From the First Hospital to the WHO: a Brief History of Public Health
The concept of public health was born thousands of years ago, around 500 BCE, when the Ancient Greeks realized the connection between infectious diseases and hygiene. The realization led to the first installation of water supply and drainage — two municipal services deeply intertwined with the modern public health system.
The Romans were next — around 100 BCE, they constructed buildings called valetudinaria to take care of sick slaves, gladiators, and soldiers. While these valetudinaria buildings were far from what we consider hospitals today, it was remarkable progress for humanity.
(Source: Getty Images)
Fast forward a couple of centuries to when Christianity became the main religion in the Roman Empire and provision care expanded to every cathedral town. One of the first official hospitals recorded in history was in Constantinople around the fifth century, consisting of buildings for patients and separate houses for doctors and nurses. In other parts of the world, people started to recognize the importance of having clean water to fight against diseases. Somewhere between the 14th and 15th centuries in Europe, penalties for polluting water supplies were issued in various cities.
And yet, the Middle Ages was still a dark time in public health history. Multiple pandemics happened, among them measles, smallpox (both around 1000 CE), influenza (between 1100 and 1450 CE), and the Black Death (around 1340 CE).
While people had realized the connection between reducing waste and widespread diseases, other factors still enabled numerous pandemics to rampage the land. The Crusades, which were widespread around Europe during this period, was considered one of the main factors contributing to the spread of pandemics. By then, physicians had acknowledged that person-to-person communication played a key role in spreading diseases. Thus, quarantine — in other words, community expulsion — was imposed.
After the Renaissance came the Enlightenment, along with a new wave of physicians and surgeons determined to fend off the diseases — both old and new — that had been terrorizing public health. Hospitals were built, not only as places to treat patients, but also as centers to train young, aspiring doctors. In 1700, the Treatise of Worker’s Diseases — the first comprehensive work on diseases and health hazards — was published by Ramazzini. City councils around Europe started to assume the responsibility of public health administration, although this practice was still far from what we are familiar with today.
The 18th century was the Golden Age for public health, with many scientific discoveries regarding infectious diseases. Many authorities around the world also took up the responsibility to maintain public health, starting with compulsory quarantines for travelers and explorers who arrived from foreign lands.
It was during one of those expenditures that inoculation made its debut in Europe. While the practice appeared far earlier in parts of Asia, it wasn’t until the early 18th century that Europeans knew of smallpox inoculation. Due to its effectiveness, the practice quickly became popular, inspiring doctors and scientists in Europe to pursue it further. By the end of the 18th century, the first smallpox vaccine was created by Edward Jenner, signaling a revolutionary period in public health.
The Industrial Revolution in the 19th century brought the Sanitary Movement. People paid more attention to public health and its related topics, such as the health of prisoners (“State of Prisons” in England) and mental health reforms in York. One of the most notable achievements in this revolutionary period was the Poor Law, commissioned by Edwin Chadwick in London in 1834. While the goal of the Poor Law was to implement an effective measure to manage the health and poverty rate of the population, it also raised awareness of poor living conditions. As a result, 14 years later the first National Health Officer of England — John Snow — was appointed, leading the General Board of Health. Snow issued various measures to improve the sanitary and living conditions of the population, which subsequently helped raise the public awareness of disease prevention by social interventions. In a few decades, living conditions improved considerably. The success caught the attention of other nations; the United States and Germany subsequently adopted the same practices.
While public health systems were installed in the 19th century, 20th-century scientists moved forward with the Bacteriological Era. With the discovery of microscopic organisms in 1676 by Leeunwenhock and the development of vaccines in 1796 by Edward Jenner, scientists were able to identify more causes of disease. As a result, they could predict and prevent pandemics from rampaging the Earth as they once did centuries ago.
Soon, the need to globally organize disease prevention arose. In 1948, the World Health Organisation was established as a branch of the United Nations, where member countries can trade public health information and coordinate resources and measures. Public health became a recognized interdisciplinary field that concerns disease prevention, health politics, health economics, and health education.
(Source: Getty Images)
Yet, despite many achievements, we still need to acknowledge the fact that the current public health system is far from perfect. The outbreak of COVID-19 should be an alarm bell, one that reminds us of our flaws, and the never-ending journey of improving the public health system, so that a health catastrophe like COVID-19 can be avoided in the future.
The first attempt to improve public health was around 500 BCE by the Greeks, with water supplies and drainage.
The first hospital was built by the Romans around 100 BCE and was called a valetudinarian.
The Middle Ages in Europe was a dark period riddled with various pandemics, leading to the implementation of compulsory quarantine for travelers.
In the 18th century, many countries started building a system to control and improve public health.
Scientific developments in the 19th and 20th centuries resulted in many achievements for public health. Public health became a global effort in the middle of the 20th century, with the establishment of the World Health Organisation (WHO).