after the three month course, these men are usually sent back to their in charge of repair crews, army trucks from nearby camps are soon put in order. the class in specialized training is now given in hampton's engineering department for hundreds of men in the united states navy. thousands of men and women of these colleges over nation are now taking their places in our war effort physically and mentally fit.

welcome back, everyone. it is fantastic to see your smiling faces on tuesday. you might remember from our very first class, we really just gave a broad introduction to what is public health, what are some of the key focuses in public health that we like to work on? what are the key themes is what is a social determinant of health? and we're going to explore all of those concepts throughout the

semester. but today we want to give you a brief history of public health and how we have gotten to where we are with the public health system, both in america and globally, based on historic events before i launch into today's lecture, i want to give just a quick acknowledgment of all of my colleagues from across campus and from either other campuses. now who have contributed to this content and this course. you will meet some of these people throughout the semester. they are really fantastic individuals to work with and who have a really big wealth of knowledge. so we should forward to some guest lectures from this group. so we're going to focus on really being able to explain the evolution and concepts about the cause and prevention of disease. we're going to discuss the major, his story of figures and events that shaped public health as we know it today. and we're going to try to

explore how lessons for public health history inform current public health practices, and then also how current public health events might inform the future. all right, so we're gonna put our thinking caps on at the end of this lecture before you came to class today, you had a few readings and, videos, and particularly we're going to focus on some of the content from the module developed by boston university school of public health that you reviewed. and then also the video, the ghost map, talking about a ghost map and discussing the cholera epidemic and jon snow's role in epidemiology and public health. so why study history? don't even read the quote on the screen. now, i see a lot of people kind of staring right now, but you tell me why study history? this is a public health class. what is why are we doing this. yes, my name is nick and it kind of helps us to know, like where

how we got here. so we're out today. yes. absolute. so, nick, thank you. that's a fantastic answer. he said it helps us figure how we got where we are. okay. can anyone build on that? yes. and we can also build out different approaches from history or things that have happened in previous years to formulate new ways of thinking or ways of approaching a certain issue or conflict that we're facing. now that may have not been faced before. absolutely. so if i can summarize, we need to learn from history in historic events and look at what worked, what didn't work at different really key historic events to inform our approach to public health now and in the future. absolutely fantastic fantastic. so today we're going to walk through really we're going to kind of group it by centuries and we're to have a really broad overview of the world pre 19th century the world public health, pre 19th century just know it as kind of in the broadest terms

and we could probably do an entire degree focus on health evolution during that big span of time and then we'll focus in on the 19th century and some really key movements that shape public health today, like the sanitary movement, industrialized bacteriology. and then we'll talk about the top achievements of public health in health systems in the 20th century. and we'll talk a little bit more about what's going on today, the 21st century. and again, like i said, how that's going to inform where public health goes in the. as we look at this content today, i want you to focus on a few foundational shifts over time. and so what we're going to see is that over centuries, public health emerged and became organized because of two important developments and shifts in thought. the growth of knowledge, which is going to be a very clear theme and this public acceptance that disease control was both possible and a public

responsibility. and we're going to learn more about that. but essentially, when we went through back to the bacteriology movement, right, and developed germ theory, we found out what is actually causing disease. that's when we went through the shift of we actually can control disease and we should. and there's something that we need to do about this. okay. and so another key theme that you're going to see throughout today's lecture is this ebb and flow throughout history on this individual focus of health and individual health outcomes, individual responsibility for for health, and then also real structure, moral determinants of health. and again, this concept of public health and public responsibility of health. okay, this is an image you are going to see again and again throughout the semester. so you can go ahead and mark this as a red star slide. so this is one example of the social, ecological framework

that really maps out that health happens both at an individual level with genetic components, right? but then it's also influenced by behaviors and lifestyle factors as well as your social and community networks and community factors, your living and working condition ones. and then most broadly, the general socioeconomic culture, environmental and political conditions of where you live, work and play. we're going to dive into this again. like i said, the entire semester of particularly when we talk about social determinants of health in just a few weeks. okay. so as we look at health throughout the centuries, a key thing that you need to remember is that environment impacts lifestyle. okay? where you live, your access resources, the geography of where you live, the climate that you live in, your access to

transportation and technology, the knowledge base that you have access to this all determines your health outcomes and we're going to see how this impacted and influenced health outcomes in civilizations over time. and this is a preview again, i'm giving you lots of little previews today for what's to come this semester of the epidemic logic triad, which is just a really it's a different way to visualize this impact of environment on health and this interconnected nature of a disease causing agent. so bacteria virus, you name it, right. and the environment in which you live and your health outcomes. okay, the person, the agent in the environment, this agent we're going to see, we didn't really understand for centuries. right. but it became very clear very early on how key the environment was. and so you can really start to explore this pattern in this impact when. you look at the shift from hunter gatherers.

we're talking thousands and thousands of years ago, humans were hunting animals for food. for food, scavenging for food. they weren't living in any place very long. right. for safety. they had to move place to place. so what kind of health threats did you think they faced? number one, do you think they lived very long now? okay. why not. yes. my name is margaret and it was really long because of just the things they were eating. they had a really hard lifestyle. they had to find all their food. and also, if a disease occurred during that time, there wasn't any really like true medicine. they probably had like osteopath ways, but nothing that we would have today. and so absolutely fantastic answer. so essentially we are talking like thousands of years before christ, right? b.c absolutely don't have access to modern medicine, modern resources, things like that. when you're hunting and moving

and on the move all the time, right? your safety is major risk. you're living in the elements with other animals. interesting thing that you mentioned about nutrition. so they actually have a fairly very a fairly varied diet. and so nutrition wasn't a huge. and another thing that wasn't a huge concern at the time was like sewage systems and things like that. right. obviously they didn't have them, but also they're moving from place to place and we're going to see why that becomes relevant later on. so like, that's that's the scene that we have in this hunter gatherer area era. and then we move into the agricultural revolution when people are starting to grow their own crops. and the great thing about growing your own crops is, okay, you actually have a sustainable food source, but they also saw some limitation in the variety in their diet that the hunter gatherers had. right. so you had different nutritional concerns during this time and threats to life and of course, we know there are threats to the

reliability of crops depending on the environment and whether that lead to nutritional concerns. and then we get into the industrial revolution and that's where the fun really begins that we're going to talk about today. who knows what was happening in the industrial revolution, really? i'm thinking london 1700, 1800. so what was going on? yes, they started urban living where people, mass populations of people and livestock were living in a very small and densely packed. absolutely so jobs boomed, manufacture, ring boomed. and all of a sudden you see this mass migration into cities and become densely populated. and so now you see health threats like sanitation and right people aren't on the move all the time if there are issues with cesspools wastewater right like they're living in it they're right there there's nowhere else to go. we also see concerns within disease because people are living in closer quarters than they ever have before.

we also start to see issues in workers, health and working conditions and how influence health so you can see how each area is facing its own health challenges and then we move into the scientific revolution that we're going to dive into a little bit and this is when we learn that it becomes possible to test associations, risk factors and health outcomes. we learned that there are identify viable causes of disease that we can address. and you can imagine the world shifts and really brings us to really what we understand of health in public health today. but let's dive into this and highlight a few key events and key people throughout these times. so again, let's start with pre 19th century, really short time. throughout throughout history before.

the 1800s, disease was really as a sign of poor moral or spiritual condition. people had a lot thoughts about disease related to religion, myths and gods and disease outcomes were really a reflection of all of those things, rather than any kind of biologic factor that we know today. right right? there was no means, like we mentioned before, to test the associations between exposures and health outcomes. and this there was this idea that started in the era of hip hypocrisies in ancient greece of humorous. right. and that was that there was a balance of four fluids in the human body and that when things happened to throw those fluids out of balance. that's when disease occurred. and the interesting thing here is that we know that's not how it works. right. but it did lead to some

individual individus for treatment for disease and also idea that the environment could impact health because there was a belief that different environmental factors could actually knock you out of sync. right. and change the balance of your fluids of your humerus is what they were called. there was also a belief that everyone had a different balance of humors that was influenced by individual characteristics. and so doctors started prescribing intervention ends but also started prescribing things like diet and exercise. right. we're talking as early as ancient greece. and then we also see before the 1800s. let's fast forward to the plague right, which comes around mid 1300 years, early, early 1700s. it spanned a good chunk of time, but during the plague, we see early efforts to quarantine and

as a matter of fact, one of the things that you read was the word quarantine actually comes from the italian. i won't i won't attempt it. but the italian phrase for 40 days because something in the quarantine efforts were in the ports of venice during the plague, and they realized that ships were coming from areas that were ridden with plague, needed to stay anchored for 40 days before they let anyone off that boat to come in to try to keep their city safe. okay. so that's some of the earliest quarantine efforts that we ever saw. and we actually also so that happened again during the plague. it happened here in america during plague time, about 1600s in massachusetts. we actually implemented some of the quarantine efforts, i think it was with ships coming up from barbados where they knew the plague was rampant in india. to make sure to try to keep the colony safe here.

okay. so again, we're in the pre 19th century or actually even transcending into the early 19th century here with jeremy bentham. jeremy bentham was a utilitarian and really spearheaded this utilitarian idea of ethics. now we're at boston college, right. most of you, if you've taken an ethics class or philosophy class, please raise your hand. yes, most people have. who can tell me what utilitarian is amiss. i know someone knows. yes, there. the realization that social efforts to help the ill are beneficial for society as a whole. amazing. absolutely fantastic. so you knocked out even my next question so my first question what broadly is utilitarianism

and it's at its most simple definition. it's the idea that an act is good if it creates the greatest good for the greatest number of people. and want to avoid acts that do widespread harm. okay. and so you took it a step further and already address my next question, though. okay, that's great. but why am i talking about this in a public health lecture? this is abso lutely crucial because it means that we have a social responsibility, do good and promote outcomes amongst the greatest good good. does that sound familiar? sound a little bit about like public? absolutely. and then there were other efforts going on during this time. we had some very early efforts at trying to collect vital statistics. this is our first our first attempt, even especially here, massachusetts, in the early 1600s. that was our first attempt to really track when people live and die for how long. there were early efforts to try

to even curb industry pollution, inspect food and promote food safety. some public water wells. there were some early, early inoculation. and so there are things happening at time, even before we really even understood what caused disease. and like i said, this brings us into. 1900s in the context of industrialization, which we already mentioned involved lot of urbanization. there was a lot of swamps, slum dwelling at this time as cities, there's a was a real concentration of filth. and then this explosion of endemic infectious diseases. and one of the key things that happened during this time is that people realized that the plight, the poor impacted the rich. basically, when you have infectious diseases and you are living in those of quarters that close supporters, right? no one is safe or protected from disease. so, again there's this idea of

public good and that improving the health one group is going to improve the health of all. and also during the time we have the great awakening. and so again, we still haven't got to germ theory, right? we still don't know. i think soon on a i'm going to talk about miasma. that was the general thought of disease causation the time right but so we still don't actually know what causes disease but we have an idea that filth isn't for you, right? in general, like living around a cesspool is probably not the healthiest thing. and so cleanliness was really identified as a central objective of public health. that time we're looking at kind of the midnight century here in and here we are, the prevailing theories of disease causation were miasma so that this idea that it waconditions of the

atmosphere, they thought that there were like vapors coming from filth that were actual causing disease, which really justified sanitary approach. and then they also that specific contagions caused infections and disease which really justified quarantine. they don't know what causes this. they do think there is a cause. and so that's why they that's why they implement quarantine, to try to contain health. there's also oliver wendell holmes publishes the contagiousness of pure pearl fever at the time. and this really aligned with work of a colleague in london, ignaz semmelweis, who realized he was working on maternity wards and he realized that there was a maternity ward where students went and there was a maternity ward where they didn't go. and so they were seeing higher rates of poor girl. i can't even say that postpartum infection, that's what it is.

they were seeing higher rates of postpartum infection on the ward. were the medical students went and he said, why don't we start washing our hands just to see. he actually had a colleague who didn't autopsy and cut his hands during the autopsy of one of these patients who developed similar symptoms. and so that's he said, i think i think there might be something going on here with direct contact. so why don't we start washing our hands in between patients and see if that helps? and it did. okay. and so william oliver warren noticed the thing and they start talking about it, but it's still, years before we actually get to theory. okay, but we're starting to see precursors to that theory and a growing understanding of what's causing health or what's influencing health. and so during this time, we also have edwin chadwick in london, who publishes sanitary conditions of the laboring population of great britain. and what he found was that life expectancy was much lower in these urban than in the

countryside. and he proposed the sanitary idea, including pure water, sewage, he says, look, there's this discrepancy in life expectancy. we need to clean up our cities. okay. and it was controversial still, but it was eventually adopted as the public health act of 1848. and so this brings us we're kind of in the mid 1800s to late 1800s. and you actually read a poem before coming class, hopefully. and it was talking the fence or the ambulance. and you also watched the video by dr. camara jones talking about the cliff of good health. and they had very similar messages. but the poem that you read, the fence or the ambulance that talks about, well, everyone's falling off the cliff. they're getting injured, they're dying. we increase the number of ambulances at the bottom to try

to save lives. but also we could just build a fence right and keep them from falling right. so that was written we suspect that it was written in the late 1800s. it was published in the very early 20th century. but we think it was written in the late 1800s. and like i said, you watch the video by dr. camara jones explaining, a very similar analogy, but over a century later. well over a century later. so we see this early idea of prevention when we talk about things like improving sanitary conditions in cities, improving worker eating environments, improving workers health. right? we start to see this idea, oh, we can actually prevent disease. and so over a century ago, whether well over a century ago, we had people writing about this concept, but that maybe we should shift our focus. but during that time, we still lacked the benefit of.

we did start to see a rise in statistical analysis and statistics local approaches to studying health and health outcomes. then in humongous, large part to who is the father of epidemiology? can anyone tell me? yes, you can read this slide. hold on. i've heard from you. who else? who else? say it out loud. i'm going to go with john snow. oh, my goodness. fantastic i don't know where you pull that answer, john. so let me tell you all. now, listen up. if you don't know the answer on exam, at least write down john snow. it does not matter what the question is, just at least write down jones down john snow and i'll know you will have something from this class. so who can tell me based on the readings and videos before class, what did john snow do.

yes already people voting for colorado is out of water and they are not transmitted through the air. and he was able to do that by there was this one pump on broad street and he was able to track geo geographic ali the number of people who are infected and right surrounding the pump as, the number is smaller as you were farther removed. absolutely. fantastic answer. so remember that there was a major cholera outbreak in london in the mid 1800s. at the time, miasma was still the kind of prevailing theory of disease causation. people didn't know what to do. and john snow suspected he realized, you know what, when people get cholera, they usually start with die symptoms. but everyone's saying it's something in the air. if it was something in the air, wouldn't it start as respiratory like, hmm, i think i think something might be wrong here. he said, think it's in the

water. and so when did have a massive outbreak he was the one who went and identified he went and surveyed who was getting cholera, who was dying from cholera. and he actually mapped it out. and these were the earliest efforts, epidemiologic data collection and conclusion john's that we see hence why he's the father of epidemiology. so he mapped it out and he said, you know what, people who are getting cholera are caught and traded around the broad street pump. exactly like you said. and he went and he the handle and it was radical at the time but they saw a drastic decrease in cholera when he did that and this revolutionized how we approached health and health surveillance. other things going on at this time, as you imagine, we've talked a lot public sanitation and water, sewage and garbage

removal. and there was a real focus on the comments, resources by all, how can we improve sanitation of the resources shared by all? and then there was also growing critique of housing and working conditions for. the poor. so we talk about this ebb and flow at the beginning of class between individual level health and kind of societal health, public, public good. where do you think we sit right now during this time? not right now. in 2024. do you think we're more on individual health or public health? public good. 5050 chance? yes in the wake of the pandemic? i think public good. yeah, absolutely. so at this time right in this

context, when we're really focusing on working conditions of poor public sanitation, right. there's a major focus on public good when we see this growth in utilitarianism and kind of the structural impacts on health outcomes. fantastic. okay. another major figure at this time, particularly here in massachusetts sits was lemuel shattuck. he was a former school teacher, bookseller, but he released the report of massachusetts of the massachusetts sanitary commission. and he was the one that really proposed the ongoing and regular collection of those vital statistics that i mentioned before, birth and death data and conducting ongoing statistical analyzes to inform sanitary measures and to track health during this time. he also proposed that we have state and local boards of to oversee this data and his recommendations were later

adopted with the first the creation of the first state board health in massachusetts in. 1869. and so i won't walk through all of these but this just to highlight the number of reports being released that really emphasized the importance of worker workers, health and housing, right. and giving kind of that preference preferential option for the poor. there is a growing recognition that were disparate health outcomes, disparate conditions, and something needed to be done. so there was a real recognition, again, of kind of these, what we now call social determinants of health. and there was a recognition that health was no longer just an individ responsibility, but it became necessary to form public boards of agencies, an

institution to protect the health of all citizens. and that was a statement from the institute of medicine. and so we already talked about, if we're in this ebb and flow as we kind of head into the late the late 1800s with this focus on the structure, determinants of health, sanitation workers, health, social determinants, and then back to your realogy hits and the world changes forever. can you imagine being first person to look through a microscope and seeing a bunch of bacteria? i can't even imagine what went through his mind. like, right, like what they looked like, what he thought it was. and i can't even imagine. how can you comprehend the impact that that is going to have on the world? but at this time, in the late 1800s, early 1900s, finally understand what causes disease and that there are disease

causing agents like bacteria and viruses that can be addressed in germ theory. really. and it replaces the old miasma theory that prepare, prepare prevailed for centuries before this time. okay. and so during this there are many, many big okay. but one just one that will highlight. and i'm sure some people would cringe if they're like, oh, no, you only have time to talk about just one when you're talking about germ theory. but we chose louis pasteur. who knows what are some of the things us can read from slide? but what are some of the things that pasteur is known for. there's one big process. yes pasteurization. pasteurization. that's the lutely. yes. fantastic. so he did a lot of research that contributed to germ theory.

he found out that he proved anthrax was caused by a specific bacteria along with several other diseases as he developed some very vaccines and really built on edward jenner's work, who had demonstrated the principle of inoculation, smallpox before him to really continue the vaccine technology, he popularized germ theory, but with that with pasteurization, he found out that you can heat things right to kill the bacteria right so this shifted how we approach disease transmission and treating health for the centuries to come. what impact do you think germs theory had on this ebb and flow between focusing on individual determinants of health and structural of health.

we were going into this time really focused on sanitation, the built environment impacting workers health. what do you think? yes, i think that comparatively it was more like of an individual and talking about like the individual person and like how each of those like diagnoses can be completely different. yes, fantastic so, yes, there was a shift back to the focus of treating the individual with disease, because now we knew how. okay. and this was revolutionary. so we shift back to individual level interventions. we really popularize immunizations and disease treatment, immunizations does fall under prevention. so we still have that. but then we have a major shift in disease treatment. there was a major focus child and infant health at this time, particularly immunizations, started be required for school

first in providence, rhode island, right. one of our neighbors, they started school inspection programs, child education programs. there was a major focus on health in early ages ages. and actually, i do want to highlight that last little quote here, because i think it's a great highlight of what was happening. so we went into the era of bacteriology thinking that sanitation efforts were really the key to disease prevention and social compassion, a concern for the common good that utilitarian approach. those were the impetus for prevention. and then now the basis of prevention was knowledge and expertise. it was focused on the science. and so that's why you see things shift to immunizations as a prevention measure. and that us into public health in the century, the early 1900s.

and so here is a list from the cdc of the top public health achievements of the 20th century. what a time these were some major right vaccinations massively widespread. we even saw the elimination of smallpox as one of the greatest public health achievements in modern times. we saw drastic improvements, motor vehicle safety that will actually, i think, listen to a podcast about later in the semester when we talk about injuries. but over decades and decades of the middle 20th century, efforts were put in place to reduce motor vehicle deaths very successfully. there were efforts at the federal level to improve workplace safety, to control infectious diseases. so we saw a decline in deaths from coronary heart disease and stroke, safer and healthier foods, healthier mothers,

babies, improved family planning resources, fluoridation of drinking water, recognition of tobacco use as a health hazard, which was a major achievement that transcended into the early 21st century as well. so during this time, there was a major focus also on behavior change and education and physician well visits. and so let's start just talking about health, education. so it was a central public health intervention during the 20th century, right. we see lots of massive anti tobacco campaigns. we see a growth in radio-tv. cinema is right. it makes sense that health education would take off this time for both prevention of disease and promotion of health. and so i mention we see anti tobacco campaigns right towards

the later into the 20th entry who has seen anti tobacco campaign in their life? yes, a commercial. absolutely. the truth campaign is a major one that's out there. do you think that alone is what led to the success of tobacco control efforts in the late 20th, early 21st century? no, no, no, no, no, no. so repeat after me. repeat after me. education is good and good, but not enough. okay? i you to remember that when you do your group projects this semester and you come up with public health interventions because everyone wants to start, i'm going to address childhood obesity by teaching kids how get active and teaching kids about fruits and vegetables which is absolutely fantastic and we absolutely need. hey, i'm a health person, right? wait until i do the health communication lecture. it's my day. okay, so absolutely needed and

important, but am i not that be enough. yes because you can teach them much about what they should be eating. but you don't think about do they have access to these? can they actually find them in their local neighborhoods and do they have the money to buy them? absolutely. fanta tastic answer. so think about that social ecological framework that i started with today that i said we come back to again and again and again. that's fantastic that you can teach good behaviors and people can have the best of intentions right? you can have everyone in america, everyone across the world in ten to quit smoking because sell your educational campaign and they know it's bad for them but you don't know what the social context is right. and you have to build the environment both in the immediate community there. their immediate social environment and their broader social and political environment in, a way that promotes health and helps actually do choose the health behaviors that healthy

behaviors that they want to choose. so absolutely fantastic. so what efforts in addition, the ads were good? what other efforts with control do you think we're led to? the success that we saw. so we have massive health education campaigns. what else did we do to control tobacco. yes, we raised the age. absolutely. yes we implemented policies to limit purchase of tobacco products and i think there are something things there are dozens. let's just say that i won't try to give an exact number. but there are dozens of across the world right now that have smoke free policies in place. absolutely fantastic. and there's something else to policy, but also distinct, what else do we do? yes, taxation. we raise the prices absolutely. if you want to this discourage something, make it expensive and

so that try factor really led to the success that we had and that is a lesson that we can learn for health behaviors to common health promotion to come. okay and so i mentioned so we have this growth in health education during the 20th century and then we also the physician well visit so up until this time actually let me just do a poll right like who has been to just an annual well visit right either recently i before you come to college right you have to up your vaccines when you're growing you go in for an annual visit make sure all your vaccines are up to date so you can go to school to all your camps, participate in your sports. absolutely. but until this time, until the 20th century, people went to the doctor when they were sick. and that was it. and so this really continues this focus and is a another effort on disease prevention in a different way than we've seen

in the past. during. this time, we also see specialized health care clinics and public health clinics, particularly the poor. so you see a renewed focus on health for the poor and trying to expand access to tb care, care for venereal disease baby clinics. right. try to promote health of the common good. and so that brings us into the end of the 20th century, where we see a mix of things, right? so we some funding cuts to the public health system. we see a renewed focus, health care financing and the medical side of the health care system. but we also see a renewed focus on the socioeconomic contexts to some extent and we see a vast globalization of public with the millennium development goals from the united nations.

that really set out, i think at the time it was eight goals don't quote me on but they set out a list of goals to achieve by 2015 to try to end poverty and health across the world. and that led to the development of the sustainable development goals, which you will also explore during your group project this semester. it's a renewed set of goals. there are 17 priority priority areas to improve equity and poverty and, improve health across the globe by 2030. and so that brings us into the 21st century, into today. and so what do you think would be the major public health event highlighted in the 21st century? if i were teaching in 2100 or 33,000, what do you think it would be? yes. so with the covid pandemic, absolutely. just now, i brushed over i didn't even mention the spanish of 1918 in this talk, but very similarly, right.

people are going look back in time and you can see these are ten leading cause of causes of death in the united states published by the cdc in 2019, 2020 and 2021. and there it pops up. right? in 2020 is the third leading cause of death. it maintained its status as the third leading cause of death in 2021. i think according to some preliminary data, it's fourth in 2022. but this had major, major impact. i don't have to teach you all this on the health across the world, health outcomes across the world and so when we look at the top public health achievements of the 20th century, one of the things that we saw is control of infectious diseases, which absolutely this doesn't negate the progress that we made in that. right. but all of a sudden, diseases, diseases, an emerging infectious diseases are a major public health concern. again, before i go too much further, do you think some of

the lessons learned will be from covid pandemic that people talk about from now. yes, the names alec and i think the effectiveness of 14 absolute. so there will be a renewed talk of quarantine measures just like we talked about it at different points throughout history. absolutely. that was a major part, the pandemic. what else? yes, as you say, personal hygiene. yes. yes. who wore a mask? and now this is this can actually also be cultural and depends on where you lived and where you up in the world. but who wore a mask before covid hit ever? right. very, very few of us ever saw it. how people went to school with a cold at some point, right? growing up in grade school, went to school a cold. it just it just didn't happen. right. but now we all think you start to get the sniffles and you think, oh, like, should i mask

up? right. that's a major public health shift. fantastic. what. yes. and i was thinking about specifically in the us, like the political implications of how they are intertwined. so say that last part, how they are way intertwined. yes, absolutely. how vaccines and politics became intertwined. absolutely. and so i think to kind of group the first couple of answers, i think there was a rapid growth knowledge on disease transmission control, right. with handwashing with masking quarantine. but then this other thing that came out right as vaccine. and how political it became. absolutely. and so i think what we saw is that. we made a ton of progress in

vaccination and 20th century, but now we have to revisit that again and make sure are we are we adequately engaging communities as in the vaccination process? are we adequately building trust? because there some real valid concerns among communities who have been taking advantage in the public health system and in the medical system when this brand new vaccine came out that seemed to be produced at a rapid pace. right. and so there was a lot of hesitancy at that time. so i think to build on that right became politicized. but from a public health standpoint, how do we in that and how do we build trust with communities and how we effectively communicate? i think these are all themes. you're 100% right. all themes that came up during the pandemic that we have the opportunity, learn from anything else. what do you think? yes, i think the effective social media and like the

internet on how people get information about public health issues and like developments within the medical industry is a thing that people look back on. but i make absolutely so another theme with health communication, right? so i told you it's not enough, but is my jam. so another thing with health communication is what do we do in the era that anyone can say anything online and it becomes really, really hard to out who the expert is who knows why, who you can trust, expect actually when there's growing in the institutions that people traditionally turn to so absolutely that's a challenge and an opportunity for growth let's see i'll come here in the back. over here. yes. like being cautious of also who getting sick because i know if like a grandparent or so it was an older age or someone who already has previous or more, we're more conscious of getting covid people, family members

worry about someone younger or our age or about concern if we don't know their health conditions that could intertwined with it. absolutely. so almost a little bit of self triaging, almost, right. who's heard of triaging either in in a medical emergency in an emergency room. right. and trying to figure out who's at highest risk and providing them the care that they need. but similarly, right there was kind of this level of thought for each individual of oc. i think i might be okay to go my 20 year old friend, but i might not go visit my sick grandparent or my aunt who has cancer, right? absolutely and there was a huge growth in knowledge around that around what population, asians are immunocompromised and at risk when either covid or any other infectious disease outbreak occurs. fantastic. i think i some hands over here. yes. in line with what was just said, a shift back to like the public doing things for the public good rather than just individuality. absolutely. so i love you again,

anticipating my questions today. so i wanted to ask if we see this ebb and flow between and a focus on structural determinants of health and public good individual determinants of health. it sounds like you think that there was a shift back towards a focus on the common good structural determinants. do people agree with that? and anyone disagree? because that's where the best learning comes from. okay. okay. yeah, i think i think i would agree think there was a renewed understanding that your health impacts others that we're all in this together right. fantastic so i want to broaden out a little bit before i get off this slide. we're talking a lot about covid. that is the major public health event of this century. so far. and i will say, talking public health, teaching public health is drastically different in 2024 than it was in 2019, for all of

the reasons that you all just highlighted. but what else do you think has at all since the 20th century? do you think that there is for growth on any of these achievements. yes, i that the recognition of tobacco use as a health hazard is something that sort of like evolved because of the rise of vaping and like e-cigarettes and also the legalization of marijuana and like many different states and that's something that like our generation and like teenagers have really struggled with. absolutely. so we can never get complacent. right. and new things are coming out all of the time, including things like e-cigarettes, vaping. now there's a whole new area in need of research and education, right? with marijuana legalization? absolutely. that's an area revisit. yes, i think that's looking at

that like the socio economic standpoint and how we improve access that it's. just i love that. i love that. so we've made great strides in food safety, but making sure that that those advances are equitably distributed and that people equitably have access to healthy and safe foods, fantastic. they talking about it's more common to defer starting families with later in life introduction like there is this technology but working to make that a more equitable and more effective for people who don't have as much access. absolutely. so shifts in family planning practices require a continued look at our recommendation and how equitably interventions are being offered to promote individual family planning. is that a good summary fantasy stick?

i would say like on a larger level that there's still like huge, like significant gaps with like access to health care and like adequate health care and education about health care and resources like, like social, social economically. yeah, kind of like. i mean, it has gotten better, but like, is that enough for our society today? absolutely. so i think if i'm understanding and i'm starting to hear a theme here is that, yes, we've made great strides, all of this in all of these areas. but maybe the challenge of our generation and our century is to make sure that these advances are equitably distributed. is that right? fantastic and i think this is where this is where i get excited. this is where the magic happens. and it can be daunting because can focus on the problems. we can focus on the challenges which there are many. right. but we know the task at hand. and your generation is so much smarter than any of us your generation is so much better prepared to fight to address these issues from an

interdisciplinary standpoint, using things like design thinking and innovative engineering and technology like you all are the ones that are going to figure this out. and i know some of you are like, yeah, okay. but others you were like, yeah, i know i got this. and i fully, fully anticipate that you do. and so the last that i'll highlight here that goes along that is that people i don't think i've mentioned healthier mothers and babies. so we have made great strides in this globally. we have made great strides in america, but we continue to have the highest maternal mortality of any of our peer income countries here in america. and we continue to see abysmal disparities in maternal health outcomes, particularly impacting black mothers. so i think that's another area that's going to i hope right that's going to be addressed by in this century any other. well, i'm going to ask this some more right.

so we'll come back to this idea of other thoughts and things that we hope to achieve this century. but we will say, right, barriers to good health do persist, even though we've known since the greeks. right. we talked about ancient greek civilizations since the egyptians we've we've known the importance of sanitation. right. but people still don't have access to clean water across the globe. and so why do you think that is? yes, there's ahead. but why do you think that is? if we've known about it for centuries, centuries, centuries. and why do you think we see disparities within the country, across countries? we're going to talk about global disparities a lot in this class. it's about distribution of resources. right. so it's about distribution of

resources globally. it can be nationalism. and so you have to think about you have to think about finances. you have to think about economies. you have to think about all of these different disciplines that impact health when you're making health decisions and you're trying to promote health for the common good in the global sense. okay? and so what do we need to strengthen public health? we need funding. we need strong, coordinated between different public health sectors. we need a larger workforce is why i'm so happy we have over 90 of you in here. i'm hoping every single person goes into the public health workforce here. one of the things that's really challenging public health and i remember talking about this a lot at the beginning of the pandemic, is that our efforts are largely invisible. if public health works well, you'll never know what we did right. if public health works well, the pandemic didn't happen. the food outbreak didn't occur

right. we avoid these major tragedies, but no one ever will know what could have been. that's the goal. but that also, from a marketing standpoint, makes it pretty until get a century in. and you can look back and say, whoa, look at everything that we did in the 20th century and we need evidence. but like i said in the slide before, you need to marry scientific evidence with the political context, with the social norms, right? evidence alone is not always enough. distribution of resources is a big deal and it's complicated. there are a lot of competing factors, so you need to have voice in all of these worlds and be able to work with the different players of the room to actually achieve some of these health goals that we've already mentioned and who remembers this slide from class one, the first class? okay, i'm seeing head nods. good, good.

i got a little worried when i didn't see any hands that we totally missed the entire lecture. but public health is interdisciplinary and complicated because of everything that we just talked about. it takes financing. it takes health policy, education policy. it takes all different disciplines. it takes technology, science, advocacy to actually optimize the public good and kind of back to that utilitarian approach to promote the most for the largest population. so that's just why there's really no easy solution in challenges. but again, why i have a lot of faith in this group who i grew up in an interdisciplinary world. and so we talked about a little bit. do you all think where we going? do you think we're continuing? we're going to shift back to an individual focus? do you feel a continued shift to

towards the kind of structural determinants health focus? where do you think we're headed in the centuries come decades to come? yes, i think like personalized medicine become, more prominent, especially with like the genetic. yes, absolutely. the best way. right. so personalized medicine growing, knowledge and genetics. and how to individualize treatment are some of the most exciting advances in health right now and are going to really shift towards that individual focus in a really fantastic way. what else. yes, i think you could also shift to like a structural focus just because when when you look at maternal mortality rate, that's more of a structural issue. and bias or racism in general. so i feel like it turn into a more structural thing. so. sure, absolutely so there's

there could be this continued focus on the social determined voice of health, the structural influences on health that we've seen trending since the pandemic. yes, i think another reason why we go in a more structural way, like i'm talking about like the debates about universal health care, kind of like the united states role in that and kind like how can that possibly close, you know, some socioeconomic gaps we're not or that that's up in the bay area. absolutely so they continue for universal health care in america. how that influence possible a possible shift to kind of population health. i agree. but i think it's much as the public health field and professionals want it to be, structural. there's a lot of individuals, especially in this country, who think very individualistic. we think only for themselves and what they already have, which i think, prevents a lot of progress in this field because. we saw it during covid. we saw it in a lot of, i think,

southern in the south. people going again. people that it was going against their freedoms to wear a mask or you know why it turned so political was because individuals believe that their freedom and their rights were being taken away from them. and so i think as much as want to progress in a structural manner, i feel like there's a lot of individuals who are also pushing back against that, which is preventing so much progress from happening. sure. absolutely. yes. there's another hand couple more hands. yes. like bridging like the answers that were given before. i feel like social media plays such a big part in this because like for like people are speaking out about how they felt like their freedoms were being sort of like gone against with the application of mass and everything and vaccines. but then you can also at how marginalized communities have used media to bring more attention on like the issues that they face. and so i feel like it's just kind of splitting both ways to both like a structural approach to medicine, but also an individual approach to medicine.

absolutely. okay. i saw some other hands to the individual. i think a big shift that like we've seen, especially in our generation, is that the focus on mental health and looking at your lifestyle a whole person. so i definitely think that we'll have these great shifts structurally going back to really like what do i individually need to succeed and to help these structural aspects. so looking back on mental health issues and what i need to do in my life to ensure like i can help others as well. absolutely. an individual focus, but all for the effort so you can contribute the common good. i like that. i think, i saw another hand. yes. i was just going into a structural component as health and health terms and into political and just public fields. we're at a time where the entire population has to vote for health matters. it only affects a certain subgroup, whether it's people of lower income or women but now everyone has a say towards what health restrictions, health

commodities will be allowed. mm okay. so if i correctly, you were saying that we live in an era where the masses making are voting to make the decision for health decisions for specific populations. is that is that a good summary? yeah. okay. yes, absolutely. fantastic. and i saw another hand actually insight. so can you repeat, was that a vote towards structural determinate focus or individual level focus? i would say structural impact it's no longer seen as necessarily like a scientific sphere and out of the public sphere of public and political and but yes. okay, i see. yes, yes. my fearless. go to another question from lindsay. what do you think will be the single important public health threat in this century during your life? it's all about what where are we are going? we have heard a lot of issues that may be new pandemics. who knows?

but what do you think is the single most important one? got to two hands back here. yes, i think it's going to be change. you know, you have refugees if you have adverse health effects from climate change, smog, pollution, things like that. our one vote is for climate change. the earth right next to. i it i guess i kind of like the question differently. i would say ignorance and indifference to people's issues because. if you're not like voting is such a big part of like what public health will be. and if people aren't taking into account, the issues that other people in their community are facing, then there won't be any progress for the different marginalized communities, which is probably like the highest concentration of health issues, like where those lie both excellent. the first one is the one that i had on my mind. but the second one of course strongly influences how we can cope with this because there's still important, influential

people who question if there's really a climate change that will drive us into crisis. just again, yesterday at the world economic forum, the new president of argentina, he says there is no plan, the crisis. so with this backdrop now, what do you think in terms of public health versus medicine? what will really us in this century? i think that any i think that i'm definitely in the mindset that structural with the health care system, whether globally or locally will the biggest impact on individuals. i think that we are we have done so much work on individual health that now it's time to make those fundamental changes in society. absolutely. so a vote for structural. other thoughts. yeah, i think i would build that. what again, excites me most and really gets me jazzed is trying to think through how we can

marry individual interventions and continue medical technology advances right. that continue our in precision medicine things like that and marry that with equal emphasis and focus on these structural determinants of health to try improve health for all. and it's big and it's challenging. and when you're talking again about distribution of resources, like there are only so much to go around. but i maybe too optimistically, but i don't think so. right. i optimistically have and. curt so my last slide. but that's good but that's perfect. we talked what were we the 20th the 21st century taught public health issues and successes that we would hope so. we want to address climate change. what are what other topics that you hear a lot the news related to public health right now that face our generation i don't. conflict with war.

yeah because not only to make climate change but it reduces your access to water medical facilities. absolutely so the impact of war on the environment in addition to the access to resources, clean water, food, medicine, right. the supply chain impacts and also the impacts on mental. you mentioned mental health a little while ago, and i'm hoping we're going to have a guest lecture from a fantastic here on campus later in the semester who looks at the implications of war on children's mental health and who are really doing really great work across the world. so i hear war, heard climate change. i think you mentioned mental health as an example. a while ago i get out onto the mental health part of it, i feel like we're kind of in a generation where we're shifting from just treating mental health issues after some things already happened to the more preventative stage of where people can now go get therapy, bring it up because it's a little bit more stigmatized. yes, absolutely. so building on kind of these lessons of prevention that we've

talked about throughout centuries, there has been a shift or maybe an add on, i think, in mental health care, in trying to figure out how can we promote mental health, healthy mental health outcomes. absolutely. and prevent mental health concerns. yes, i think something is just emerging right now is the rise of disordered eating, especially our generation and traditional the like. physicians don't really understand and like why disordered eating really occurs, like how to treat that as a mental issue as well as a physical. and i think that's something like in the decades to come, people will have to do a lot more research on and like how to help people have a diet that fits them and like the issues that they face. absolutely. so bridging a lot of what we talked about with mental health concerns and physical health concerns in disordered eating. mm. i think addiction is going continue to be a large health

issue, especially with like the rises in overdose from fentanyl. oh, absolutely. yes. i think poverty and homelessness is going to get overshadowed slightly because it's a past event. i think that if we don't put enough effort into it, it's going to continue grow. whereas like if we can satisfy the past and complete all of our past problems, then we can move into the future, which is like climate change. yes, absolutely. so homelessness before before you we heard definitely the opioid epidemic is a major issue of our time. so now i just want to rephrase this question just a little bit with the focus on this slide. again, because because you talked about if we don't address this, right, the is going to become overcrowded, shadowed and have major public health implications. what do you hope or what do you think will be the biggest success of your generation?

yes, i think overcoming the barriers education system and the children's hospital going across the success iso. awesome. so there's a both and our biggest successes that we're going to increase access to childhood across the globe which we know education is linked to health outcomes. so it would be a major win for public health. absolutely. yes. i hope i hope that there will be more representation for generation in office and people a part of this generation who have a say in policies we put in place to help the public health world that we live in. absolutely so can i. so better representation in office and voices a better representation among voices who are making policy decisions that influence public health in the effort for to towards health equity is that is that the general. yes. yes. so health equity increased representation.

absolutely. a vote for that? yes i would like to see a more widespread communication just because social media is so accessible, like tiktok is the new google. so things like that that are more accessible to more. absolutely. so we talked a lot about or even i would say during the pandemic kind of misinformation was was kind of the highlight. right. the news story. but on the side of that, you're right. i think we're going to look back and see what a growth in access to we had. and so we have to learn how to sort through it. right, and identify what's credible. but there has been a ignore mis boom in access to information and that's going to have extreme implications on public health. fantastic any. yes, i'm going to hope that in this century we're able to provide for us gun violence. yes, absolutely. so particularly the united states.

your hope is that we are the generation that addresses violence. absolutely absolutely. yes. although that's driving motivation for access prevention. absolutely. so you see promising interventions growing right now to control, control and address addiction. absolutely. and so that's your hope for. the big success, i think we've already seen this a little bit, localization of medical care and hoping we can make sure that people are dying in lower income countries from diseases we've prevented and higher income countries absolutely. okay. so bringing back to global health again. right, which that's the focus of this semester. absolutely. so how can we address diseases in income countries like a lot

of infectious diseases? right. like cholera that we mentioned earlier today. right. so how can we address those in those areas and that we've already addressed in higher income countries and we're going to talk about this. epidemiologic transition when we talk. i think i think in our epidemiol do lecture about how you see that transition in disease in a country and as you move from kind of a lowering some status with more unstable infrastructure to higher income countries how you see this shift from communicable disease to what do you think some of the leading causes of death in income countries are. i'll just go ahead and tell this one because i don't know that you'll pull up, you'll get this answer just out of your hat. but non-communicable diseases, right, like cancer, heart, lung disease, right. as we're living longer as we're not dying from infectious disease at younger ages, you see

all these non-communicable diseases creep up. yes. i'm surprised that i didn't hear anything. the latest hype in terms of potential successes for, the 21st century, what else is in the pipelines and may have an important impact on individual medicine and public and the relation between the two during this century century. sure, you're all talking it daily. weight loss drugs was, i guess just. yeah, yeah, yeah. certainly it might be everybody knows i artificial intelligence can it used for public health we'll find out and we're on the way finding out. all right so last quick question. what do you think you can do to promote public health? we are talking it's kind of

tough if it works, if it works that the disease didn't happen right there, the major event didn't happen. so how do you promote public health. yes, i think kind of the history where people in world past, i think that like kind going back to like what this lecture is about, like learning from history, i feel like it's one of the best ways to improve future. you know what? i think that's the best way we could up our history lecture that i could even think of, learn from history. absolutely. and point to our successes not only in the 20th century, but the centuries before that. right where we started, before the 1800s. what worked what didn't work and try to bring that to today's context, fantasy stick. any other thoughts. yes i think as you were moving

beyond just educating those around us, but also living our lives a way that promotes the common good and so taking that education and or knowledge and putting it into action in a way that others can and also see. oh, i love that and it actually serves as a great transition. my last slide because we are here at a jesuit institution, right. and so we are all taught to be men and women for others right here at boston college. and we're rooted our jesuit ideals here. and so one of the things that i like to think about, added jesuit institution is, how can i mirror these catholic these seven themes of catholic social teaching and my public health approach right? how do i give a preferential option to the poor when i'm thinking about public health policy? how do i promote solidarity and build to promote health in our global society?

how do i promote care for god's creation? so i always love to come back to these seven themes when i'm thinking public health and final thoughts or questions, you all were absolutely fantastic. thank you so much. have a great weekend