Public health starts with the concept that improving the health of the community’s most vulnerable residents improves the physical, economic and civic health of the community as a whole. Less suffering and greater well-being for the community makes people’s individual lives better.

Next, public health practices change as scientific understanding evolves, putting into practice what we learn to reduce people’s suffering and help everyone live healthier lives.

Here’s one example of the kind of work public health programs do: In 1900, the United States of America’s second-most deadly disease was tuberculosis, often infecting the lungs and causing about one-quarter of all deaths. Scientists, doctors and social workers figured out that the bacteria causing tuberculosis spreads fast in dark, stuffy, crowded and unsanitary living conditions. Starting in 1901, laws were enacted that required new buildings to have windows in every room, open courtyards, proper ventilation and indoor toilets, eventually leading to the decline of tuberculosis infections and deaths, according to the U.S. Centers for Disease Control and Prevention and the Virginia Commonwealth University Social History Project.

Public health efforts have worked: Americans’ life expectancy of about 39 years in the mid-1800s rose to an average of nearly 79 years by 2018. (COVID-19 has lowered that life expectancy by about two years, to nearly 77 years on average, according to research based on National Center for Health Statistics data. In addition, life expectancy varies widely depending on gender, race, ethnicity and income level.)

In California today, public health includes the tracking and reporting of 80 infectious diseases, including whooping cough and Lyme disease, and providing vaccinations for common childhood diseases such as chicken pox and measles that used to scar and kill. Programs that encourage exercise and discourage smoking help reduce deaths from cancer, heart disease and diabetes. Education and support for parents about healthy food and the use of car seats and seat belts helps children stay well and do better in school. Public health workers also handle birth and death records — the vital statistics that tell us the basics of how we are doing as a society.

Dr. Georges Benjamin is a former emergency room physician for the U.S. Army. He is the executive director of the American Public Health Association, in Washington, D.C. Courtesy APHA.
Dr. Georges Benjamin Photo courtesy APHA

“These are people who get up every morning to do their jobs, more concerned about the community’s health than their own individual health,” said Dr. Georges Benjamin, a former emergency room physician for the U.S. Army and executive director of the American Public Health Association, based in Washington, D.C. [Ed note: Georges is CQ]

America’s first public health system attended sailors

The Nevada County Public Health Department’s response to the novel coronavirus pandemic is the latest chapter in an American tradition that goes back more than 200 years.

In the late 1700s, the freshly independent United States depended heavily on coastal and trans-Atlantic shipping for its economic sustenance. Sailors in the merchant marine were the essential workers of the time. What to do when they fell ill? In 1798, the federal government established the Marine Hospital Fund to provide for hospitals and doctors to attend sick and disabled seamen. The men themselves paid for it with a 20-cent tax on their monthly earnings, according to the U.S. National Library of Medicine.

Over the next century, the nation faced waves of smallpox, diphtheria, fevers and other diseases. Doctors still didn’t know they needed to wash their hands with soap before seeing a patient. Women and their babies often died in childbirth. Nearly a third of all deaths were among children younger than 5, and they most often died of pneumonia, influenza, tuberculosis and diarrhea-causing microbes borne by dirty water, historical records show.

In England in 1854, Dr. John Snow connected a cholera outbreak in London to a single public water pump. By the late 1800s, medical researchers were discovering that viruses and bacteria caused these fatal epidemics. Scientists also were confirming the link between disease and people’s living conditions, such as crowding, poor sanitation, poor diet, poor hygiene and sewage contamination of drinking water.

The United States of America’s first public health effort was the creation of hospitals to attend to merchant seamen. A temporary facility on Castle Island in Boston Harbor was the first, shown here circa 1800. Its physician-in-charge was Dr. Thomas Welsh, a veteran of the Revolutionary War battles of Lexington and Bunker Hill, appointed in 1799. Courtesy “Images from the History of the Public Health Service,” National Library of Medicine.

They also were beginning to understand that fighting illness and death involved the whole community. In 1878, Congress began enacting laws that expanded the Marine Hospital Fund to embrace the general public, funded with public money. What eventually became the Public Health Service originally had the mission of preventing contagious diseases from entering the country, and keeping internal outbreaks from spreading. Tools included the authority to order quarantines, the medical inspection of immigrants and public health research. Branches within the Public Health Service eventually became the U.S. Centers for Disease Control, the National Institutes of Health, and the office of the Surgeon General, according to the National Library of Medicine’s history of public health.

‘Keep bad things from happening’

The period from 1880 to 1920 is sometimes called the “First Public Health Revolution.” It saw campaigns to create or improve sanitation and sewage management, public water treatment and municipal garbage collection. New laws required food safety inspections and safe handling practices. Campaigns educated people to wash their hands and eat fresh fruits and vegetables. More-productive agriculture, improved transportation and safer techniques to preserve food brought a more-balanced diet within more people’s reach.

During the 1900s, the development and distribution of vaccines became an important new tool for public health efforts in the U.S. and around the world, especially for children. For example, a major immunization campaign against polio starting in the 1950s eliminated the virus that formerly crippled more than 35,000 Americans yearly, many of them children. As diseases declined, public health attention broadened to attack the factors that lead to birth defects, cancer, heart disease, diabetes, lead poisoning, lung conditions such as emphysema, and injuries and deaths involving consumer products and automobiles.

Today, public health professionals in Nevada County continue with that legacy. They help improve the lives of pregnant women; mothers, their babies and young children; elderly people; residents living in remote areas; and people with addictions and special needs. Employees educate residents about how to stay healthy, manage chronic conditions and find help getting medical care and healthy food. They operate a family clinic in Truckee. Childhood immunizations remain an important focus of their work, with public clinics five times each year, and an influenza clinic every fall.

All those and more efforts to protect public health boil down to three basic tasks, county Public Health Director Jill Blake wrote in her 2018-19 annual report:

Keep bad things from happening, find out early if bad things are happening, and reduce the consequences when bad things do happen.

Pascale Fusshoeller, editor

Pascale is one of YubaNet’s co-founders and the editor.