Public Health and Safety
WF Anderson (1936-), the so-called father of gene therapy, summarized medical progress over the past 150 years as a series of revolutions, regarding gene therapy as the fourth revolution and public health and sanitation as the first. The world was a much different place in the 1850s when Dr John Snow* (1813-1858), an English physician and the father of public health was faced with an outbreak of cholera in Soho, London.
Without the benefit of Louis Pasteur’s future work in microbiology which would have linked bacteria (Vibrio cholerae) to the raging epidemic, Snow painstakingly placed marks on a map (top image) of London of homes where deaths from cholera had occurred. He found that the closer the home was to a particular pump used to draw drinking water from the Thames, the higher the death rate. What made the Broad Street pump special was that it was downstream of places where raw, fecally contaminated, sewage passed directly into the Thames. Once Snow presented his findings, the local council removed the handle from the pump, effectively ending the epidemic.
*Not to be confused with Jon Snow, the bastard son of Eddard “Ned” Stark, Lord of Winterfell, and half-brother to Robb, Sansa, Arya, Bran and Rickon.
Whilst disabling the Broad Street pump was the seminal event that launched public health, the field had been progressing on other fronts, in particular, in prevention of infectious diseases. As early as 1838, Parliament’s Poor Law Commission concluded that “the expenditures necessary to the adoption and maintenance of measures of prevention would ultimately amount to less than the cost of the disease now constantly engendered“, i.e., an ounce of prevention is worth a pound of cure. The public health measures of the 19th century were primarily focused on controlling infections. These interventions included vaccination (in particular, against smallpox) and public works–e.g., construction of sewers and waterworks providing clean water; public projects–e.g., drainage of standing water and swamps to prevent the breeding of mosquitoes; and public services–e.g., regular removal of waste and incineration or disposal in landfills.
Public health frameworks in one form or another have been in place in developed countries since the dawn of the 20th century. The state of a country’s public health services reflects in large part that nation’s manpower and resources, its government’s priorities and its disease(s) du jour. Is the nation battling third world diseases–e.g., epidemic infections and parasites, or chronic first world diseases–e.g., heart attacks, strokes, obesity and diabetes; or something in between–e.g., tuberculosis? Typically, when its major public health authority, body or commission first goes online, it is driven in response to an infectious disease–e.g., tuberculosis and/or epidemic–e.g., yellow fever. The initial focus of the Communicable Disease Center (CDC), a branch of the US Public Health Service founded in 1946 was on eradicating mosquitoes to eliminate malaria, then still extant in the USA.
Later renamed the Centers for Disease Control and Prevention, the CDC has grown to become the world’s premier public health institute. Based in Atlanta, it provides training in epidemiology, diagnostic workups of Hazard Level 4 (the highest) pathogens and emergency response teams for global epidemics–e.g., Ebola and Zika virus infections. In addition to its long-term focus on infectious disease, the CDC has an active interest in food-borne pathogens, environmental health, occupational safety and health, health promotion, injury prevention and educational activities designed to improve national and global health.
We are surrounded by modern public health initiatives designed to maximize our well-being. Some reflect what has been disparagingly called the nanny state effect: legislation banning smoking in public places, mandating seat belts and helmets for motorcycles and bicycles, and requiring minimum ages for purchase of alcohol. These initiatives may be subliminal–e.g., fluoridation of water supplies to reduce caries; others have the subtlety of a wrecking ball–e.g., the ever-present reminders to use condoms to reduce the risk of STDs and AIDS. Somewhere in the middle are strategies meant to change bad habits-e.g., public service announcements encouraging people to get off their fat asses and exercise, eat fruit and vegetables (the NHS’s Five-a-Day initiative), smoking cessation programs and what is for some, an absolute coup, getting Hollywood to incorporate the concept of designated drivers in storylines to reduce the risk of alcohol-related vehicular (MVA/RTA) accidents.
Public health’s success lies in its efficacy in reducing the risk of acute and chronic disease, as in, …an ounce of prevention…