’s interest in widening the federal government’s role in advancing public health discovery and research. Roosevelt ensured funding for a massive hospital and expanded facilities associated with the National Institutes of Health (NIH). Although Roosevelt —who shielded his paralysis from the disease—didn’t live to experience the unveiling of the vaccine, “his struggle against polio and dedication to the expansion of medical science for the benefit of all Americans demonstrate the value of seeing national preparedness as broad enough to encompass scientific and medical research,” according to The Washington Post.

    Roosevelt formed a strong appreciation for science and public health research, as he maintained strong relationships with top experts and incorporated federal government efforts into polio research and discovery.

    HIV and AIDS: 1980s

    When the HIV epidemic entered the United States in the 1980s, scientists believed it was a rare lung infection. After scientific research was conducted, the country discovered that HIV, instead, impairs the body’s immune system, compromising its ability to be strong enough to combat other infections.

    HIV can be transmitted through sexual contact or via blood or bodily fluids, or it can be transmitted from the mother to an unborn child if it’s not treated correctly.

    AIDS is the final stage of the HIV infection, according to the CDC, and in 2018 it was ranked in the top ten leading causes of death in the United States among young people between the ages of twenty-five to thirty-four years old. The first documented case was in 1981.

    Although HIV doesn’t have a cure, scientists have configured how to minimize risk and reduce transmission of the infection. Like coronavirus, HIV crushed racial and ethnic minorities due to a lack of access to proper medical supplies and health care.

    During the HIV epidemic, the country was under President Ronald Reagan’s administration, but leadership failed to garner support from Americans as he handled “the epidemic as a joke.”

    In a documentary about the AIDS epidemic, footage revealed Reagan’s press secretary and members of the media poking fun at the infection, dubbing it as a “gay plague.” The documentary revealed that the Reagan administration didn’t have much knowledge about the disease when it first infected the country and wasn’t serious in squashing it. Reagan’s candidacy still receives pushback for his rhetoric and leadership during the epidemic.


    A History of Public Health

    Since publication in 1958, George Rosen’s classic book has been regarded as the essential international history of public health. Describing the development of public health in classical Greece, imperial Rome, England, Europe, the United States, and elsewhere, Rosen illuminates the lives and contributions of the field’s great figures. He considers such community health problems as infectious disease, water supply and sewage disposal, maternal and child health, nutrition, and occupational disease and injury. And he assesses the public health landscape of health education, public health administration, epidemiological theory, communicable disease control, medical care, statistics, public policy, and medical geography.

    Rosen, writing in the 1950s, may have had good reason to believe that infectious diseases would soon be conquered. But as Dr. Pascal James Imperato writes in the new foreword to this edition, infectious disease remains a grave threat. Globalization, antibiotic resistance, and the emergence of new pathogens and the reemergence of old ones, have returned public health efforts to the basics: preventing and controlling chronic and communicable diseases and shoring up public health infrastructures that provide potable water, sewage disposal, sanitary environments, and safe food and drug supplies to populations around the globe.

    A revised introduction by Elizabeth Fee frames the book within the context of the historiography of public health past, present, and future, and an updated bibliography by Edward T. Morman includes significant books on public health history published between 1958 and 2014. For seasoned professionals as well as students, A History of Public Health is visionary and essential reading.


    Lessons public health professionals learned from past disasters

    Objectives: Delineate the lessons that public health professionals learned during past disasters and information/resources found to be lacking during past disasters.

    Design/sample: Qualitative research consisting of 32 participants who attended the 2006 Association for Professionals in Infection Control and Epidemiology Conference and participated in 1 of 3 focus groups.

    Measurements: Focus group sessions were audiotaped tapes were transcribed verbatim. Content analysis included identifying, coding, and categorizing participants' responses. Major themes were identified and categorized.

    Results: Disasters can result in public health crises if infection prevention/control interventions are not implemented rapidly and appropriately. Gaps in past public health disaster response include infection prevention/control in mass casualty incidents, public education, internal and external communication, mental health, physical plant, and partnerships with outside agencies. Participants emphasized the need to provide consistent messages to the public, communicate between agencies, and provide public education on disaster preparedness. These tasks can be challenging during infectious disease emergencies when recommendations change. Effective communication is necessary to maintain public trust. Infection control issues in shelters, such as hand hygiene products/facilities, sanitation, outbreaks of unusual infectious diseases, overcrowded conditions, and poor environmental decontamination, were identified as critical to prevent secondary disease transmission.

    Conclusion: Public health and infection control nurses must partner and continue to address gaps in disaster planning.


    History of health, a valuable tool in public health

    The aim of this article is to highlight the importance of the history of public health for public health research and practice itself. After summarily reviewing the current great vitality of the history of collective health oriented initiatives, we explain three particular features of the historical vantage point in public health, namely the importance of the context, the relevance of a diachronic attitude and the critical perspective. In order to illustrate those three topics, we bring up examples taken from three centuries of fight against malaria, the so called "re-emerging diseases" and the 1918 influenza epidemic. The historical approach enriches our critical perception of the social effects of initiatives undertaken in the name of public health, shows the shortcomings of public health interventions based on single factors and asks for a wider time scope in the assessment of current problems. The use of a historical perspective to examine the plurality of determinants in any particular health condition will help to solve the longlasting debate on the primacy of individual versus population factors, which has been particularly intense in recent times.


    50 Women Who Shaped America's Health

    If you've received a blood transfusion, had lifesaving radiation therapy, experienced a natural birth or even lost weight by counting calories, you have used one of the many health innovations given to us by women in medicine.

    In honor of Women's History Month, the Healthy Living staff has been thinking about the accomplishments of the women who pioneered work in the sciences. As health journalists, we believe that all doctors and researchers deserve more recognition for their contributions to society. And as women, we can't help but notice that our gender can affect the way we're treated in these disciplines -- from colleague discrimination to legislation aimed at lessening the control female patients have over their bodies, it can sometimes feel as though we're living in a previous era.

    That is, until we realize what previous generations actually went through. Take for example the story of Rosalind Franklin: the geneticist's strides in X-ray photography led to the best images of DNA strands of her era, but coworker Maurice Wilkins shared her images with a competing team at Cambridge, who used it to help solve the mystery of how DNA is structured. It wasn't until decades later that Franklin was recognized for her contribution -- well after her death and after that competing team (along with Wilkins) were awarded the Nobel Prize.

    Now, we live in a country where half of medical school graduates are women and a country where we value -- have actually written into law -- retelling the accomplishments of women in our own history. So we decided to celebrate by bringing together a list of 50 women who have had the greatest impact in medicine and health research and have, in the process, taught us about our own bodies.

    This is by no means a definitive list. We couldn't include everyone -- and thank goodness the entirety of female medical accomplishment cannot fit squarely into 50 slides. With a few exceptions, we focused on American women. We tried to divide evenly between living and dead. But we did our best to choose women, both famous and unknown, who have built our understanding of health. We have Civil War-era doctors and contemporary neurobiologists field researchers in Congo and political organizers in Boston. But this is just the start of the conversation. Please tell us who inspires you in the comments.


    Watch the video: Stalking a BIG MULEY Buck! - New Mexico Public Land


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