Foreword

The first edition of Milton Rosenau’s textbook of Preventive Medicine and Hygiene was published in 1913. This book appears just over 100 years later. It is identified as the 16th edition, which is justifiable despite the change in the title, the publisher, the increased number of editors, contributors, and the changes in emphasis on concepts, themes, and topics.

Early in the twentieth century, Milton Rosenau was the pre-eminent scholar of the science, art, and practice of public health. Rosenau and Kenneth Maxcy, his successor as editor, identified pathogenic microbes as the most dangerous threats to population health. By the time Philip Sartwell took over from Kenneth Maxcy, the importance of epidemiology as the basic science of public health was recognized. Evidence-based public health practice was taking over from practice based on the observations and opinions of respected elders. Sartwell contributed a comprehensive summary of the science of epidemiology, and I enlarged on this during my time as editor. I also introduced chapters on the epidemiology of cancer, heart disease, and other “noncommunicable” conditions. More important, social and behavioral determinants of susceptibility to infectious pathogens such as ignorance and overcrowding were made explicit and discussed in chapters by experts in these domains. As knowledge and understanding expanded in the middle decades of the twentieth century, we became aware of the complex interconnections among causal factors that were often synergistic. The multifactoral causes of diseases of public health importance were recognized, and policies, strategies, and tactics to control and, if possible, to prevent such diseases were spelt out. The need for such comprehensive thinking and planning is well illustrated by the newly emergent public health problem of road traffic injury and death. Mitigation required road design that separated vehicles traveling in different directions at different speeds, limiting risks of collision at road junctions, etc., car design that protected drivers and passengers, and measures to ensure that drivers were well educated about safe operation of their cars, were fit to drive and their judgment was not impaired by use of alcohol, drugs, or prescribed medication.

Another set of scientific disciplines and technologies of increasing importance is environmental health. This examines threats to health caused by exposure to toxic chemicals, dusts, etc., often in workplaces and sometimes in dwellings adjacent to refineries, factories, etc., where these toxins are produced.

The editors and chapter authors of this most recent edition of Public Health & Preventive Medicine have reintroduced in modern guise, enlightened by current concepts of genetic determinants of disease, pertinent ideas derived from these concepts. The old debate about the relative importance of nature versus nurture in disease causation remains alive, enlightened now by technical advances and greatly increased knowledge and understanding. In truth, nature and nurture are equally important, a theme that is woven into the fabric of this exciting new edition.