Historical Foundations

This chapter considers the history of the rise of ethical concerns in the public health movement and epidemiology, which is the study of the distribution and determinants of disease in human populations. It explains that epidemiology is a basic science in public health. It also provides an overview of early developments in public health and ethics. The chapter looks at recent developments, including the origins of bioethics, regulatory safeguards for human subjects research, public health ethics, and contemporary epidemiological ethics. It begins with the end of the Middle Ages, wherein few advances were made in public health except for the control of a very limited number of communicable diseases achieved through the segregation and quarantine of persons thought to be infectious.

A entrada na agenda brasileira do Projeto Nacional de Saneamento Rural (1985)

This article seeks to understand the circumstances that culminated in the formulation and implementation of the National Rural Water Supply and Sanitation Project (PNSR) in the 1980s, using the Multiple Streams Model as its theoretical reference. The results show that the theme’s ascension to the government agenda stemmed from a conjuncture marked by intense transitions that contributed to opening a policy window. The struggle to guarantee social rights in the Brazilian re-democratization process; the activities of social movements like the grassroots public health movement; the large sanitary deficit and its consequences for public health; the joint involvement of institutions with considerable expertise like Economic and Social Planning Institute (IPEA), Public Health Special Service Foundation (FSESP) and Pan-American Health Organization (PAHO) and the availability of financial resources stemming from a partnership arrangement with the International Bank for Reconstruction and Development (IBRD) provided a favorable environment for the elaboration of the PNSR.

Controlling contagion? Watercress, regulation and the Hackney typhoid outbreak of 1903

The part played by the public health movement in controlling epidemics in urban areas has received considerable attention from historians, as has the regulation of the milk and meat industries that commenced in the late nineteenth century. However, comparatively little work has been carried out on health in a rural context – and the role played by the horticultural sector in the spread of contagious diseases has barely been covered. Yet, as this article shows, it was a sector that had the potential to produce potent contaminants. By examining histories of the production of one horticultural crop, watercress, it reveals how issues around the provision of a clean urban water supply and idealised imaginings of the countryside as a pure space, played a part in exacerbating the extent of outbreaks of typhoid in the industrial city. It also shows that there was governmental reluctance to regulate an industry that grew a staple product, even when growers themselves were keen for guidance.

Policy Responses to Addressing the Issues of Environmental Health Impacts of Charcoal Factory in Nigeria: Necessity Today; Essentiality Tomorrow

Worldwide trebled of wood charcoal production over the last 50 years from 17.3 million tons in 1964 to 53.1 million tons in 2014 with sixty-one percent of current global production occurring in Africa, primarily to satisfy the demand for cooking fuel from urban and rural households with 2.7 billion people relying on wood fuels in the global south, while, the rural populace in Nigeria use about 80 million cubic meters of wood fuel annually for household energy. The furnaces of the world are now burning about 2, 000, 000, 000 tons of charcoal a year. When this is burned, uniting with oxygen, it adds about 7, 000, 000, 000 tons of carbon dioxide to the atmosphere yearly. This tends to make the air a more effective blanket for the earth and to raise its temperature. The effect may be considerable in a few countries. With Nigeria’s population projected to hit 410.6 million by 2050 and 550million by 2070 and consequently, becoming the third most populous country on our planet, and with an increased population growth rate in this part of the global village is alarming and worrisome, couple with rural-urban migration in key producing states, including Kwara, Ogun, Osun, Ondo, Ekiti, Kogi, etc. Whilst demand for charcoal is projected to increase in Nigeria, the availability of woody biomass is declining due to widespread net deforestation and biomass being the only energy source of choice due to large scale poverty and unaffordable prices of other alternatives like gas and electricity. While the human population naturally increases geometrically, the power of the improvements in resources goes up arithmetically leading to disequilibrium. This disequilibrium promotes a lot of crises bordering on economy, security, health, and politics among others. It is a fact that human populations tend to increase much more rapidly than the means of subsistence. Given the increasing demand for charcoal, and decreasing availability of biomass, policies are urgently needed that ensure secure energy supplies for urban and rural households and reduce deforestation. There is potential for charcoal to be produced sustainably in natural woodlands, but this requires supportive policies, economic diversification, and investment in improved eco-stoves. New advocacy and public health movement are needed urgently to bring together governments, international agencies, development partners, communities, and academics from all disciplines to address the effects of charcoal factories on health.

ANALISIS KELENGKAPAN IMUNISASI DASAR DI WILAYAH KERJA PUSKESMAS LEMO KABUPATEN BARITO UTARA

Healthy behaviour is a proactive attitude to maintain and improve health, prevent the risk of disease, protect yourself from disease threats and play an active role in public health movement activities. One of the healthy attitudes that must be created is the attitude of prevention and disease management with immunization activities. This research aims to analyse the relationship level of education, knowledge and attitude of baby mothers with the completeness of basic immunization in the work area of Puskesmas Lemo Teweh District of North Barito Regency. The method used is an analytical survey with a Cross Sectional approach aimed at knowing the relationship level of education, knowledge, attitude with immunization in the baby. The result is a relationship between knowledge and attitude with the completeness of immunization in infants, completeness of basic immunization in infants 48.4% (31 babies). To increase the percentage of completeness of basic immunization in Lemo Puskesmas is by improving the extension, especially about the benefits and schedule of immunization administration.

‘Cleanse or Die’: British Naval Hygiene in the Age of Steam, 1840–1900

This article focuses on the consolidation of naval hygiene practices during the Victorian era, a period of profound medical change that coincided with the fleet’s transition from sail to steam. The ironclads of the mid- to late- nineteenth century offered ample opportunities to improve preventive medicine at sea, and surgeons capitalised on new steam technologies to provide cleaner, dryer, and airier surroundings below decks. Such efforts reflected the sanitarian idealism of naval medicine in this period, inherited from the eighteenth-century pioneers of the discipline. Yet, despite the scientific thrust of Victorian naval medicine, with its emphasis on collecting measurements and collating statistics, consensus about the causes of disease eluded practitioners. It proved almost impossible to eradicate sickness at sea, and the enclosed nature of naval vessels showed the limitations – rather than the promise – of attempting to enforce absolute environmental controls. Nonetheless, sanitarian ideology prevailed throughout the steam age, and the hygienic reforms enacted throughout the fleet showed some of the same successes that attended the public health movement on land. It was thus despite shifting ideas about disease and new methods of investigation that naval medicine remained wedded to its sanitarian roots until the close of the nineteenth century.

The Environment in Health and Well-Being

Most people today readily accept that their health and disease are products of personal characteristics such as their age, gender, and genetic inheritance; the choices they make; and, of course, a complex array of factors operating at the level of society. Individuals frequently have little or no control over the cultural, economic, and social influences that shape their lives and their health and well-being. The environment that forms the physical context for their lives is one such influence and comprises the places where people live, learn work, play, and socialize, the air they breathe, and the food and water they consume. Interest in the physical environment as a component of human health goes back many thousands of years and when, around two and a half millennia ago, humans started to write down ideas about health, disease, and their determinants, many of these ideas centered on the physical environment. The modern public health movement came into existence in the 19th century as a response to the dreadful unsanitary conditions endured by the urban poor of the Industrial Revolution. These conditions nurtured disease, dramatically shortening life. Thus, a public health movement that was ultimately to change the health and prosperity of millions of people across the world was launched on an “environmental conceptualization” of health. Yet, although the physical environment, especially in towns and cities, has changed dramatically in the 200 years since the Industrial Revolution, so too has our understanding of the relationship between the environment and human health and the importance we attach to it. The decades immediately following World War II were distinguished by declining influence for public health as a discipline. Health and disease were increasingly “individualized”—a trend that served to further diminish interest in the environment, which was no longer seen as an important component in the health concerns of the day. Yet, as the 20th century wore on, a range of factors emerged to r-establish a belief in the environment as a key issue in the health of Western society. These included new toxic and infectious threats acting at the population level but also the renaissance of a “socioecological model” of public health that demanded a much richer and often more subtle understanding of how local surroundings might act to both improve and damage human health and well-being. Yet, just as society has begun to shape a much more sophisticated response to reunite health with place and, with this, shape new policies to address complex contemporary challenges, such as obesity, diminished mental health, and well-being and inequities, a new challenge has emerged. In its simplest terms, human activity now seriously threatens the planetary processes and systems on which humankind depends for health and well-being and, ultimately, survival. Ecological public health—the need to build health and well-being, henceforth on ecological principles—may be seen as the society’s greatest 21st-century imperative. Success will involve nothing less than a fundamental rethink of the interplay between society, the economy, and the environment. Importantly, it will demand an environmental conceptualization of the public health as no less radical than the environmental conceptualization that launched modern public health in the 19th century, only now the challenge presents on a vastly extended temporal and spatial scale.