On the Origins of Public Health

Public health runs deep in the roots of the nurse practitioner profession.  Loretta Ford, a public health nurse in Boulder, Colorado, saw a need in her community.  She believed that with more specialized training nurses could better improve the health of their communities ultimately leading to the nurse practitioner profession.  But what if we go back even further to the roots of public health itself?

MIdlevelU intern and PharmD student Melanie Chen has explored the origins of public health and presents them to us today so we as nurse practitioners can better understand our roots.

On the Origins of Public Health

By Melanie Chen

In some ways, public health is a modern concept of human development in science, though many of its core services are rooted in antiquity.  Some of these services include health promotion, access to hospitals, engineering feats such as sewage systems, and vaccination, all of which originated in ancient societies.  From the beginning of human civilization, it was recognized that keeping one's individual self healthy was the first step toward protecting the health of many.  This concept of personal hygiene was then expanded into widespread inoculation and the construction of the first public health systems like hospitals and sewage lines.

Although it is commonly accepted that the basic concepts of 'Health Promotion' have been developed in the last two decades, they in fact have their roots in Greek civilization.  The ancient Greeks broke away from the supernatural governances of health and disease, advocating for moderate consumption and exercise as a personal, as opposed to divine, responsibility.  In one of the earliest known forms of health promotion, a guide called "A Programme for Health," Hippocrates explains the ideal "balance of opposites": "In winter, it is best to counteract the cold by eating dry, warming foods such as wheat bread and roast meat...In summer, eat smaller amounts of softer, purer food; drink smooth, white, diluted wines.  Take lukewarm baths, and take only short strolls after dinner."  He also provides the citizens of Greece with directions for following a healthy lifestyle, which included how to keep themselves at an even temperature, eat properly, wash themselves, clean their teeth, and go on daily walks.  According to Ottawa Charter for Health Promotion, such concepts were crucial in establishing the foundations for modern health promotion.

Using these Greek ideals, the Romans built free hospitals for former soldiers, called valetudinaria, which are generally regarded as the first 'real' hospitals that resemble what we have today.  Though religious temples meant for housing the sick existed in Egypt as early as 400 BC, the Romans, like the Greek, diverged from relying on prayers and sacrificial offerings to gods as forms of treatment.  Instead, the Romans were the first people to charge trained doctors with the responsibility of observing sick patients directly, an example of the Roman values of practicality and self-reliance.  Construction sites around Roman hospitals were also quite advanced.  The Romans understood that stagnant, dirty water housed all kinds of disease communicators such as malaria-infected mosquitoes.  With their renowned engineering skills, they built a network of aqueducts and sewage systems that were used to drain marshland hospital sites prior to construction.  These water transportation channels, the aqueducts which transported clean water to different parts of the city and the huge Cloaco Maxima sewage system which transported wastewater out, proved immensely influential in improving public health by ensuring a constant circulating supply of clean water.  The basic concept of the centralized Cloaca Maxima sewage tunnels is reflected in underground sewage designs today.

On the other side of the world, the earliest known instance of vaccination was recorded by Chinese author Wan Quan in 1549.  In his work Douzhen Xinfa, Wan Quan makes the first clear reference to smallpox inoculation when the eldest son of Prime Minister Wang Tan died of smallpox around the year 1000.  According to Wan Quan, the Prime Minister was so desperate to protect the rest of his family members that he found a holy Taoist hermit who introduced the technique of inoculation to the capital, probably by blowing pulverized powder from smallpox scabs into patient's nostrils.  Inoculation may also have been practiced by scratching matter from a smallpox sore into a healthy person's arm.  The Prime Minister noticed that patients grew immune to the deadly virus upon being exposed to a tiny amount of it.  Throughout the centuries, the procedure for administering vaccines has been polished to include needle sterilization methods, dosage protocols, and standardized "how to" guides, but the basic principle of introducing a pathogen into the body so that the patient can develop an adaptive immunity response remains unchanged.

Global urbanization continues to challenge researchers, healthcare personnel, and policymakers to keep raising modern public health standards, but those standards remain rooted in the ideals and discoveries of ancient civilizations that thrived thousands of years ago.  Understanding where the foundations of our current policies came from allows us to more greatly appreciate not only the challenges faced by our predecessors, but also the years and years of continuous improvement that have allowed us to enjoy out public healthcare today.

Who knew public health went back as far as ancient Rome?  Thanks to Melanie for giving us insight into the depths of our profession.