X. History of Public Health

The converging histories of science and public health have emerged as a major interest of mine over the past 30 years. Particular events have provided the impetus for this. For example, the juxtaposition of 19th century India as the site of the largest famines the world had ever known and the realities both of observing its vitality and resilience in daily life and its remarkable record of achievement since independence struck me as kind of odd.

This apparent inconsistency, between the historical facts and current realities, became a major focus of mine when I returned to the US in 1980. At that time, I was just embarking on a doctorate at Harvard. As part of my daily routine in Boston I would walk on roads and by buildings named after the pioneers of the great sanitary and public health revolution of the late 19th and early 20th centuries; Shattuck, Bowditch, Walcott, Bigelow. At that time, I had no idea of how interwoven my deepening understanding of the roots of public health in my home country would become with the reality of India that was beginning to flourish in my consciousness and change my perception of the world.

Jane Teas, a postdoctoral fellow at Harvard whom I met the following year and married the year after that, introduced me to the history of public health in Massachusetts through a book entitled “Public Health and the State: Changing Views in Massachusetts, 1842-1936.” (Rosenkrantz B. Cambridge, MA: Harvard University; 1972.). I don't know the full story of how she came to possess this. However, I do know that I appreciated it so much that I purchased a copy which has occupied a treasured place in my library for 30 years. The ideas would transport me back and forward in time and space, to India, Massachusetts, Uganda, New York, Québec, and South Carolina. They would draw me deep into the stacks of the Widener and Countway libraries and leave me a pretty different person than I was before I opened myself up to these possibilities. Stories such as the one about Lind and the trial he conducted with sailors in the British Navy in the middle of the 18th century took on meanings at many different levels (or, more accurately, their meanings were revealed) .

When teaching epidemiology, I often remind the students that the biggest improvements in public health, which occurred during the age of health protection, had much more to do with social, economic, and environmental justice than with advancements in medical technology. This was very humbling to the students (especially medical students), and starkly evident. The largest decreases in overall mortality rates in human history occurred in the last decades of the 19th and early decades of the 20th centuries (about a 90% reduction in infant mortality in places like New York City). This was a direct result of providing some very basic sanitary services to people who were unable to provide these things for themselves. Before then, life, very literally, stunk. With a sense of purpose and social and environmental justice it changed – dramatically and very quickly. I think that these are lessons we must learn once again.