CHAPTER
2
Historical Developments
in Public Health and
the 21st Century
James A. Johnson, James Allen Johnson III, and Cynthia B. Morrow
LEARNING OBJECTIVES
t
t
t
t
To better understand the historical context of public health
To gain perspective on the role of public health in society
To grasp the key milestones in the evolution of public health practice and policy
To understand recent reform and its implications for the future of public health
Chapter Overview
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Chapter 2 Historical Developments in Public Health and the 21st Century
Early History of Public Health
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Early History of Public Health
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Chapter 2 Historical Developments in Public Health and the 21st Century
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16
Chapter 2 Historical Developments in Public Health and the 21st Century
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Industrialization and the Influence of Great Britain
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9781449657413_CH02_PASS02.indd 16
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Early History of Public Health
17
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The Emergence and Impact of Bacteriology
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18
Chapter 2 Historical Developments in Public Health and the 21st Century
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The specters cholera, yellow fever, and smallpox recoil in fear as
their way through the port of New York is blocked by a barrier
labeled “Quarantine” and by an angel holding a sword
and a shield on which is written “Cleanliness.”28, p. 139
—Description of “At the Gates,” an etching printed by Harper and Brothers,
New York, September 5, 1885
The American Colonies and the Early United States
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9781449657413_CH02_PASS02.indd 18
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Public Health in the United States
19
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9781449657413_CH02_PASS02.indd 19
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20
Chapter 2 Historical Developments in Public Health and the 21st Century
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Public Health in the 20th Century
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9781449657413_CH02_PASS02.indd 20
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Public Health in the United States
21
Exhibit 2.1 Early Influenza Warning
Source: Reproduced from National Library of Medicine. Office of Public Health Historian.
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9781449657413_CH02_PASS02.indd 21
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22
Chapter 2 Historical Developments in Public Health and the 21st Century
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Exhibit 2.2 Surgeon General’s Warning
Source: CDC/Debora Cartagena.
9781449657413_CH02_PASS02.indd 22
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Public Health in the United States
23
Exhibit 2.3 Ten Great Public Health Achievements
1. Vaccines: Few treatments were effective in the prevention of infectious diseases in 1900.
Now, smallpox, measles, diphtheria, pertussis, rabies, typhoid, cholera, and the plague are
preventable through widespread use of vaccines.
2. Recognition of tobacco use as a health hazard: Since the 1964 surgeon general’s report on risks
associated with smoking, smoking among adults has decreased, saving lives.
3. Motor vehicle safety: Improved engineering of vehicles and roads plus the use of seat belts, car
seats, and helmets have reduced the number of deaths, as has decreased drinking and driving.
4. Safer workplaces: A 40% decrease in fatal occupational injuries (since 1980) has resulted
through efforts to control work-related disease such as pneumoconiosis (black lung) and
silicosis, which are associated with coal mining, and to improve safety in manufacturing,
construction, transportation, and mining.
5. Control of infectious diseases: Efforts to protect the water supply and keep it clean with
improved sanitation methods have greatly improved health, particularly curbing the spread of
cholera and typhoid. The discovery of antimicrobial therapy has helped to control tuberculosis
and sexually transmitted diseases (STDs).
6. Fewer deaths from heart disease and stroke: Smoking cessation, blood pressure control, early
detection, and better treatments have resulted in a 51% decrease in death rates for coronary
heart disease since 1972.
7. Safer and healthier foods: Major nutritional deficiency diseases such as rickets, goiter, and
pellagra have been virtually eliminated in the United States through greater recognition
of essential nutrients, increases in nutritional content, food fortification, and decreases in
microbial contamination.
8. Healthier mothers and babies: Better hygiene, nutrition, access to health care, antibiotics,
and technologic advances have helped to reduce infant mortality by 90% and maternal
mortality by 99%.
9. Family planning and contraceptive services: These services have altered the social and economic
roles of women. Access to counseling and screening has resulted in fewer infant, child, and
maternal deaths. Contraceptives have provided protection from human immunodeficiency virus
and other STDs.
10. Fluoridation of drinking water: Nearly 150 million people have access to treated water, a
safe and effective way to prevent tooth decay. Fluoridation has helped reduce tooth decay in
children 40–70% and tooth loss in adults 40–60%.
Source: Adapted from Centers for Disease Control and Prevention. Ten great public health achievements—United States,
1900–1999. MMWR. 1999;48(12):1–3.
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9781449657413_CH02_PASS02.indd 23
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24
Chapter 2 Historical Developments in Public Health and the 21st Century
Public Health in the 21st Century
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9781449657413_CH02_PASS02.indd 24
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Public Health in the United States
Increasing
Population Impact
Counseling
and Education
25
Increasing Individual
Effort Needed
Clinical
Interventions
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Interventions
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Individuals’ Default Decision Healthy
Socioeconomic Factors
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26
Chapter 2 Historical Developments in Public Health and the 21st Century
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Public Health in the United States
27
Box 2.1 Affordable Care Act Public Health Elements
tt
Investments in public health and prevention:
Prevention and Public Health Fund (PPHF): Provides the greatest amount of funding for
public health initiatives including Community Transformation Grants; Epidemiology and Lab
Capacity Grants; National Public Health Improvement Initiatives; and National Diabetes
Prevention Programs
National Prevention, Health Promotion, and Public Health Council: Establishes a council to
coordinate and lead federal government’s prevention, wellness, and health-promotion efforts
Maternal, Infant, and Early Childhood Home Visitation Programs: Authorizes funds for
evidence-based home visitation programs for this target population
Public health workforce:
Fellowship Training in Public Health (partially funded by PPHF)
Public Health and Preventive Medicine Programs (partially funded by PPHF)
Expansion of coverage, awareness, and access to clinical preventive services:
Contains numerous provisions to improve insurance coverage of family planning services and
U.S. Preventive Services Task Force (USPSTF)–recommended services, in addition to many
areas of expanded coverage under Medicare and Medicaid specifically
Authorizes funding for Personal Responsibility Education (adolescent abstinence,
contraception, and prevention of sexually transmitted infections), Pregnancy Assistance Fund
(support of victims of domestic violence and sexual assault), school-based health centers,
and oral health activities
Provides recommendations with respect to the USPSTF and the Community Preventive
Service Task Force (Community Guide) with funding from PPHF
Wellness programs:
Authorizes grants to small businesses to provide comprehensive workplace wellness programs
Requires the Centers for Disease Control and Prevention (CDC) to provide employers with
assistance to evaluate worksite wellness programs
Public health research and data:
Directs the CDC to fund research on effectiveness of evidence-based practices that relate to
public health initiatives
Authorizes funds for a childhood obesity demonstration project through the Centers for
Medicare and Medicaid Services (CMS)
Other:
Requires the U.S. Department of Health and Human Services (HHS) to develop a national
quality improvement plan
Requires nutrition labeling at restaurants with more than 20 locations
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Source: Adapted from NACCHO. Public Health and Prevention Provisions of the Affordable Care Act. Available at:
http://www.naccho.org/advocacy/upload/PH-and-Prevention-Provisions-in-the-ACA-Revised.pdf. Accessed
February 8, 2013.
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Chapter 2 Historical Developments in Public Health and the 21st Century
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ZPVSQVCMJDIFBMUISPMF
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/"$$)0-PDBMIFBMUIEFQBSUNFOUKPCMPTTFTBOEQSPHSBNDVUTëOEJOHTGSPNUIF+BOVBSZ4VSWFZ "WBJMBCMF BU IUUQXXXOBDDIPPSHUPQJDTJOGSBTUSVDUVSFMIECVEHFUVQMPBE3FTFBSDI#SJFG'JOBM
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o
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EJêFSFODFTBSFXJEFOJOHBOENBZOPUDBUDIVQHealth Affairs.
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+PIOTPO + Introduction to Public Health Management, Organizations, and Policy $MJGUPO 1BSL /:
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31
Additional Resources
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-V[BD
4JSBJTJ/(Avicena in Renaissance Italy. The Canon and Medical Teaching in Italian Universities after 1500.
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NFEJDJOFBOETVSHFSZJOUIFMBUF.JEEMF"HFTTrans Stud Coll Physicians Philao
"MMCVUU$5The Relations of Medicine and Surgery to the End of the Sixteenth Century-POEPO.BDNJMMBO
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(JMNBO4Disease and Representation: Images of Illness from Madness to AIDS*UIBDB$PSOFMM6OJWFSTJUZ
1SFTT
1FMMJOH.$POUBHJPO(FSNɨFPSZ4QFDJëDJUZ*O#ZOVN8'1PSUFS3FETCompanion Encyclopedia
of the History of Medicine, 2 vols-POEPO3PVUMFEHFo
ɨF*MJBEPG)PNFS5SBOTMBUFECZ"MFYBOEFS1PQF$POOFDUJDVU&BTUPO1SFTT
"UUIF(BUFT0VS4BGFUZ%FQFOET6QPO0ïDJBM7JHJMBODF8PPEFOHSBWJOHGSPN)BSQFST8FFLMZ
4FQUFNCFS
*O(FPSHF3A History of Public Health
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