public health, the art andscience of preventingdisease, prolonging life, and promoting physical andmental health, sanitation, personal hygiene, control ofinfectious diseases, and organization of health services. From the normal human interactions involved in dealing with the many problems of social life, there has emerged a recognition of the importance ofcommunity action in the promotion ofhealth and the prevention andtreatment of disease, and this is expressed in the concept of public health.

Comparable terms for public healthmedicine aresocial medicine andcommunity medicine; the latter has been widely adopted in theUnited Kingdom, and the practitioners are called community physicians. The practice of public health draws heavily on medical science and philosophy and concentrates especially on manipulating and controlling theenvironment for the benefit of the public. It is concerned therefore with housing,water supplies, andfood. Noxious agents can be introduced into these through farming,fertilizers, inadequate sewage disposal and drainage, construction, defective heating and ventilating systems, machinery, and toxic chemicals.

Public health medicine is part of the greater enterprise of preserving and improving the public health. Community physicians cooperate withdiverse groups, from architects, builders, sanitary and heating and ventilating engineers, andfactory and food inspectors to psychologists and sociologists, chemists, physicists, and toxicologists. Occupational medicine is concerned with the health, safety, and welfare of persons in the workplace. It may be viewed as a specialized part of public health medicine since its aim is to reduce the risks in the environment in which persons work.

The venture of preserving, maintaining, and actively promoting public health requires special methods of information-gathering (epidemiology) and corporate arrangements to act upon significant findings and put them into practice. Statistics collected by epidemiologists attempt to describe and explain the occurrence of disease in a population bycorrelating factors such as diet, environment, radiation exposure, or cigarettesmoking with the incidence and prevalence of disease. The government, through laws and regulations, creates agencies to oversee and formally inspect and monitor water supplies,food processing,sewage treatment, drains, andpollution. Governments also are concerned with the control ofepidemic andpandemic diseases, establishing guidelines for appropriate medical responses and isolation procedures, and issuing travel warnings to prevent the spread of disease from affected areas.

Various public health agencies have been established to help control and monitor disease within societies, on both national and international levels. For example, the United Kingdom’s Public Health Act of 1848 established a special public health ministry forEngland andWales. In theUnited States, public health is studied and coordinated on a national level by theCenters for Disease Control and Prevention (CDC). Internationally, theWorld Health Organization (WHO) plays an equivalent role. WHO is especially important in providing assistance for the implementation of organizational and administrative methods of handling problems associated with health and disease in less-developed countriesworldwide. Within these countries, health problems, limitations of resources,education of health personnel, and other factors must be taken into account in designing health service systems.

Advances in science and medicine in developed countries, including the generation ofvaccines andantibiotics, have been fundamental in bringing vital aid to countries afflicted by a high burden of disease. Yet, despite the expansion of resources and improvements in the mobilization of these resources to the most severely afflicted areas, the incidence of preventable disease and of neglectedtropical disease remains exceptionally high worldwide. Reducing the impact and prevalence of these diseases is a major goal of international public health. The persistence of such diseases in the world, however, serves as an important indication of the difficulties that health organizations and societies continue to confront.

History of public health

A review of the historical development of public health, which began in ancient times, emphasizes how various public health concepts have evolved. Historical public health measures includedquarantine of leprosy victims in theMiddle Ages and efforts to improve sanitation following the 14th-centuryplagueepidemics. Population increases inEurope brought with them increased awareness of infant deaths and a proliferation of hospitals. These developments in turn led to the establishment of modern public health agencies and organizations, designed to control disease withincommunities and to oversee the availability and distribution of medicines.

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Beginnings in antiquity

Most of the world’sancient peoples practiced cleanliness and personalhygiene, often for religious reasons, including, apparently, a wish to be pure in the eyes of their gods. TheBible, for example, has many adjurations and prohibitions about clean and unclean living. Religion,law, and custom were inextricably interwoven. For thousands of years societies looked upon epidemics as divine judgments on the wickedness of humankind. The idea that pestilence is due to natural causes, such as climate and physical environment, however, gradually developed. This great advance in thought took place inGreece during the 5th and 4th centuriesbce and represented the first attempt at a rational,scientific theory of disease causation. An association betweenmalaria and swamps, for example, was established very early (503–403bce), even though the reasons for the association were obscure. In the bookAirs, Waters, and Places, thought to have been written by Greek physicianHippocrates in the 5th or 4th centurybce, the first systematic attempt was made to set forth a causal relationship between human diseases and the environment. Until the new sciences ofbacteriology andimmunology emerged well into the 19th century, this book provided a theoretical basis for the comprehension ofendemic disease (that persisting in a particular locality) andepidemic disease (that affecting a number of people within a relatively short period).