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Definition of Public Health
• Public health is the science and art of• Preventing disease.
• Prolonging life.
• Organizing community efforts for the:
• Sanitation of the environment.
• Control of communicable diseases.
• Education of the individual in personal hygiene.
• Organization of medical and nursing services for the early diagnosis and preventive treatment of disease.
• Development of the social machinery to ensure everyone a standard of living adequate for the maintenance of health.
(Winslow, 1923)
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“On Airs, Waters, and Places”
“ These things one ought to consider most attentively, and concerning the waters which the inhabitants use, whether they be marshy and soft, or hard, and running from elevated and rocky situations, and then if saltish and unfit for cooking; and the ground, whether it be naked and deficient in water, or wooded and well watered, and whether it lies in a hollow, confined situation, or is elevated and cold; and the mode in which the inhabitants live, and what are their pursuits, whether they are fond of drinking and eating to excess, and given to indolence, or are fond of exercise and labor, and not given to excess in eating and drinking.”
Hippocrates, 400 BC, translated by Francis Adam
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0
500
1000
1500
2000
2500
3000
3500
1860 1870 1880 1890 1900 1910 1920 1930 1940 1950 1960 1970
Tuberculosis
Whooping Cough
Measles
Death Rates 1860 – 1970D
eath
s p
er 1
00,0
00
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Leading Causes of Death, 1990
1. Heart disease
2. Cerebrovascular disease
3. Cancer – lung, trachea
4. Lower respiratory infections
5. Chronic Obstructive Pulmonary Disease
6. Cancer – colon, rectum
7. Cancer – stomach
8. Traffic accidents
9. Self-inflicted injuries
10. Diabetes
Developed Nations 1. Lower respiratory infections
2. Heart disease
3. Cerebrovascular disease
4. Diarrhoeal diseases
5. Perinatal conditions
6. Tuberculosis
7. Chronic Obstructive Pulmonary Disease
8. Measles
9. Malaria
10. Traffic accidents
Developing Nations
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Twentieth Century
• Governmental Reform
• 1908 First Bureau of Child Hygiene, New York City Health Dept.
• Dr. Josephine Baker
• Appointed Bureau chief.
• Established school nurse program.
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What are the Requirements for Survival?
• Write down a list of critical things that humans need.
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Mortality Rates U.S. vs % GNP Spent on Medical Care, 1900-1970
J. McKinley and S. McKinley, “The Questionable Contribution of Medical Measures to the Decline of Mortality in the Twentieth Century.” Millbank Memorial Fund Quarterly 55 (1977): 413 Millbank Memorial
5
7.5
10
12.5
15
17.5
1900 1910 1920 1930 1940 1950 1960 1970
8.5%
7.5%
6.5%
5.5%
4.5%
3.5%
% G
NP
on
Med
ical
Car
e Percent GNP on Medical Care
Total Mortality
Mortality Minus 11 Infectious DiseasesM
ort
alit
y ra
tes
per
1,0
00
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U.S. Congress
State Legislatures
Federal Agencies
State Agencies
Local Health Dept.
Municipal Home Rule
U.S. Constitution
State Constitution
Legal Hierarchy
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Legal Functions
Rules, Regulations Laws, Statutes,
Ordinances
Legislative Branch Executive Branch
Judicial Branch
Interpretations