HISTORY OF PUBLIC HEALTH
Infections caused by microorganisms are often spread more easily in an unsanitary environment. Even today, for example, Escherichia coli infections of food and between people are still commonly caused by poor hygienic practices, such as the failure to properly wash hands after toileting.
Because of the association between microbial infection and sanitary conditions, many public health initiatives and regulations have been instituted around the world. Before the recognition that microbes caused infections, and even before the realization that microbes existed, public health was a foreign concept. The history of public health parallels advances in the understanding of microorganisms and disease.
Prior to the fourteenth century, public health was nonexistent. The sanitary environment in urban centers was appalling by today's standards. However, at that time there was no knowledge that, for example, the flow of raw sewage alongside streets was connected to illness. The occurrence of bubonic plague in Europe in 1348 began to change this view. Between 1348 and 1350, the infection caused by Yersinia pestis killed almost two-thirds of the population in the major urban centers of Europe. In the aftermath of this devastation came an increased awareness of the influence of health conditions and disease. In the 1350s, Italian government initiatives sought to improve sanitary and living conditions. These initiatives occurred even though the existence of microorganisms was not
yet known. By the sixteenth century, the idea of a microbial cause of disease (e.g., "contagion") was being debated.
In the United States, the organized public health initiative that is today's Public Health Service began in the late eighteenth century. Legislation passed by the United States Congress in 1798 provided care and relief for afflicted mariners. Hospitals to serve seamen were established on the eastern seaboard and later in cities on the Great Lakes, Gulf coast and Pacific coast. In 1870, the control of these hospitals became the responsibility of the newly formed Marine Hospital Service, headquartered in Washington, DC.
Because mariners were often the carriers of infectious diseases acquired in other countries, the Marine Hospital Service soon became concerned with infectious diseases. In 1887, a small bacteriology laboratory (the Hygienic Laboratory) was created at a marine hospital on Staten Island in the New York harbor. The laboratory was later relocated to Washington, DC, where it became the National Institutes of Health.
The increasing responsibility for infectious disease treatment and research prompted a name change of the organization to the Public Health and Marine Service (1902) and the Public Health Service (1912). In the twentieth century, the services' role in controlling infectious microbial diseases and funding infectious disease research expanded. For example, among the agencies that comprise the Public Health Service are the Centers for Disease Control, the National Institutes of Health, and the Food and Drug Administration. Approximately 60,000 people are employees of the Public Health Service, whose annual budget now exceeds 15 billion dollars.
As the public health infrastructure was growing in the nineteenth century, public health nursing was also growing in the United States. In 1898, Los Angeles became the first city to employ a nurse to care for sick people in their homes. Thereafter, more governments recognized that caring for the populace in the homes and workplaces had a positive effect on the society as a whole, in terms of reducing the spread of infectious diseases.
During the nineteenth century, microbiologists such as Louis Pasteur and Robert Koch demonstrated the involvement of bacteria in disease. The importance of maintaining a hygienic atmosphere in hospitals was recognized. Indeed, Joseph Lister's implementation of the use of a disinfectant spray and fresh changes of operating smocks for surgeons greatly decreased the mortality rate associated with operations. Because of these public health efforts, operations moved from a position of last resort to a procedure that could improve the health and alleviate suffering in people.
The increasing disparity between the developed and underdeveloped countries of the world spawned major international public health efforts in the twenty-first century. The most prominent example is the World Health Organization (WHO), created in 1948. Other agencies are noteworthy as well, such as the United Nations International Children's Emergency Fund (UNICEF), which was created in 1946 to aid children victimized by World War II.
At the time of the creation of UNICEF and the WHO, the average life expectancy in the world was 46 years. As of the late 1990s, this average life expectancy had risen to 65 years of age. Much of this increase is attributable to organized public health initiatives such as vaccination, medical care and hydration programs.
The recognition of the involvement of microorganisms and disease has continued to the present day. Since the 1970s, a series of microbiologically related diseases (i.e., Acquired Immunodeficiency Syndrome) has prompted renewed emphasis on public health. Other diseases that were thought to be due to a genetic or physiological abnormality (e.g., stomach ulcers, heart disease) have been demonstrated to be at least partially due to chronic bacterial infections. Lessening the chances of exposure to such infectious agents has become another public health concern.
Another watershed in the history of public health has occurred in the latter decades of the twenty-first century. Then, the importance of the adherent bacterial populations known as biofilms to the establishment and maintenance of long-lasting infections that are extremely resistant to treatments became known. Biofilms are important in environments ranging from the operating room to the drinking water treatment plant. This importance has focused public health efforts on the prevention of biofilm build-up and on the creation of strategies that eliminate the biofilm bacteria.
