HISTORY AND DEVELOPMENT OF MEDICAL AND HEALTH

SERVICES

BY

PROFESSOR M.C. ASUZU

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 PUBLIC HEALTH 1

.. Is the science and the art of preventing disease,

prolonging life, and promoting physical health and
efficiency through organized community efforts for the
sanitation of the environment, the control of
community infections, the education of the individual in
principles of personal hygiene, the organization of
medical and nursing services for the early diagnosis and
preventive treatment of disease, and the development of
the social machinery which will ensure to every
individual in the community a standard of living
adequate for the maintenance of health - C.E.A
Winslow, 1923.
Public health is not a concrete intellectual discipline,
but a filed of social activities - C.EAW
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 PUBLIC HEALTH 2

is the protection and improvement of the health of the

public through community action, primarily by government
agencies. It includes four major areas:
(1)the promotion of positive health and vitality (primordial
prevention and /or health promotion and
(2)The prevention of infectious and non-infectious disease as well
as injuries (primary prevention). The others are
(3)The organization and provision of services for the early
diagnosis and prompt treatment of illness (efficient public
medical and health services by the government and/or by the
people)
(4)The rehabilitation of sick and disabled persons to their highest
possible level of function in spite of the disability (tertiary
prevention).
Funk and Wagnalls Encyclopedia, 1984
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 PUBLIC HEALTH BEFORE THE MIDDLE AGES

Health practices as nursing, midwifery, herbalism as

traditional medicine, apothecary (and later alchemy)
all till the scientific transformation of medicine &
the health professions by Hippocrates.
Public health largely as cultural practices or public
welfare minded practices
Usually linked with religion or merely aesthetics
More and more recognized as public health now by
hindsight and incorporation - ancient India, China,
Mesopotamia/Jewish, Egypt and Greece up to
Hippocrates; Galen, etc
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EARLY ORIGINS OF ORGANIZED PUBLIC HEALTH

A public service by humanitarian and good

politicians - Ancient Rome up to Venice and the
birth of disciplinary public health in sanitary police.
Mainly to protect commerce and promote culture
and civilization in the Mediterranean civilization for
aspects of modern disciplinary public health; the
quarantine laws, Venice (1374), Marseilles (1393)
and thereafter.
As a contribution of organized (missionary) religion
hospices, hospitals, etc as public health of the
organized public health services later beginning
with the Pennsylvania Hospital in 1751.
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 BIRTH OF MODERN PUBLIC HEALTH AND EVENTUALLY
COMMUNITY MEDICINE
Prelude in Paracelsus, Fracastorius, Bernardino
Rammazini, James Lind, Edward Jenner, John Howard, Sir
Robert Peel, Lord Ashley, etc
The great sanitary awakening Edwin Chadwick, John
Simon, Lemuel Shattuck, John Snow.
Consolidation of Public Health achievements in community
medical care - the office of the MOH - Liverpool, London,
Massachusetts.
The international health movement, Florence Nightingale
etc.
Extension of community medicine to schools, prisons and
to industry, etc; William Rathbone and community nursing
as community mother; Sir Thomas Legg.

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 MATURATION OF PUBLIC HEALTH TO COMMUNITY
MEDICINE AND HEALTH
The development of community medicines lower arm
of community nursing - school health, organized
domiciliary midwifery, etc
Community nursing (district and zonal nursing) as
ultimate maturation of community health care in
statutory community medicine and health care.
How community nursing works where it is practiced,
developing and developed countries alike.
The story and failure of community health (especially
community nursing) in Nigeria, and why.
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 PUBLIC HEALTH & COMMUNITY MEDICINE IN
NIGERIA
Community health before colonization
Colonization and the trade, religious missionary
and military medical excursions in Nigeria
Occupational health, medical services and public
health in Nigeria in the colonial and immediate
post colonial era.
Drs. McGregor, Horton, Sapara, IL Oluwole,
Ajose, Lambo, Manuwa, Lucas, Ransome-kuti,
Otolorin, Ibiam, Okpara, Umaru Shehu, Adeleye,
Fom, Ogunlesi, Sofoluwe
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 NIGERIAN HEALTH & DEVELOPMENT PLANS

Colonial Development Plan, 1946 1956

Regional plans, 1954 1960
1st National Development Plans, 1962 1968
2nd NDP The three Rs, 1970 1974
3rd NDP, 1975 1980; BHSS
4th NDP, 1981 1985
The Rolling Plans, Health Policy, Population
Policy, PHC, etc, to date. Health Systems Reforms
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CURRENT STATUS OF THE NIGERIAN PUBLIC
HEALTH SYSTEM

The 2000 UN World Health Report and following

The cacophonies and the anarchy of the Nigerian
Health System
The distinction between disciplinary PH, PH of the
PHS, community health, community medicine,
etc; Office of Surgeon General or Dir.
Medical/Health Services or Chief Medical Adviser
to the Government; the MOH, community nurse-
midwives; auxiliary health workers; etc
Where to go from here?
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SUB-DISCIPLINES OF COMMUNITY MEDICINE/PH
The basic sciences Epid & biostats
The major field practice areas & their relative
importance to each other: health mgt (esp., as
MOH), R&FH as most socio-politically relevant,
Env Hlth (as greatest contributor) and Inf and Chr
Dx control programmes as the immediate field
application of epid
The others: HE as the basic social sci & art of
med. & P/CH, OH, PHNutr, R&SM, Int Hlth &
PHSrvs
Emerging areas: P/CDH, MH, Nature & WL
conservation
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TEACHING AREAS BUT NOT SUB-DISCIPLINES

PHC as a management approach to all of P/CH

Medical sociology
Medical ethics
Demography
At PG levels: the sociology of medicine & allied
hlth professions, ergonomics, industrial & social
psychology, health economics, entomology, etc

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PHC AS MANAGEMENT APPROACH TO ALL OF CH 1
Rational same as the genesis of the hospice
movement, poor law reforms and the entire CM
movement
The 6 primary principles and their sub-principles
or mgt imperatives: political will; orientation & re-
orientation of the HS & P, intra- & inter-sectoral
integration & collaboration, community
mobilization & involvement to the point of self-
ownership and reliance, appropriate tech & new
or improved mgt methods including new cadres of
health workers if need be!
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PHC AS MANAGEMENT APPROACH TO ALL OF CH 2

The original minimum service components of 8

The limitless No of minimum components & why
The lesser component approaches of many
resource-poor regions yet expanding minimum
service components even in these same places
The constancy of EDS, RFH + immunization & EH
in most lesser content discussions + CM&I in
other places
The ever-present and growing danger of vertical
PH and NGOism in Pry & overall HC!
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