The first wealth is health. ~ American essayist Ralph Waldo Emerson
Health has been a public issue throughout human descent. We have always been gregarious, and so subject to contagious infections and other health consequences from sharing food and close quarters. The problem became more pronounced with the rise of settled communities and trade among them.
Religion embraced public health early on. The Old Testament contains many adjurations and prohibitions for clean living.
Primitive societies looked upon epidemics as divine wrath for wickedness. Attributing pestilence to natural causes gradually developed in 5th-century Greece, but intrusion of rationality did not staunch religious superstitions.
Throughout the world, ancient cities developed ways to remove waste and provide clean water. The Indus civilization is a fine example.
The most famous water supply system in antiquity is that of ancient Rome, with its multi-storied aqueducts. Rome’s first aqueduct was commissioned in 312 bce to alleviate a chronic water shortage.
Water management has always been the key to the well-being of communities. Ancient settlements not near a freshwater source dug wells and used cisterns to collect rainwater.
Aqueducts let communities import water from a distance, and so inhabit otherwise untenable places. The Minoan civilization on Crete and contemporaneous Mesopotamia had aqueduct systems in the 2nd millennium bce. Incorporating tunnels which ran several kilometers, the first sophisticated long-distance canal system was constructed by the Assyrian empire in the 9th century bce.
Inoculation was practiced in ancient China, India, and other places. Health officials knew that those who recovered from certain diseases, such as smallpox, developed lifelong immunity. Doctors inoculated those not stricken by exposing them to infected blood or dried wounds.
Another early public health measure was to segregate sick people from healthy ones. Many communities kept their lepers in separate colonies or cast them out.
The eras of the Middle Ages were delineated by plagues, beginning with one in 542, and ending with the Black Death in the mid-14th century (which was a series out plague outbreaks lasting decades). Epidemics from a variety of infectious agents were a periodic feature of medieval European life.
The term quarantine comes from the Latin quadraginta, meaning 40. In Venice during the 14th century, officials kept ships out of port for 40 days if they suspected infection among its passengers.
Epidemics were sometimes lessened, or prevented, before the cause of a disease was known. The association between malaria and swamps was established in ancient Greece by the 5th century bce, even as the reason for the association between the 2 remained obscure.
In 1854, English physician John Snow found that Londoners with cholera were getting their water from a public pump on Broad Street. Closing that pump down dropped the incidence of the disease.
Local governments during the late Middle Ages made efforts to improve sanitation, including the provision of potable water, garbage and sewage disposal, and food inspection.
Political leaders during the Renaissance recognized that the economic power of the state required a population in good health. Nonetheless, no national health policies emerged in Europe during that time, as the government lacked the knowledge and capability to carry out such initiatives. Public health problems continued to be handled on a local community basis, as they had in medieval times.
From 1750, Europe’s population grew rapidly, despite high infant mortality. Countries struggled to improve sanitation and public health.
In the late 19th century, France and Germany pointed the way. In France, the public health movement was invigorated by political and social reform. The French significantly contributed to the science of identifying, treating, and controlling the spread of communicable diseases.
After Germany unified in 1871, it began a central public health administration. Germany introduced the science of hygiene into the field of public health.
19th-century economic liberals fantastically prophesized that the increased production of goods would eventually end scarcity, poverty, and suffering. By the turn of the 20th century, with malnutrition, alcoholism, and diseases of all kinds rampant in the slums of England and America, it was clear that the state would have to step it to address public health problems.
There were a few international public health efforts in the early 20th century. Among them were the Pan American Sanitary Bureau, founded in 1902 to improve health conditions in the Americas. The Paris-based International Office of Public Health started in 1907 to rely information about epidemics, and to develop standards for sanitation, and quarantine regulations, for train and ship travel. These organizations were later absorbed into the World Health Organization, established in 1948 as a specialized agency of the United Nations.
Health care continues to be dominated by national regimes. Every country has a public health system that reflects its history, cultural values, economic development, and political ideology.