Hawai i -a unique public health history
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1 Hawai i -a unique public health history National Public Health Week 2015 celebration April 9, 2015 Affirmative Action Office Hawai i State Department of Health DOH AAO 04/09/15 for HPHA NPHW 1
2 Public Health Pre-Contact The earliest health/public health providers in Hawai i - kahuna lapa au Kapo ekahiko600 CE settlement to first known other contact. British explorers arrive in
3 Impact of disease on Native Hawaiians Captain James Cook arrived in 1778 biologic threats - syphilis and gonorrhea Cholera 1804 (killed 15,000) Flu, mumps, pertussis, measles : Native Hawaiian population decreases by nearly half Mass depopulation of villages, plantations and urban areas 3
4 Population Decline of Native Hawaiians Travel to Hawai i by Polynesians from 600 CE to first documented other contact in : Native Hawaiians estimated at 250,000 by Captain James Cook as robust and healthy : estimated at 130, : estimated at 71, : estimated at 51, : estimated at 40,622 4
5 Missionary Arrivals: Physicians treated westerners, plantation workers and others. Little western medical training and little PH knowledge -cupping, bleeding, simple surgical procedures, caster oil, tooth-pulling and purges Contagion concepts not well understood Doctors shops -often sold other poisons, perfume, writing materials and other sundries 5
6 Honolulu, early 1800 s 6
7 Hawai i s Board of Health ( An Act relating to the Public Health ) Oldest state DOH in U.S. Kingdom-wide by 5/16/1853 by Kamehameha III (Kauikeaouli) King appointed three to serve without pay to serve entire kingdom (GerritJudd, Thomas Rooke, William Parke) Impetus due to smallpox threat -ships quarantined up to 42 days -also led to vaccination efforts, day of prayer on 6/14/1853 Hospital/quarantine station established for smallpox (present-day Kapi olani Park) 7
8 8
9 Smallpox in Hawai i 1825: Vaccination attempts by Dr. Abraham Blatchley 1839: Dr. Thomas Rooke and others work to vaccinate 8,000 to 10,000 Smallpox worldwide threat -reaches Honolulu in 1836, 1841 and : houses became small hospitals and whole families died without care -afraid to go to facilities, feared death 1853: A sand island off Honolulu provided by Prince Lot Kapuāiwa (later Kamehameha V) for quarantine? spread by via infected clothing from San Francisco 9
10 Hawai i s Leaders in Public Health Hawai i DOH traces its origin to 1850 under Kamehameha III (Kauikeaouli) The Queen s Hospital established in 1859 by Kamehameha IV (Alexander Liholiho) & Queen Emma Hawai i s 1st medical society started by Kamehameha IV and community physicians 10
11 Repopulation Efforts for Hawai i 1850: passage of Act for the Government of Masters and Servants Reciprocity treaty with US : 57,000 Chinese to work sugar plantations :18,000 Portuguese immigrated with families : 200,000 Japanese immigrated with families : 113,000 Filipinos begin influx as Nationals. Sugar planters hired physicians to care for workers and families - developed plantation care system Cultural and social care factors evident in plantation care system still visible today ( cradle to grave medicine) 11
12 12
13 Hansen s Disease (Leprosy) in Hawai i Also called Ma i Pake and Ma i Ho oka awale Ohana First thought found here circa 1830 Quarantine in Kalihikai west of Honolulu in 1865 and in Kaka ako in 1881 Leprosy Colony on Moloka i (Kalaupapa) in 1866 Father (Saint) Damien at Kalaupapa from Mother (Saint) Marianne who arrived at Kalihi 1883 and at Kalaupapa 1888 Disproportionately affected Native Hawaiians and poor immigrants 13
14 14
15 Bubonic Plague in Hawai i Diagnosed in Chinatown by Dr. Sun Chin in patient Yon Chong in 1899 (12/9/1899) Case confirmed with others who informed Board Military quarantine of Chinatown and port of Honolulu closed Burning of Chinatown 1900, a political and PH blunder (12/31/1899 to 1/20/1900) Plague blunted 1900 (3/31/1900) 61 dead Epidemic control led by Board of Health 15
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17 Effects on Population Health & PH By 1900, rural hospitals established on or near plantations 1906 First PHNs employed by Palama Settlement for TB control 1901 to 1917: TB sanatoriums established at Le ahi, Kula, Pu umaile, and Kapa a 1920: unions and plantations better wages, housing, health care, MCH and other welfare programs improved 1923: Board of Health dairy campaign to make milk safer baby feeding clinic established at Queen s 17
18 18
19 Effects on Population Health & PH PH nursing and health centers started in 1923, to improve MCH, especially on neighbor islands 1930 s: systemic improvements made to plantation housing, sanitation, and health centers Epidemiological data gathered regularly - improved diets, medications and immunizations reduced mortality and morbidity rates By 1956, most infants were born in hospitals and delivered by physicians 19
20 20
21 Some mileposts PH and personal 1940 s-wwii. Dengue fever. Sulfonestreat Hansen s Disease. HPHA founded 1950 s-a century of PH. Statehood s-isolation for Hansen s Disease ended. Board of Health re-organized 1970 s-abortion liberalized. Clean Air/Clean Water. Pre-Paid Health Care Act 21
22 Recent past and present Prior to, but especially after 9/11 and the anthrax mail threat, public health emergency preparedness and response and public s attention increased to multiple threats, hazards, and emergencies. 22
23 Some mileposts PH and personal 1980 s-heptachlor. VOG. AIDS. SHIP reduces uninsured to 3%. OHH 1990 s-iniki. Recession and cuts. NPHPSP. DOJ, Felix and Makin suits 2000 s-bioterrorism threat. Core Competencies. TSP 2010 s-revised strategic plan. accreditation What is your part in PH of the past and future? 23
24 Public Health everyone s kuleana +YOU DOH AAO 04/09/15 for HPHA NPHW 24
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