Hltb16 Notes Pt 1.1 PDF

SEP 4 2024 INTRODUCTION TO PUBLIC HEALTH; WHAT IS PUBLIC HEALTH Keywords/Formulas Main points/Thoughts PUBLIC HEALTH; WHAT IS PUBLIC HEALTH? - Preventing disease - Science and art of; - Prolonging life - Preventi...

SEP 4 2024 INTRODUCTION TO PUBLIC HEALTH; WHAT IS PUBLIC HEALTH Keywords/Formulas Main points/Thoughts PUBLIC HEALTH; WHAT IS PUBLIC HEALTH? - Preventing disease - Science and art of; - Prolonging life - Preventing disease - And promoting physical - Prolonging life health and efficiency - And promoting physical health and - Charles-Edward A. efficiency Winslow - Charles-Edward A. Winslow PUBLIC HEALTH IS ACCOMPLISHED THROUGH EVERYONE & MEDICAL FIELD MAKING AN EFFORT TO HAVE; - Clean and sanitised living environment accomplished by everyone in the PUBLIC HEALTH IS ACCOMPLISHED THROUGH; community - Organised community efforts for the sanitation - Community infection of the environment control - Community infection control - Leading pro-hygienic - Education of the individual in principles of the lives personal hygiene - Medical field advising - Organisation of medical and nursing services and being pillars of for the early diagnosis and preventive diagnosis and treatments treatment of disease of disease - Development of social machinery which - Development of social ensures every individual in the community a machinery standard of living that's good for making health well 3 CORE FUNCTIONS OF - Social machinery example; faucets PUBLIC HEALTH without handles (sensors for disability or 1. Assessment people with certain needs) 2. Policy development 3. Assurance MISSIONS OF PUBLIC HEALTH - Future of Public Health (study conducted by ASSESSMENT; constitutes the Institute of Medicine in 1988) says; diagnostic function, in which a public health agency collects, Mission of public health: ‘fulfilment of society’s assembles, analyses, and interest in assuring the conditions in which the makes available information on people can be health’ the health of the population - Understanding cause of - Public health substance; sickness/aetiology - Organised community efforts aimed at the prevention of disease and POLICY DEVELOPMENT; like a promotion of health doctor’s development of a - Organisational framework of public treatment plan for a sick patient, health encompasses ‘both activities involves the use of scientific undertaken within formal structure of knowledge to develop a strategic government and associated efforts of approach to improving the private and voluntary organisations and community’s health.  - Implementing a individuals’ strategy for sickness - Basically; everyone making a part to ensure prevention that our environment is well so that we don’t infect/endanger others by taking care of ASSURANCE; equivalent to themselves and each other doctor’s actual treatment of patient - Easing the worries of others that they can have access to resources and healthcare 10 ESSENTIAL PUBLIC HEALTH SERVICES ASSESSMENT 1. Monitor health status to identify community health problems 3 CORE FUNCTIONS OF PUBLIC HEALTH 2. Diagnose and investigate 1. Assessment health problems and 2. Policy development health hazards in the 3. Assurance community ASSESSMENT; constitutes the diagnostic function, in POLICY MAKING which a public health agency collects, assembles, 3. Inform, advocate, and analyses, and makes available information on the empower people about health of the population health issues - Understanding cause of sickness/aetiology 4. Mobilize community - Example; people getting more sick in an partnerships to identify area? More surveillance on that area for and solve health potential factors that made this possible problems 5. Develop policies and POLICY DEVELOPMENT; like a doctor’s development plans that support of a treatment plan for a sick patient, involves the use individual and community of scientific knowledge to develop a strategic approach health efforts to improving the community’s health. - Implementing a strategy for sickness ASSURANCE prevention 6. Enforce laws and - Example; making a policy on how to regulations that protect prevent the spread of these illnesses by health and ensure safety taking these actions 7. Link people to needed personal health services ASSURANCE; equivalent to doctor’s actual treatment and assure the province of patient of health care when - Public health has the responsibility of assuring otherwise unavailable that the services needed for protection of public 8. Assure a competent health in the community are available and public health and accessible to everyone personal healthcare - Easing the worries of others workforce 9. Evaluate effectiveness, 10 ESSENTIAL PUBLIC HEALTH SERVICES accessibility and quality of personal and  population-based health services SERVING ALL FUNCTIONS 10. Research for new insights and innovative solutions in health problems BENEFITS OF PUBLIC HEALTH PROGRAMS - Saving money from medical costs - Public health contributes to health of population than individualisticalised medicine - (overall effort than specialised effort) - Top 3 are good to know for upcoming tests - Improvements in public - Are these an essential function for a health grant? POLITICS AND PUBLIC BENEFITS OF PUBLIC HEALTH PROGRAMS HEALTH POLICY - Effective public health programs save money - Must be able to be from medical costs accepted by the public - Public health contributes to health of population masses to let the policy than medicine (overall effort than specialised be followed effort) - Since community will - Life expectancy of American increased from have to pay for the 45→ 75 within 20th century ‘treatments’, usually - Only 5 of those 30 additional years can be through taxes, they must attributed to the work of the medical care decide how much ‘health’ system they’re willing to fund - Majority of gain has come from improvements - Deciding whether in public health to willingly accept - better nutrition, possible - housing, limitations on their - sanitation, freedom may be - access to free healthcare, required in order - occupational safety to improve community health - Despite the government control on which policies are allowed to be implemented (and restricts individual / community liberty), need to understand that politics helps limits resources to not be overconsumed EPIDEMIOLOGY; study of distribution and determinants of RESPONSIBILITIES OF PUBLIC HEALTH health-related states or events in - One responsibility is to educate public masses specified populations, and the and politicians; 'crucial role that a strong public application of this study to health capacity must play in maintaining and (prevent) and control health improving the health of the public… by its very problems nature, public health requires support by members of the public– its beneficial’ 4 USES OF EPIDEMIOLOGY - Comes with the responsibility of public 1. Etiology health officials that are rooted in 2. Disease spread scientific evidence and reasoning 3. Disease burden - Need to educate members of public in 4. Health policy, planning, simple language why policies must be and services implemented (persuasion) ETIOLOGY; Studying cause(s) POLITICS AND PUBLIC HEALTH POLICY of disease(s) of conditions - Politic decisions need to have careful and lengthy consideration to be done before a DISEASE SPREAD; Identify and policy is implemented determining spatial and - Must be able to be accepted by the geographic patterns in which public masses to let the policy be groups are affected followed - It might be by the influence of the public DISEASE BURDEN; Identifying masses speaking up that a problem and analysing social, spatial, needs to be addressed, and that the and geographic disparities to government needs to tackle it see the weight of affected go - Example; communities and through organisations reaching out to the government for stricter laws regarding HEALTH POLICY, PLANNING, incidents to not be repeated or have AND SERVICES; implementing more severe consequences to take mitigation strategies to prevent action against these incidents to not disease spread occur again (MADD, HIV orgs, etc.) - Politics enters public health process as part of HOW DOES EPIDEMIOLOGY the policy development function and especially CONTRIBUTE TO PUBLIC as part of the assurance function HEALTH? - Since community will have to pay for the - Prevention effectiveness ‘treatments’, usually through taxes, they must - Surveillance decide how much ‘health’ they’re willing to fund - Epidemiology - Deciding whether to willingly accept - Informatics possible limitations on their freedom - Laboratory may be required in order to improve community health PREVENTION AND - Example; quarantining. People felt INTERVENTION** restricted and controlled, increased 1. Define health problem anxieties, and made people disobey 2. Figure out risks related to rules which made a stagnant problem progression in stopping the spread of 3. Experiment covid-19 community-level - Among the assurance functions of public health interventions to try to is the provision of basic medical services; how prevent/eradicate cause this should have been a matter of great political of problem controversy 4. Implement interventions - Public health professionals are often impatient to improve population’s with politics, as the Institute of Medicine report  health notes, seeming to “regard politics as a 5. Monitor interventions to contaminant of an ideally rational assess their decision-making process rather than as an effectiveness essential element of democratic governance’ EPIDEMIOLOGICAL TRIANGLE MEDICINE VS. PUBLIC HEALTH MEDICINE PUBLIC HEALTH Illness = Host + Agent + Environment Individual patient’s care Community is patient and improve population health as a whole Healing patients who are Focus on prevention of ill illnesses SCIENCES OF PUBLIC HEALTH WHY IS PUBLIC HEALTH CONTROVERSIAL? EPIDEMIOLOGY; study of distribution and - True definition of health determinants of health-related states or events in - Social reforms specified populations, and the application of this study - Economic impacts to (prevent) and control health problems - Individual liberty - ‘Tragedy of the Commons’ - Traditions, morals and religious opposition Questions 4 USES OF EPIDEMIOLOGY 1. Etiology 2. Disease spread 3. Disease burden 4. Health policy, planning, and services ETIOLOGY; Studying cause(s) of disease(s) of conditions - Determining primary risk factor or agent or ascertaining causative factors - Analysing contributing factors DISEASE SPREAD; Identify and determining spatial and geographic patterns in which groups are affected - Analyse the characteristics of the agent or causative factors (in the context of infectious disease) - Determine mode of disease transmission DISEASE BURDEN; Identifying and analysing social, spatial, and geographic disparities to see the weight of affected go through - Reporting on morbidity, disability, injury, and mortality HEALTH POLICY, PLANNING, AND SERVICES; implementing mitigation strategies to prevent disease spread - Aid the planning and development of health services and programs - Provide administrative and planning data - Provide foundation for public health measures and policies SHIFT FROM INDIVIDUAL-LEVEL APPROACHES TO POPULATION-WIDE APPROACHES - By making everyone contribute to a change in their livelihood to be more sanitary and better health-wise, helps reduce the risk of increasing medical cases HOW DOES EPIDEMIOLOGY CONTRIBUTE TO PUBLIC HEALTH? - Prevention effectiveness - Surveillance - Epidemiology - Informatics - Laboratory PREVENTION AND INTERVENTION** 1. Define health problem 2. Figure out risks related to problem 3. Experiment community-level interventions to try to prevent/eradicate cause of problem 4. Implement interventions to improve population’s health 5. Monitor interventions to assess their effectiveness TRADITIONAL APPROACH TO FINDING CAUSE OF INFECTIOUS DISEASES; EPIDEMIOLOGICAL TRIANGLE Illness = Host + Agent + Environment - Think that illness/injury as result of chain of causation involving an agent, host, and environment - Agent may be disease-causing bacterium or virus - Host is susceptible human being - Environment includes means of transmission by which the agent reaches the host (contaminated water, food, human being) - Prevention is accomplished by interrupting the chain of causation at ANY step WHY IS PUBLIC HEALTH CONTROVERSIAL? - True definition of health  - Social reforms - Economic impacts - Individual liberty - ‘Tragedy of the Commons’ TRUE DEFINITION OF HEALTH IN PUBLIC HEALTH? - They say they want society to have input to make sure that everyone is healthy– what is the definition of healthy? - Is health encapsulating to everyone? - Is there one true definition of health? - How do people want to maintain their definition of health to their standards? - Like, we’re only here for a certain amount of time, why not make the most of it rather than focus on living a boring and long life? (take risks in health that could endanger it such as drinking, doing drugs, lots of junk food, etc.) - The conditions include many factors that might not normally be thought of as relevant to public health. - For example, the factor most significant in determining the health of a community is its economic status: People with higher incomes tend to be healthier for a variety of reasons - Winslow’s 80-year-old definition specifically includes as part of public health’s role, “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.” PUBLIC HEALTH AND SOCIAL REFORM - Early US history showed public health thrived with social reform movements - In addition to sanitary science and public hygiene, 19th-century reformers campaigned for improved housing, trade unions, the abolition of child labour, maternal and child health, and temperance. - Winslow thought of public health as a military-style campaign and wrote of “whole populations mobilised for the great war against preventable disease.” ECONOMIC IMPACT - Most public health measures have negative economic impact of some kind on some segment of the population or on some industry - Any proposed regulation may inspire opposition from some political quarter; - cost jobs,  - add to price of product, - require tax increases - Cut company products - Industries resisting change - Milk producers resisted pasteurisation - Landlords resisted building codes - Automobile manufacturers resisted design changes to improve safety - Opposition to programs that might be expensive so need as much scientific evidence to argue for these programs to be implemented INDIVIDUAL LIBERTY - Governments = promotes general welfare (by US Constitution terms, democracy is lowkey dead though since their pres options suck ngl) - General welfare = health + safety + economic well-being - Government’s role is to provide maximum health and safety for community as a whole - One of central controversies in public health is the extent to which government can and should restrict individual freedom for the purpose of improving the community’s talk ‘TRAGEDY OF THE COMMONS’ - But governments implementing restrictions on the public masses causes indirect harm, consequently seen to be controlling and totalitarianistic - Garrett Hardin (1968) calls above  ‘tragedy of the commons’ - A lot of herdsmen own many of cows - They all share a small field for cows to graze on - If each herdsman tries to max how many cows they put on the field, the field will become barren - The cows will starve, and the herdsmen will lose cows = losing profits - To make sure that the field doesn’t get overgrazed, there must restrictions on how much freedom the herdsmen get - Fair and equitable limits must be implemented on how much cattle the herdsmen are allowed to put on the field - In the industrial world, commons = air, water, elements of environment that people share - Government action is implemented to protect common resources that everyone shares since people are bound to overconsume - While general principle of protecting the ‘commons’ is accepted by most citizens, there is plenty of room for controversy in defining what to include among the protected resources, as well as how extensive the protective measures should be JUSTIFICATIONS OF PUBLIC HEALTH POLICY - Most public health advocates believe that there are more fundamental justifications for restrictions on individual behaviour for the sake of the public health - Beauchamp argues that laws are needed most for behaviours that are common and carry small risks - Examples; seatbelts are good to reduce risk of making sure that people don’t  fling out of car seats during crashes. But people can choose to buckle them on, a small choice that can changes the risk as individual faces - While each individual’s choice to take the risk of driving unbuckled may be rational, society’s interest in preventing the thousands of deaths and injuries outweighs the minor inconvenience of obeying the seatbelt law MORAL AND RELIGIOUS OPPOSITION - Moral opposition in regards to confronting sexual-reproductive issues (in US) - AIDS or other sexually transmitted diseases - Teen pregnancy - Low birth-weight babies - Public health approach to these problems includes sex education in schools and the provision of contraceptive services, especially condoms - These measures are often vigorously opposed by members of certain religious groups who believe that they promote immoral behaviour EXAMPLE; AIDS - AIDS is inherited through sexually transmitted diseases, through sexual acts that are deemed immoral - If not taught of how to prevent that spread and do these immoral acts in a safe and proper manner, then people would make conscious decisions whether or not they want to partake in these immoral acts and risk the consequence of contracting this illness - Consequently, AIDS-related policy has often been confounded by moral revulsion against the disease and the victim - Similarly, moralists frown on the practice of providing clean needles to drug addicts because, while effective in reducing spread of virus, people believe it condones the use of intravenous drugs Summary - what is public health - public health is accomplished by - 3 core functions public; assessment, policy development, assurance - 10 essential public health services - benefits of public health health programs - politics and public health policy - epidemiology - 4 uses of epidemiology; etiology, disease spread, disease burden, health policy + planning + services - epidemiology contributing to public health; prevention effectiveness, surveillance, epidemiology, informatics, laboratory - prevention and intervention - epidemiology triangle - public health controversies SEP 11 2024 HISTORY OF PUBLIC HEALTH PT. 1 Keywords/Formulas Main points/Thoughts Important to know QUARANTINE AND SANITATIONS BEGINNINGS - Quarantine and - Indigenous peoples have been in North sanitation introduced America first - Everyone - Living conditions were affected by European contributing to immigration (invasion) in 1600s preserving health - Fur trade made the French and British expand and hygiene their influence all over North America - Incidence - Smallpox, measles, tuberculosis and - Typhus/typhoid alcohol destroyed many Indigenous - Miasma/cholera lives since they didn’t have the - John Snow measures to protect themselves from - Toxins these foreign substances and illnesses - Edward Playter - No tolerances built up, so it was easier - Peter Bryce to be affected by foreignities too - Montreal smallpox cases - As more settlers moved to North American, & vaccination vessels arriving at Port of Quebec brought lots requirements of sick people, especially due to typhus fever - Dr. Alexander Stewart of Palmerston EARLY DISEASE SPREAD  - Diphtheria - WW1-polio/venereal disease - Social hygiene program established - Health institutions over canada’s provinces and territories - Vaccines = good - Polio, smallpox, venereal disease (sexually transmitted diseases), typhoid, typhus, tuberculosis, influenza, plagues = bad - Haphazard efforts to inspect ships before landing got better in 1710 Questions - Quarantine happened in 1721 because of fears of the black plague spreading across europe DISCUSSION POINTS TO - Black or Bubonic plague happening THINK ABOUT; (potential exam - Plague never came to canada but still got questions) cases of these illnesses too - A physician was appointed as health officer of Pre-confederation; what lower Canada in 1816, in response to high difficulties might local incidence of illness occurring among thousands governments have faced of new immigrants– ‘the wretched and regarding disease spread and miserable class of starved people that annually management? arrive’ in Quebec city from Britain - Lack of economic stability - Incidence* → important to know and evidence to prove - Incidence; new cases how social hygiene - Prevalence; proportion of population programs are beneficial that is affect, new or old cases - Lack of masses trust INOCULATION What were some of the social institutions of the time and how might they have related to disease spread? - Travelling, transport (carriages, trains, boats)= made the transfer of diseases more faster How does this reflect back to - Idea that smallpox could be prevented could be what we learned in lecture 1? prevented through arm-to-arm inoculation - It makes you realise how (vaccination) difficult it was to prove - 1720s Britain any legitimacy of social - Asia knew it earlier hygiene programs being - In 1796, British physician Edward Jenner used beneficial in the past and fluids collected from cowpox lesions on all the controversies livestock to protect humans from smallpox around their methods infection, creating the first effective vaccine (speaking of vaccines, giving sex-ed classes to CHOLERA SPREADS TO THE COLONIES the young, constraining women?? Very questionable and new to implement) - In the early 1830s, pandemic cholera spread across britain and europe and some physicians linked cholera and other fevers with impoverished living conditions - Argued diseases could be prevented if community to action, others blamed it on ‘miasma’ - Idea of german theory was not present at this time - Predominant thought of the cause of disease = miasma - Miasma; ill-defined poisonous vapour or mist believed to emanate from rotting organic matter EARLY GOVERNMENT ACTION - Lower Canada had some form of government that had been petitioned by physicians and funds for local boards of health to make funds for boards and the costs of quarantine - As cholera spread across Lower Canada, colonial governments (New Brunswick, Nova Scotia, and Newfoundland) took steps to prepare by establishing central boards of health and passing temporary legislation to strengthen quarantine provisions - In 1849, government of United Canadas (Upper and Lower) created a Central Board of Health with new legislation, but dissolved when  epidemic ended STRENGTHENING INFRASTRUCTURE - There were consolidations of public health legislations during the early 1850s in Nova Scotia and the United Canadas with the establishment of permanent local boards of health and strengthening of quarantine laws - When cholera came back in 1854, Canadian Central board of health was revived and government assumed full control of Grosse Isle IRISH FAMINE AND MIGRATION - In 1847, some 100k poor Irish emigrants fled famine and en route to British North America, many fell victim to typhus - Many people died along the way and infected others in Canada - Typhus; related to typhoid but more related in being a bacterial infection, But spread through lice, fleas, ticks instead of direct contact/contaminated food/water BRITAIN’S JOHN SNOW` - Britain’s 1848 Public Health Act resulted in more proactive measures to prevent disease and promote health, including the establishment of vital statistics  - John Snow* (1854) → important since he’s the guy who started the study of epidemiology - Many people died of cholera - He wanted to find the true source - Took a map of london, walked around, found cases of cholera in each area - Observed spatial trends in cases → saw clusters of cases and deaths around neighbourhood water pumps (saw a disease spread geographically) - ⇒ Deduced that there needs to be improved of sanitation and water health checks in these areas - ** Improved the establishment of public health policy and vital statistics in Canada - Britain’s 1848 Public Health Act resulted in more proactive measures to prevent disease and promote health, including the establishment of vital statistics INTRODUCTION OF VACCINE - Compulsory vaccination measures to prevent smallpox were introduced in the  early 1860s in the United Canadas and PEI - Hudson bay launched a vaccination campaign as a de facto public health agency - Doing in the favour for their own gain - If disease affects the production of fur and fur trade, they want to fix the problem to pick up on profits and business again - Introduction of understanding the importance of clean water and proper sanitation (they only acted on it when another disease outbreak happened again, call to imminency than action) THE SANITARY IDEA (1867-1909) HYGIENE AND SANITARY REFORM - Creation of permanent local and provincial boards of health was still a work in progress but efforts to control infectious disease and build effective water and sewage systems were aided by discoveries of the heterological revolution in the 1880s - As knowledge and infrastructures developed, a growing number of voluntary organisations and individual sanitary reformers preached the gospel of hygiene GERM THEORY AND SANITATION MEASURES - Invention of microscope - Late 17th century; Permitted of discovery of the microbe - 19th century; Field of bacteriology develops - Early 20th century; ‘the germ theory’ - Specific causative bacillus in 1880 is caused by a type of typhoid in 1896 - Discovery and successful testing of both the  diphtheria and achievements provided in the first reliable and scientific biological tools for the control of these deadly diseases - Toxins* are primary causes of disease SANITATION - Knowledge about how infectious diseases were spread brought the realisation that individuals and communities could do something to prevent the spread of disease and benefits from early detection - Introductions that individuals and communities can contribute to lower the infection rate of diseases - Introduction of relation between biological mechanisms are and reaction with people - “The Sanitary Idea” - First adopted by medical elites - Then educated middle class - Then everyone CONFEDERATION AND GROWTH - Delegates at Charlottetown Conference - Charlottetown allowed for establishment of confederation but resulted in uniting different provinces to have central government, larger health providing structures - Indigenous people were excluded, unless it was missionaries, traders, and individual physicians that treated them - The health of First Nations and Métis people had begun to seriously deteriorate by 1900, due to the decline of the fur trade and relegation of Indians to under-developed and isolated reserves MODELS FOR PUBLIC HEALTH - Ensuring a health model for people to follow - Great Britain and Public Health Act of 1875 were models for sanitary reform in Canada - Landmark legislation enshrined the British government’s responsibility for the health of the people, most of whom were living in old but rapidly changing cities and densely populated rural areas - In contrast, first generation of Canadian sanitary reformers; - ‘Functioned in relatively new cities which were trying to erect basic industrial, housing, and sanitary infrastructure while often absorbing immigrants on a scale not seen in Europe.’ - Outside canada’s towns and cities, the widely scattered populations often living in wilderness conditions had no counterpart in western europe EDWARD PLAYTER* (1834-1909) - Person that made the first canadian public health journal - Recognized practice of medicine went beyond treating the sick to include the prevention of sickness and promotion of health– not only saving lives and suffering but also to protect economic health of country - Made the first Sanitary Journal - One of the most important early sanitary reformers - Playter financed, produced, and promoted The Sanitary Journal (1876); ‘devoted to public health and individual hygiene’ - Playter’s first editorial argued that more attention was needed to look after the health and development of infants, children, youth, mothers and their unborn. - Playter called out medical professions to improve Ontario Public Health Act of 1873 and lobby the government to establish a sanitary bureau EXPANSION OF MUNICIPAL PUBLIC HEALTH  - Awareness of public health increasing through local governments - For example, winnipeg implemented By-Law No. 13 in 1874 with regulations against unadulterated food and tainted meat, defiling of water and allowing stagnant pools to stand and keeping dead animal carcasses in the city (basically food and water regulations to make sure there are no infections or infestations) - The law required every home to connect a privy and keep it clean and to collect all dirt into one place and keep filth off the lots and streets, with penalties of a fine up to 20$ or a jail sentence up to 21 days MEASURES IN TORONTO AND MONTREAL - In toronto at this time, sanitary reformers were concerned about expense and safety of the city’s proposal to build a trunk sewer line across the waterfront to channel the sewage into the lake, 3 miles from the city, in the questionable hope that currents would not carry it back to where the water supply was drawn - Public health activity also expanded in Montreal, where before 1870, these matters related only to the control of nuisances, with a few policemen giving attention to cleaning yards, lanes and privy-pits SMALLPOX IN MONTREAL  - During 19th century, there were lots of records of highest mortality rates in Montreal because of chickenpox ⇒ improve sanitation guidelines - There was a smallpox outbreak in 1870 - At a public meeting called by the mayor, a Citizen’s Public Health Association was established, supplanting the Montreal Sanitary Association, to ‘increase and diffuse knowledge on all subjects relating to the public health, by the discussion of sanitary subjects, by exposure of sanitary evils, and by promoting sanitary legislation’ - In 1875, Province of Quebec adopted compulsory smallpox vaccination, despite strong opposition - People of quebec said nuhuh to vaccines frfr (antivaccers) MONTREAL SMALLPOX EPIDEMIC, 1885 - Vaccine enforcement had no backing so it scared people, making them against it and ‘act’ on it - 1885 spring, two Pullman-car conductors infected with smallpox arrived in Montreal from Chicago - Smallpox spread within and beyond Hotel Dieu hospital - Public health officials tried to enforce vaccination and isolation of the sick, but were met with resistance and some were assaulted as they tried to remove corpses from the worst-infected neighbourhoods - Sept. 28, police from all over the city assembled to disperse an angry mob that roamed the streets while hurling stones SMALLPOX IN ONTARIO  - Peter Bryce* - Secretary of Provincial Board of Health in Ontario (1884) managed smallpox - Ordered schools and churches banned public gatherings - Suspended stagecoach service - Posted constables on the roads and railway stations to control the movement of anyone who might be carrying disease - Brought in medical students to conduct house-to-house vaccinations, disinfected and fumigated all infected houses, and issued a special pamphlet that attacked the anti-vaccination views of local practitioner - Jan. 1885, after 202 cases and 45 deaths, smallpox was kept from spreading outside the township AMENDMENTS TO LAWS - Montreal smallpox experience led to requirement that all people arriving to canada show proof of smallpox vaccinations or get a vaccine ASAP - Ontario had amended its Public Health ACt to compel the appointment of a local medical officer of health and sanitary officers answerable to the provincial board and if necessary, to appoint local health officers and tax municipal funds to pay closed them - Ontario had less deaths (30 deaths), Montreal had more deaths (3k deaths and 19.9k cases) - Total of 5,964 deaths across Quebec - Montreal outbreak proved to be the last uncontained outbreak of smallpox in a modern city - Quebec passed public health act in 1886, establishing a provincial board of health in 1887 BACTERIOLOGY AND PUBLIC HEALTH LABORATORIES  - Louis Pasteur* - Producer of anthrax vaccine for sheep - Robert Koch - Discovery of ‘the germ of tuberculosis’ - Dr. Alexander Stewart of Palmerston** - Producer of smallpox vaccine - 1890; Ontario established the first public health lab. In North America DIPHTHERIA*; serious bacterial infection caused by Corynebacterium diphtheriae. It primarily affects the throat and nose, but can also impact other parts of the body. - Incidence of this disease increased around the world during second half of 19th century - Its causative bacterial organism was identified in 1883-84 and the specific endotoxin produced by the disease was recognized in 1888 - NYC Department of Health produced and administered the first supplies of diphtheria antitoxin on the continent in 1895 - Some production and business happened and became the first thing in North America to supply that - Cost of importing diphtheria antitoxin was the focus of lively discussion at a meeting of Ontario Medical Association in 1905 PUSHING FOR PROGRESS - Playter and other sanitary reformers work on keeping public health relevance at a federal level - Convincing the government of how much money would be loss if not implementing programs and focus on the care of managing preventable sickness and death than waste so much money through treating each individual  case that pops up (better sanitation and health protocols that the public can put effort into as well) - Critique on the push for animal vaccination-disease spread rather than for human disease prevention research EDUCATION AND SCIENTIFIC KNOWLEDGE - Appearing before prime minister, canadian medical association say they’re not taking full advantage of science and its technologies to find the sources of sicknesses and illnesses - Like solving illness cases costed a couple thousand-million dollars yearly - Public education remained fundamental to reformers’ public health crusades, even with the advancement of science, people in rural areas stuck with the old beliefs of infectious diseases (miasma) TRANSFORMATION AND WORLD WAR I (1910-1919) INFANTILE PARALYSIS; NEW EPIDEMIC - Pushing funds for war than for public health research and programs - Polio was a big thing that inconvenienced everyone - Rabies and poliomyelitis are both viral diseases that affect the central nervous system and symptoms of the two were frequently confused - People affected by tuberculosis lowered, polio affected more people due to its cause being known at the time with less focus on science and more on warfare TUBERCULOSIS/TYPHOID PERSISTENCE IN CANADA - Medical advisor, Charles Hodgetts, focused on the persistent incidence of typhoid due to contaminated water in Canadian cities - Conference recommended creation of a laboratory to conduct research and manufacture vaccines and antitoxins - Canada’s typhoid death rates >> the world’s typhoid death rates  - Hodgett’s recommended more efficient and federally-enforced legislation, with cooperation of the provincial departments of health - Conference called for establishment of federal council for health, government action to prevent pollution of public water supplies, establishing subsidised federal and provincial tuberculosis sanatoriums and funding for an educational campaign against the white plague (tuberculosis) ⇒ basically a prevention strategy and plan against tuberculosis CANADIAN PUBLIC HEALTH ASSOCIATION - 1910: Peter Bryce pulled up with his homies to make the Canadian Public Health Association (CPHA) - CPHA purpose; establish professional public health standards, conduct research and provide technical and scientific information - CPHA objective; ‘development of the science and art of general prophylaxis with promotion of social welfare, in judicious conservation of natural resources, popularisation of eugenics and more effective national and international cooperation along all lines of public health)’ TYPHOID - Ottawa showed typhoid=bad by showing poor sewage system - Little action done when first declared, the second epidemic managed to make everyone take action PUSH FOR EDUCATION - Science advancements and preventive medicine became central element of local and  provincial public health disease control strategies - Art exhibits increased traction and public health education strategies - Causes of health concerns; houseflies, public drinking cups, and kissing - Saw flies = ‘germs with legs’ (always eating and flying around, transferring germs) - To prevent the ‘massacre of the innocents’ people were advised to ‘screen your doors, windows, foods against this pilot of pollution. Swat flies and sweep them from the confines of your homes’ (I’m sorry that is so dramatic just say kill the flies and go home) VENEREAL DISEASE EDUCATION - Venereal disease = gonorrhoea - Serious public health threat to be educated about (all the STDs must be prevented) - STDs can be prevented through sex hygiene education taught at elementary level - Became controversial because people thought it was inappropriate to discuss and educate a very private/intimate matter with children (children are too young to learn the birds and bees) PROVINCIAL STRUCTURES  - John McCullough asking for more comprehensive public health legislation ⇒ targeting local health organisations and their responsibilities - Made these kinds of health institutions in each province that had health professionals operate there (legible when passed postgraduate course at UofT’s Department of Hygiene) and are paid a reasonable salary - Basically doctors in each province - ⇒ These kinds of institutions helped alleviate the stress of any infections spreading and can be minimised at a municipal/provincial level than be federally burden and endanger everyone ONGOING CHALLENGES; WWI - Many physicians and nurses called into military service - Difficult to deal with local health dangers with lack of personnel/professionals - Polio endangered ontario, described to be one of the most dangerous polio epidemics that have been recorded by McCullough and FitzGerald - Strict quarantine imposed, but it economically cost a lot to maintain and manage the sick and the quarantined while trying to survive in a world war PERSISTENT DISEASES DURING WWI - Threat of venereal diseases (Syphilis) became a dominant issue as the war progressed - Conservation passed the law to have power in detaining women (women that are suspected of having venereal disease) → controls venereal disease  (gonorrhoea, syphilis, and chancroid) - Those infected were required to seek professional medical treatment through provincially-funded hospitals and the provincial government or its agents were to be the only source of educational literature, a measure aimed at patent medicine vendors and medical quacks SPANISH FLU - New and unusually deadly influenza strain originated in China in February ⇒ France through transient workers - War made diseases spread at a crazy amount around the globe - By the time the pandemic eased, ⅙ of Canadian population (young adults) were affected and 50k died, pneumonia quickening the rate of death - Quebec and alberta most affected - Indigenous community affected to the extremes due to lack of inclusion and medicine and knowledge - Influenza so severe among the Haida living on islands off the north coast of BC that entire settlements were wiped out NATIONAL COORDINATION - Ending of war and pandemics urged national organisations to increase interest in health for establishment of federal department in government  - Thanks to military authorities, Prime Minister Robert Borden called national conference in Ottawa on Feb. 3, 1919 to organise a national Social Hygiene program aimed at controlling venereal disease - Conference’s principal resolution concludes that ‘it is in the interests of the future health and life of the Citizenship of Canada that there should be immediately established a Federal Department of Health’ MODERNIZATION AND GROWTH (1920-1929) MATERNAL AND CHILD HEALTH - Concerns of factory work on pregnant women and health of mothers with small children issued maternal and child health concerns, especially since there were women in the workforce during ww1 - 1920; Dominion Council of Health endorsed an international minimum standard for women working in industry before and after childbirth that had been developed at the 1919 International Labour Conference - Compared to other countries, canada rated poorly in both infant and maternal mortality since the lack of healthcare professionals aiding in (child-rearing) pre- or post-natal medical care - Red cross founded CPHA’s new child welfare section to reduce infant mortality throughout canada - Dominion council of health (DCH) endorsed CPHA’s child welfare section as the national focus of voluntary child welfare programs to work with public health departments at all levels of government - Kids and women living in rural areas were endangered more; having to work themselves to death to earn food and lack of accessibility to health care or  safe living conditions - Rural schools received limited medical inspection and home sanitation INCREASED INVESTMENT IN PROGRAMS - A lot of health programs boomed in universities to increase the production of health experts and bring awareness of the importance of more medical experts needed on the field for any unexpected health crisis that needs to be addressed - The universities required financial assistance to develop public health nursing courses and to attract and support students FIRST FULL-TIME COUNTY HEALTH UNIT - Canada’s first full-time county health unit was created in BC (1912) - Although many urban areas had full-time health departments staffed by well-qualified, full-time medical officers of health - Canada’s second full-time county health unit was in quebec (1926) - Saskatchewan, with almost fully rural conditions, took a different approach by providing free consultative health clinics SERVICES FOR INDIGENOUS COMMUNITIES - Indigenous communities had very limited public health services - Federal government was responsible for health promotion and protection for canada’s  aboriginal peoples, but few services were provided at thai time - Indian health service did not begin to develop until 1927, when Dr. E. L. Stone succeeded Dr. Peter Bryce as Medical Superintendent General - Bryce had been an outspoken critic of the federal government’s failure to provide health care and services for First Nations and his persistent advocacy effectively ended his career in the federal public service INDIGENOUS HEALTH - High rates of tuberculosis in Indigenous communities became publicly known ~mid-1920s - Thanks to canadian tuberculosis association doing a 2-year study of coast and interior bands in BCon behalf of the department of indian affairs - First substantive federal effort to provide health services to indigenous people in the north began in 1922 with the appointment of Dr. L. D. Livingston as medical officer for the NW territories and yukon branch of the department of the interior - Catholic and Anglican missionaries operated small northern hospitals, annoying Livingston. - Objecting to building of hospitals to serve the very sparse and nomadic northern indigenous population (go king, just teach them how to treat the illness and yeet out) LAPSES IN OVERSIGHT; SMALLPOX AND TYPHOID - Lack of public health action + local government neglect = typhoid and smallpox epidemics - Anti-vaccination sentiments among some members of the public and the medical profession were often reinforced when physicians improperly stored or administered vaccines - When smallpox outbreak occurred in Toronto, authorities hesitated to carry out compulsory vaccinations - USA needed proof of recent smallpox vaccination in order to cross the border and have quarantine restrictions from Toronto → Manitoba/Quebec - Epidemic in Toronto eased after 200,000 voluntary vaccinations were given (and those with no vaccines died duh) - No one who had been vaccinated over the previous 12 years contracted the disease and  no one who had ever been vaccinated died in Windsor - Meaning; In Windsor, over the past 12 years: - No one who got vaccinated got sick with the disease. - No one who ever got vaccinated died from the disease. - When the emergency was over, seen the efficiencies of vaccines being proven as a protective measure - Vaccines = good TYPHOID IN ONTARIO AND QUEBEC - Major typhoid epidemic in Ontario (1923) and 4 years later in Montreal (1927) - Ontario→ typhoid-contaminated sewage entered water supply, resulting in more than 800 cases and 50 deaths among a population of 3.4k - The provincial board of health provided engineers, general and public health nurses, as well as $20k to help the town - Montreal- typhoid-epidemic caused by contaminated milk and left more than 5k cases and 533 dead - Ground-breaking 1929 montreal health survey report reflected importance of statistics and placing public health within social context - Outbreaks of typhoid and other enteric disease exposed weaknesses in sanitary controls of milk supplies - Outbreaks and persistent threat of milk-borne tuberculosis enflamed the debates between advocates of raw milk and those calling for compulsory pasteurisation - Why milk being pasteurised is important to make sure there’s not another epidemic - Good milk = good for the nation? Or is a substitute needed hmmmmm POLIOMYELITIS  - In contrast with successful control of diphtheria, poliomyelitis/polio increased dramatically in incidence - BC - Alberta (1927) - Manitoba (1928) - Ontario (1929) - Quebec (1930) - Polio still widely called ‘infantile paralysis’, although new and strange disease did not strike infants only– any other disease could impair the population and sweep up the world again - The only weapon against polio at this time was a human ‘convalescent’ serum made with blood collected from polio victims - Serum was freely supplied in most provinces to prevent polio’s paralytic effects, although its effect was unclear - Similar notion of using covid-19 vaccines working Refresher on how covid-19 vaccines working; 1. The COVID-19 vaccine (mRNA or viral vector) introduces a genetic material (DNA or RNA) that encodes for a specific COVID-19 protein (e.g., spike protein) into your body. 2. This genetic material is taken up by cells, which then translate it into the COVID-19 protein. 3. The immune system recognizes this protein as foreign and mounts an immune response, producing antibodies that specifically target the COVID-19 protein. 4. These antibodies help to neutralise the virus if you're exposed to it in the future. 5. Additionally, immune cells like T-cells and B-cells learn to recognize the COVID-19 protein, allowing them to quickly respond and attack the virus if it enters your body.  The genetic material in the vaccine doesn't directly introduce COVID-19 DNA into your body. Instead, it instructs your cells to produce a specific COVID-19 protein, which triggers the immune response. You're correct that the vaccine helps your immune system recognize the COVID-19 protein as a threat, allowing it to prepare a defence against future infections! Summary - Introduction to quarantine and sanitation - Early disease spread - Early government action to diseases and cholera and miasma - Conducting the research on where diseases come from than spread through miasma - Introduction to vaccines - Sanitary idea - Hygiene and sanitary reform - Germ theory and sanitation measures - Confederation and public health programs - Smallpox in canada - Implementing public health laws - Bacteriology and public health labs - Diphtheria - Education and scientific knowledge (sex-ed) - War and lack of advance in public health/health at all - Lack of medical professionals to help out, Polio epidemics, venereal diseases, childbirth, health of women/mothers and children, typhoid epidemics, plagues - Increased health programs and institutions established in canadian universities and provinces/territories - Indigenous health - Smallpox, typhoid, polio epidemics in canada