History of Public Health

by

L. Fleming Fallon

• LAST REVIEWED: 28 October 2011
• LAST MODIFIED: 28 October 2011
• DOI: 10.1093/obo/9780199756797-0008

Introduction

The history of public health is dynamic and being generated on a constant basis. Diseases have provided the stimulus for much of the activity in public health. In a handful of instances, overcoming a disease has removed a barrier to commerce or another desired goal. For example, overcoming yellow fever facilitated construction of the Panama Canal in the early 1900s, and finding a cure for scurvy allowed mariners to make longer voyages of exploration. It is important to note that advances in public health usually have impacts on people throughout the world and that public health is an international effort. Public health researchers are focusing on heart disease and type 2 diabetes in response to contemporary epidemics. Efforts to understand and cure diseases have had the unintended consequences of developing tools. The science of epidemiology emerged from efforts to stop cholera in England. In addition, forces other than disease have affected public health. Examples include the sanitary movement that began in England and was quickly duplicated in a new England (mid-1800s), social concerns that reformers used to promote mandatory schooling for children as a way to stop child labor in factories (mid-1800s), and concern for wholesome food (late 1800s). A small number of diseases have had a disproportionate impact on the history of public health throughout the world. These include smallpox, influenza, tuberculosis (TB), and HIV/AIDS. The first three diseases have been known since antiquity; HIV/AIDS is a more recent problem. Smallpox is noteworthy for its mortality rate and because it is the only disease that has been eradicated. Influenza became a human disease after individuals domesticated pigs. Because influenza mutates so readily, it continues to challenge public health planners. In periodic pandemics, influenza kills many people. Tuberculosis, like influenza, migrated to humans after cattle were domesticated. TB is a concern for public health for at least two reasons. Experts estimate that one person in three carries the TB pathogen. Because the length of time required to treat TB is long (months), most strains of TB have developed drug resistance. Finally, as of 2010, HIV/AIDS has caused more than 40 million deaths. With the exception of HIV/AIDS, vaccines have been developed for these diseases. The smallpox vaccine provided the means for eradication, whereas influenza mutates so readily that the vaccine must be frequently revised. A vaccine for TB is also available, because it is not effective in all recipients, it is not used in the United States as a matter of public health policy.

General Overviews

Several books have been written about the history of public health. Each emphasizes a different aspect of public health, reflecting the background and interests of the authors. Mullan 1989 wrote an extensive history of the US Public Health Service. Duffy 1992 was the first historian to analyze the work of sanitarians. The history of public health in Rosen 1993 is comprehensive through its original publication date (1953); the expanded edition features a new introduction by Elizabeth Fee. Porter 1999 provides a much longer historical time frame that is international in scope. Fee, et al. 2002 began a series of articles that add to the history of public health, and Warner and Tighe 2006 shows links between clinical medicine and public health. Schneider and Lilienfeld 2008 is a comprehensive but brief history of public health, whereas Ravenel 2010 is a history of public health in the United States that has been republished. The latter was complete through the original date of publication in 1921.

• Duffy, John. 1992. The sanitarians: A history of American public health. Champaign: Univ. of Illinois Press.

  This history of public health focuses on public health from the perspective of the tasks and responsibilities that grew out of the sanitary movement that began in the mid-1800s. These encompass water quality, safe disposal of wastes, air quality, and environmental cleanliness.

• Fee, Elizabeth, Theodore M. Brown, Jan Lazarus, and Paul Atheerman. 2002. The tooth puller (L’arracheur de dents). American Journal of Public Health 92.1: 35.

  DOI: 10.2105/AJPH.92.1.35

  This is the first of a series of occasional pieces called “Voices from the Past” written by Elizabeth Fee and colleagues. The author provides biographical material about individuals that have had an impact on the history of public health. The writing is outstanding. As of 2010, the series continues. Available online for purchase or by subscription.

• Mullan, Fitzhugh. 1989. Plagues and politics: The story of the United States Public Health Service. New York: Basic Books.

  This book provides a comprehensive history of public health from its founding in 1799 to 1989. The author notes that the Public Health Service (PHS) has become the primary health agency of the federal government. He also notes that the PHS has played a role in most health initiatives in which the United States has become involved. Although well known for its epidemiological studies, the PHS has conducted or collaborated with research on diseases and treatments. Throughout is history, the PHS has been an advocate for improving health for people throughout the world.

• Porter, Dorothy. 1999. Health, civilization and the state: A history of public health from ancient to modern times. New York: Routledge.

  This history of public health covers a longer time span, beginning before public health was formally recognized. The author is an historian with training in public health. The coverage is reasonably complete.

• Ravenel, Mazÿck. 2010. A half century of public health. Memphis: General.

  Mazÿck provides a comprehensive history of the origins of public health in the United States from 1870 to 1920. The beginning reflects the advent of a uniformed professional service employing individuals based on their training, credentials, and examinations. The last major episode in the book is a description of the influenza pandemic of 1918–1919 and the role assumed by the Public Health Service. The book was originally published by the American Public Health Association in 1921.

• Rosen, George. 1993. A history of public health, expanded ed. Baltimore: Johns Hopkins Univ. Press.

  This is a revised edition of a public health classic. It traces the history of public health by focusing on epidemiology, disease surveillance, and disease eradication. The book was originally published in 1953. Elizabeth Fee, Chief of the History of Medicine Division for the National Library of Medicine, wrote an introductory commentary for this expanded (1993) edition.

• Schneider, Dona, and David E. Lilienfeld. 2008. Public health: The development of a discipline, from the age of Hippocrates to the Progressive Era. New Brunswick, NJ: Rutgers Univ. Press.

  The authors of this most recent history of public health attempt to be all inclusive. They succeed but at the cost of brevity for many interesting eras in public health. In general, the coverage in the book is reasonably balanced.

• Warner, John H., and Janet A. Tighe. 2006. Major problems in the history of American medicine and public health: Documents and essays. Major Problems in American History Series. Florence, KY: Wadsworth.

  The authors note that the histories of clinical medicine and public health are intertwined. They devote more pages to the history of medicine than public health. However, their coverage of public health is succinct.