The history and future of public health

Dec 22, 2018

Our current understanding of public health is the result of modern advancements in health data collection and analysis, but that change was slow, with still more work to be done, according to our latest guest on "Take Care."

Dr. Wayne LaMorte is a professor of epidemiology and assistant dean for education at Boston University School of Public Health. He said for much of history, people did not understand public health because there was no analysis of it.

“People frequently relied on religion or even myths to explain poor health,” LaMorte said. “Things like Pandora’s Box became an explanation for bad health or perhaps God’s punishment for our sins.”

A slow emergence of ideas showed the importance of collecting data around health, he said. In the late 1500s, clerics began reporting information about causes of health, and in the centuries following that, people analyzed that data to see the leading causes of death. By the 1800s, that evolved into a more faithful recording of health events, including a formal health office that tracked causes of death.

“Much of the public health system that we know today actually began to emerge largely in the United Kingdom in the mid-1800s,” LaMorte said.

During this time, there were economic reasons to have good health data to identify and fix the horrible health conditions of the working poor.

“One of the big motivating factors was the monarchy, which was interested in keeping the state strong,” LaMorte said. “Their view was that, in order to do that, they needed a healthy work force.”

By the 1900s, the methodology of health data collection improved substantially, leading to an overall improvement in public health, LaMorte said.

“It’s important to recognize the fact that the methodology of public health and the advancement in medicine have really worked together in a very synergistic way to improve health and our understanding of the causes of poor health,” LaMorte said.

That improvement of data collection led to a definition of public health that prevailed since the 1920s: the science of preventing disease, prolonging life and promoting physical health. With even more improvements to public health understanding and systems, LaMorte said that has evolved to include more areas.

“In the current age, things are changing quite a bit, and now, I think a more realistic definition includes dealing with issues like mental health, violence, substance abuse, addiction and disparities in health care,” LaMorte said.

There are still barriers to bettering that public health knowledge, though, including widespread ignorance regarding overall health, LaMorte said.

“Lack of understanding is really one of the big obstacles,” LaMorte said. “Another one is simply that public health is really not well understood, and its benefits are not fully appreciated.”

LaMorte said this stems from the fact that the effects of good public health practices are harder to see because they are the absence of poor health conditions.

“You can sort of think about successful public health being all of the epidemics of infectious disease that never happened,” LaMorte said.

As far as where public health is headed, LaMorte said he foresees much greater emphasis on social determinacy and environmental conditions that can be manipulated to improve health. This includes focusing more on the factors that promote positive public health behaviors. Low socioeconomic status is still associated with an increased risk of cardiovascular disease, for example.

“If we want people to be able to get more activity, we have to think about how we are constructing our environment so it makes it possible for people to walk to a store or to even go for a walk in their neighborhood safely,” LaMorte said. “All of those things are the social determinants of disease that have been largely unrecognized and not fully dealt with effectively.”