Evolution of Public Health Thinking

Public health is a science and art of preventing disease, prolonging life, and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals

CEA Winslow

Public health is about searching the effective way to secure health and prevent disease in the population. The strategies to dealt with diseases evolved through trial and error, scientific knowledge, also related to societal condition, religion, culture, beliefs. The evolution of public health thinking is a dynamic process, although there is much new perspective and arguments in public health today, many of the currents debate are echoes of the past.

Since the ancient time, there are four different phase of public health in the history. First, the Diseases control phase (1880-1920), second Health promotional phase (1920-1960), then Social engineering phase (1960-1980) and the last is periode of “Health for All” phase (1980-2000 AD).  The history writing in the era of ancient society such as Indian, Chinese, Egyptian, Greek, Mesopotamian, and Roman, human already did the efforts of controlling disease. Since the ancient era, man already realized the relationship between personal hygiene, sanitation, nutrition and health though the practical coexisted with mystical belief, divination and shamanism. Some cultures relate cleanliness and godliness, they provide sanitary measure, water, sewerage and drainage because of the religion.

Then, in the beginning of 7th century, community realized the importance of public health after there were outbreak of several infectious diseases and became epidemic, such as cholera that spread form Asia, South Asia and to Africa. In the 7th century India was the centre of cholera outbreak. Besides that leprosy also spread from Egypt to Middle Asia and Europe through the immigrant. There were some efforts that done by the community to tackle the epidemic such as effort to maintain the sanitation of environment, built latrine, provided clean water for drinking, built house ventilation. In the 14 century there was epidemic of plaque, the worst in India and China. It called “The Black Death because so many people died in that era. Until the 18th or 19th century as the knowledge also increasing, the efforts of public health also increasing but in the whole of that period the efforts were focus on environment or sanitation.

Today the new public health not only focus on environment, but also individual. If the old public health searching the source of the disease especially infectious disease in the environment, however in the new era of public health the source search in the human themself. To tackle the public health problem not only doing effort in the environment but also must be concern in behaviour changing of the person also. Do not only introduce pure water, sewage system and street cleaning but also increase the capacity of community to live in healthy lifestyle including live cleaner. This logic led to a radical reformation of the environment.

In Indonesia, the history of public health since 16th century, in the era of colonial. There were many public health problem in Indonesia at that time such as high newborn mortality until 1807, so the colonial government registered and gave capacity building to community that assisted delivery of pregnant women, then epidemic of cholera in 1927, smallpox in 1948, plague epidemic in Java island in 1932-1935. In 1925, a Netherland health worker, Hydric started efforts after found the poor sanitation problem, open defecation practice, drinking unsafe water, etc. Hydric conducted health education to community and developed area as a model for better sanitation.

After Indonesia got the independence, in 1956 a concept of curative can not be separated from preventive measures was developed, the health worker trained to developed an integrated health service for people in the village, this concepts is the root model of puskesmas.  Then, in 1968 in the national meeting, puskesmas became an integrated health facility that deliver integrated curative and preventive measures with several main area of public health such as environmental health, nutrition health, maternal and children, etc.

In the new public health era, as the health thinking developed, the function of puskesmas also expanded, not only focus on sanitation or personal hygiene, but also puskesmas conduct public health education to the community as part of effort for behaviour changing. For example puskesmas conduct counselling or clinic for smokers to stop smoking.  Puskesmas become the important institution that has many role to implement  the public health services in Indonesia.

References :

1. Tulchinsky TH, Varavikova EA. A history of public health. New Public Heal., USA: 2014.
2. Park JE. Park’s Textbook of Preventive and Social Medicine. 23rd ed. 2015.
3. Surahman, Supardi S. Modul Ajar Ilmu Kesehatan Masyarakat PKM. Jakarta: BPPSDMK Kementerian Kesehatan RI; 2016.
4. Fairchild AL, Rosner D, Colgrove J, Bayer R, Fried LP. The exodus of pulic health what history can tell us about the future. Am J Public Health 2010;100:54–63. https://doi.org/10.2105/AJPH.2009.163956.