and personal prophylactic interventions such as immunization, while public health activities have been relatively neglected. This helps explain why India’s health indicators are so much poorer than in East Asia and much of the rest of the world.<sup>4</sup>

# **2. The evolution of public health services in the developed world**<sup>**5**</sup>

In developed countries, the need for effective public health services was triggered partly by military concerns, since army casualties from disease were far higher than from battle. Elites also had a stake in disease control because cure was uncertain until antibiotics began to be mass-produced in the mid 20<sup>th</sup> century. Besides, business interests were at stake, as illustrated by the massive business losses following a cholera epidemic in Hamburg in 1892.

In the last decades of the nineteenth century, scientists began to identify germs and learn how they cause disease. This led to the “sanitary movement”, which involved radical changes in citizens’ health behaviors and private lives, including foregoing keeping livestock in urban areas. Protests arose: ranging from mass protests to the case of the irate butcher chasing a sanitary inspector down a Chicago street with a knife. The changes had to be implemented not only rigorously (sometimes coercively), but with much attention to persuading citizens of how better sanitation improved their wellbeing.

Much effort was devoted to building the organizational and technical infrastructure of public health services, and public health engineering. By the mid-twentieth century, the institutions and procedures for preventing exposure to communicable diseases had become well-established in the developed world. They had brought about rapid declines in mortality and morbidity. Non-communicable diseases became the major source of illhealth, and public health services were broadened to control these through lifestyle changes and controlling environmental pollution. Nevertheless, public health services continue to be highly successful at communicable disease control, and are overhauled periodically in response to changing circumstances.

Japan studied European public health services and moved early to emulate them as part of its preparation for becoming a world power, and applied similar measures in their colonies in Korea and Taiwan. Johansson and Mosk (1987) have argued that reducing the toll of communicable diseases raised labor force productivity and life expectancy in Japan, despite lack of rise in wages and consumption. This is consistent with the fact that in 1940, life expectancy in all three East Asian countries was nearly 50 years, significantly higher than in India (32 years), although per capita caloric availability was fairly similar across them all.<sup>6</sup>

> 4 UN estimates (http://esa.un.org/unpp/p2k0data.asp). 5 This section draws on Barclay (1954), Duffy (1990), Easterlin (1999), Evans (1987), McGuire (2001), McKeown (1976), Johansson and Mosk (1987), Preston (1976); Preston and Haines (1991), Rosen (1993), Tatara , Schofield et al. (1991), Sung (2003), Szreter (1999),Vögele (1998), and Woods (2003). 6 Das Gupta et al. (2003), Figure 1.

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