3.6: The Modern Era of Public Health

Many advances were made in the mid-19th century in hospital care and record-keeping. For example, a Hungarian obstetrician performed one of the earliest case-control studies and identified that women who were attended by physicians during labor and delivery had a higher odds of contracting “childbed fever” (a streptococcal infection) than those attended by midwives. This was due to the fact that physicians also conducted autopsies on victims of this disease and were in fact spreading the infection due to a lack of handwashing and sterilizing practices. Another example was Florence Nightingale’s work tending to injured soldiers during the Crimean War, from which she and others developed standards for hospital care. She later began the first nursing school, and established that profession as essential to medicine (Tulchinsky & Varavikova, 2014). Mary Seacole, born to a British soldier and Jamaican “doctress” mother, treated hundreds of British soldiers during the cholera pandemic and Crimean War in the 19th century. Her legacy has been largely overshadowed by Nightingale's in the history of nursing (Contributors to Wikimedia projects, 2024).

Treatment of sick and wounded soldiers was one of the priorities of the first of the Geneva Conventions in 1864, an international treaty which also established the International Committee of the Red Cross (ICRC). This neutral entity was created to provide international medical services to wounded soldiers and prisoners of war, and advocate to prevent humanitarian atrocities for both soldiers and civilians in areas of conflict. American nurse Clara Barton provided relief to soldiers injured during the Civil War, and then volunteered with the ICRC during the Franco-Prussian war. Upon her return to the U.S. she founded the American Red Cross in 1881 (Clara Barton, n.d.). During WWII the ICRC was hamstrung by its ties to the neutral Swiss government and failed to provide cohesive action on behalf of Jews during the Holocaust. In 1949, it urged the addition of a fourth protected group to the Geneva Conventions: civilians living in occupied territories. Currently, the ICRC includes the National Red Cross and Red Crescent movements of 192 nations, forming the International Federation of Red Cross and Red Crescent Societies (IFRC). These international and national organizations combined provide emergency response to wounded soldiers, prisoners of war, and victims of disasters, and distribute humanitarian aid across the globe. The symbols used include a red cross, crescent, or crystal on a white background to indicate protection of international law for those providing humanitarian aid (not any religious affiliation) (International Committee of the Red Cross, 2017).

Figure \(\PageIndex{1}\): Clara Barton. (Copyright; NPGallery, Public domain, via Wikimedia Commons)

In 1872 the American Public Health Association (APHA) was established. This association has and continues to: lobby the U.S. government for public health policies, publish well-conducted research in the American Journal of Public Health, and provide education (as well as set standards) for public health professionals. While advocating for federal public health responsibilities, the APHA has long supported state, county, and local control of public health, while still supporting federal assistance. The mission of the APHA is to “improve the health of the public and achieve equity in health status” (American Public Health Association, 2023).