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There have been many historical markers in the development of modern society, but there is one in particular that stands out to me as its most influential factor in public Health prior to the 20th Century: the Code of Hammurabi.
Written by the Babylonian King Hammurabi, who reigned between 1795 and 1750 B.C.E., the Code of Hammurabi is one of the best preserved examples of Mesopotamian society and policy as well as one of the oldest sets of laws to have been found. It has inspired numerous legal codes, thus providing some of the basis for the construction of the social framework we know today. It covers legal regulations in free trade, taxes, accounting, capital punishment, legal problems such as robbery, kidnapping and adultery and, of course among many others, medicine and healthcare. In the code there are drastic punishments for doctors, executions in case of death, wounds, worsening of a disease or losing an injured. Despite the penalties being extreme and, in many cases cruel, they maintained Mesopotamian order and worked towards justice for all.
The developments of the medical and health professions are framed within the knowledge and implementation of codes that govern the practice of medicine; all the activities and attitudes of the physician, especially those that border the limits of morality, values and ethics with defined human principles. One could say that medical and surgical practice is regulated by the Hammurabi Code (minus the cruelty, of course), which also includes the first regulation known for professional practice. The control of the surgeons was particularly strict at that time, establishing remuneration and sanctions for treatment errors as well as compensation to patients injured during treatment. In essence, the government regulated the doctor's behavior and the sanctions could even lead to cruel physical punishments. The Code of Hammurabi serves as proof that even in ancient times the medical profession (in its many variations) not only existed, but its members performed some operations for which they were subject to higher standards and stricter regulations.
Regulations are a series of measures that seek to ensure the welfare of a country's production, its own economy, the environment and, of course, health among the population, while seeking to establish adequate and necessary guidelines so that the products and services offered to the population have the quality and security they deserve. It’s quite common to use the concept of order in this sense as opposed to chaos, referring to the first as one of the ways to achieve progress and growth, especially when applied to different areas of our lives and to those of great concern to public health such as in the case of control of infectious diseases.
The need to establish a regulatory body for control of infections has been recognized in the United States since the mid-1950s. It’s a national priority, represents a set of related activities that allow the permanent and dynamic study of behavior and other factors of diseases, and to obtain knowledge of the health status of the population, in order to establish measures of prevention and control of illnesses. The establishment of a body responsible for the control of infectious diseases is a highly significant marker in public health in the 20th century, as it influences the decrease in morbidity and mortality rates, and is one of the many contributing factors of increased life expectancy.
The epidemiological surveillance and control of infectious diseases guarantees a better quality of medical care, by allowing the application of norms, procedures, and other multidisciplinary approaches for the early identification and study of infections. It’s a support instrument for the functioning of health services and programs that are offered in hospitals. In the United States, the Center for Disease Control (CDC) is responsible for identifying, investigating, preventing and controlling infections, and carry out epidemiological surveillances based on established guidelines.
Health goals in the United States, however, should not be limited to reducing the prevalence or incidence of diseases, however, or even improving health services, but also aim at reducing health inequities, by including health as part of all health policies and the understanding that health is both a component and a crucial factor for the sustainable development of a population. It will have to be translated into quantifiable goals that guide governments and people towards universal health coverage and the reduction of all inequities in health access and outcomes.
Inequalities in income levels as well as in opportunities and access to social services are still existent. It’s possible that the most important milestone in health policy in other countries, and one in which we’re way behind and falling, is universal healthcare. A strong social implementation, universal healthcare, is perhaps the "most powerful" instrument to balance a society, especially in times of economic crisis which are generating a lot of inequality. Universal health coverage is essential for efforts to reduce social exclusion in the United States and increase access to its citizens. This opens a new opportunity to place people at the center of development while taking into account their determinants of health. It is based on the needs of individuals and communities, while addressing the disparities and promoting justice for all.
- Check out Historical markers in the development of public health. Which event stands out to you? Why?
- Which advancement would you consider the most important out of the Ten Great Public Health Achievements in the 20th Century? Why?
- What do you think is the most prevalent public health issue we face today? Comment below!
Thanks for reading.
Achievements in Public Health, 1900-1999: Control of Infectious Diseases (1999 July 30). Morbidity and Mortality Weekly Report. Center for Disease Control. D.O.I.: 48(29);621-629 https://www.cdc.gov/mmwr/preview/mmwrhtml/mm4829a1.htm
Crittenden, Crista. Lesson 3: The History of Public Health and Health Promotion [Module] (Spring 2018). The Pennsylvania State University - World Campus. University Park, PA.
CDC: The Top 10 Public Health Achievements in the 20th Century (17 Jan 3). Berkeley Wellness. http://www.berkeleywellness.com/healthy-community/health-care-policy/article/cdcs-top-10-public-health-achievements-20th-century
CDC: The Top 10 Public Health Achievements in the 20th Century (17 Jan 3). Berkeley Wellness. http://www.berkeleywellness.com/healthy-community/health-care-policy/article/cdcs-top-10-public-health-achievements-20th-century
Gidey, Gebrezgi; Taju, Sadik; Hagos, Ato. Introduction to Public Health (2005). Mekelle University. In collaboration with the Ethiopia Public Health Training Initiative, The Carter Center, the Ethiopia Ministry of Health, and the Ethiopia Ministry of Education. Pages 19-39. https://www.researchgate.net/publication/282182986_Introduction_to_Public_Health
Unnatural Causes [Documentary]. Fortier, James M. California Newsreel and Vital Pictures, Inc. (2008). Kanopy. https://pennstate.kanopystreaming.com/video/unnatural-causes-series
The Evolving Role of Public Health [Interactive Timeline]. Roots of Health Inequity. National Association of County & City Health Officials, and the National Institute of Health. http://rootsofhealthinequity.org/public-health-timeline.php
