WEBVTT 00:00:16.454 --> 00:00:18.419 Hello and welcome back. 00:00:18.459 --> 00:00:21.018 In this video we'll get a preview of course 3. 00:00:21.058 --> 00:00:23.778 We'll dig deeper into the history of public health 00:00:23.818 --> 00:00:27.818 and examine key events that have shaped where public health is today. 00:00:28.860 --> 00:00:32.940 Public health, often confused with healthcare, is many things 00:00:33.235 --> 00:00:37.235 but it primarily concerns health as it relates to community and social life. 00:00:38.016 --> 00:00:42.016 For example, that which concerns our physical environments and sanitation, 00:00:43.529 --> 00:00:46.633 the quality of our food and water systems, 00:00:46.673 --> 00:00:50.409 the transmission of disease and more. 00:00:50.449 --> 00:00:53.520 Historically, different communities all around the world 00:00:53.560 --> 00:00:57.560 have implemented measures to create conditions that enabled public health. 00:00:57.848 --> 00:01:00.719 In early civilizations the invention of of bathrooms, 00:01:00.759 --> 00:01:03.024 and other practices were abundant. 00:01:03.064 --> 00:01:06.280 In ancient China, we saw the use of well digging 00:01:06.320 --> 00:01:08.473 to access clean drinking water. 00:01:08.513 --> 00:01:10.381 In ancient India we saw the practice of 00:01:10.421 --> 00:01:13.078 covering sewer drains for sanitation. 00:01:13.118 --> 00:01:16.139 Ancient Greece emphasized healthy living habits 00:01:16.179 --> 00:01:18.490 like nutrition and physical fitness. 00:01:18.530 --> 00:01:22.365 And ancient Egypt developed many innovations in sanitation, 00:01:22.405 --> 00:01:26.301 like personal hygiene practices, the isolation of infected persons, 00:01:26.341 --> 00:01:28.707 and other early medical practices. 00:01:28.747 --> 00:01:32.747 As human civilizations advance, so did science and technology, 00:01:33.696 --> 00:01:37.696 creating new avenues for disease prevention and health protection. 00:01:38.756 --> 00:01:42.756 Public health developed alongside and sometimes in conflict with 00:01:43.228 --> 00:01:47.228 changes in government, religion, business and industry, 00:01:48.033 --> 00:01:52.033 culture, demographic shifts and social movements. 00:01:53.553 --> 00:01:56.577 In different periods, in different countries, 00:01:56.617 --> 00:02:00.464 some of these areas had greater influence than others. 00:02:00.504 --> 00:02:02.364 They also would come to embody the interests 00:02:02.404 --> 00:02:06.404 of whatever groups in society were more powerful at the time. 00:02:06.408 --> 00:02:09.955 For example Lords over surfs in feudal societies, 00:02:09.995 --> 00:02:13.125 or dominant religious groups over marginal ones 00:02:13.165 --> 00:02:17.165 in societies where religion was the primary mode of social organization. 00:02:17.271 --> 00:02:19.452 As we've discussed in The Roots Course, 00:02:19.492 --> 00:02:22.975 power imbalances lead to social injustice, 00:02:23.015 --> 00:02:25.047 which leads to health inequity. 00:02:25.087 --> 00:02:28.364 Public health's mission to build healthy communities for everyone 00:02:28.404 --> 00:02:31.750 can put it at odds with these conflicting interests 00:02:31.790 --> 00:02:34.831 especially when dominant groups have more influence 00:02:34.871 --> 00:02:37.474 over what public health can do, than marginalized ones. 00:02:37.514 --> 00:02:41.514 This puts public health in a position where we can and have 00:02:42.011 --> 00:02:46.011 been both part of the problem and part of the solution. 00:02:46.301 --> 00:02:50.301 The modern era of public health began with the Sanitary Reform Movement 00:02:50.484 --> 00:02:54.484 in the United Kingdom during the 1830s and 1840s. 00:02:54.535 --> 00:02:58.535 The industrial revolution had reached its peak, and across London 00:02:58.847 --> 00:03:02.847 masses of people lived in crowded, unsanitary conditions. 00:03:03.652 --> 00:03:07.652 Diseases spread easily, sanitation was practically nil, 00:03:07.983 --> 00:03:11.983 and there was a belief that washing one's hands was actually bad for you. 00:03:12.659 --> 00:03:16.659 A lack of clean running water and sewage treatment made things worse. 00:03:16.906 --> 00:03:19.369 Fevers of all sorts were rampant. 00:03:19.409 --> 00:03:23.409 Many people got sick and or died on a regular basis. 00:03:23.473 --> 00:03:27.473 But in 1838, the Central Poor Law Commission's findings on the 00:03:29.137 --> 00:03:33.137 "Physical causes of fever in the Metropolis of London determined 00:03:33.437 --> 00:03:37.437 that fever might be prevented by proper sanitary measures." 00:03:38.942 --> 00:03:42.942 Rules and laws governing public sanitation began to emerge. 00:03:43.259 --> 00:03:47.259 The practice spread to the United States, slowly taking route. 00:03:47.587 --> 00:03:52.580 One big idea, new at the time, was that clean water and fresh air 00:03:53.857 --> 00:03:55.931 were recognized as being beneficial 00:03:55.971 --> 00:03:58.068 to decreasing the incidence of illness. 00:03:58.108 --> 00:04:03.100 This idea is hard to imagine today, but back then it was revolutionary. 00:04:03.728 --> 00:04:06.900 In the United States of the 1840s, 00:04:06.940 --> 00:04:09.958 conditions were similar to those in London. 00:04:09.998 --> 00:04:13.799 Overcrowded, poorly lit, windowless tenements 00:04:13.839 --> 00:04:16.704 with no running water or working sewage systems 00:04:16.744 --> 00:04:19.506 were breeding grounds for disease. 00:04:19.546 --> 00:04:22.865 So public health started pushing for relieving overcrowding. 00:04:22.905 --> 00:04:26.905 Requiring windows, and advocating for clean drinking water 00:04:27.253 --> 00:04:29.842 and sanitary sewage systems. 00:04:29.882 --> 00:04:33.882 In 1850, Lemuel Shattuck published his landmark report 00:04:33.939 --> 00:04:36.245 of the Massachusetts Sanitary Commission. 00:04:36.285 --> 00:04:38.454 Which included a series of recommendations 00:04:38.494 --> 00:04:41.616 to monitor and address poor sanitary conditions. 00:04:41.656 --> 00:04:44.414 Including the establishment of a State Board of Health 00:04:44.454 --> 00:04:47.798 to enforce sanitary regulations. 00:04:47.838 --> 00:04:50.871 As these and other recommendations began to be accepted, 00:04:50.911 --> 00:04:54.911 new laws and regulations were passed by state and local governments. 00:04:56.196 --> 00:04:59.348 But not everyone was on board with these changes. 00:04:59.388 --> 00:05:03.030 These practical reforms cost money, of course. 00:05:03.070 --> 00:05:07.070 And so were resisted by industry, business and government. 00:05:07.337 --> 00:05:11.337 Landlords and businesses resisted local mandates to clean up their act. 00:05:11.754 --> 00:05:15.754 Industrialists bought off politicians to avoid upgrading their factories. 00:05:16.999 --> 00:05:20.172 And public health practitioners fought these forces 00:05:20.212 --> 00:05:22.954 for the sake of the public's health. 00:05:22.994 --> 00:05:25.878 A fight that continues today. 00:05:25.918 --> 00:05:29.918 Public health, as an academic field, became solidified in 1915, 00:05:30.241 --> 00:05:32.763 when Yale University named its first 00:05:32.803 --> 00:05:34.834 Chairman of the Department of Public Health 00:05:34.874 --> 00:05:38.874 at the Yale University School of Medicine: Charles-Edward Amory Winslow. 00:05:39.201 --> 00:05:41.734 Winslow defined public health as: 00:05:41.774 --> 00:05:45.774 "The science and art of preventing disease, prolonging life, 00:05:46.638 --> 00:05:49.532 and promoting health through the organized efforts 00:05:49.572 --> 00:05:52.960 and informed choices of society, organizations, 00:05:53.000 --> 00:05:56.490 public and private communities, and individuals." 00:05:56.530 --> 00:06:00.530 Charles-Edward Amory Winslow 00:06:00.977 --> 00:06:03.958 While public health had been taught for many years, 00:06:03.998 --> 00:06:07.747 Winslow's appointment as chair of the department at Yale 00:06:07.787 --> 00:06:11.213 galvanized public health reform in Connecticut. 00:06:11.253 --> 00:06:15.253 Among other, things he created health surveys to measure and improve 00:06:15.740 --> 00:06:19.211 public health practices in communities across the US. 00:06:19.251 --> 00:06:23.251 And helped create Connecticut's State Department of Public Health. 00:06:23.948 --> 00:06:28.940 Public health has made many advances since its establishment as a field. 00:06:29.666 --> 00:06:33.666 Groundbreaking medical discoveries have advanced our ability to 00:06:33.717 --> 00:06:37.717 understand, contain and treat infectious diseases. 00:06:38.031 --> 00:06:40.939 We've won huge legislative gains with the passing 00:06:40.979 --> 00:06:44.979 of the Medicare and Medicaid Act of 1965 00:06:45.257 --> 00:06:49.257 and the Patient Protection and Affordable Care Act of 2010. 00:06:49.640 --> 00:06:52.621 And we've continued to advance our knowledge and skills 00:06:52.661 --> 00:06:55.605 in treating various public health issues. 00:06:55.645 --> 00:06:58.869 However, we've also had some misses. 00:06:58.909 --> 00:07:04.900 Root causes like racism, capitalism, patriarchy, and gender inequity 00:07:05.510 --> 00:07:09.442 are woven into the fabric of American society. 00:07:09.482 --> 00:07:13.133 So unsurprisingly, these have also played a part 00:07:13.173 --> 00:07:15.719 in shaping our public health systems. 00:07:15.759 --> 00:07:17.866 With each advance in public health, 00:07:17.906 --> 00:07:21.906 we've seen different marginalized communities left behind. 00:07:22.507 --> 00:07:25.846 And, in too many cases, we've even seen advances 00:07:25.886 --> 00:07:28.743 that have come at the cost of exploiting these same groups 00:07:28.783 --> 00:07:31.267 for the benefit of dominant groups in society. 00:07:31.307 --> 00:07:35.307 We see these injustices exacerbated by the public health threats 00:07:35.663 --> 00:07:37.836 we faced in more recent decades. 00:07:37.876 --> 00:07:41.876 Like the AIDS crisis, or the maternal mortality crisis happening now. 00:07:42.915 --> 00:07:46.482 With each threat, injustices are unearthed. 00:07:46.522 --> 00:07:50.522 Myths perpetuated and marginalized groups are blamed. 00:07:50.927 --> 00:07:54.540 The COVID-19 pandemic is a perfect example 00:07:54.580 --> 00:07:57.572 of public health in a time of crisis. 00:07:57.612 --> 00:08:00.915 As public health fought to contain the spread of COVID-19 00:08:00.955 --> 00:08:04.955 it again had to navigate conflicts with government and industry. 00:08:05.458 --> 00:08:08.839 As many figures denied or downplayed the threat of the virus. 00:08:08.879 --> 00:08:12.879 At the same time, public health's role in historical injustices 00:08:13.343 --> 00:08:17.343 like the US Public Health Services Tuskegee Syphilis Experiment, 00:08:17.664 --> 00:08:21.664 made many marginalized communities reluctant to trust public health guidance. 00:08:22.200 --> 00:08:26.200 All this led to pervasive misinformation about COVID-19 00:08:26.385 --> 00:08:29.986 and widespread hospitalization and death. 00:08:30.026 --> 00:08:34.026 But the COVID-19 pandemic also provided a wakeup call. 00:08:34.337 --> 00:08:38.030 Health inequities have been pervasive throughout American communities 00:08:38.070 --> 00:08:40.254 and getting worse every year. 00:08:40.294 --> 00:08:42.183 With each new public health threat, 00:08:42.223 --> 00:08:46.223 we've seen the same communities face the worst health outcomes. 00:08:46.547 --> 00:08:50.129 But more people in public health are recognizing the need 00:08:50.169 --> 00:08:53.931 to advance health equity and to learn just how we do that. 00:08:53.971 --> 00:08:57.971 Luckily health equity scholars and practitioners have been studying 00:08:58.294 --> 00:09:01.530 the drivers of health inequity for decades. 00:09:01.570 --> 00:09:03.607 So we don't have to start from scratch. 00:09:03.647 --> 00:09:07.647 One of Dr. Camara Jones's prerequisites for achieving health equity 00:09:07.714 --> 00:09:11.505 is recognizing and rectifying historical injustices. 00:09:11.545 --> 00:09:15.545 So learning about our shared histories, is a key place to start. 00:09:15.841 --> 00:09:19.841 As we go through course 3, we'll get to learn about a few key moments 00:09:21.077 --> 00:09:25.077 and explore our own experiences with these examples in public health. 00:09:26.398 --> 00:09:29.166 We'll also learn about a few ways we can start to rectify 00:09:29.206 --> 00:09:32.352 these historical injustices as a public health strategy 00:09:32.392 --> 00:09:36.392 to create health equity and eliminate health inequities. 00:09:36.669 --> 00:09:39.074 There's much to explore in course 3. 00:09:39.114 --> 00:09:43.114 Let's get started.