The term "public health" is a broad one. It can be used to describe the literal health of your community or society, or it can refer to the system used to protect, maintain, and improve that health. It encompasses the sometimes controversial idea that everyone has a responsibility in preserving and protecting not only their own health, but the health of those around them.
The American Public Health Association defines "public health" as follows:
"Public health promotes and protects the health of all people and their communities. This science-based, evidence-backed field strives to give everyone a safe place to live, learn, work and play."
Because of the way pathogens evolve, environments change, and public sentiment shifts, maintaining an effective public health system is a never-ending process of study, adaptation, adjustment, and refinement. This has been true of the public health system in the United States as a whole, and here in Alabama as well.
Prior to the 18th century, epidemics such as plague, cholera, and smallpox were often believed to be the result of poor morals and spiritual conditions. Prayer and piety were the widely accepted solutions to these conditions until the end of the 17th century, when it became increasingly common to isolate and quarantine the infected in an effort to stop the spread of disease.
The 19th century brought about a movement known as "the great sanitary awakening." It was marked by the scientific community's identification of filth as not only a cause of disease, but a method of transmission as well. As such, cleaning up and improving shared environments joined quarantine and isolation as primary tools in the fight against disease, and the focus on outbreaks shifted from reaction to prevention. Physicians began to recognize and promote the idea to the public at large that diseases were in fact caused by germs that could be transported from place to place and transmitted from person to person.
This shift helped change how society viewed the general public's role in health. As cities grew and urbanization became more widespread, those who once had the option of isolating themselves from areas where disease was rampant now found avoidance to be a less viable option. As contagious diseases such as smallpox continued to spread through families regardless of their social standing, society was forced to confront the idea that disease was a potential problem for every person, whether they be wealthy, working class, or destitute.
As the 19th century drew to a close, advances in scientific knowledge continued to snowball. Scientists learned that diseases such as anthrax, tuberculosis, diphtheria, and yellow fever come from bacteria, a discovery that paved the way for the development of interventions such as water purification and immunization. By the late 1890s, state and local health departments in the U.S. began establishing their own laboratories to help in the fight against local outbreaks.
These breakthroughs, which set the country's public health system on a path guided by the advancement of scientific knowledge, came at an important time in the young life of the state of Alabama, which had been admitted to the Union as the 22nd state in 1819.
On February 19, 1875, the state's legislative body, the Alabama General Assembly, passed a law recognizing the Medical Association of the State of Alabama as the official State Board of Health. This gave the Board the authority to create and implement a much needed plan that would develop health laws, educational programs, and a "system of hygiene" designed to preserve and prolong life. Today, we consider this development the birth of the Alabama Department of Public Health (ADPH).
The statewide program was modeled largely on the work of cities like Mobile and Tuscaloosa, where boards of health oversaw elected officials in roles designed to promote healthy environments, such as sanitary inspectors and quarantine physicians. These boards also oversaw the reporting of diseases, the recording of births and deaths, and the administering of free medical treatments to those in need.
The primary responsibilities of this new State Board of Health included the investigation of epidemics and the administration of quarantine programs. In addition, the first recognized State Health Officer, Dr. Jerome Cochran, actively pursued a centralized reporting system for vital health statistics, but this was not fully realized until 1908, with Dr. William Henry Sanders serving as State Health Officer at that time.
As the Board became more established and the state legislature began to increase its funding, its programs and services continued to grow. A historical timeline detailing major initiatives and projects is available. Highlights include:
The mission statement of today's ADPH is "To promote, protect, and improve Alabama's Health." The agency's vision is "Healthy People. Healthy Communities. Healthy Alabama." For 150 years, ADPH has endeavored to make it possible for all Alabamians to enjoy the benefits of good health. However, as we move forward and face the known and unknown challenges ahead, it's important to remember that public health is not just a service provided by the government. It is a responsibility carried by the community --- everyone who works together, plays together, and lives together.