1.
Sagar Parajuli
MPH- PHSM 2022
School of Health and Allied Sciences
Pokhara University
The return of Liberalism
1970 to Present days
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2.
Development of Public Health in Developed
Countries
• The age of liberalism 1798-1880
• The Golden age of Public Health 1880-1970
• The return of liberalism 1970 to present
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3.
Concept of Liberalism
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Major themes of Liberalism, may vary according to leadership and
system governance
• Equality
• Individual Rights (Human and Civil Rights)
• Individual Liberty
• Democratic practices
• Rule of law
• Economic and political freedom

4.
The return of Liberalism
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• In 1970, with conquest of fascism and subsequent decline of
communism, Liberalism re-emerged as “The return of Liberalism”
• The statement ‘Health and welfare are birthright of all’- WHO,
1968, symbolizes beginning of period of return of liberalism
• Shifting of focus from Health to Welfare and nation’s
responsibility and obligations to ensure individual rights of
health and welfare realized

5.
The return of Liberalism: Major Changes
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• Infectious diseases in developed countries receded with effective
immunization, use of antibiotics, epidemiological and environmental
control.
• New Personal disciplines adopted to prevent lifestyle diseases and
accidents- avoiding smoking, controlling fats, use of recreational
drugs, fluoridated water supply, but these measures were objected in
terms of their intrusion into personal liberty and culture
Disciplines emerged in response to transition from infectious to chronic diseases.

6.
The return of Liberalism: Major Changes
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• Shift of focus from individual hygiene to environmental sanitation
• Realization of interaction between physical and social
environment, suggesting comprehensive changes in them for the
control of heart diseases, birth defects, low sperm count and
cancers
• Addresses environmental public health problems in which
individuals more victimized by corporate oligopolies and
governance in 19th century

7.
The return of Liberalism: Major Changes
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• ‘Community will and means to act collectively’- for communal
character environmental problems addressed- Community
ownership and participation dimension
• Regulation function of public health identified in regard to food
safety and regulation, resulting development of departments of
Environmental Protection to mitigate environmental problems
• Relationship between people and public health institutions
realized and focused on behavior change approaches for Health
Promotion

8.
The return of Liberalism: Major Changes
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• In 1980s and 1990s, emergence of Ebola virus and other
infectious disease taken as environmental diseases, caused by
change in environment allowing animal viruses to acquire
secondary human hosts for whom they are virulent and
traditional means of control like isolation, restriction of mobility
were practiced which are now epidemiologically proven.
• Influence of media like TVs- people spending hours watching and
absorbing images of violence and hitting spouse and children

9.
The return of Liberalism: Major Changes
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• Highlighted need of rationale public health policy and
interventions, for e.g. subsidizing production of tobacco and
addiction of people to it rather than blaming them for smoking
habit
• Public Health and Social Welfare were found associated- the trend
of emergence of prominent diseases affecting individual and it’s
impact on community in terms of productivity assessed.

10.
The return of Liberalism: Major Events
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.
• Emergence of Public Health Services in France, Germany and Russia,
being closely linked with Medical Services for the poor
.
• In mid-nineteenth century, Edwin Chadwick equated public health
with Sanitary engineering, retained distinction between public health
and social welfare.
.
• In Ireland- Integrated system of public health, welfare and medical
care emerged in late-nineteenth century

11.
The return of Liberalism: Major Events
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.
• Expanded scheme of prevention, with key focus on personal and
social behavior proposed by Fabians in British Parliaments
.
• Concept of insurance introduced to pay for medical care, as part of
occupational health
.
• Establishment of British’s National Health Service as post-war
response with ‘Health for Heroes” sustaining Veterans Administration
medical system in USA

12.
Influences in Public Health Development in
Developed Countries in 21st Century
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 Lalonde Report, Canda- suggests human biology, life-style,
environment and health care services as critical factors in
determining health
Recommended health promotion, regulatory & research strategy
 Health for all by 2000
 International Conference on PHC 1978
 Healthy people- Health Promotion and Information Act, USA
 Inequalities in Health/Black Report 1980, UK
 Health Targets for Europe by WHO 1984, based on equity,
empowerment, participation, cooperation and primary care

13.
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 Conferences on Health Promotion- Ottawa Charter to 10th Global
Conference on Health Promotion
 Marmot Review of Health inequalities 2010
 One Health concept
 Digitalization of Health services
Influences in Public Health Development in
Developed Countries in 21st Century

14.
The return of Liberalism: Challenges
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• Conflict on imperatives of public health and civil rights
• Liberal resistance to public health imposition- dynamics of
liberalism concept and leadership
• Regulation in Public Health
• Conflict of public health with Medical Services

15.
Learning Reflections & Conclusions
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• Economic and political progress (policy to practice) were found
subordinate to securing health- Economic and political factors as means
and health as an end
• Rational and evidence-based interventions for addressing
dynamics of disease and health phenomena
• Addressing health care needs and health inequalities is vital to
achieving health for all

16.
Learning Reflections & Conclusions
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• Public participation and community engagement for public
health programs
• Social Behavior change communication strategies (SBCC) as core
of public health interventions for Health Promotion Activities

17.
1. Roger Detels et.al., 2015 The return of Liberalism Oxford textbook of Global
Public Health volume 1, fifth edition. Oxford university press. 2015; p32-34
2. Irvine, L., Elliott, L., Wallace, H., & Crombie, I. K. (2006). A review of major
influences on current public health policy in developed countries in the
second half of the 20th century. The Journal of the Royal Society for the
Promotion of Health, 126(2), 73–78. doi:10.1177/1466424006063182
3. Fielding J, Public Health in Twentieth Century: Advances and Challenges,
Ann. Rev. Public Health 1999; 20
References
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18.
Thank you!