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Advances in the History of

the County of San Diego’s

Public Health

 

By Dr. Wilma Wooten, Public Health Officer
County of San Diego Health and Human Services Agency

The impact of public health and what it means to the daily lives of citizens usually goes unnoticed, but over the past 150 years, advances in public health have made a difference in the quality of life for San Diego County residents and the public nationwide.

A child born in 1900 could expect to live into their late 40s, but by 2000 life expectancy doubled, to 80 years old. In the early 1900s, public health was more of a sanitation issue, and keeping the streets free of horse manure was a top concern. Today, Public Health is concerned with promoting health and well-being, prevention of disease and disability, and protecting the public’s health.

HHSA offers a variety of services and resources in areas including:

· Tuberculosis Control and Refugee Health
· Immunizations
· Maternal, Child and Family Health
· Emergency Medical Services
· Epidemiology (investigation and surveillance of diseases)
· Chronic Disease (including Tobacco Control)
· HIV, Sexually Transmitted Diseases (STDs) and Hepatitis

Public health deals with the health of populations, while medicine deals with an individual’s health. Public health primarily addresses preventing disease, or the risk factors that cause certain diseases; promoting health activities; and protecting the public’s health by monitoring the water, air, the environment, even animals, for agents that spread disease to humans.

 In the late 19th/early 20th centuries, state and local public health departments primarily focused on issues related to infectious diseases and maternal and child health. Other issues included epidemics of typhus, cholera and yellow fever; in 1850, a quarantine process was established to combat epidemics of such diseases, and in 1857, the San Diego Board of Health was established.

That year, the local population was just 798 people. But in 1888, the population exploded to 30,000 people. Then, as now, people were attracted to San Diego County’s mild weather and low pollution. Also in 1888, a San Diego Department of Health was established, and immediately tackled new health challenges resulting from the population boom, such as safe food and clean drinking water. The first annual report of the Board of Health emphasized smallpox vaccination, food safety along with sanitation concerns in jails and the county as a whole.
        
Back in 1900, nearly one in 100 mothers died of pregnancy-related complications.  Thirty percent of infants died before their first birthday. In 2000, the population reached 2,813,833; one in 10,000 mothers died of pregnancy-related complications that year.
        
In 1910, heart disease emerged as the leading cause of death nationally and locally. Today, a major public health concern is the “Obesity Epidemic” affecting adults and children. In California, adult obesity reportedly causes an estimated economic burden exceeding $21.7 million.

San Diego County’s public health system has weathered the “Spanish Flu” epidemic of 1918, which killed 368 people locally, and seen advances in disease prevention including the polio, measles and Rubella (German measles) vaccines.
Many of these events support significant achievements in public health.  Some of the top achievements of the 20th century were:
· Vaccinations,
· Motor-vehicle safety,
· Safer workplaces,
· Control of infectious diseases,
· Decline in deaths from coronary heart disease and stroke,
· Safer and healthier foods,
· Healthier mothers and babies,
· Family planning, and
· Recognition of tobacco use as a health hazard.

Today’s public health system must address an array of new challenges, including chronic diseases, mental health, substance abuse, traumatic injuries, and environmental and occupational health, not to mention recent  concerns such as bioterrorism. Notably, events of 9/11 and the 2001 anthrax attacks have increased the visibility of public health, resulting in a focus on security issues.

The future of public health will focus on new agendas, while preparing for coming epidemics. While past events and accomplishments in public health have improved the health of our nation, there are opportunities to make significant strides to address the health of the world.