Anoop Raman - Global History

The Plague!

Symptoms?

Response?

Impact?

Parasite? Vector? Reservoir

1 out of 3 people - dead.

Lymph nodes

Bleeding

Death

City-states with 1st Public Health Boards

Ships dock for 40 days before unloading

Yersinia Pestis

Flea

Rats

Columbus "discovers" America

Columbian Exchange

Eurasia--> Americas :Measles, smallpox, influenza, mumps, typhus, and whooping cough, among others

Amer--> Eur: Syphillis

1913

Rockefeller foundation -- The First real non-king "Super Philanthropist"

Founded 1st Schools of Public Health

Harvard & Johns Hopkins University .

Also... who founded our School of Public Health?

World War I

Massive death.

League of Nations founded in aftermath, but... US doesn't join. Why?

1918- The "Spanish Flu"

Impact - Deadly

Fascinating:

Why SO deadly??

Why the name?

-Surgeon General of the U.S. Army and the Journal & AMA recommended very large doses of 8 to 31 grams of aspirin.

-

Caused by the H1N1 influenza A virus. (Viruses were discovered in 1930s!)

Thought to trigger a cytokine storm, which ravages the stronger immune system of young adults...

Also: malnourishment, overcrowded medical camps and hospitals, and poor hygiene, all exacerbated by the recent war, promoted bacterial superinfection

500 million people – about a third of the world's population at the time

death toll is anywhere from 17 million to 50 million-- one of the deadliest pandemics in human history

affected the young more because older people thought to have been exposed to h1n1 like strain during an earlier pandemic

Pandemic spread to Spain from France November 1918.

-Spain was not involved in the war, NO imposed wartime censorship.

Newspapers were therefore free to report the epidemic's effects, such as the grave illness of King Alfonso XIII, and these widely-spread stories created a false impression of Spain

https://www.youtube.com/watch?v=dHGz4QvDVlM

https://www.youtube.com/watch?v=NSLKFwXBdbg

1928

Alexander Fleming discovers penicillin -- from fungus.

Not until 1944... mass produced

1961: JFK

Creates the Peace Corps

Creates USAID (United States Agency for International Development

1969- Family Medicine

Born as a part of counter culture of ever sub-specializing

Specialty to train doctors to care for entire community

(Generalists prior to this, did not complete a residency...)

1971: MSF/ Doctors Without Borders

Goes to war torn nigeria; unlike red cross doesn't ask for permission

dogmatically, apolitical

1978: Alma Ata

International Conf. on Primary Health Care, Almaty, Kazakhstan, Sept 1978.

declared need for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all people . By the year 2000

US funding of WHO cut drastically following this conference.

Malaria Eradication Project

Focused on Europe and Americas-- very successful

Global South -- Africa/Asia/S. America --deemed too difficult to tackle.

Decolonization of the World

Tremendous Pressureson New Governments being formed.

Impoverished citizens

Neighboring Countries jockeying over made-up borders

Former Colonizers & international corporations trying to exert control over natural resources and political processes

1955: Polio vaccine

The 80s

Sex, Pox, & SAPs

1980: Small Pox Eradicated

This was so successful, that people stopped believing they need vaccines

1981: AIDS discovered/defined

Initially, disease with incredibly high stigma- The 4 H's of HIV

• Homosexuals
• Heroin Addicts
• Haitians
• Hemophiliacs

Took much longer to address this pandemic

1980s: Selective Primary Care

Rockefeller Foundation Funds vertical programming- GOBI ... FFF

• Growth Monitoring
• Oral Re-hydration
• Breast Feeding
• Immunizations
• Female education
• Family Planning
• Food supplementation

1982: Structural Adjustment Programs

Mexican & Latin American Debt Crisis. What to do when a nation defaults?

devalue currency

Increase Exports,

Decrease Imports

Decrease Government Spending

Decrease "Consumption",

Increase Production

If not the military, what was government spending on?

1988: Global Polio Eradication Program Started

End of 1980s

8,000,000 people with HIV

1994: Gates Foundation

The next Rockefeller foundation...

1996: Anti-retrovirals developed

only used in developed / 1st world countries

22 million people living with HIV.

1998: Rollback Malaria Campaign started

2000: MDGs

2001: Global Alliance for Vaccines and Immunization (GAVI)

Public Private Partnership to spread vaccines: developing country and donor governments, the World Health Organization,UNICEF, the World Bank, the vaccine industry in both industrialised and developing countries, research and technical agencies, civil society, the Bill & Melinda Gates Foundation

Pros: works quickly to disseminate vaccines.

Critiques:

• Contrasts with the approach typified by the Alma Ata Declaration, which focuses on the effects of political, social, and cultural systems on health.
• Gives private donors more unilateral power to decide on global health goals, prioritizing new, expensive vaccines while putting less money and effort into expanding coverage of old, cheap ones,

More PPPs

2002: Global Fund to Fight AIDS, Tuberculosis and Malaria

2002: Clinton HIV/AIDs Initiative (CHAI) formed

2003: President's Emergency Plan for AIDS Relief

Launched by U.S. President George W. Bush.

PEPFAR has provided more than $80 billion in cumulative funding for HIV/AIDS treatment, prevention, and research since its inception, making it the largest global health program focused on a single disease in history

2015: Sustainable Development Goals

1842: Edwin Chadwick

1842

Asked to find ways to decrease spending on poor.

Sanitary Conditions of the Laboring Population

"The cost of filth is... Widows & Orphans"

1849: John Snow

Founder of Epidemiology...

"on the communication of Cholera

"Broad St Pump"

1849

1850: 1st International Sanitary Conference

1850

• Couldn't agree if cholera was contagious. (Conference of diplomats / politicians, not scientists)
• England opposes formation of 1st International Health Organization.
• Don't regulate my commerce!

1845: Friedrich Engel

"Conditions of the Working Class...."

Also 1845: Ether

1845

first used in surgery by William G Morton at MGH for a tooth extraction

1848 : Dr. Rudolf Virchow

Father of Pathology

1848

Medicine is a social science, and politics is nothing else but medicine on a large scale. Medicine, as a social science, as the science of human beings, has the obligation to point out problems and to attempt their theoretical solution: the politician, the practical anthropologist, must find the means for their actual solution.

The physicians are the natural attorneys of the poor, and social problems fall to a large extent within their jurisdiction.

All together led to Public Health Act of 1848--> revolutionized Public Health.

1860-99

1944

1945-1948: United Nations founded

1945

US does join this time

• head quartered in NYC

(1946- American CDC founded

"Communicable Disease Center" was founded July 1, 1946, as the successor of the Office of National Defense Malaria Control Activities)

1948: WHO founded on 4/7/48, "World Health Day"

• Premier organization for statistics & epidemiology
• "one country, one vote"