University of Sourthern California


History of Public Health and Its Evolution

A public health worker treats a young patient.

In April 2021, the White House sent out a press announcement to mark the start of National Public Health Week (NPHW). The significance of NPHW had increased dramatically in the past year, the White House said, in that the nation was mourning the loss of more than 500,000 lives to the COVID-19 pandemic. Because of that, Americans, and their neighbors throughout the world, were just starting to realize how essential public health workers, and public health efforts, are.

“Whether it is the scientists and researchers who developed life-saving vaccines in record time; or local leaders who have taken evidence-based action to keep their communities safe; or the staff and volunteers who have worked to slow the spread of the virus through testing, case investigation, and contact tracing; or the doctors, nurses, and clinicians who continue to provide around-the-clock care to those who have fallen ill, dedicated public health professionals on the front lines of our response to COVID-19 deserve our gratitude,” the announcement said.

Public health has played an important role in the U.S for more than two centuries, but the pandemic has shone a spotlight on its importance. COVID-19 also highlighted numerous public health disparities, including in education, income, housing and health care access, and how they were associated with an increased risk of infection, serious illness and death.

Consequently, public health officials have begun to reimagine how public health systems must work, so that sufficient preparedness, proactive crisis management and enhanced surveillance capabilities can improve public health infrastructure in the future.

Whether you are pursuing an advanced degree in public health or are an established professional, understanding the history of the field of public health is key to contributing to its future development.

History of Public Health: The Origins of Public Health in America

The Commissioned Corps of the U.S. Public Health Service credits John Adams with establishing national public health policy in 1798, with the Act for the Relief of Sick and Disabled Seamen. That establishment was a critical moment in the history of public health. Progress continued throughout the 19th century, as military hospitals were established in key cities, forming the foundation for a national public health system.

A series of infectious disease epidemics toward the end of the 19th century, including smallpox, cholera and yellow fever epidemics, fueled the passage of the National Quarantine Act and drove the development of immunization standards. The focus of public health policy began to shift from the military to the general population, driven by a need to stop infectious diseases from taking hold in the U.S.

Key 20th-Century Developments

Immunization was just the beginning of the progress in store for public health in the 1900s. Another area of significant improvement was workplace safety. Nearly 200 steel workers died in work-related fatalities in Allegheny County, Pennsylvania, between July 1906 and June 1907. In 1997, that number totaled just 17 nationwide. Improvements in workplace safety are credited to labor and management efforts and to considerable education and regulation by government agencies, like the Occupational Safety and Health Administration (OSHA), which was established in 1970, and the Mining Enforcement and Safety Administration, established in 1973 and now called the Mine Safety and Health Administration (MSHA).

Food safety improved greatly, thanks to sanitation discoveries and improvements, such as the importance of hand washing, pasteurization, refrigeration and better care of livestock. In the 1960s, amid steadily increasing rates of motor vehicle fatalities, Congress passed the Highway Safety Act and established the National Highway Safety Bureau, now known as the National Highway Traffic Safety Administration (NHTSA). These initiatives established public health standards that have saved thousands of lives in subsequent years.

Modern Challenges

In the years following the turn of the 20th century, climate change is creating new public health challenges. The Environmental Protection Agency (EPA) cites heat waves, extreme weather events, reduced air quality and climate-sensitive diseases among the threats to human health associated with climate change.

The Centers for Disease Control and Prevention (CDC) is working to address these challenges through their Climate and Health Program, which the agency says “is helping state and city health departments prepare for the specific health impacts of climate change that their communities will face.” Participating cities and states receive funding to help them identify aspects of their communities that face climate-related risks, and develop response plans to minimize those risks beyond what is provided for through existing programs and services.

Just as events such as global pandemics, military conflicts, industrialization and climate change affect society, they also affect public health. By understanding how the public health field has adapted in response to challenges throughout history, the next generation of public health leaders can help that evolution continue into the future. As the COVID-19 pandemic has made clear, public health leaders must work to overcome disparities that affect outcomes, and make sure that public health projects are equitable.


Recommended Readings

The Importance of Disease Prevention

Refugee Health: From the Public Health Perspective

New Innovations in Emergency Response


American Journal of Public Health, “Reimagining Public Health in the Aftermath of a Pandemic”

Local Government Association, “A Perfect Storm — Health Inequalities and the Impact of COVID-19”, A Proclamation on National Public Health Week, 2021