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CHAPTER
2
Historical Developments
in Public Health and
the 21st Century
James A. Johnson, James Allen Johnson III, and Cynthia B. Morrow
LEARNING OBJECTIVES
t To better understand the historical context of public health

t To gain perspective on the role of public health in society
t To grasp the key milestones in the evolution of public health practice and policy
t To understand recent reform and its implications for the future of public health
Chapter Overview
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11
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12 Chapter 2 Historical Developments in Public Health and the 21st Century
Early History of Public Health

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Early History of Public Health 13
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Hellenistic Health
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Latin Engineering and Administration

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9781449657413_CH02_PASS02.indd 14 23/04/13 10:03 AM

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The Middle Ages

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9781449657413_CH02_PASS02.indd 15 23/04/13 10:03 AM

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Industrialization and the Influence of Great Britain

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9781449657413_CH02_PASS02.indd 16 23/04/13 10:03 AM

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The Emergence and Impact of Bacteriology

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9781449657413_CH02_PASS02.indd 17 23/04/13 10:03 AM

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Public Health in the United States

The specters cholera, yellow fever, and smallpox recoil in fear as
their way through the port of New York is blocked by a barrier
labeled Quarantine and by an angel holding a sword
and a shield on which is written Cleanliness.28, p. 139
Description of At the Gates, an etching printed by Harper and Brothers,
New York, September 5, 1885
The American Colonies and the Early United States

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9781449657413_CH02_PASS02.indd 18 23/04/13 10:03 AM

Public Health in the United States 19
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Public Health in the 19th Century

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9781449657413_CH02_PASS02.indd 19 23/04/13 10:03 AM

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Public Health in the 20th Century

*OUIFFBSMZQBSUPGUIFT UIFQVCMJDIFBMUIXPSLGPSDFIBEHBJOFETLJMMTJOVOEFSTUBOEJOH
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FPSUQFSUBJOJOHUPUIFDPOUSPMPGJOVFO[BDBOCFTFFOJOExhibit2.10WFSUIFOFYUTFWFSBM
EFDBEFT QVCMJDIFBMUISFBMJ[FEUSFNFOEPVTHBJOTXJUIJOUFSWFOUJPOTTVDIBTJNQSPWFETBOJUB-
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9781449657413_CH02_PASS02.indd 20 23/04/13 10:03 AM

Exhibit 2.1 Early Influenza Warning
Source: Reproduced from National Library of Medicine. Office of Public Health Historian.
BWFSBHFMJGFFYQFDUBODZJO/FX:PSL$JUZBOE#SPPLMZOXBTZFBSTCZ MJGFFYQFDUBODZ
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EJTFBTFUISFBUTBOEUIBUTVDIiBDIJFWFNFOUTXFSFBMNPTUXIPMMZCBTFEPOUIFPSHBOJ[FEBQQMJDB-
UJPOPGUIFTDJFODFTPGTBOJUBSZFOHJOFFSJOHBOECBDUFSJPMPHZw Q
"UUFNQUTUPSFQMJDBUFUIFTVDDFTTFTBDIJFWFEXJUIJOGFDUJPVTBOEFOWJSPONFOUBMMZSFMBUFEEJT-
FBTFT IBWF CFFO FYUFOEFE UP UIF DPOUFNQPSBSZ IFBMUI DIBMMFOHFT PG PCFTJUZ EJBCFUFT JOKVSZ
QSFWFOUJPO WJPMFODF TVCTUBODFBCVTF )*7JOGFDUJPO UPCBDDPSFMBUFEEJTFBTFT BOEPUIFSOPO-
DPNNVOJDBCMFEJTFBTFT"TFBSMZBT 8JOTMPXBSHVFEFBSMZGPSUIJTFYUFOTJPOJOBTQFFDI
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9781449657413_CH02_PASS02.indd 21 23/04/13 10:03 AM

UIFSBUFTPGIFBSUEJTFBTFNPSUBMJUZBOENPUPSWFIJDMFoBTTPDJBUFEGBUBMJUJFT BOEJNQSPWFERVBMJUZ
PGUIFXPSLQMBDF8IJMF,JOH+BNFT*PG&OHMBOEIBEXSJUUFOBOEQVCMJTIFEBOBOUJTNPLJOH
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$&WFSFU,PPQXIPBEWPDBUFEGPSBTNPLFGSFF"NFSJDBCZUIFZFBSBOECFHBOUIFQSBD-
UJDFPGSPUBUJOHNFTTBHFTPOXBSOJOHMBCFMT BTTIPXOJOExhibit 2.2
FHSFBUQVCMJDIFBMUIBDIJFWFNFOUTJOUIF6OJUFE4UBUFTJOUIFTJODMVEFBEWBODFT
JOCPUIDPNNVOJDBCMFBOEDISPOJDEJTFBTFQSFWFOUJPO BTMJTUFEJOExhibit 2.3
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Exhibit 2.2 Surgeon Generals Warning
Source: CDC/Debora Cartagena.
9781449657413_CH02_PASS02.indd 22 23/04/13 10:03 AM

Exhibit 2.3 Ten Great Public Health Achievements

1. Vaccines: Few treatments were effective in the prevention of infectious diseases in 1900.
Now, smallpox, measles, diphtheria, pertussis, rabies, typhoid, cholera, and the plague are
preventable through widespread use of vaccines.
2. Recognition of tobacco use as a health hazard: Since the 1964 surgeon generals report on risks
associated with smoking, smoking among adults has decreased, saving lives.
3. Motor vehicle safety: Improved engineering of vehicles and roads plus the use of seat belts, car
seats, and helmets have reduced the number of deaths, as has decreased drinking and driving.
4. Safer workplaces: A 40% decrease in fatal occupational injuries (since 1980) has resulted
through efforts to control work-related disease such as pneumoconiosis (black lung) and
silicosis, which are associated with coal mining, and to improve safety in manufacturing,
construction, transportation, and mining.
5. Control of infectious diseases: Efforts to protect the water supply and keep it clean with
improved sanitation methods have greatly improved health, particularly curbing the spread of
cholera and typhoid. The discovery of antimicrobial therapy has helped to control tuberculosis
and sexually transmitted diseases (STDs).
6. Fewer deaths from heart disease and stroke: Smoking cessation, blood pressure control, early
detection, and better treatments have resulted in a 51% decrease in death rates for coronary
heart disease since 1972.
7. Safer and healthier foods: Major nutritional deficiency diseases such as rickets, goiter, and
pellagra have been virtually eliminated in the United States through greater recognition
of essential nutrients, increases in nutritional content, food fortification, and decreases in
microbial contamination.
8. Healthier mothers and babies: Better hygiene, nutrition, access to health care, antibiotics,
and technologic advances have helped to reduce infant mortality by 90% and maternal
mortality by 99%.
9. Family planning and contraceptive services: These services have altered the social and economic
roles of women. Access to counseling and screening has resulted in fewer infant, child, and
maternal deaths. Contraceptives have provided protection from human immunodeficiency virus
and other STDs.
10. Fluoridation of drinking water: Nearly 150 million people have access to treated water, a
safe and effective way to prevent tooth decay. Fluoridation has helped reduce tooth decay in
children 4070% and tooth loss in adults 4060%.
Source: Adapted from Centers for Disease Control and Prevention. Ten great public health achievementsUnited States,
19001999. MMWR. 1999;48(12):13.
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9781449657413_CH02_PASS02.indd 23 23/04/13 10:03 AM

Public Health in the 21st Century

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9781449657413_CH02_PASS02.indd 24 23/04/13 10:03 AM

Increasing Increasing Individual

Population Impact Effort Needed
Counseling
and Education
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Changing the Context to Make

Individuals Default Decision Healthy
Socioeconomic Factors
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9781449657413_CH02_PASS02.indd 25 23/04/13 10:03 AM

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9781449657413_CH02_PASS02.indd 26 23/04/13 10:03 AM

Box 2.1 Affordable Care Act Public Health Elements
tt
Investments in public health and prevention:
Prevention and Public Health Fund (PPHF): Provides the greatest amount of funding for
public health initiatives including Community Transformation Grants; Epidemiology and Lab
Capacity Grants; National Public Health Improvement Initiatives; and National Diabetes
Prevention Programs
t National Prevention, Health Promotion, and Public Health Council: Establishes a council to
coordinate and lead federal governments prevention, wellness, and health-promotion efforts
t Maternal, Infant, and Early Childhood Home Visitation Programs: Authorizes funds for
evidence-based home visitation programs for this target population
tt
Public health workforce:
Fellowship Training in Public Health (partially funded by PPHF)
t
tt
Public Health and Preventive Medicine Programs (partially funded by PPHF)
Expansion of coverage, awareness, and access to clinical preventive services:
Contains numerous provisions to improve insurance coverage of family planning services and
U.S. Preventive Services Task Force (USPSTF)recommended services, in addition to many
areas of expanded coverage under Medicare and Medicaid specifically
t Authorizes funding for Personal Responsibility Education (adolescent abstinence,
contraception, and prevention of sexually transmitted infections), Pregnancy Assistance Fund
(support of victims of domestic violence and sexual assault), school-based health centers,
and oral health activities
t Provides recommendations with respect to the USPSTF and the Community Preventive
Service Task Force (Community Guide) with funding from PPHF
tt
Wellness programs:
Authorizes grants to small businesses to provide comprehensive workplace wellness programs
t Requires the Centers for Disease Control and Prevention (CDC) to provide employers with
assistance to evaluate worksite wellness programs
tt
Public health research and data:
Directs the CDC to fund research on effectiveness of evidence-based practices that relate to
public health initiatives
t Authorizes funds for a childhood obesity demonstration project through the Centers for
Medicare and Medicaid Services (CMS)
tt
Other:
Requires the U.S. Department of Health and Human Services (HHS) to develop a national
quality improvement plan
t Requires nutrition labeling at restaurants with more than 20 locations
Source: Adapted from NACCHO. Public Health and Prevention Provisions of the Affordable Care Act. Available at:
http://www.naccho.org/advocacy/upload/PH-and-Prevention-Provisions-in-the-ACA-Revised.pdf. Accessed
February 8, 2013.
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9781449657413_CH02_PASS02.indd 27 23/04/13 10:03 AM

Tobacco Free Living

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Increase the number of
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Figure 2.2 /BUJPOBM1SFWFOUJPO$PVODJM"DUJPO1MBO

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9781449657413_CH02_PASS02.indd 28 23/04/13 10:03 AM

References 29
"TBGVUVSFQVCMJDIFBMUIBENJOJTUSBUPS XIZEPZPVGFFMJUJTJNQPSUBOUUPLOPXUIFIJT-

UPSZQSFTFOUFEJOUIJTDIBQUFS 8IBUBSFTPNFFNFSHJOHDIBMMFOHFTUIBUZPVNJHIUGBDFJO
ZPVSQVCMJDIFBMUISPMF
"TBDSPTTEJTDJQMJOBSZFYFSDJTF DIPPTFBOFWFOUZPVTUVEJFEJOPOFPGZPVSIJTUPSZDMBTTFT
BOESFWJTJUJUGSPNBQVCMJDIFBMUIQFSTQFDUJWF8IBUEJEZPVMFBSO
References
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1PSUFS%. Health, Civilization and the State: A History of Public Health from Ancient to Modern Times
/FX:PSL3PVUMFEHF
$PIFO./Health and the Rise of Civilization/FXIBWFO:BMF6OJWFSTJUZ1SFTT
.D,FPXO5The Origin of Human Disease0YGPSE#BTJM#MBDLXFMM
$PDLCVSO"8IFSFEJEPVSJOGFDUJPVTEJTFBTFTDPNFGSPN FFWPMVUJPOPGJOGFDUJPVTEJTFBTFT CIBA
Foundation Symposium.o
.D/FJMM8Plagues and Peoples/FX:PSL"ODIPS1SFTT%PVCMFEBZ
-MPZE(&3Magic, Reason and Experience$BNCSJEHF$BNCSJEHF6OJWFSTJUZ1SFTT
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(BSSJTPO')An Introduction to the History of MedicineUIFE1IJMBEFMQIJB8#4BVOEFST
4NJUI8%The Hippocratic Tradition*UIBDB /:$PSOFMM6OJWFSTJUZ1SFTT
#SVVO$The Water Supply of Ancient Rome. A Study of Roman Imperial Administration. )FMTJOLJ4PDJ-
FUBT4DJFOUJBSJVN'FOOJDB
3PCJOTPO0'Ancient Rome City Planning and Administration-POEPO3PVUMFEHF
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3VTTFMM "8 FE The Town and State Physician in Europe 8PMGFOCUUFM (FSNBOZ )FS[POH "VHVTU
#JCMJPUIFL
%BWJFT38*O#SFF[F% .BYFME7" FET Service in the Roman Army&EJOCVSHI&EJOCVSHI6OJ-
WFSTJUZ1SFTT
3PTFO(A History of Public Health/FX:PSL.%1VCMJDBUJPOT
1BMNFS3The Control of Plague in Venice and Northern Italy, 134816001I%UIFTJT 6OJWFSTJUZPG
,FOU
#ZOVN 8 1PSUFS 3 Living and Dying in London -POEPO 8FMMDPNF *OTUJUVUF GPS UIF )JTUPSZ PG
.FEJDJOF
"" #SFTMPX-"NBUVSJOHQBSBEJHNPGQVCMJDIFBMUIAnnu Rev Public Healtho
%VZ+A History of Public Health in New York City, 18661966./FX:PSL3VTTFMM4BHF'PVOEBUJPO

4NJMMJF8Public Health: Its Promise for the Future/FX:PSLF.BDNJMMBO$P
,PUUFL4(FNTGSPNUIF5BMNVEQVCMJDIFBMUI*XBUFSTVQQMZIsr J Med Scio
"TIUPO+ 4SBN*.JMMFOOJVNSFQPSUUP4JS&EXJO$IBEXJDLBMJo
'FF&1VCMJDIFBMUIBOEUIFTUBUFUIF6OJUFE4UBUFTClio Medicao
3PTOFS%Hives of Sickness/FX#SVOTXJDL /+3VUHFST6OJWFSTJUZ1SFTT
'FF&FPSJHJOTBOEEFWFMPQNFOUPGQVCMJDIFBMUIJOUIF6OJUFE4UBUFT*O)PMMBOE88 %FUFMT3
,OPY( FUBM FETOxford Textbook of Public HealthOEFE0YGPSE 6,0YGPSE6OJWFSTJUZ1SFTT
o
#ZSOF +1 FE Encyclopedia of Pestilence, Pandemics, and Plagues 7PM
8FTUQPSU $5 (SFFOXPPE
1SFTT
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%VZ+Epidemics in Colonial America#BUPO3PVHF -"-PVJTJBOB4UBUF6OJWFSTJUZ1SFTT

#FOFOTPO" FEControl of Communicable Diseases in Man8BTIJOHUPO %$"NFSJDBO1VCMJD)FBMUI
"TTPDJBUJPO
&MMJT+#VTJOFTTNFOBOEQVCMJDIFBMUIJOUIFVSCBOTPVUIEVSJOHUIFOJOFUFFOUIDFOUVSZ/FX0SMFBOT
.FNQIJT BOE"UMBOUBBull Hist Med
o
1PSUFS & F IJTUPSZ PG QVCMJD IFBMUI BOE UIF NPEFSO TUBUF JOUSPEVDUJPO <FEJUPSJBM> Clio Medica
o
4IBUUVDL-General Plan for the Promotion of Public and Personal Health.#PTUPO%VUUPO8FOUXPSUI
4UBUF1SJOUFST
,SBNFS)"HJUBUJPOGPSQVCMJDIFBMUISFGPSNJOUIFTJ Hist Med Allied Sci***
o
8JOTMPX$&"The Untilled Fields of Public Health/FX:PSL)FBMUI4FSWJDF /FX:PSL$PVOUZ$IBQ-
UFSPGUIF"NFSJDBO3FE$SPTT
+FDLFM+)FBMUIEFQBSUNFOUTJOUIF64oTUBUFNFOUTPGNJTTJPOXJUITQFDJBMSFGFSFODFUPUIF
SPMFPG$&"8JOTMPXYale J Biol Medo
,JWMBIBO$1VCMJDIFBMUIJOUIFOFYUDFOUVSZMo Med
o
8JOTMPX$1VCMJDIFBMUIBUUIFDSPTTSPBETAm J Public Healtho
64%FQBSUNFOUPG)FBMUIBOE)VNBO4FSWJDFT 1VCMJD)FBMUI4FSWJDFFor a Healthy Nation: Returns
on Investment in Public Health. Executive Summary8BTIJOHUPO %$64(PWFSONFOU1SJOUJOH0DF

:PVOH21VCMJDIFBMUIBQPXFSGVMHVJEFJ Health Care Finance
o
+POFT8 +PIOTPO+AIDS Programs and Initiatives in Education and Prevention'SFFNBO 4%1JOF)JMM
1SFTT
7BMEJTFSSJ3JSUZZFBSTPG"*%4JO"NFSJDBBTUPSZPGJOOJUFIPQFAIDS Education and Prevention

o
/"$$)0-PDBMIFBMUIEFQBSUNFOUKPCMPTTFTBOEQSPHSBNDVUTOEJOHTGSPNUIF+BOVBSZ4VS-
WFZ "WBJMBCMF BU IUUQXXXOBDDIPPSHUPQJDTJOGSBTUSVDUVSFMIECVEHFUVQMPBE3FTFBSDI#SJFG'JOBM
QEG"DDFTTFE%FDFNCFS
+BSSJT1$IBMMFOHJOHUJNFTGPSUIFHPWFSONFOUQVCMJDIFBMUIFOUFSQSJTFJ Public Health Management
Practice.
o
0MTIBOTLZ4 "OUPOVDDJ5 #FSLNBO- FUBM%JFSFODFTJOMJGFFYQFDUBODZEVFUPSBDFBOEFEVDBUJPOBM
EJFSFODFTBSFXJEFOJOH BOENBZOPUDBUDIVQHealth Affairs.
o
'SJFEFO 53 " GSBNFXPSL GPS QVCMJD IFBMUI BDUJPO UIF IFBMUI JNQBDU QZSBNJE Am J Public Health.

o
*OTUJUVUF PG .FEJDJOF. For the Publics Health: The Role of Measurement in Action and Accountability
8BTIJOHUPO %$/BUJPOBM"DBEFNZPG4DJFODFT
*OTUJUVUFPG.FEJDJOFFor the Publics Health: Revitalizing Law and Policy to Meet New Challenges.8BTI-
JOHUPO %$/BUJPOBM"DBEFNZPG4DJFODFT
*OTUJUVUFPG.FEJDJOFFor the Publics Health: Investing in a Healthier Future8BTIJOHUPO %$/BUJPOBM
"DBEFNZPG4DJFODFT
*OTUJUVUF PG .FEJDJOF Primary Care and Public Health: Exploring Integration to Improve Population
Health8BTIJOHUPO %$/BUJPOBM"DBEFNZPG4DJFODFT
/"$$)01VCMJD)FBMUIBOE1SFWFOUJPO1SPWJTJPOTPGUIF"PSEBCMF$BSF"DU"WBJMBCMFBUIUUQ
XXXOBDDIPPSHBEWPDBDZVQMPBE1)BOE1SFWFOUJPO1SPWJTJPOTJOUIF"$"3FWJTFEQEG "DDFTTFE
/PWFNCFS
$FOUFSTGPS%JTFBTF$POUSPMBOE1SFWFOUJPO$PNNVOJUZ5SBOTGPSNBUJPO(SBOUT"WBJMBCMFBUIUUQ
XXXDEDHPWDPNNVOJUZUSBOTGPSNBUJPO"DDFTTFE%FDFNCFS
/BUJPOBM1SFWFOUJPO$PVODJM/BUJPOBM1SFWFOUJPO$PVODJM"DUJPO1MBO+VOF"WBJMBCMFBUIUUQ
XXXIFBMUIDBSFHPWQSFWFOUJPOOQIQQIDOQDBDUJPOQMBOQEG"DDFTTFE%FDFNCFS
+PIOTPO + Introduction to Public Health Management, Organizations, and Policy $MJGUPO 1BSL /:
%FMNBS$FOHBHF
9781449657413_CH02_PASS02.indd 30 23/04/13 10:03 AM

Additional Resources 31
Additional Resources
*OTUJUVUFPG.FEJDJOFThe Future of Public Health.8BTIJOHUPO %$/BUJPOBM"DBEFNJFT1SFTT
#VOLFS+*NQSPWJOHIFBMUINFBTVSJOHFFDUTPGNFEJDBMDBSFMilbank Q. 1994o
$BNFSPO(0A Treatise on the Cannon of Avicenna, Incorporating a Translation of the First Book.-POEPO
-V[BD
4JSBJTJ/(Avicena in Renaissance Italy. The Canon and Medical Teaching in Italian Universities after 1500.
1SJODFUPO1SJODFUPO6OJWFSTJUZ1SFTT
"NVOETFO%8.FEJDJOFBOETVSHFSZBTBSUPSDSBGUUIFSPMFPGTDIFNBUJDMJUFSBUVSFJOUIFTFQBSBUJPOPG
NFEJDJOFBOETVSHFSZJOUIFMBUF.JEEMF"HFTTrans Stud Coll Physicians Philao
"MMCVUU$5The Relations of Medicine and Surgery to the End of the Sixteenth Century-POEPO.BDNJM-
MBO
#SPEZ4/The Disease of the Soul: Leprosy in Medieval Literature*UIBDB$PSOFMM6OJWFSTJUZ1SFTT
(JMNBO4Disease and Representation: Images of Illness from Madness to AIDS*UIBDB$PSOFMM6OJWFSTJUZ
1SFTT
1FMMJOH.$POUBHJPO (FSNFPSZ4QFDJDJUZ*O#ZOVN8' 1PSUFS3FETCompanion Encyclopedia
of the History of Medicine, 2 vols-POEPO3PVUMFEHFo
F*MJBEPG)PNFS5SBOTMBUFECZ"MFYBOEFS1PQF$POOFDUJDVU&BTUPO1SFTT
"UUIF(BUFT0VS4BGFUZ%FQFOET6QPO0DJBM7JHJMBODF8PPEFOHSBWJOHGSPN)BSQFST8FFLMZ
4FQUFNCFS
*O(FPSHF3A History of Public Health
9781449657413_CH02_PASS02.indd 31 23/04/13 10:03 AM

9781449657413_CH02_PASS02.indd 32 23/04/13 10:03 AM

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CHAPTER

t To better understand the historical context of public health

9781449657413_CH02_PASS02.indd 11 23/04/13 10:03 AM

Early History of Public Health

9781449657413_CH02_PASS02.indd 12 23/04/13 10:03 AM

9781449657413_CH02_PASS02.indd 13 23/04/13 10:03 AM

Latin Engineering and Administration

9781449657413_CH02_PASS02.indd 14 23/04/13 10:03 AM

The Middle Ages

9781449657413_CH02_PASS02.indd 15 23/04/13 10:03 AM

Industrialization and the Influence of Great Britain

9781449657413_CH02_PASS02.indd 16 23/04/13 10:03 AM

The Emergence and Impact of Bacteriology

9781449657413_CH02_PASS02.indd 17 23/04/13 10:03 AM

Public Health in the United States

The American Colonies and the Early United States

9781449657413_CH02_PASS02.indd 18 23/04/13 10:03 AM

DBSSJFSPGZFMMPXGFWFS JUXBTSFRVJSFEUPZBZFMMPXBHVQPOJUTNBTUIFODF UIFOBNFPGUIF

Public Health in the 19th Century

9781449657413_CH02_PASS02.indd 19 23/04/13 10:03 AM

FYBNQMF FTUBCMJTIFEBCPBSEPGIFBMUIJO XIJDIDPOTJTUFEPGUISFFDPNNJTTJPOFSTBOEB

Public Health in the 20th Century

9781449657413_CH02_PASS02.indd 20 23/04/13 10:03 AM

Exhibit 2.1 Early Influenza Warning

9781449657413_CH02_PASS02.indd 21 23/04/13 10:03 AM

Exhibit 2.2 Surgeon Generals Warning

Source: CDC/Debora Cartagena.

9781449657413_CH02_PASS02.indd 22 23/04/13 10:03 AM

Exhibit 2.3 Ten Great Public Health Achievements

9781449657413_CH02_PASS02.indd 23 23/04/13 10:03 AM

Public Health in the 21st Century

9781449657413_CH02_PASS02.indd 24 23/04/13 10:03 AM

Increasing Increasing Individual

Changing the Context to Make

Figure 2.1 )FBMUI*NQBDU1ZSBNJE

9781449657413_CH02_PASS02.indd 25 23/04/13 10:03 AM

IFBMUI BOEUIFOFFEGPSTJHOJDBOUMZJODSFBTFEJOWFTUNFOUJOQVCMJDIFBMUI$PMMFDUJWFMZ UIJT

9781449657413_CH02_PASS02.indd 26 23/04/13 10:03 AM

Box 2.1 Affordable Care Act Public Health Elements

BDPMMBCPSBUJPOBNPOHUIF8IJUF)PVTF %))4 BOEUIF%FQBSUNFOUTPG&EVDBUJPO &%

9781449657413_CH02_PASS02.indd 27 23/04/13 10:03 AM

Tobacco Free Living

ive Alcohol Use

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