publichealth-1 B

Transcriber:	Yvonne Cherne
Brief Bio:
Date finished:	5-3-2007
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file: hph_lec1b.mp3

A History of Modern Public Health: Introduction (continued)

When we are considering the effectiveness of therapeutics, it is
important to realize that for very much of much of human history,
medicine could actually do very little to have an effect on the
progress of disease in the human body.

Here we have two examples of plague charms from Lucerne in the
17th century. And these charms generally used to contain
medicinal herbs and perfume substances that were thought to
prevent a person contracting plague and the disease. Clearly in
today's world, we can look back and see these as ineffective
means of prevention of the plague. However, historically in times
when ideas about the causation of plague were not known,
instruments or plague charms such as this were thought to purify
the air and were thought to cleanse the air surrounding an
individual, and this in some senses has an internal logic if it
is thought that it was the air itself that might have carried the
plague germ or the plague virus.

Here we can see a warehouse in Amsterdam with cases of cinchona,
which is also known as Peruvian or Jesuit's bark, and cinchona
was the source of quinine, an antimalarial drug. From the 16th
century onwards, vast quantities of drugs were imported into
Europe, especially opium from the East and cinchona, as you can
see here, from Southern America.

This slide shows an advertisement for particular forms of drugs
in 1900. You can see from the left-hand side here that heroin is
being marketed as a sedative for coughs. So there were changing
ideas over time about what is and is not useful in terms of drug
therapies and what can be used to combat disease, and this is
particularly important when we go on to consider later in this
class the changing epidemiological panorama over the course of
the 19th and 20th centuries and the possible impact and influence
of medicine on that changing panorama.

Of course, people only go in search of drug therapy, are only
administered drug therapy, when they consider themselves or a
health professional considers them to be ill or diseased. And
this links into ideas of health and normality. One of the
important aspects of public health history is the way in which
measurement in terms of the population, in terms of collecting
information about the anthropometric status of the population,
information that looks at specific characteristics by age, sex,
and ethnic group served to constitute what emerges as being a
normal person. Any deviation from what is considered to be normal
impacts on our ideas about what is considered to be abnormal, and
ill health and disease come to be considered as deviations from
what is a normal state of being. So information that is collected
on population statistics and on population disease becomes part
of a project that influences ideas about what it means to be
healthy and what it means to be normal. And so you have to
consider this when we look at the history of public health.

Here you can see representations on the left-hand side, a child,
a young boy who has rickets, which is a vitamin-D deficiency, and
resulted in the bowing of his legs. Once the deficiency has been
corrected, you have a normal, healthy little boy. In the right-
hand picture, you have a little girl who seems to be suffering
from malnourishment, and you can see the supposed effects of
better care and feeding and nutrition on the right-hand side.
These representations emphasize for us what is normal (the
children on the right-hand side) and what is abnormal on the left-
hand side, what is outside the experience of normality. I would
just like to emphasize for you that public health is an important
part of how we come to these definitions and these notions of
normality and abnormality.
It also influences very much the place of sick people in society.
If you have definitions of what is normal and what is not, and
one definition of abnormality or deviance is based on disease and
whether a person is unhealthy, then we automatically have to
consider how society treats those people with ill health and with
disease. And so clearly, public health has an influence and a
role in terms of how people are treated when they have a disease
that is either threatening to their own lives or might actually
threaten the lives of others.

And so here public health in this slide has a role to play in
making sure that society knows that there is a case of disease in
a particular locality. You can see the sanitary police officer
placing a placard on a home to say that there is somebody inside
this environment that has a case of disease, and it is informing
the rest of society to stay away from this potential source of
infection. And automatically that creates a stigma, it creates a
separation, and it creates an isolation of the diseased from the
healthy, the normal from the abnormal. This view of people as
being abnormal or normal links into ideas of what it means to be
sick in modern society.

And so this is a really fascinating slide of a construction
project in southern England in the 1980s. It is for a local
health authority and it is going to be what I assume was a
primary care center. It is not being called here a health center,
it is being termed a sickness center, and this is all about how
this feeds into the idea that we are concentrating on ill health
and how to remedy a person who has deviated from what we consider
to be the normal place in society. Our concentration here is on
sickness and the form of sickness and trying to return people
back to a state of well-being, but that is not being reflected
necessarily here in this placard which is describing the fact
that it is going to be a sickness center as opposed to a health
or well-being center.

But of course public health is primarily concerned with how we
prevent disease. What this course is going to emphasize in
particular is the way in which these modes of prevention have
changed over time. And I am going to be talking predominantly in
this course about the shift from environmental concerns with
disease towards public health being interested in the behavior
and the actions of individuals. And so these sets of slides just
illustrate this progression.

Here you have a Roman aqueduct at Pont du Guard near Nimes in
Southern France, and this is all about the provision of a clear
and safe water supply that goes back to ancient historical times.

In this slide, you have a Chinese public health poster, and the
translation is how to prevent the typhoid: get inoculation, wash
hands before eating, don't drink unboiled water, and eat clean
food. While this poster is primarily, in terms of the imagery,
reminding people of the importance of the inoculation, the
washing hands, the evocation not to drink unboiled water and to
eat only clean food reminds us of the implicit relationship
between disease and the wider environment: the cleanliness of the
water, the cleanliness of the food, and the importance of washing
hands.

This final slide shows a child being vaccinated in India. While
smallpox is no longer a threat -- and smallpox immunization will
be one topic of our classes -- while smallpox is no longer a
threat, immunizations for measles, diphtheria, cholera,
influenza, polio, and several other diseases save lives and
prevent outbreaks more effectively than other medications.
However, they often of course fail to reach those who would
benefit most. But the key point for me about vaccination is the
way in which it represents public health beginning to intrude on
and interfere with bodily space as opposed to the environment or
the domestic space.

So to summarize, public health is concerned with knowledge, it is
concerned with effectiveness, and it is concerned with means of
prevention. And once again, I want to reemphasize the fact that
all these aspects have changed over time, and the way I want to
consider that in a little bit more detail is by looking at the
current dominant paradigm of public health practice which has
come to be known as "the new public health."