(an experiment in live conference blogging)
We've been in Puerto Rico for days, and the meeting proper is finally getting underway. Yesterday was CE day, and the welcome reception. Now the meeting is opening with Dr. Angel Roman-Franco, who is on the faculty at the School of Medicine here. Notes on the history of public health is his topic.
He starts, in the idiosyncratic way that he promised, talking about our relationship to bonobos and chimpanzees. He says that's where public health really starts -- "primates know how to deal with their diseases."
All great civilizations began around great rivers -- he starts with Egypt. They were great builders. And it was there that they first encountered the problem of public health. He tells of referring to the Edwin Smith Papyrus to find cases to use to teach his current students.
Building the pyramids was an organizational and logistical nightmare. And you must figure out how to manage infection and other diseases. There were many accidents in this setting. The average lifespan was 30 to 35 years.
The Egyptians also gave us geometry ("Egypt" means "the measured land"). Imhotep, one of the architects of the pyramids, was also the first physician in history.
Neither the Egyptians nor the Greeks ever developed the arch -- the Romans did, however, which enabled them to build the great aqueducts, with which they could deliver fresh water widely. Delivering clean water continues to be one of the major public health problems we face. Physicians treat illness; they don't prevent illness. The solutions to public health problems are in the hands of engineers and government officials. In Rome, the senators had to pay for public works -- Caesar did not. The first public libraries in history were in the baths of Rome. "I was recently asked by our librarians," he says, "how to bring people back into the library." The room erupts in laughter...
As the Romans built great aqueducts to bring water in, they always created the sewage systems to take the waste away -- these are the two fundamentals to public health. (Unfortunately, the Romans drained their waste away in the Tiber.) The world did not see water distribution systems as advanced as these until the London of the 1800s. Constatine closed the public baths, and hydraulic engineering disappeared for centuries.
"Let me turn now to children. In the past, children had no social value." Because of the rate of infant mortality, people had to inure themselves -- you couldn't allow yourself to invent too much emotional energy into children because so many of them did not survive. Blake's poems, Songs of Innocence (1794) are the first poems in western civilization to speak of children. It was a cry for social justice.
Child labor laws did not exist -- and still do not exist in some places. And he shifts from children exploited for labor, to children exploited as soldiers around the world. This is a public health issue!
Moving on... the balance of payments problem brought on by huge purchases of tea, led England to sell huge amounts of opium to the Chinese, leading to addiction. The convergence of tea and sugar led to slavery in the new world.
Today, we have new emergent diseases and the threat of bioterrorism. And perhaps the most dangerous -- avian flu. 150 million people are expected to die when the pandemic hits. This will be a public health catastrophe as dire as slavery was, and as child labor was. This morning CNN is reporting further extension of avian flu to other countries. Soon it will be on our shores.
In closing he quotes Matthew Arnold,
And we are here as on a darkling plain
Swept with confused alarms of struggle and flight,
Where ignorant armies clash by night.