Like all ideologies, Public Health has a creation myth, or, to be more precise, two. As told in Kevin Dew’s enlightening 2014 book The Cult and Science of Public Health, those foundational tales come with two real-life founders. The legend of Dr John Snow heroically dismantling the Broad Street Pump in London in 1854 to defeat the scourge of cholera is the story of the purported birth of the epidemiological/spatial mapping of disease and of the revelation of the importance of collecting morbidity data. A figure perhaps less well known outside of the realm of Public Health, but nonetheless equally hallowed within it, is Rudolf Virchow.
Just a few years prior to Snow, at the other end of Europe, in Prussia, whilst tending to miners stricken with typhus in Upper Silesia, Virchow went beyond identifying the source of infectious disease. Observing that poverty was the main determinant of the outcome of the illness, he campaigned for social transformation in order to alter the underlying "social determinants of health".
While in reality Snow did not personally remove the water pump handle, and Virchow’s patients mostly succumbed to the disease, both stories illustrate a central tension within Public Health. On the one hand, the usefulness of observation and theorizing about causes of disease, with a particular emphasis on sanitation and hygiene. On the other hand, intervening for societal change, albeit via the political sphere in a top-down approach.
Uniting these stories is both the degree to which Public Health’s reputation and power have been built on preventing infectious disease, and the corollary that Public Health practitioners are not merely neutral scientific observers: advocacy and action are a core part of the Public Health mission, which inevitably makes Public Health political. Naturally this can lead to totalizing projects.
Advocacy and action are a core part of the Public Health mission, which inevitably makes Public Health political. Naturally this can lead to totalizing projects.
However, even prior to these founding myths, governments had already used the health of populations as both a rationale and a goal of state control, such as in the case of the “medical police” in Germany, as far back as the 18th century. Likewise the French National Assembly, formed revolutionary France in 1792, declared health to be a right of liberated citizens. The history of Public Health, as these examples clarify, has inevitably been entangled with the emergence of modern states.
