The subject is too large to be treated adequately in the course of an evening’s address; and to bring it within manageable compass it is necessary for me to select my material rigidly and, as far as I can, to present this material in such a manner as will bring into relief its salient and most instructive features.
The evolution of public health in England proceeded by experimental steps, some mistaken and then retraced, others mistaken and not retraced, but steps oftenest in the direction of a complete service, which is the goal of our work.
The evolution has been a gradual growth arising out of realized needs, rather than a logical development based on general principles; and as politicians and legislators seldom take a wide outlook, or consider a specific proposal in relation to what is already being done, and to what is the desired goal, the English experience is especially instructive.
Town-living and Health Problems
Public health work became an urgent necessity when men began to huddle in towns; and with the industrial revolution of the eighteenth and early nineteenth centuries the need for remedial action became acute. It is hard to realize that in the days of our grandfathers, the home was in most instances the unit of industry; and that in the eighteenth century communications between districts and towns were not more advanced than those of the ancient Egyptians. When, however, vast urban aggregations of population multiplied, travelling facilities rapidly increased, and the results of crowding, of contaminated water supplies, of intensive and widespread infection, were seen in devastating endemic and epidemic diseases. Poverty, squalor, dirt, and their consequences, were rampant in the towns, where underpaid work-people were exploited by masters, whose self-centred outlook had some share of justification in the political economy doctrines of the time, which regarded any interference with “freedom of contract” as useless or even pernicious.
What is public health work? It is best defined by stating its object, which is to secure the maximum attainable health of every member of the community, so far as this can be secured by the authorities, local, state, or federal, concerned in any part of government, acting in coöperation with all voluntary agencies whose work conduces to the same end. The connotation of public health becomes wider year by year. It embraces physiological as well as pathological life; being as much concerned with improving the standard of health of each person as with the prevention and cure of disease. Hence the importance of the “concentration on the mother and her child” (John Burns), to secure for them by all practicable means the conditions of complete health, which during the last twelve years has been a vital part of our public health work, and which is now being made to include not only all hygienic and medical help that may be needed, but also such domestic aid as may enable the mother to bring her children into the world and to rear them under advantageous conditions.
Scope of Constructive Health Work
Public health embraces some eugenic elements, and may comprise more when eugenists have accumulated adequate non-fallacious evidence on which to base valid conclusions. Already partial steps are being taken to secure the segregation and prevent the propagation of the feeble-minded and the insane; and in sorting out congenital infection from true heredity action is being taken to avoid congenital syphilis and to prevent the large number of still-births due to this race poison.
Public health in the main is concerned primarily with the environmental measures calculated to prevent the attack of man by disease, whether pre-natal or post-natal. These measures may be industrial, as in the prevention of accidents, of dust, of noxious vapours; or sanitary, as in the control of water supplies, food, or milk, and in the removal of organic filth; or may be the application of preventive medicine against infectious and non-infectious diseases; or therapeutic, consisting of the prompt and adequate treatment of all illnesses and the curtailment of the incompetence due to them; or educational, consisting, first in importance, in the training of medical practitioners, of public health officials, and nurses; and, next, in the education of the general public and especially of the children in our schools, in the science and practice of public health.
Advances in public health in many directions can only be secured by continued and extended medical research, and public health, therefore, has a direct and immediate interest in promoting and subsidizing such research.