Formulaire d’Hygiène Infantile Collective. From the holdings of Center for the History of Medicine/Francis A. Countway Library of Medicine—Harvard Medical School.
Public health is a population–based concept for addressing the causes and the prevention of disease among demographic groups rather than among individuals. Experts in public health regard social and environmental factors as fundamental to understanding the relative health and longevity of particular populations. These social and environmental factors change over time—just as the understanding of diseases, their causes, and their prevention changes.
Studying the history of public health can add many dimensions to the study of class, economics, politics, gender, race, ethnicity, and religion—all of which play significant roles in public health.
Epidemics and Social Conditions
In 1848, after studying a typhus epidemic, the German pathologist Rudolf Virchow stated that all epidemics had social causes—most typically poverty, hunger, and poor housing. Virchow believed that improving social conditions would have a positive effect on public health. This important early perspective plays a significant role in today’s thinking about public health, especially when there are major health disparities among social classes within an individual society or between rich and poor countries.
Hygiene and Sanitation
Hygiene and sanitation are major factors in the history of public health. In Europe and the United States, public sanitary practices and the professional discipline of public health came of age in the mid-19th century in response to urbanization, immigration, and industrialization, and to the 19th-century cholera epidemics. Until the development of germ theory in the later part of the 19th century, sanitary practices were based primarily on miasmatic theories of disease (where disease was thought to be caused and spread to susceptible people by decaying plant and animal matter, various kinds of waste, bad smells, and bad air), on contemporary ideas about infection and contagion, and on beliefs about the health impact of personal behaviors, morality, and innate susceptibility associated with particular social classes or ethnic groups.
By the end of the 19th century, most major urban areas had sewer systems, and indoor plumbing could be found in many middle-class and most well-to-do homes. Although there had been some earlier state-based or other organized responses to individual epidemics—primarily quarantine and disinfection measures related to outbreaks of plague—it was in the period from the mid-19th to the early 20th centuries that permanent boards of health were established in many major urban centers.
Public Health, Medicine, and the State
Tensions sometimes arise between medicine and public health. Each discipline has its distinct priorities. Medicine aims at cures for individual diseases and primarily involves individual patients. Public health emphasizes the prevention of disease and a population–based understanding of its causes.
The methods and goals of public health officials are also sometimes at odds with local governments and members of the public who object to the role of the state in personal health. Within the discipline of public health there have also been differences in priority, often between lab-based or other scientific work and work that studies other factors involved in disease. For example, vaccination campaigns have sometimes been criticized for deemphasizing the sanitary, nutritional, and other social contributors to the transmission and severity of infectious disease.
The Demographic Transition
The mortality rate from infectious diseases had risen during the 19th century with urbanization. The rate began to drop toward the end of the 19th century, and historians have theorized that public sanitation and improved nutrition were responsible for most of this improvement. However, with the decline in severity of infectious disease came a rise in chronic diseases, cancer, and injuries and health damage associated with industrial labor.
Selected Contagion Resources
This is a partial list of digitized materials available in Contagion: Historical Views of Diseases and Epidemics. For additional materials on the topic “Public Health,” click here or search the collection’s Catalog and Full Text databases.
Riva di San Nazarro, Gianfrancesco. De peste libri tres. Avignon: Imp[re]ssum fuit p[re]sens opus in ciuitate Auenioni per solertem impressorem magistrum Johanem de channey, anno domini 1522 die 12 Septembus.
Bologna (Italy). By the King, a Proclamation Concerning the Prorogation of the Parliament (forthcoming). London: Printed by John Bill and Christopher Barker, 1665.
Tardieu, Ambroise. Dictionnaire d’Hygiène Publique et de Salubrité. Paris: J.B. Baillière; Londres; New York: H. Baillière; Madrid: Bailly-Baillière, 1852–1854.
The following sources were used in writing this page.
Baldwin, Peter. Contagion and the State in Europe, 1830–1930. Cambridge, UK: Cambridge University Press, 1999.
Barnes, David S. The Great Stink of Paris and the Nineteenth–Century Struggle Against Filth and Germs. Baltimore: Johns Hopkins University Press, c2006.
Delaporte, Francois. Disease and Civilization: The Cholera in Paris, 1832. Arthur Goldhammer, trans. Cambridge, MA and London: MIT Press 1986.
Farmer, Paul. Pathologies of Power: Health, Human Rights, and the New War on the Poor. Berkeley: University of California Press, 2003.
Harrison, Mark. Public Health in British India: Anglo-Indian Preventive Medicine 1859–1914. Cambridge: Cambridge University Press, 1994.
Jones, David S. Rationalizing Epidemics: Meanings and Uses of American Indian Mortality Since 1600. Cambridge, Mass.: Harvard University Press, 2004.
Latour, Bruno. The Pasteurization of France. Translated by Alan Sheridan and John Law. Cambridge, Mass.: Harvard University Press, 1988.
McKeown, Thomas. The Role of Medicine: Dream, Mirage, or Nemesis? Princeton, N.J.: Princeton University Press, 1979.
Rosen, George. A History of Public Health. Expanded edition. New York: MD Publications Inc., 1958. Baltimore: Johns Hopkins University Press, 1993.
Rosen, George. From Medical Police to Social Medicine: Essays on the History of Health Care. Expanded edition. New York: MD Publications Inc., 1958. Baltimore: Johns Hopkins University Press, 1993.
Rosenberg, Charles E. The Cholera Years: The United States in 1832, 1849, and 1866. Chicago: Chicago University Press, 1962, 1987.
Sigerist, Henry. Civilization and Disease. Ithaca, NY: Cornell University Press, 1943.
Tomes, Nancy. The Gospel of Germs: Men, Women and the Microbe in American Life. New York: Science History Publications, 1974.