The historical evolution of public health

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CARLOS NETO, Daniel [1]

DENDASCK, Carla [2]

OLIVEIRA, Euzébio de [3]

CARLOS NETO, Daniel; DENDASCK, Carla; OLIVEIRA, Euzébio de. The historical evolution of public health – Multidisciplinary Core Scientific knowledge Magazine – Vol. 1. Year. 1. March. 2016, pp: 52-67 ISSN:0959-2448


It is found in the earliest historical records, the constant search for man's pursuit of curing their illnesses. One of the first records about the practice of medicine through the Bible itself, where in addition to mentions of individuals search for cures for their illnesses. Meet the historical evolution of health, especially public health, it is essential for them to understand the phenomena that are part of the contemporary table, looking like that, through this recognition taking lessons that enable administrative strategies and/or Resolutive to what is as "health care crisis".

KeyWords: Public Health. Evolution of health. History of health.


The concept of health has suffered several interventions over the past 100 years, it was conceptualized from different world views, in a social and historical construction, leaving the simple concept of absence of disease to a broad concept with various dimensions, such as biological, behavioral, social, environmental, political, and economic.

Today, the concept adopted worldwide is the World Health Organization defines as: "a State of complete physical, mental and social, and is not only the absence of disease or infirmity." (Who, 1946)

However, it wasn't always so treated in the course of its historical evolution, because the study here carried out, it was found that the health "from religious through magic design design simplistic absence of disease, until you reach the most comprehensive design adopted by the World Health Organization" (CZERESNIA, 2003).

Therefore, the design of which is health suffered several modifications until the current concept more adopted the World Health Organization and seeks primarily to health promotion which is based on the fundamental human right to allow to increase control over their health and its determinants, and the health of all peoples is essential to achieve peace and security.

Weaving a brief comment about the origin of the term health, this comes from the etymological root salus. In Latin, this term designated the main attribute of the integers, intact, intact, and the Greek term originates salus holos, in the sense of wholeness, root of the terms holism, holistic. In other words, this term refers to all.

Once defined what is health, is of paramount importance to understand its historical development in the world, because as already stated earlier, health suffered religious, social and economic interventions. And to understand the approach of health is at the present time it is necessary to know its history, since what you see today is the report of contemporaneity and which has its roots in were very old. Pointing such importance on the history of health and disease it is noted:

That health and illness are something more than biological phenomena; that around the care, control mechanisms and cures are relevant dimensions of the history of health and disease and that th[…]e health-disease process relates not only to the healthiness or unhealthiness of our countries, but it is revealing, constituent and trainer of crucial aspects of modernity and the social, political, intellectual history and culture. (HOCHMAN; XAVIER; PIRES-ALVES, 2004, p. 45)

Assuming the premise of health as a religious concept, it can be said, then, that the concern about health in a collective way, came with the first epidemics that affected a larger number of people, causing it to think the cause of them. In the Bible, has records of diseases, such as leprosy (Hansen's disease currently), which affected the lives of many people in the time before Christ, bringing the concern of isolating lepers to avoid contagion from the rest of the population, because they understood that the disease was contagious, as it was seen as a divine punishment. Note:

Leper is that man is filthy; the priest shall declare totally filthy, in your head has the plague.

Also the robes of the leper in whom the plague is, will be torn, and his head will be discovered, and will cover the upper lip, and shall cry: filthy, filthy.

Every day in which the plague there is in it will be unclean; filthy's, dwell alone; your home will be outside the camp. (LEVITICUS 13:44 -46)

In this conception of religion, still in the middle ages, the Church exerted great influence on politics and consequently with respect to health. Because, following the biblical teaching above referred to, the disease was treated as a divine punishment and patients were isolated. However, this conduct to isolate patients ended up delaying the scientific advances in the field of health, as proved just the lack of treatment of the population, as shown in Sevalho vision (1993, p. 5):

In the middle a[…]ges houses to assist the poor, shelter to travellers and pilgrims, but also instruments of separation and exclusion when served to isolate patients from the rest of the population. One of the basic values that involved the existence of hospitals in the medieval period was the charity, because caring for the sick or contribute financially to the maintenance of these houses meant the salvation of the souls of benefactors.

However, this understanding of divine grace came to be questioned with the appearance of new diseases, causing some scholars to believe that diseases could pass from one person to another and starting the idea that there are ways to prevent disease, as Sevalho points out (1993, p. 5):

In the year 1300, the time of the black death, an Arab doctor reported that the disease could be contracted by contact with patients or through clothes, dishes or earrings (Sournia & Ruffie, 1986). Anyway, in the medieval Christian world view, was the fear that the disease contextualized printed. The feeling that should be kept at a distance, the necessary removal of unknown danger sensed, fear of suffering and death.

After that was the Church's domain, then the phase of rationalism and scientific breakthrough, it is called the enlightenment. During this period, along with science, the knowledge of the health field had a huge breakthrough, this is because "the human being that accompanied the birth of modern science was Conqueror and owner of nature, no longer your participant and observer harmonious. This paved the way to therapeutic interventionist practices ". (SEVALHO, 1993)

From this more rational vision of the disease, it was possible to think of ways to prevent epidemics of the time. With the release of scientific research during this period, major discoveries were made as the way to prevent some diseases and contain contagion. One of them were vaccines which represented a milestone for the prevention of tuberculosis, tetanus, meningitis, a disease that in remote times were able to decimate populations.

It has been during this period also the discovery of the first microscope.

With the arrival of the Enlightenment, anticipated the emergence of capitalism. Capitalism by starting the factories, generating jobs extremely exhausting.

Consequently, there were urban centers, social inequality and the lack of structure in these centres. As is pointed out:

The serious social problems of the early industrial capitalism, the disastrous conditions of life and work, generated by the formation and growth of urban centres and the growing need to expand the industrial capital, at the expense of the exploitation of the workforce and of poverty. (SEVALHO, 1993, p. 6)

In this manner, surge, from then on, the influence of social context on the health of the population, for the disorderly growth of the cities and of the nuclei of workers not always had the most perfect condition of housing, basic sanitation, proper treatment of water. And with these serious social problems began to worry about the influence of living conditions in the health of the individual.

Then, realizing that social issues influenced health conditions of the population, and for the first time heard the term social medicine, as Sevalho (1993, p. 6):

A penetration of medical knowledge in the field of social environment, applied to the panorama of Germany and France's mercantilist of 18th century and the incipient capitalism of the 19th century industrial England, gave birth to the social medicine in the interweaving of three movements from Foucault (1979). The police German doctor, a medicine that compulsory measures for disease control, the French urban medicine, remedial of cities while spatial structures that sought a new social identity, and, finally, a medicine of the work force in Britain, where industrial had been faster development of a proletariat. These moves came to social medicine, driven by the revolutionaries of 1848 and their prospects for economic and political reforms, as a speech about living conditions, about the kind of socially organized by capitalist conformed by the Industrial Revolution due.

And social medicine would be duly registered in the middle of the century, as it is said:

Furthermore, only in the mid-19th century, in 1848, the term social medicine would win record. Arose in France and, although the General concomitant took hold of Europe, in the process of fighting for the political and social changes. (NANI, 1998, p. 108)

However, after this period the emergence of capitalism and with the new findings as to the existence of germs, have given rise to new forms of understanding the disease, as the "theory of causation" of Louis Pasteur.

And was the left of these new discoveries and new concepts of social disease that health became focused on biomedical disease and not the individual, as it analyzes Nunes (1998, p. 109):

It was only from the second half of the 19th century, marked by investigations of Pasteur and Koch, that inaugurate the Era of germ, and that would transform dramatically medicine "a people-oriented profession for disease-oriented."

As Salomon-Bayet (1986, p. 12), the biomedical revolution brought about by the work of Pasteur can be called "lapastorization of lamédicine" that distinguishes it from "lapasteurization of lamédicine", in the sense that it means, on the other hand, a eórica revolution and, on the other, the medicalization of society, legislating on public health, institutionalizing teaching and acting politically and socially. Without doubt, the discoveries of micro-organisms will be of the utmost importance to public health, especially when, in addition to the individual agent relationship, established an epidemiological model as an interaction between these two elements and the environment.

From that moment there was a decline of public health, concern with the social context and the living conditions of the population.

However, over time the alternative health and holistic (whole) health again defended by many health professionals. To do so, treat health as a positive concept and not just as a concept of absence of disease, as the more classical definition of public health in the year of 1920, see:

Public health is the science and art of preventing disease and disability, prolong life and develop physical and mental health, through organized community efforts for environmental sanitation, control of infections in the community, the education of individuals nosprincípios personal hygiene and the organisation of medical services eparamédicos for the early diagnosis and early treatment dedoenças and the máquinasocial improvement that will ensure cadaindivíduo within the community, a standard of living adequate for health àmanutenção. (WINSLOW, apud ROUQUAYROL 1920; ALMEIDAFILHO, 2003 p. 29)

And finally, in the year 1946, the current concept of health proposed by the World Health Organization, as had been exposed.

From the who concept, in the 70, in Latin America, raised the importance of the social sciences in health approach. Reason were organized conferences, like the one in Alma-Ata and the Ottawa Conference, to think about strategies to improve health worldwide promotion and reach the full physical, mental and social.

Among what was agreed in the Declaration of Alma-Ata (1978) is mainly:

  1. The achievement of the highest degree of health requires the intervention of many other social and economic sectors, in addition to the health sector

III. The promotion and protection of the health of the population is essential for sustained economic and social development and contribute to improving the quality of life and achieve world peace;

  1. The population has the right and duty to participate individually and collectively in the planning and implementation of actions;

The concept of health has suffered several interventions over the past 100 years, it was conceptualized from different world views.

  • first the duty of the State to ensure the health through the formulation and implementation of economic and social policies that aim to reduce risks of diseases and other diseases and in establishing conditions that ensure universal access and equal to the actions and services for its promotion, protection and recovery. (BRAZIL, 1990)

You can see clearly that the Brazil adhered to the concept of the health World Health Organization of the search for complete wellness, physical, mental and social, as in art. 3 of law 8080/90 lays down that:

Art. 3 levels of health express the social and economic organisation of the country, taking the health as determinants and conditions, among others, to food, to housing, basic sanitation, the environment, work, income, education, physical activity, transportation, recreation and access to essential goods and services.

Therefore, we can conclude that the current Constitution was crucial for the recognition of the right to health as a social right and crucial to the entire population, guaranteed, because as he studied for a long time health assistance was provided only a portion of the population.


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[1] Post doctoral candidate in Clinical Psychoanalysis, and master in Bioethics, Director of the Center for research and development of advanced studies, Coach, and teacher of MBA courses in company, Campinas and São Paulo-email:

[2] Lawyer. Of academic medicine. PhD in public health. Executive Mba. Specialized in Applied health services. Graduation in family health. Audit specialist. Email:

[3] Biologist. Master in biology. Doctor of medicine/Tropical Diseases. Researcher of the Graduate program of the Center for Tropical Medicine of the UFPA. Professor in graduate level and post-graduate and researcher at the Federal University of Pará – UFPA. Email:

Theologian, PhD in Clinical Psychoanalysis. Has been working for 15 years with Scientific Methodology (Research Method) in the Scientific Production Orientation of MSc and PhD students. Specialist in Market Research and Research in the area of ​​Health


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