International Journal of Noncommunicable Diseases

: 2021  |  Volume : 6  |  Issue : 4  |  Page : 155--158

History of public health-distorted Indian contribution although significant for addressing noncommunicable diseases

JS Thakur, Harmanjeet Kaur 
 Department of Community Medicine, School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Correspondence Address:
Dr. J S Thakur
Department of Community Medicine, School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh

How to cite this article:
Thakur J S, Kaur H. History of public health-distorted Indian contribution although significant for addressing noncommunicable diseases.Int J Non-Commun Dis 2021;6:155-158

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Thakur J S, Kaur H. History of public health-distorted Indian contribution although significant for addressing noncommunicable diseases. Int J Non-Commun Dis [serial online] 2021 [cited 2022 Jan 26 ];6:155-158
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History of public health has developed through various phases. During prehistoric times, most of the ancient people practiced cleanliness and personal hygiene, but often it is argued that it was for religious reasons. Although an association between malaria and swamps was established very early (503–403 BC), the reasons for the association were unclear. In history of public health, the first rational and scientific evidence on disease causation is thought to be during the 5th and 4th centuries BC, when in 460–360 BC, Greek physician Hippocrates described disease as an imbalance in natural forces or an imbalance in humors (or fluids): melancholy, phlegm, bile, and blood. The Hippocratic text – Airs, Waters, and Places – analyzed the environmental determinants of health and differentiated the diseases as endemic and epidemics. Greek medicine always embraced a tradition of combining therapeutic measures with preventive measures.[1],[2],[3] During the 2nd century BC, sanitation reform in the form of piped water supplies, drainage systems, underground sewage systems, and public pay lavatories, is considered an important milestone in history of public health.[1],[4]

During middle ages (500–1500), two major epidemics Justinianic plague (543 AD) and Black Death (1348) occurred along with smaller outbreaks of various other diseases including smallpox, leprosy, tuberculosis, and measles. The concept of isolation of persons with communicable diseases, establishment of hospitals to limit the spread of the disease, and efforts to improve sanitation was given during this period. The 17th century is considered as start in epidemiology, due to work on vital statistics and cause of death by William Perry and John Graunt. These statistics started governments looking at “Health Policy.”[5]

During the 18th century, the population of Europe increased rapidly, and with this increase came a heightened awareness of the large number of infant deaths and of the unsavory conditions in prisons and in mental institutions. During this period, James Lind suggested the use of lemon juice to combat scurvy in seamen.[5]

The 19th century is marked as “The great sanitary awakening.” In 1842, Edwin published “General report on sanitary conditions of labouring population of Great Britain.” Furthermore, Thomas Southwood Smith published reports on quarantine, cholera, yellow fever, and the benefits of sanitary improvements. In 1848, John Snow reported on his findings of an outbreak of cholera associated with the Broad Street pump and this led to establishment of the General Board of Health under the Public Health Act of 1848, to furnish guidance and aid in sanitary matters to local authorities. Since this time, several public health acts have been passed to regulate sewage and refuse disposal, the housing of animals, the water supply, prevention and control of disease, registration and inspection of private nursing homes and hospitals, the notification of births, and the provision of maternity and child welfare services. Similarly, in America, Shattuck report, published in 1850 by the Massachusetts Sanitary Commission, recommended an outline for a sound public health organization based on a state health department and local boards of health in each town. Nineteenth-century developments in Germany and France also pointed the way for future public health action. The last decades of the 19th century, are marked by development of methods for isolating and characterizing bacteria by Louis Pasteur, Ferdinand Julius Cohn, Robert Koch, and others. Concepts of spread of diseases such as malaria, plague, and yellow fever were also developed during this period.[1],[5]

While Western history of public health talks about Greek and Roman practices of sanitation as public health measures, it has largely ignored the Indian contribution. The history of public health in India can be divided into three parts – pre Vedic era, Vedic era, and post Vedic era including colonial period and postcolonial period [Figure 1].[6],[7]{Figure 1}

The concern for environmental health and maintenance of proper public hygiene was deeply embedded in the ancient Indian customs and traditions. Archaeological excavations at Mohenjo Daro and Harappa in the Indus Valley uncovered cities of over 2000 years old which revealed the large roads paved with baked bricks, well laid drainages, aqueducts, private and public baths, other sanitary features of the civic and domestic life. All of this evidence indicate a highly advanced knowledge of sanitation, water supply, and engineering existed even in the pre Vedic period of the Indian civilization (2500 BC).[5]

Tracing back into Indian history during Vedic times, the proponents of Ayurveda such as great saint Charaka and others, have already emphasized three important features of public health, i.e., preventing disease, prolonging life, and promoting physical and good health. The two principle objectives of Ayurveda are Swasthasya swasthya rakshanam and Aturasya vikar prashamanamcha.[8],[9]

The first part of this hymn emphasizes on prolonging the life and promoting perfect health, i.e., add years to life and life to years. To achieve this, Ayurveda advocates various lifestyle administrations, including Dinacharya (daily health promotional activities) and Ritucharya (health promotional activities during specific season), Aahara (specific dietary regimen), Vihar (coordination with mental health-related functioning with the physical and social health), Pathya (complementary to medications), and Apathya (contradictory to medications). Most of these modalities are basically the part of health promotion strategies of the present day which are best suited to address the risk factors of noncommunicable diseases (NCDs) (70%–80% of NCDs are preventable).[7],[10]

The other part of the hymn highlights about curative and preventive health, which means the elimination of the disease and dysfunction of the body. Various therapeutic regimens described in the classical texts of Ayurveda, also justify three levels of prevention such as primary, secondary, and tertiary prevention.

Ayurveda is based on the principle of Dosha, Dhatu, Mala, and Agni. Health is the outcome of the harmonized state of these factors along with the doshas whereas the opposite leads to ill health.[7],[8] Ayurveda describes “tridosha theory of disease.” The doshas or humors are Vata (wind), Pitta (gall), and Kapha (mucus).[6] Some people compare Vata with nervous system owing to some of its characteristics, Pitta with gastrointestinal system especially with gastric enzymes and Kapha with some of the fluids of our body such phlegm and synovial fluid.[11]

According to hymn in Sushrut Samhita, health can be understood as follows:

“sama dosha” (balanced humor), “samagnischa” (balanced enzymes and metabolites), “sama dhatu” (balanced tissue system), “malakriya” (state of excretory functions), “prasanna” (ecstasy), “atmendriya manah” (soul, sense organs, and mind), and “swasthya iti abhidhiayate” (called as healthy state).

This definition proposed by Sushrut also says about the WHO's physical, mental, and social health concept; the physical health is related to Dosha, Dhatu, Mala, and Agni, which means that their harmonized presence will lead to healthy state, while the opposite will result in diseased state; the social and mental dimensions of health are related with the stage of ecstasy of soul, sense organs (Indriya), and the mind. Here, the sense organs get access to social issues and happenings bringing social dimension into health.[12]

The ancient masters of Indian medicine observed the bodily health not only as a personal problem, but also its relations to heredity, geographical environment, climate, water supply, quality of air, time, and seasonal variation.

Charaka's concepts of polluted air and contaminated water are still relevant today.[13] The importance of water sanitation and the details of diseases spread through poor quality of water were included in the great ancient ayurvedic works such as “Charaka Samhita,” “Sushruta Samhita,” “Astanga Sangraha,” and “Bhavaprakasham.” To prevent water pollution, hygienic disposal of feces by covering them in deep ground with sticks, grass, leaves, clod, etc., for natural decomposition was practiced. These were mentioned long before cholera epidemic which is considered to be the era of rise of public health.

Yoga, which is acknowledged for its holistic health benefits especially relevant in modern era of NCD epidemic, also originated in India. Descriptions of yoga can be found in ancient sacred text Rigveda which dates back approximately 5000 years and Patanjali yog sutra.[14],[15] Yoga brings balance to all the dimensions of the health including physical, mental, emotional, and spiritual. Recently, recognizing its importance for the health of the communities, the United Nations has declared June 21 as the “International Day of Yoga.”[16]

Ancient measures are capable of preventing community infections like COVID-19 and are in coherence with our modern epidemiological and scientific knowledge. The laws of Manu were a code of personal hygiene which included washing hands before eating and performing any ritual, washing hands with water and fly ash or clay or Lona (having detergent properties) after the use of toilets, cleaning of body, surroundings and objects to be used, and separate slippers for outdoor and indoor. In India, an organized medical system was evolved with its great Vedic age though not uniform as in comparison to modem one.

In post-Vedic era, emperor Ashoka established many hospitals throughout the country. Takshila University in ancient India (now in Pakistan) is one of the oldest universities which was known for specialization in field of medicine.

During colonial period, public health efforts were largely focused on British civilians and army cantonments. Medical historians ignored the Indian contribution. The main focus was on sanitation and early detection and control of contagious diseases. Various training and research institutions in public health were established. For the first time, public health legislations ascertaining local sanitary conditions, vital registration, monitoring of disease trends, vaccination programs, and technical advice on control of epidemics were established. The health survey and development committee (Bhore committee) was established in 1946.[17]

During postcolonial period, the Bhore committee recommended comprehensive remodeling of health services which included integration of preventive and curative services at all levels, hospital based health-care system, development of primary health-care system, and training in preventive and social medicine. Emphasis was given on mass production of antibiotics and availability of vaccines for tetanus, diphtheria, pertussis, measles, and poliomyelitis. Since the Bhore committee, several committees were constituted to evolve the public health system and recommendations of all these committees retained the core model given by the Bhore committee. However, there was no systematic efforts for integrated medicine in the country.

It is clear that ancient Indian public health concepts are remarkably modern and still relevant today for addressing health issues and NCDs. But unfortunately, the history of public health has largely omitted the contributions in public health from ancient India, which needs to be incorporated in history of public health. There is a need to rewrite the history of public health including the Indian contribution to public health which is still relevant to address the rising epidemic of NCDs.

Ethical approval statement

As this paper is not an original study, it is not necessary to seek ethical approval.


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