liverpool sanatory act championed by the borough of liverpool health of towns committee) designed the world's first integrated sewerage system, in liverpool (1848–1869), with joseph bazalgette later creating london's sewerage system (1858–1875). the vaccination act 1853 introduced compulsory smallpox vaccination in england and wales. by 1871 legislation required a comprehensive system of registration run by appointed vaccination officers. further interventions were made by a series of subsequent public health acts, notably the 1875 act. reforms included the building of sewers, the regular collection of garbage followed by incineration or disposal in a landfill, the provision of clean water and the draining of standing water to prevent the breeding of mosquitoes. the infectious disease (notification) act 1889 mandated the reporting of infectious diseases to the local sanitary authority, which could then pursue measures such as the removal of the patient to hospital and the disinfection of homes and properties. public health legislation in other countries example of historical public health recommendations during the 1918 flu pandemic in new haven, connecticut, united states in the united states, the first public health organization based on a state health department and local boards of health was founded in new york city in 1866. in germany during the weimar republic the country faced many public health catastrophes. the nazi party had a goal of modernizing health care with volksgesundheit, german for people's public health; this modernization was based on the growing field of eugenics and measures prioritizing group health over any care for the health of individuals. the end of world war 2 led to the nuremberg code, a set of research ethics concerning human experimentation. epidemiology early epidemiologist john snow mapped clusters of cholera cases in london. the science of epidemiology was founded by john snow's identification of a polluted public water well as the source of an 1854 cholera outbreak in london. snow believed in the germ theory of disease as opposed to the prevailing miasma theory. by talking to local residents (with the help of reverend henry whitehead), he identified the source of the outbreak as the public water pump on broad street (now broadwick street). although snow's chemical and microscope examination of a water sample from the broad street pump did not conclusively prove its danger, his studies of the pattern of the disease were convincing enough to persuade the local council to close the well pump by removing its handle. snow later used a dot map to illustrate the cluster of cholera cases around the pump. he also used statistics to illustrate the connection between the quality of the water source and cholera cases. he showed that the southwark and vauxhall waterworks company was taking water from sewage-polluted sections of the thames and delivering the water to homes, leading to an increased incidence of cholera. snow's study was a major event in the history of public health and geography. it is regarded as the founding event of the science of epidemiology. control of infectious diseases paul-louis simond injecting a plague vaccine in karachi, 1898 with the pioneering work in bacteriology of french chemist louis pasteur and german scientist robert koch, methods for isolating the bacteria responsible for a given disease and vaccines for remedy were developed at the turn of the 20th century. british physician ronald ross identified the mosquito as the carrier of malaria and laid the foundations for combating the disease. joseph lister revolutionized surgery by the introduction of antiseptic surgery to eliminate infection. french epidemiologist paul-louis simond proved that plague was carried by fleas on the back of rats, and cuban scientist carlos j. finlay and u.s. americans walter reed and james carroll demonstrated that mosquitoes carry the virus responsible for yellow fever. brazilian scientist carlos chagas identified a tropical disease and its vector. society and culture education and training education and training of public health professionals is available throughout the world in schools of public health, medical schools, veterinary schools, schools of nursing, and schools of public affairs. the training typically requires a university degree with a focus on core disciplines of biostatistics, epidemiology, health services administration, health policy, health education, behavioral science, gender issues, sexual and reproductive health, public health nutrition, and occupational and environmental health. in the global context, the field of public health education has evolved enormously in recent decades, supported by institutions such as the world health organization and the world bank, among others. operational structures are formulated by strategic principles, with educational and career pathways guided by competency frameworks, all requiring modulation according to local, national and global realities. it is critically important for the health of populations that nations assess their public health human resource needs and develop their ability to deliver this capacity, and not depend on other countries to supply it. schools of public health: a us perspective in the united states, the welch-rose report of 1915 has been viewed as the basis for the critical movement in the history of the institutional schism between public health and medicine because it led to the establishment of schools of public health supported by the rockefeller foundation. the report was authored by william welch, founding dean of the johns hopkins bloomberg school of public health, and wickliffe rose of the rockefeller foundation. the report focused more on research than practical education. some have blamed the rockefeller foundation's 1916 decision to support the establishment of schools of public health for creating the schism between public health and medicine and legitimizing the rift between medicine's laboratory investigation of the mechanisms of disease and public health's nonclinical concern with environmental and social influences on health and wellness. even though schools of public health had already been established in canada, europe and north africa, the united states had still maintained the traditional system of housing faculties of public health within their medical institutions. a $25,000 donation from businessman samuel zemurray instituted the school of public health and tropical medicine at tulane university in 1912 conferring its first doctor of public health degree in 1914. the yale school of public health was founded by charles-edward amory winslow in 1915. the johns hopkins school of hygiene and public health was founded in 1916 and became an independent, degree-granting institution for research and training in public health, and the largest public health training facility in the united states. by 1922, schools of public health were established at columbia and harvard on the hopkins model. by 1999 there were twenty nine schools of public health in the us, enrolling around fifteen thousand students. over the years, the types of students and training provided have also changed. in the beginning, students who enrolled in public health schools typically had already obtained a medical degree; public health school training was largely a second degree for medical professionals. however, in 1978, 69% of american students enrolled in public health schools had only a bachelor's degree. degrees in public health the london school of hygiene & tropical medicine is the oldest school of public health in the anglosphere. schools of public health offer a variety of degrees generally fall into two categories: professional or academic. the two major postgraduate degrees are the master of public health (mph) or the master of science in public health (msph). doctoral studies in this field include doctor of public health (drph) and doctor of philosophy (phd) in a subspecialty of greater public health disciplines. drph is regarded as a professional degree and phd as more of an academic degree. professional degrees are oriented towards practice in public health settings. the master of public health, doctor of public health, doctor of health science (dhsc/dhs) and the master of health care administration are examples of degrees which are geared towards people who want careers as practitioners of public health in health departments, managed care and community-based organizations, hospitals and consulting firms, among others. master of public health degrees broadly fall into two categories, those that put more emphasis on an understanding of epidemiology and statistics as the scientific basis of public health practice and those that include a more wide range of methodologies. a master of science of public health is similar to an mph but is considered an academic degree (as opposed to a professional degree) and places more emphasis on scientific methods and research. the same distinction can be made between the drph and the dhsc. the drph is considered a professional degree and the dhsc is an academic degree. academic degrees are more oriented towards those with interests in the scientific basis of public health and preventive medicine who wish to pursue careers in research, university teaching in graduate programs, policy analysis and development, and other high-level public health positions. examples of academic degrees are the master of science, doctor of philosophy, doctor of science (scd), and doctor of health science (dhsc). the doctoral programs are distinct from the mph and other professional programs by the addition of advanced coursework and the nature and scope of a dissertation research project. notable people john graunt (1620–1674) was a british citizen scientist who laid the foundations for epidemiology. edward jenner (1749–1823) created the smallpox vaccine, the first vaccine in the world. he is often known as "the father of immunology." benjamin waterhouse (1753–1846) introduced the smallpox vaccine in the united states. lemuel shattuck (1793–1859) has been described as an "architect" and "prophet" of american public health sir joseph william bazalgette (1819–1891) created a sewer network for central london in response to the great stink of 1858. this proved instrumental in relieving the city from cholera epidemics. louis pasteur (1822–1895) conducted research that laid the foundation for our understanding of the causes and preventions of diseases. charles v. chapin (1856–1941) public health advocate and researcher credited with planting "the roots of quality in public health" in the united states sara josephine baker (1873–1945) was an "instrumental force in child and maternal health" nora wattie (1900–1994) led the development of public health services and sanitation, and education in improving women and child health in the poorest slums of glasgow, for which she received the obe. jonas salk (1914–1995) developed one of the first polio vaccines and campaigned vigorously for mandatory vaccinations. ruth huenemann (1910–2005) she became a pioneer in the study of childhood obesity in the 1960s studying the diet and exercise habits of berkeley teenagers. country examples public health by countrybrazilchinacubaindiamexicounited states canada in canada, the public health agency of canada is the national agency responsible for public health, emergency preparedness and response, and infectious and chronic disease control and prevention. cuba since the 1959 cuban revolution the cuban government has devoted extensive resources to the improvement of health conditions for its entire population via universal access to health care. infant mortality has plummeted. cuban medical internationalism as a policy has seen the cuban government sent doctors as a form of aid and export to countries in need in latin america, especially venezuela, as well as oceania and africa countries. colombia and bolivia public health was important elsewhere in latin america in consolidating state power and integrating marginalized populations into the nation-state. in colombia, public health was a means for creating and implementing ideas of citizenship. in bolivia, a similar push came after their 1952 revolution. ghana ghanaian children receive insecticide-treated bed nets to prevent exposure to malaria transmitting mosquitos. though curable and preventive, malaria remains a major public health issue and is the third leading cause of death in ghana. in the absence of a vaccine, mosquito control, or access to anti-malaria medication, public health methods become the main strategy for reducing the prevalence and severity of malaria. these methods include reducing breeding sites, screening doors and windows, insecticide sprays, prompt treatment following infection, and usage of insecticide treated mosquito nets. distribution and sale of insecticide-treated mosquito nets is a common, cost-effective anti-malaria public health intervention; however, barriers to use exist including cost, household and family organization, access to resources, and social and behavioral determinants which have not only been shown to affect malaria prevalence rates but also mosquito net use. france this section is an excerpt from health care in france § public health initiatives (1871–1914). the french third republic followed well behind bismarckian germany, as well as great britain, in developing the welfare state including public health. tuberculosis was the most dreaded disease