If we want more evidence-based practice, we need more practice-based evidence.*


Chapter 1
Through the Centuries

Table of Contents

REFERENCES - since publication of 8th edition

"The technology of medicine has outrun its sociology." -- Henry E. Sigerist, medical historian (1891-1957)

"Health cannot be forced upon the people. It cannot be dispensed to the people. They must want it and be prepared to do their share and to cooperate fully in whatever health program a country develops." – Canadian Journal of Public Health (1944) 35: 260.


Setting the stage for later chapters, this opening chapter offers a set of definitions and historical benchmarks in community and population health. In addition to the three objectives stated at the beginning of the chapter, the aim is to bring community and population health to life as having an intellectual history as well as a biological and social history. The contrasting quotes by Mahatma Gandhi and Ogden Nash at the beginning of the book chapter demonstrate perceptions of social change and the role of the public in the increasingly rapid development of the human sciences. Your task is to develop an understanding that community and population health are both a cause and a consequence of history, and that action to improve community health can contribute to the overall advancement of civilization, quality of life, and social justice.



The opening definition of health in the book and the bewildering array of factors listed in the following paragraphs prepares the reader to welcome a definition in the second section that organizes the multiple elements of community and population health into the three spheres of action (educational, social, and environmental) and the several spheres of practice represented by the various institutions and personnel influencing community health. The latter are depicted in Figure 1-1. This figure and a more detailed representation of Figure 1-1 with suggested labels for the overlapping spheres are provided among the series of supplemental graphics in this manual, which can be used as transparency masters. They are found in the back pages of this Instructor's Manual.

The remainder of the chapter marches through the significant events, discoveries, legislative and organizational developments influencing community and population health from Babylonian to contemporary eras. Our labeling of eras is somewhat arbitrary. More detail could be offered within those offered by the chapter subheadings, depending on your interest in particular dimensions of community and population health and the context in which you are teaching.


Kelly J. The Great Mortality: An Intimate History of the Black Death, the Most Devastating Plague of All Time. New York: HarperCollins, 2005. 364 pp., $25.95.  Reviewed in San Francisco Chronical, Mar. 5, 2005, p. B1,4. 

Pox: The Story of Syphilis and Famous People.  (SF Weekly, January 15-21, 2003).  Deborah Hayden's new book explores the role of Syphilis throughout history in the lives of the world's elite.

Immunity Refined Over Centuries.  .  With the introduction of the modern vaccine era in 1796 by British doctor Edward Jenner, mass vaccinations led to the elimination of the smallpox virus in nature by the late 1970s.  However, laboratory samples were retained by the Russian and U.S. governments.  Current threats of terrorist attacks involving the virus has led to the resurrection of a limited vaccination program in the U.S.

Anti-vaccinationists past and present. (The British Medical Journal, October 2002).  Recent disagreement regarding the efficacy and risks of vaccinations has led to a highly publicized debate.  However, this is a debate that has continued since the 1850s.

Current and Future Public Health Challenges.  (Department of Health and Human Services, 2000).  Public health efforts have led to much progress in the prevention and/or control of a variety of health concerns.  However, many challenges still loom ahead.

Knighthoods for Cancer Pioneers. LONDON (Ian Murray, Times writer, 1999). A leading cancer researcher received a knighthood. One is Professor Richard Peto, who worked closely with Sir Richard Doll on showing the link between tobacco and lung cancer. He has since devised a series of statistical methods that are in use worldwide to analyze randomized clinical trials and he was closely involved in setting up the worldwide trials that showed the benefits of breast cancer treatments, including tamoxifen. Professor Peto, director of the Imperial Cancer Research Fund clinical trial unit at Oxford University, once said: "Smoking kills as many people a year in the UK as a jumbo jet crashing every day of the year killing all the passengers."

Y2K and Water: Developing Countries Unprepared for Millennium Bug (Various sources below, Mar. 5, 1999). The Australian Department of Foreign Affairs has warned against traveling overseas around 1 January 2000 because essential services like water supply and sewerage may break down in some countries. Although the World Bank has set up a special Y2K program (http://www.worldbank.org/infodev/y2k/) to help developing countries carry out program assessment and awareness on the Y2K problem, resources are limited and only a handful of developing countries have prepared national action plans.

Interior Department Marks 150 years. WASHINGTON (AP, Mar. 3, 1999) - At the Interior Department's block-long granite headquarters, the story of America is emblazoned on floor-to-ceiling murals. The art works, painted in the 1930s, show homesteaders racing westward vowing Oklahoma or bust; wildcatters working the oil fields of Texas; a landscape of barren Southwest desert turned to lush green thanks to a government dam and irrigation. Having been at the center of history, the department Thursday marks its 150th birthday, and President Clinton is among those who will celebrate. The fifth cabinet agency, created in 1849, no federal agency played a greater role in the sculpture of America. It directed how the West was to be developed, opened vast areas to timber, ranching, mining and the railroads and in the 1880s controlled the destiny of more than 1 billion acres – at the time nearly half the United States.


For related news stories, please click here. 



Web:   Click on the chapter for which you would like updated material. The material found here will appear in a form suitable for students to review or study, with new material added or substituted over time until the 9th edition of the text is published.

Local media:  If you do not have access to the WWW, review the local newspaper to find examples of community health relevant to this or other chapters in the book.

Information sources:   You might want to contact some of the following information sources through the web, by phone, or in writing to get more information on topics of interest to you.  For historical background on a given disease or condition, the voluntary health organization specifically concerned with that disease usually can supply educational materials. Selected examples of more general sources of audiovisual materials, historical statistics and records are listed here. Sources for more specific community health problems will be found in the appropriate chapters that follow.



National Institutes of Health, Bethesda, Maryland 20894
Phone 1-888-356-3656 
http://www.nlm.nih.gov/pubs/factsheets/hmd.html Rockefeller Foundation  http://www.rockfound.org/display.asp?Context=1&Collection=1&  Preview=0&ARCurrent=1

An animated presentation of the history of the Rockefeller Foundation presents its early contributions to community and population health with worldwide hookworm campaigns and other communicable disease programs, its funding of the first schools of public health at Johns Hopkins, Harvard, and Michigan, and its further development of public health training around the
world in the early decades of the twentieth century: 

National Archives and Records Service
General Services Administration,
Washington, DC 20409
Phone: (301) 763-1896 Fax: (703) 321–8547

http://www.trumanlibrary.org/findinga.htm http://www.archives.gov/index.html



National Library of Medicine (NLM)
Department of Health and Human Services

8600 Rockville Pike, Bethesda, MD 20209   Phone: (301) 496-4244


Health Canada Phone: (613) 954-8842  Fax: (613) 941-5366

Health Canada

ODPHD National Health Information Center (ONHIC)
P.O. Box 1133
Washington, DC 20013-1133
Phone: (800) 336-4797; (301) 565-4167  Fax: (301) 984-4256
nhicinfo@health.org  http://www.health.gov/nhic/

National Film Board of Canada

International program, 125 Houde Street
Saint-Laurent, Québec   Canada H4N 2J3
Phone: (514) 283-9439  Fax: (514) 496-1895 


U.S. Federal Information Center

(US) (FIC) Program
Phone: (800) 688–9889 Phone: (800) 326–2996 (TDD/TTY)

Federal Information Center

Addiction Treatment Locator by State [data about addiction, treatment, and rehab centers for each state in the U.S.]



Journal References

Alderslade, R.  (1998).  Editorial. The Public Health Act of 1848. BRITISH MEDICAL JOURNAL 317: 549-550.
For full-text article, go to:
http://www.bmj.com/cgi/content/full/317/7158/549.   For related articles in this issue of BMJ, go to: http://www.bmj.com/content/vol317/issue7158/ .

Calman, K.  (1998).  Personal paper: The 1848 Public Health Act and its relevance to improving public health in England now.   BRITISH MEDICAL JOURNAL 317: 596-598.  For full-text article, go to: http://www.bmj.com/cgi/content/full/317/7158/596.   For related articles in this issue of BMJ, go to: http://www.bmj.com/content/vol317/issue7158/ .

Card, Josefina J. (1999). Teen Pregnancy Prevention: Do Any Programs Work? ANNUAL REVIEW OF PUBLIC HEALTH 20: 257-286.
   ABSTRACT/Full-Text: http://arjournals.annualreviews.org/cgi/search?volume=20&firstpage=257&sendit=Search&author1= &author2=&titleabstract=&fulltext=&fyear=1984&tyear=2001&hits=10&journalcode=anthro&journalcode =energy&journalcode=polisci&journalcode=psych&journalcode=publhealth&journalcode=soc&fmonth=All&tmonth=All&fdatedef= 1+January+1996&tdatedef=1+January+2000.

Cullen, M. R. (1999). Personal Reflections on Occupational Health in the Twentieth Century: Spiraling to the Future. ANNUAL REVIEW OF PUBLIC HEALTH 20: 1-14.
   ABSTRACT/Full-Text: http://publhealth.annualreviews.org/cgi/content/abstract/20/1/1?maxtoshow=&HITS=10&hits=10& RESULTFORMAT=&searchid=1032965933023_961&stored_search=&FIRSTINDEX=0&volume=20 &firstpage=1&journalcode=anthro&journalcode=energy&journalcode=polisci&journalcode=psych&journa lcode=publhealth&journalcode=soc.

Diehr, P., Yanez, D., Ash, A., Hornbrook, M., & Lin, D.Y. (1999). Methods for Analyzing Health Care Utilization and Costs. ANNUAL REVIEW OF PUBLIC HEALTH 20: 125-158.
   ABSTRACT/Full-Text: http://publhealth.annualreviews.org/cgi/content/abstract/20/1/125?maxtoshow=&HITS=10&hits= 10&RESULTFORMAT=&searchid=1032966009689_967&stored_search=&FIRSTINDEX=0&volume =20&firstpage=125&journalcode=anthro&journalcode=energy&journalcode=polisci&journalcode= psych&journalcode=publhealth&journalcode=soc.

Dinse, G. E., Umbach, D. M., Sasco, A. J., Hoel, D. G., & Davis, D. L. (1999). Unexplained Increases in Cancer Incidence in the United States from 1975 to 1994: Possible Sentinel Health Indicators. ANNUAL REVIEW OF PUBLIC HEALTH 20: 173-210.
   ABSTRACT/Full-Text: http://publhealth.annualreviews.org/cgi/content/abstract/20/1/173?maxtoshow=&HITS=10&hits=10& RESULTFORMAT=&searchid=1032966197778_1003&stored_search=&FIRSTINDEX=0&volume= 20&firstpage=173&journalcode=anthro&journalcode=energy&journalcode=polisci&journalcode=psych &journalcode=publhealth&journalcode=soc.

Fielding, J. E. (1999). Prefatory: Public Health in the Twentieth Century: Advances and Challenges. ANNUAL REVIEW OF PUBLIC HEALTH 20: xiii-xiv.
   ABSTRACT/Full-Text: http://arjournals.annualreviews.org/cgi/search?volume=20&firstpage=&sendit=Search&author1=&author2 =&titleabstract=&fulltext=&fyear=1984&tyear=2001&hits=10&journalcode=anthro&journalcode=energy& journalcode=polisci&journalcode=psych&journalcode=publhealth&journalcode=soc&fmonth=All&tmonth= All&fdatedef=1+January+1996&tdatedef=1+January+2000.

Fisher, L. D. (1999). Advances in Clinical Trails in the Twentieth Century. ANNUAL REVIEW OF PUBLIC HEALTH 20: 109-124.
   ABSTRACT/Full-Text: http://publhealth.annualreviews.org/cgi/content/abstract/20/1/109?maxtoshow=&HITS=10&hits=10& RESULTFORMAT=&searchid=1032966606857_1039&stored_search=&FIRSTINDEX=0&volume= 20&firstpage=109&journalcode=anthro&journalcode=energy&journalcode=polisci&journalcode=psych &journalcode=publhealth&journalcode=soc.

Freund, D., Lave, J., Clancy, C., Hawker, G., Hasselblad, V., Keller, R., Schneiter, E., & Wright, J. (1999). Patient Outcomes Research Teams: Contribution to Outcomes and Effectiveness Research. ANNUAL REVIEW OF PUBLIC HEALTH 20: 337-360.
   ABSTRACT/Full-Text: http://publhealth.annualreviews.org/cgi/content/abstract/20/1/337?maxtoshow=&HITS=10&hits=10& RESULTFORMAT=&searchid=1032966664495_1048&stored_search=&FIRSTINDEX=0&volume= 20&firstpage=337&journalcode=anthro&journalcode=energy&journalcode=polisci&journalcode=psych &journalcode=publhealth&journalcode=soc.

Ginzberg, E. (1999). US Health Care: A Look Ahead to 2025. ANNUAL REVIEW OF PUBLIC HEALTH 20: 55-66.
   ABSTRACT/Full-Text: http://publhealth.annualreviews.org/cgi/content/abstract/20/1/55?maxtoshow=&HITS=10&hits=10& RESULTFORMAT=&searchid=1032966723848_1051&stored_search=&FIRSTINDEX=0&volume =20&firstpage=55&journalcode=anthro&journalcode=energy&journalcode=polisci&journalcode=psych &journalcode=publhealth&journalcode=soc.

Green, L. W. (1999). Health Education's Contributions to Public Health in the Twentieth Century: A Glimpse Through Health Promotion's Rear-View Mirror. ANNUAL REVIEW OF PUBLIC HEALTH 20: 67-88.
   ABSTRACT/Full-Text: http://arjournals.annualreviews.org/cgi/search?volume=20&firstpage=67&sendit=Search&author1= &author2=&titleabstract=&fulltext=&fyear=1984&tyear=2001&hits=10&journalcode=anthro&journalcode =energy&journalcode=polisci&journalcode=psych&journalcode=publhealth&journalcode=soc&fmonth =All&tmonth=All&fdatedef=1+January+1996&tdatedef=1+January+2000.

Gochfeld, M., & Goldstein, B. D. (1999). Lessons in Environmental Health in the Twentieth Century. ANNUAL REVIEW OF PUBLIC HEALTH 20: 35-54.
   ABSTRACT/Full-Text: http://publhealth.annualreviews.org/cgi/content/abstract/20/1/35?maxtoshow=&HITS=10&hits=10& RESULTFORMAT=&searchid=1032966866829_1079&stored_search=&FIRSTINDEX=0&volume =20&firstpage=35&journalcode=anthro&journalcode=energy&journalcode=polisci&journalcode=psych &journalcode=publhealth&journalcode=soc.

Hamlin, C., & Sheard, S.  (1998).  Revolutions in public health: 1848, and 1998?   BRITISH MEDICAL JOURNAL 317: 587-591. 
For full-text article, go to:
http://www.bmj.com/cgi/content/full/317/7158/587.   For related articles in this issue of BMJ, go to: http://www.bmj.com/content/vol317/issue7158/ .

Hinman, A. (1999). Eradication of Vaccine-Preventable Diseases. ANNUAL REVIEW OF PUBLIC HEALTH 20: 211-230.
   ABSTRACT/Full-Text: http://publhealth.annualreviews.org/cgi/content/abstract/20/1/211?maxtoshow=&HITS=10&hits=10& RESULTFORMAT=&searchid=1032967011346_1112&stored_search=&FIRSTINDEX=0&volume =20&firstpage=211&journalcode=anthro&journalcode=energy&journalcode=polisci&journalcode= psych&journalcode=publhealth&journalcode=soc.

Jones, K., & Klein, H. (1999). Lessons from 12 Years of Comparative Risk Projects. ANNUAL REVIEW OF PUBLIC HEALTH 20: 159-172.
   ABSTRACT/Full-Text: http://publhealth.annualreviews.org/cgi/content/abstract/20/1/159?maxtoshow=&HITS=10&hits=10& RESULTFORMAT=&searchid=1032966970222_1109&stored_search=&FIRSTINDEX=0&volume =20&firstpage=159&journalcode=anthro&journalcode=energy&journalcode=polisci&journalcode= psych&journalcode=publhealth&journalcode=soc.

Kaplan, G. A., Haan, M. N., & Wallace, R. B. (1999). Understanding Changing Risk Factor Associations with Increasing Age in Adults. ANNUAL REVIEW OF PUBLIC HEALTH 20: 89-107.
   ABSTRACT/Full-Text: http://publhealth.annualreviews.org/cgi/content/abstract/20/1/89?maxtoshow=&HITS=10&hits=10& RESULTFORMAT=&searchid=1032967046966_1115&stored_search=&FIRSTINDEX=0&volume =20&firstpage=89&journalcode=anthro&journalcode=energy&journalcode=polisci&journalcode=psych &journalcode=publhealth&journalcode=soc.

Knapp, V. J. (1998).  The Medical Response to Rising Alcohol Consumption in 18th- and 19th-Century Europe. NUTRITION AND HEALTH 12 (3),163.

Lerner, B. H. (1999). Great expectations: Historical perspectives on genetic breast cancer testing. AMERICAN JOURNAL PUBLIC HEALTH 89 (6): 938-944.
    The Journal’s Home Page is:
    ABSTRACT: Women who test positive for a genetic breast cancer marker may have more than a 50% chance of developing the disease. Although past screening technologies have sought to identify actual breast cancers, as opposed to predisposition, the history of screening may help predict the societal response to genetic testing. Early detection has probably helped to lower overall breast cancer mortality. But it has proven hard to praise aggressive screening without exaggerating its merits. Women considering genetic breast cancer testing should weigh the benefits and limitations of early knowledge.

Lipton, H. L., Kreling, D. H.; Collins, T., & Hertz, K. C. (1999). Pharmacy Benefit Management Companies: Dimensions of Performance. ANNUAL REVIEW OF PUBLIC HEALTH 20: 361-402.
    ABSTRACT/Full-Text: http://publhealth.annualreviews.org/cgi/content/abstract/20/1/361?maxtoshow=&HITS=10&hits=10& RESULTFORMAT=&searchid=1034696661101_1420&stored_search=&FIRSTINDEX=0&volume =20&firstpage=361&journalcode=anthro&journalcode=energy&journalcode=polisci&journalcode=psych &journalcode=publhealth&journalcode=soc.

McHorney, C. A. (1999). Health Status Assessment Methods for Adults: Past Accomplishments and Future Challenges. ANNUAL REVIEW OF PUBLIC HEALTH 20: 309-336.
   ABSTRACT/Full-Text: http://publhealth.annualreviews.org/cgi/content/abstract/20/1/309?maxtoshow=&HITS=10&hits=10& RESULTFORMAT=&searchid=1032967208498_1127&stored_search=&FIRSTINDEX=0&volume =20&firstpage=309&journalcode=anthro&journalcode=energy&journalcode=polisci&journalcode=psych  &journalcode=publhealth&journalcode=soc.

Palmer, S.  (1998).  Editorial.  From public health to the health of the public. BRITISH MEDICAL JOURNAL 317: 550-551.
For full-text article, go to:
http://www.bmj.com/cgi/content/full/317/7158/550.   For related articles in this issue of BMJ, go to: http://www.bmj.com/content/vol317/issue7158/ .

Rowland, D., Salganicoff, A., & Keenan, P. S. (1999). The Key to the Door: Medicaid's Role in Improving Health Care for Women and Children. ANNUAL REVIEW OF PUBLIC HEALTH 20: 403.
   ABSTRACT/Full-Text: http://publhealth.annualreviews.org/cgi/content/abstract/20/1/403?maxtoshow=&HITS=10&hits=10& RESULTFORMAT=&searchid=1032967326949_1130&stored_search=&FIRSTINDEX=0&volume =20&firstpage=403&journalcode=anthro&journalcode=energy&journalcode=polisci&journalcode=psych &journalcode=publhealth&journalcode=soc.

Schwartz, S., Susser, E., & Susser, M. (1999). A Future for Epidemiology? ANNUAL REVIEW OF PUBLIC HEALTH 20: 15-34.
   ABSTRACT/Full-Text: http://publhealth.annualreviews.org/cgi/content/abstract/20/1/15?maxtoshow=&HITS=10&hits=10& RESULTFORMAT=&searchid=1032967375411_1135&stored_search=&FIRSTINDEX=0&volume= 20&firstpage=15&journalcode=anthro&journalcode=energy&journalcode=polisci&journalcode=psych &journalcode=publhealth&journalcode=soc.

Shephard, D. A. E. (1998).  A light on medical practice in 19th-century Canada: the medical manuscripts of Dr. John Mackieson of Charlottetown. CANADIAN MEDICAL ASSOCIATION JOURNAL 159 (3): 253-57.

Sram, I. & Ashton, J.  (1998).  Millennium report to Sir Edwin Chadwick.  BRITISH MEDICAL JOURNAL 317: 592-596. 
For full-text article, go to:
http://www.bmj.com/cgi/content/full/317/7158/592.   For related articles in this issue of BMJ, go to: http://www.bmj.com/content/vol317/issue7158/ .

Vallgarda, S. (1999). History of public health. Who went to a general hospital in the eighteenth and nineteenth centuries in Copenhagen? EUROPEAN JOURNAL OF PUBLIC HEALTH 9 (2): 97-102. 
    For this issue of the Journal's Table of Contents (including abstracts) go to:
http://www3.oup.co.uk/eurpub/hdb/Volume_09/Issue_02 .

Wood, D., Saarlas, K. N., Inkelas, M., and Matyas, B. T. (1999). Immunization Registries in the United States: Implications for the Practice of Public Health in a Changing Health Care System. ANNUAL REVIEW OF PUBLIC HEALTH 20: 231-256.
   ABSTRACT/Full-Text: http://publhealth.annualreviews.org/cgi/content/abstract/20/1/231?maxtoshow=&HITS=10&hits=10& RESULTFORMAT=&searchid=1032967409075_1142&stored_search=&FIRSTINDEX=0&volume= 20&firstpage=231&journalcode=anthro&journalcode=energy&journalcode=polisci&journalcode=psych &journalcode=publhealth&journalcode=soc.

Yen, I., & Syme, S. L. (1999). The Social Environment and Health: A Discussion of the Epidemiologic Literature. ANNUAL REVIEW OF PUBLIC HEALTH 20: 287-308.
    ABSTRACT/Full-Text: http://publhealth.annualreviews.org/cgi/content/abstract/20/1/287?maxtoshow=&HITS=10&hits=10& RESULTFORMAT=&searchid=1032967449107_1145&stored_search=&FIRSTINDEX=0&volume= 20&firstpage=287&journalcode=anthro&journalcode=energy&journalcode=polisci&journalcode=psych &journalcode=publhealth&journalcode=soc.

Books and Reviews

McNeill, W. H. (1997).  Plagues and Peoples. New York: Anchor; ISBN 0385121229.
For reviews, go to:

Oldstone, M. B. A. (1998).  Viruses, Plagues, and History. New York & Oxford: Oxford University Press, ISBN No. 0195117239.
For reviews, go to:

Petersen, A., & Bunton, R. (Eds.). (1997). Foucault, health and medicine. Review by M. Shaw (1998) in HEALTH AND PLACE  4 (3): 289-90.  For a table of contents to this journal, go to: http://www.elsevier.com/inca/publications/store/3/0/5/1/9/index.htt?menu=cont.astc13538292.1

Porter, R.  (1998).  The Greatest Benefit to Mankind : A Medical History of Humanity. New York: W. W. Norton & Company; ISBN: 0393046346.
For reviews, go to:

Rafferty, A. M., Robinson, J., Elkan, R. (Eds.). (1997). Nursing history and the politics of welfare. Review by C. Webb (1998) in HEALTH AND PLACE  4 (3): 287, 1998. For a table of contents to this journal, go to: http://www.elsevier.com/inca/publications/store/3/0/5/1/9/index.htt?menu=cont.astc13538292.1

Risse, G. B. (1999). Mending Bodies, Saving Souls: A History of Hospitals. Oxford and New York: Oxford University Press Inc. $39.95. ISBN: 0195055233.
    Using 12 clinical episodes, this is the story of the hospital in Western culture from ancient Greece through the Enlightenment to the high-tech hospital and ambulatory clinics of the late 20th century.

Watts, S. (1998).  Epidemics and History : Disease, Power and Imperialism. New Haven: Yale Univ. Pr; ISBN: 0300070152.
For reviews, go to:

Wynbrandt, J.  (1998).  The Excruciating History of Dentistry : Toothsome Tales & Oral Oddities from Babylon to Braces. New York: St Martins Pr (Trade); ISBN: 0312185766.
For reviews, go to:

Yalom, M. (1997). History of the Breast. New York: Alfred A. Knopf, 1997, 331 pps.
    In ancient times the breast was seen as an object of veneration and sustenance. The sacred breast of medieval times gave way to something more erotic during the Renaissance. Jean-Jacques Rousseau led a movement to popularize maternal breastfeeding in the 18th century.




The boxed issues in each chapter are designed to challenge with questions based on case histories, contrasts between historical periods or between cultures or countries. These can be used as assignments or to generate classroom or small group discussions. Some comment on selected boxed issues or illustrations will be offered here as aids in stimulating discussion or exercises. In addition, some general discussion topics are provided for possible use depending on the make-up of the class and the interest of the instructor.

1.   The sayings of Confucius on lifestyle and the pulse. This box, following a section on Chinese health practices, breaks out of the Western bias with which we usually view the history of medicine and health. Confucius knew about the pulse some eleven centuries before the first mention of the pulse in Western medical books. He observed that the pulse varied with age, and that it varied with mood and excitement. Putting these together with life-cycle tendencies, he inferred a connection between the pulse and lifestyle. How do Chinese health traditions influence Western medicine and community health today?

2.    Epidemics in historical perspective. The parallels between epidemics of the past--such as leprosy, the plague, and polio more recently--suggest the process we might expect to go through with AIDS in the coming years. We have passed beyond denial, but we still see scapegoating and commercial and religious exploitation. We might expect public education about AIDS to erode the prejudice and to make people less vulnerable to false promises of protection or cure. Science must catch up, as it has with past epidemics, and society must adapt its customs and tolerance in the meantime.  Provide examples of the public's response to AIDS in your community.  What stereotypes and prejudices prevail?

3. Occupational health in history. Great Britain's ban on the use of silica in sandblasting represents a regulatory action that protected workers from silicosis. The American approach has been to encourage industry to replace silica and to educate workers to wear protective masks. These approaches, however, place the burden on companies that must compete with less conscientious companies and on workers who are the victims of their occupations. Regulation distributes responsibility more equitably when some are gaining their advantage at the expense of others. Technology diffuses from one country or community to another in response to competition for world markets and in response to demand for improved quality of life. Prepare a chronology of a health regulation in an area of interest.

4. Broad Street Pump and John Snow's Epidemiology. John Snow played a critical role in the development of modern epidemiology by identifying the source of disease (the well) and doing something about it (removing the pump handle) even though he did not understand the actual disease. How do modern day epidemiologist and public health officials deal with unknown disease threats?

5.    Swill Milk. The drawing in Figure 1-6 represents the unknown disease threat carried in everyday food items. The development of modern laboratories and health regulations ensures that food products are much safer than they once were. The food supply is a vital factor in the development of modern cities. Discuss the role of government food and restaurant inspectors in reducing the health threat of food poisoning and contamination.   Interview a restaurant inspector in your community.

6. Milestones of the bacteriology phase. How did the isolation of specific organisms, as causes or vectors of specific diseases, result in environmental control measures? How have the successes during the bacteriology phase of community health lead to overly simplistic expectations for the control of chronic and lifestyle causes of death today? The single-organism / single-disease relationship of most infectious diseases made community health control of disease through environmental interventions relatively easy. Discuss how the multiple risk-factor and lifestyle causes of diseases or death today make the task more complex and more dependent on educational and social action.

7. Milestones of the health promotion phase. Early-century community health actions emphasized environmental protection, the mid-century emphasized social actions directed at resources and health care organization, and the current health promotion phase emphasizes health education. It is helpful to note that community health education has been an essential part of the environmental and social reforms of the past. The essential difference today is that the education is directed at more complex lifestyle behavior rather than one-time actions such as supporting a fluoridation referendum, building a sanitary sewage system, or getting a vaccination. Therefore, today's health education must be more coordinated with organizational, economic and environmental supports for the maintenance of behavior conducive to health. Explore the role of health education in a community health issue of interest to you such as family planning, environmental quality, or injury control.

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