As the prevalence of infectious diseases in the developed world decreased through the 20th century, public health began to put more focus on chronic diseases such as cancer and heart disease. An emphasis on physical exercise was reintroduced.
In America, public health worker Dr. Sara Josephine Baker lowered the infant mortality rate using preventative methods. She established many programs to help the poor in New York City keep their infants healthy. Dr. Baker led teams of nurses into the crowded neighborhoods of Hell's Kitchen and taught mothers how to dress, feed, and bathe their babies. After World War I many states and countries followed her example in order to lower infant mortality rates.[citation needed]
During the 20th century, the dramatic increase in average life span is widely credited to public health achievements, such as vaccination programs and control of infectious diseases, effective safety policies such as motor-vehicle and occupational safety, improved family planning, fluoridation of drinking water, anti-smoking measures, and programs designed to decrease chronic disease.
Meanwhile, the developing world remained plagued by largely preventable infectious diseases, exacerbated by malnutrition and poverty. Front-page headlines continue to present society with public health issues on a daily basis: emerging infectious diseases such as SARS, making its way from China (see Public health in China) to Canada and the United States; prescription drug benefits under public programs such as Medicare; the increase of HIV-AIDS among young heterosexual women and its spread in South Africa; the increase of childhood obesity and the concomitant increase in type II diabetes among children; the impact of adolescent pregnancy; and the ongoing social, economic and health disasters related to the 2004 Tsunami and Hurricane Katrina in 2005. These are all ongoing public health challenges.
Since the 1980s, the growing field of population health has broadened the focus of public health from individual behaviors and risk factors to population-level issues such as inequality, poverty, and education. Modern public health is often concerned with addressing determinants of health across a population, rather than advocating for individual behaviour change. There is a recognition that our health is affected by many factors including where we live, genetics, our income, our educational status and our social relationships - these are known as "social determinants of health." A social gradient in health runs through society, with those that are poorest generally suffering the worst health. However even those in the middle classes will generally have worse health outcomes than those of a higher social stratum. The new public health seeks to address these health inequalities by advocating for population-based policies that improve health in an equitable manner.
Schools of public health
The Welch-Rose Report of 1915 has been viewed as the basis for the critical movement in the history of the institutional schism between public health and medicine because it led to the establishment of schools of public health supported by the Rockefeller Foundation. The report was authored by William Welch, founding dean of the Johns Hopkins Bloomberg School of Public Health, and Wycliffe Rose of the Rockfeller Foundation. The report focused more on research than practical education. Some have blamed the Rockfeller Foundation's 1916 decision to support the establishment of schools of public health for creating the schism between public health and medicine and legitimizing the rift between medicine's laboratory investigation of the mechanisms of disease and public health's nonclinical concern with environmental and social influences on health and wellness.
A year following the report, the Johns Hopkins School of Hygiene and Public Health was founded in 1916. By 1922, schools of public health were established in Columbia, Harvard and Yale universities. By 1999 there were twenty nine schools of public health enrolling around fifteen thousand students.
Over the years, the types of students and training provided have also changed. In the beginning, students who enrolled in public health schools had already obtained a medical degree. However, in 1978, 69% of students enrolled in public health schools had only a bachelors degree. Public health school training had evolved from a second degree for medical professionals to a primary public health degree with a focus on the six core disciplines of biostatistics, epidemiology, health services administration, health education, behavioral science and environmental science.
Education and training
Schools of public health offer a variety of degrees which generally fall into two categories: professional or academic.
Professional degrees are oriented towards practice in public health settings. The Master of Public Health (M.P.H.), Doctor of Public Health (Dr.PH.) and the Master of Health Care Administration (M.H.A.) are examples of degrees which are geared towards people who want careers as practitioners of public health in health departments, managed care and community-based organizations, hospitals and consulting firms among others. Master of Public Health (MPH) degrees broadly fall into two categories, those that put more emphasis on an understanding of epidemiology and statistics as the scientific basis of public health practice and those that include a more eclectic range of methodologies.
Academic degrees are more oriented towards those with interests in the scientific basis of public health and preventive medicine who wish to pursue careers in research, university teaching in graduate programs, policy analysis and development, and other high-level public health positions. Examples of academic degrees are the Master of Science (M.S.), Doctor of Philosophy (Ph.D.), and Doctor of Science (Sc.D.). The doctoral programs are distinct from the M.P.H. and other professional programs by the addition of advanced coursework and the nature and scope of a dissertation research project.
The Association of Schools of Public Health[10] represents Council on Education for Public Health (CEPH) accredited schools of public health in the United States, Puerto Rico, and Mexico.
Delta Omega is the honorary society for graduate studies in public health. The society was founded in 1924 at the Johns Hopkins School of Hygiene and Public Health. Currently, there are approximately 50 chapters throughout the United States and Puerto Rico.
Public health programs
This 1963 poster featured CDC’s national symbol of public health, the "Wellbee", encouraging the public to receive an oral polio vaccine.Today, most governments recognize the importance of public health programs in reducing the incidence of disease, disability, and the effects of aging, although public health generally receives significantly less government funding compared with medicine. In recent years, public health programs providing vaccinations have made incredible strides in promoting health, including the eradication of smallpox, a disease that plagued humanity for thousands of years.
An important public health issue facing the world currently is HIV/AIDS. Antibiotic resistance is another major concern, leading to the reemergence of diseases such as Tuberculosis.
Another major public health concern is diabetes. In 2006, according to the World Health Organization, at least 171 million people worldwide suffered from diabetes. Its incidence is increasing rapidly, and it is estimated that by the year 2030, this number will double.
A controversial aspect of public health is the control of smoking. Many nations have implemented major initiatives to cut smoking, such as increased taxation and bans on smoking in some or all public places. Proponents argue by presenting evidence that smoking is one of the major killers in all developed countries, and that therefore governments have a duty to reduce the death rate, both through limiting passive (second-hand) smoking and by providing fewer opportunities for smokers to smoke. Opponents say that this undermines individual freedom and personal responsibility (often using the phrase nanny state in the UK), and worry that the state may be emboldened to remove more and more choice in the name of better population health overall. However, proponents counter that inflicting disease on other people via passive smoking is not a human right, and in fact smokers are still free to smoke in their own homes.
There is also a link between public health and veterinary public health which deals with zoonotic diseases, diseases that can be transmitted from animals to humans.
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