History of Public Health

Community life has been at the center of public health throughout its history. Many major health concerns deal with community characteristics and conditions. For instance, the control of disease, the conditions of the physical environment, the quality and supply of water and food, medical care, disaster relief, and support for disabled or less wealthy citizens are all factors dealing with community health. Interestingly, these community health factors were addressed in civilizations dating as far back as 2100 BC. Community cleanliness and hygiene were important to Egyptians as early as 4500 years ago. Egyptian neighborhoods would “purify” the city by cleaning buildings inside and out, disposing of waste, and carrying out health ceremonies to rid the community of diseases.

The major health problems that we face today are very similar to the health problems humans encountered thousands of years ago, such as sanitation, spread of disease, and disaster relief. Although humans have experienced health problems all across the world and for thousands of years, some communities are affected differently by health problems. Throughout human history, societies that have focused on community health have been more successful at creating living conditions that protect the health and well being of its citizens. Researchers have found that these communities are usually more capable of controlling diseases, preserving water quality, and withstanding natural disasters. Longer life expectancy and lower infant mortality are usually the outcome.

Greek literature discussed the importance of healthy communities and environments as early as 400 BC. Hippocrates wrote that “ill-health developed when there was an imbalance between man and his environment." In his later book, Airs, Waters and Places, Hippocrates discussed the relationship between environmental factors and disease. He talked about how water and air quality, diet, and weather can affect the spread of disease.

Over 2000 years later, public health is still rooted in the community. However, there have been major advances in modern public health. Between 1880 and 1900, scientific investigators discovered a variety of pathogenic diseases, from typhoid and malaria to the plague using laboratory technology, such as light microscopes. The physical discovery of these diseases led to experiments that tested the behavior of these species and the possible treatments for fighting deadly pathogens. Our understanding of contagious diseases was based on the incredible amount of research conducted during the late 19th century and early 20th century. Researchers soon found that mosquitoes, ticks, and rats could quickly and easily spread diseases and used this knowledge to help prevent the spread of diseases, especially in urban environments. The development of vaccines during this time period went far to protect large populations from some of the most deadly diseases.

In the late 20th century, public health policy started to focus on the social factors that increase the risk of negative health conditions in certain populations. Health inequalities, education, and poverty received more focus from health specialists as researchers investigated the significant health differences found across communities. In the United Kingdom, approximately 20% of its health services budget goes to dealing with social and environmental conditions, such as unemployment, poverty, housing, and pollution.

Presently, public health encompasses a variety of different programs. Medical doctors, disaster relief workers, environmental groups, health educators, transportation planners, and public works experts all contribute to the field of public health. The goals of health programs are to protect citizens from health problems and to promote positive health behavior, whether it is through vaccinations or focusing on providing health services to at-risk groups. Most importantly, public health is, and always has been, about the community.

Transportation and Health Part III

One way to reduce the health consequences of traffic is to walk or cycle. Walking and cycling is a form of exercise and studies have shown that there are tremendous health benefits from participating in these activities. Health benefits include—

• a 50% reduction in the risk of developing coronary heart disease
  
• a 50% reduction in the risk of developing adult diabetes
  
• a 50% reduction in the risk of becoming obese
  
• a 30% reduction in the risk of developing hypertension
  
• reduced osteoporosis
  
• decline in blood pressure in people with hypertension
  
• relief of symptoms of depression and anxiety
  
• prevention of falls in the elderly

However, walking may not be something that is convenient or enjoyable. It depends greatly on location. Community planners use the term “walkability” to measure walking conditions in an area. There are a variety of factors that affect the walkability of a specific area. Perception of safety, population density, street connectivity, amount of retail, size of sidewalks, aesthetics of the route are just some of the factors. People want to feel that walking is worth it, so they seek safe and enjoyable routes. The most walkable routes focus on pedestrian traffic rather than vehicle traffic. For instance, larger sidewalks will make people feel safe from vehicle traffic and also increase the flow of pedestrian traffic.

Just like the traffic engineers who use Level-of-Service (LOS) measurements to assess the quality of roadways, community planners use Level-of-Service measurements to assess the quality of pedestrian routes. These measurements are often based on whether routes are convenient by looking at how routes connect with each other. Planners look at how easy it is for people to get from one destination to another. Planners also look at how dense pedestrian traffic is and whether sidewalks are providing ample amount of space for a good flow of traffic.

One popular walkability measurement looks at how far someone would have to walk to retail areas, schools, parks, libraries, and other sites. The website, walkscore.com, uses this measurement to assess how walkable an area is on a scale of 1-100. Downtown Sarasota is considered a “Walker’s Paradise,” with a score of 95 (depending on which area of downtown). However, the score drops significantly in the neighborhoods surrounding downtown. On Fruitville and Tuttle, the walkability score drops to “Somewhat Walkable” with a score of 52. This is a neighborhood that is just 1 mile away from downtown. Most dense suburban neighborhoods have a walkability score in the 40s and 50s, especially if retail plazas are nearby. Some areas of the county have a "Car Dependent" rating in the low 30s. Desoto Road and 301 received a 31. So, while many areas of downtown are highly walkable, the vast majority of residents are not in a highly walkable location.


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Walking and cycling make you active and provide numerous health benefits. However, for walking and cycling to be a major form of transportation, people need to have an environment that is walkable. This includes higher quality sidewalks, more convenient bike and walking trails, and community planning that focuses on the pedestrian.

More information:
Pedestrian LOS

Transportation and Health Part II

Transportation deals with environmental health in many ways. One of the most obvious ways is that traffic creates noise. Noise also creates problems. Noise pollution can easily cause stress and frustration for individuals. One of the major consequences to traffic noise is disturbed sleep. Not only can it be more difficult for an individual to fall asleep with a lot of traffic noise, but quality of sleep also decreases. Lack of sleep can cause fatigue, depression, and decreased performance. Traffic noise can interfere with memory, attention, and focus. Studies have shown that an increase in background noise decreases the ability for a person to solve analytical problems. Other studies show that aggression increases as noise increases. Aggression and stress can lead to heart disease and hypertension. Some noise pollution can cause hearing impairment. Overall, traffic noise is annoying and people go to great lengths to reduce their exposure to it.

A major environmental health issue dealing with traffic is air quality. According to a major study, traffic increases the amount of “particulate matter” in the air, which leads to “increased mortality, increased admissions to hospital for respiratory and cardiovascular diseases, increased frequency of respiratory symptoms and use of medication by people with asthma, and reduced lung function.” Vehicle exhaust also has health consequences. Studies have found carcinogens in diesel engine exhaust and have found higher rates of cancer among people who work around exhaust fumes. Vehicle exhaust also has a detrimental affect on our atmosphere. Carbon dioxide is a well-known air pollutant that is reported to be one of the major causes of climate change on Earth.

Hundreds and thousands of deaths across the world are attributed to air pollution. Respiratory disease has increased as more and more people are suffering from asthma and bronchitis. The World Health Organization wants stricter standards on vehicles to reduce the amount of air pollution caused by traffic each day.

Our psychological and social health are also tied to transportation in a variety of ways. Traffic can cause stress, aggression, and nervousness. An interesting quote from a study on aggressive driving behavior states, “the car has been described as an instrument of dominance, with the road as an arena for competition and control. The car also symbolizes power and provides some protection, which makes drivers less restrained.” Furthermore, accident victims experience long-term physical injuries, but also psychological problems. Long-term stress from motor vehicle accidents is common, even when there are no injuries from the accident. Some people experience trauma after a major accident, oftentimes having flashbacks or nightmares. A social consequence to driving is reduced social life. Researchers have noted that “close-knit communities have given way to neighborhoods that do not encourage social interaction, and this has resulted in increased social isolation.”

Overall, traffic has serious health concerns – from direct environmental effects to lower quality of life due to traffic noise and stress.

Transportation and Health Part I

In a previous blog post, I discussed the relationship “place” has with public health. I explained that there are many characteristics of a specific location that affect the health and well being of its citizens. In one example, I talked about the role transportation has for providing citizens with access to quality and affordable health care. Transportation has a large role in the health of a community, much larger than just providing health care access to citizens. I will be focusing on the connection between public health and transportation over the next few blog posts. This post will focus on traffic safety while the following posts will discuss environmental health issues and walkability.

Traffic safety is important. Motor vehicle fatalities are the leading cause of death for Americans under the age of 34. The highest rate of driving fatality occurs between the ages of 21 and 24. More experienced drivers are less likely to get into a fatal crash, however, more than 37,000 people each year die from a motor vehicle accident.

A significant proportion of motor vehicle deaths and injuries involve pedestrians and cyclists. Pedestrians and cyclists account for thirty-five percent of motor vehicle deaths and twenty-one percent of motor vehicle injuries.

Many accidents tend to occur in built-up areas where more pedestrians are affected. The highest risk areas for pedestrians and cyclists are on minor roads, especially around intersections. Sadly, schools and neighborhoods are often situated off these arterial roads, putting children at risk.

There are a variety of reasons for why traffic accidents occur. The three major reasons are the road, the car, and the driver. Roadway designs can greatly affect the rate of accidents in a certain area. Some roadways are better designed than others. The space between lanes, the length of merge lanes, whether there is a stop sign or traffic signal at an intersection, placement of traffic signs, posted speed limits, and roadway visibility are just some of the many variables that affect the safety of certain roads. Oftentimes, roadways are engineered exceptionally well, but over time, population growth, nearby development, and changes in traffic behavior put stress on roads and intersections. Interestingly, some transportation planners make roadways more dangerous to decrease risky driving behavior. Two ideas for making Tamiami Trail safer was to decrease the width of each lane or put roadside parking on the Trail in the downtown area. This would slow down traffic and force drivers to be more aware of their surroundings. It is what engineers call “traffic calming.”

Traffic engineers measure the quality of road infrastructures through a Level-of-Service (LOS) assessment that measures traffic flow on an A-F scale, F being the worst rating. Newly designed roads often score an A or B, even during rush hour. However, overtime, LOS ratings tend to drop as roadways reach their capacity. Many of Sarasota’s roadways have a D or F rating during rush hour. Low ranked roads can have serious safety issues, especially to pedestrians and cyclists. Driver stress and road rage increases at lower LOS ratings and many driving maneuvers become riskier.

Cars are often the cause of an accident. Popped tires, breakdowns, weak brake pedals, etc. There are many new car features on the market that have been proven to decrease vehicular accidents. Electronic stability control (ESC) is a newer feature that detects whether a vehicle is exceeding its handling capabilities. If a vehicle were at risk for losing control, the electronic stability control technology would reduce engine power and automatically apply braking power to individual wheels. ESC is only standard on some vehicles and optional in others. Car manufactures are also making vehicles safer for pedestrians in case there is an accident by designing the front-end of a vehicle in a certain way to decrease the force of impact on a pedestrian.

However, drivers are nearly always the primary cause of an accident. Speeding, reckless driving, impaired driving, road rage are all driving risks that the driver can avoid. The most common type of accident in Sarasota County are rear-end collisions. This type of accident is usually caused by a driver who was not paying attention. The most accident-prone intersection in Sarasota County is Center Road at U.S. 41.

Overall, traffic safety is a major concern. Deaths and injuries to drivers, passengers, pedestrians, and cyclists occur too often and can be easily avoided. Traffic engineers and city officials are always working towards improving roadways, car manufacturers are putting a large emphasis on safety features (not only features that protect individuals in case of an accident, but prevent accidents in the first place), and police officers and traffic safety campaigns are being aimed at stopping and preventing bad driving behavior. The life and safety of many residents are tied to transportation safety.

More information:
National Highway Traffic Safety Administration
Pedestrian Safety in Florida

World AIDS Day

Sarasota and Manatee Counties unite for World AIDS Day and AIDS Walk Theme: “Respect and Protect: Together We Can Stop the Spread of HIV and end HIV Prejudice”

To bring renewed awareness to HIV/AIDS and other health issues, Sarasota and Manatee County organizations are sponsoring the 2008 Manasota World AIDS Day Health/Wellness Expo and AIDS Walk. The events will take place on Saturday, Nov. 22 at the Sudakoff Center on the east side of the New College of Florida campus – vicinity of U.S. 41 (N. Tamami Trail), just north of University Parkway. The AIDS Walk begins at 9 a.m. Walkers should register between 8 and 8:45 a.m. that day.


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Following the AIDS Walk, people can receive a variety of free health screenings, HIV testing, and information about community services. The event, which continues through 3 p.m., will include discussions led by local experts to empower parents in talking with their teens about a range of challenging issues. Topics include teen sexuality, rape prevention, HIV prevention, Sexually Transmitted Disease (STD) prevention, teen sexuality, substance abuse, tobacco and kids, and depression/suicide.

There will be local entertainment, door prize drawings, the AIDS quilt display, and activities for families with young children. Students from New College of Florida, and area colleges and universities will offer free activities for youth. The creative work of the bi-county poster contest winners will also be on display. All World AIDS Day activities are free and open to the public, with the exception of the food venues.

The day’s events incorporate the theme, Respect and Protect: Together We Can Stop the Spread of HIV and end HIV Prejudice. “Everyone has a role to play in reducing the impact of HIV/AIDS in our community. Since HIV/AIDS is on the rise among young people, we are committed to empowering parents to help their teenage children make informed decisions about their health,” said John Acevedo, of Community AIDS Network who also serves as the HIV/AIDS Network of Sarasota (HANS) chair.

This event is sponsored by the HIV/AIDS Network of Sarasota (HANS) in conjunction with the World AIDS Day 2008 Planning Committee, a collaboration, chaired by nationally syndicated Health Beat of America radio host Rochelle Herman, that includes New College of Florida, Community AIDS Network, the Sarasota and Manatee County Health Departments, Manatee County Rural Health Services, Trinity Charities, and Southwest Florida Community AIDS Quilts.

For more information, visit www.manasotaworldaidsday.org or call 941-366-0461, extension 1042. For specific information about the AIDS Walk, call Hope Wulliman at 941-224-4999. For information about New College of Florida, call Aimee Chouinard at 941-487-4152 or visit www.ncf.edu.

More information about HIV/AIDS can be found here.

Healthy, Wealthy, and Wise

There are two life factors that have caused me to have a less-than-healthy diet. One, groceries are expensive. Two, I'm a poor college student.

I recently noticed that my grocery purchases have considerably changed. I used to have a nutritionally rich grocery list that I would use every week to find items to stack my pantry with. It was a great list; it would have made any doctor happy to have me as a patient. Over the past several months I've been crossing off more and more items from my list and just going for sale purchases. It means that my diet has become seasonal. During the 4th of July, I purchased packets of hot dogs that were 2-for-1. For the back-to-school sales, I bought a ton of Goldfish snacks that were marked half-off. And now...unfortunately, it's Halloween season and I have had a lot of Butterfingers.

It's not good. My life expectancy was probably cut in half. I'm a college student that is not just hungry for knowledge, but also hungry for real food. I really miss the weekly allowance I got when I was twelve. I also miss the great dinners my mom made. While Hot Pockets might be delicious, they're not nutritious. But, what's a student to do?

Well, I found that there are ways to buy smart. It does not have to be difficult to eat healthy on a budget. While pizza and Chef Boyardee are convenient for any person, regardless if they are a student, there are simple ways to find grocery items that make the most health sense.

First, the downtown Farmer's Market is wonderful. Local vendors provide healthy food that is cheaper and fresher than at many other places.

Health expert, Sally Wadyka, gave a good list of items that are healthy and cheap. Beans, eggs, bananas, carrots, flank steak, sweet potatoes, tuna, and walnuts are very affordable foods that provide for a well-rounded diet.

As a student, I'm starting to find more ways to save on food that my body appreciates, and these two suggestions are just a start. Going from cafeteria food to Whole Foods is not an easy jump with a small amount of money, but healthy eating is less expensive than I originally felt it to be. Fortunately, my healthier diet is returning without the same expense.

Sick Around the World

The United States spends over two trillion dollars a year on health care, which is over 15% of our GDP. Yet, 74% of Americans believe significant changes are needed to our health care system. Countries like Japan and the United Kingdom spend a lot less money on their health care system and rank higher in terms of overall level of health than the United States. How do they do it? What are the costs and benefits to different types of health care systems found around the world?

PBS Frontline investigated health care systems in five capitalist democracies to see what lessons we might be able to learn as more and more Americans demand changes to our health care system. The investigation looks into the cultural, structural, and financial differences of health care systems around the world.

This is an interesting documentary that makes you question health care from philosophical and practical perspectives. It seems that slightly different health care systems can provide huge benefits in terms of access and affordability.

The graphs below compare how much each nation spends on health care to its average life expectancy. While the United States spends the most on health care, it also has lower life expectancy compared to other developed nations.





While we have some of the best hospitals, doctors, and technology in the world, the cost of health care in America is high and many Americans have little or no health coverage.

Frontline looks at the pros and cons of health care systems found around the world to see how other nations provide adequate health services to all of its citizens at lower costs. The Washington Post correspondent and NPR commentator, T.R. Reid, goes to five countries to report on their health care systems. The full episode can be found online here.

A preview of the documentary--

The Candidates on Health Care

Health care has become one of the most important issues this election, consistently ranking among the top issues American's are concerned about. Many voters will make voting decisions based on the health care policies of the candidates. This blog post will focus on providing information on the health care plans and records of the two major presidential candidates.

First, Senator John McCain's health care plan can be found on his campaign web site here. His Senate record and speeches related to health care issues can be found on his Senate web site here.

Your Candidates-Your Health is a voter guide questionnaire that describes each candidate's views and proposals regarding health issues in our country. Senator McCain's stance on these questions can be found on his profile page here.

Senator Barack Obama's health care plan can be found on his campaign web site here. Senator Obama's stance on health care issues while in the Senate can be found at his Senate web page here. Senator Obama's survey responses to the Your Candidates-Your Health questionnaire can be found at his profile page here.

Finding an objective analysis of each candidate's health care positions can be difficult. However, there are a few good sources that have been cited frequently by health experts. One source was cited by an informative reader of this blog. The source is a policy analysis report by the Commonwealth Fund, which can be found on this web page. The report was recently written and provides detailed information regarding both candidates' plans, including an interactive summary comparison. Another great source was found in The New England Journal of Medicine, by Dr. Jonathan Oberlander. The article discusses some of the major philosophical and practical differences between the health care plans of the two major presidential candidates. The full-text of the article can be found on their Election 2008 perspective page.

I encourage readers to comment on this section with links and sources they have on the health care proposals of either candidate. I enjoy reading your comments and I think your posts will create an even better resource of health information for our community.

Below is an Associated Press video of the two candidates talking about health care during the second debate.

Health and Politics

Health and politics are closely tied together in the United States. Our elected officials make major decisions regarding health care in our country. From the creation of Medicare and Medicaid to the administration of Veteran health services, the health of our society is often based on programs and decisions made in our government. Nearly 28% of Americans have health insurance from a government program. However, the government does not just pay attention to health coverage and services. Congress created the Department of Health and Human Services to certify food and drugs through the FDA, prevent disease through the Centers for Disease Prevention, protect our lives from disasters and emergencies, and provide us with information regarding the safety of products we purchase.

Americans are aware of how important government decisions are regarding our health. According to a recent survey, 82% of the public were more likely to vote for a candidate who supported increased funding for health research and 76% were more likely to support a candidate who promised more funding for health care reform. Seventy-four percent of Americans believe that significant changes are needed to make our health care system better with eighty-one percent of Americans believing that our health care system should focus more on preventing illness rather than dealing with illnesses once symptoms are apparent. A large majority of people want increased funding for health care -- from local health departments to federal health service programs.

Framingham Heart Study

The Framingham Heart Study is one of the best studies we have of the major health factors associated with cardiovascular disease. The study started with over 5,000 participants from Framingham, Massachusetts. A substantial amount of health and lifestyle variables were collected about these participants throughout their lifetime. This has provided researchers with a rich collection of data about individuals who developed heart disease.

In addition to factors such as high blood pressure and high cholesterol, researchers have also identified psychosocial factors related to heart disease. Stress, tension, and anger were significantly correlated with heart disease. Higher levels of each variable increased the risk of heart disease. Suppressed hostility was also a variable associated with heart disease. Individuals who discussed their anger and emotions in a healthy way (for instance, talking with friends) were at a lower risk for developing heart disease than individuals who bottled up their negative emotions. A more obvious variable, job work load, was also associated with heart disease.

More information about the Framingham Heart Study can be found here.