e-Bulletin April 2025

We all know the story of the legendary John Snow and the cholera outbreak that started on August 31, 1854. Singlehandedly, Dr Snow traced the source and convinced the politicians to remove the Broad Street pump handle on September 8, 1854. Do the math—8 days to solve an outbreak and simultaneously invent the science of outbreak investigation, and translate science to policy.

Here is what happened next. The people of London put the handle back on the pump! Shallow wells remained a fixture throughout London. Cholera outbreaks kept happening for 30 more years. When London finally put an end to cholera, it did so based on a wider acceptance of Snow’s waterborne theory. This was the result of street-level health communication by sanitarians who spread this idea in salons and pamphlets. Edwin Lankester became the first Medical Officer of Health for the Broad Street neighbourhood and devoted himself to knowledge exchange to the people of London. (Lankester, 1866).

Hero scientists and temporarily persuaded politicians are no match for low health literacy and populism in the short run. We see this in action all over the world today. Carrying on the tradition of Lankester, our field has supplemented epidemiology, lab science, statistics, and physiology, with the science of communication, trust and partnership formation. Building the public’s health literacy takes time, but it is bedrock of resilience. We have had these resilience building social science tools in public health for over a century (Nathanson, 1996). They are part of what we teach our undergraduate and masters students. An interdisciplinary school like ours is an anvil to forge stronger steel by combining the metal of engaging with our community with the iron ore of science.

Our School’s celebration of Public Health Week saw our amazing anvil in action. We unite public health practitioners from government bureaus, clinics, and NGOs with new knowledge about what threatens our health and what makes us resilient. Our school welcomes the world’s John Snows and Edwin Lankesters. Together we create the conditions in which people can be healthy.

Bonus Quiz Question:
Figure 1 shows the epidemic curve from 1854. True or False? The removal of the Broad Street pump handle ended the cholera epidemic of 1854.

Professor David Bishai
Director and Clinical Professor
School of Public Health, The University of Hong Kong

References:

1. Disease Prevention as Social Change: Toward a Theory of Public Health.
   Population and Development Review, 609-637.
   Nathanson, C. A. (1996)
2. Cholera: What Is It? and How to Prevent It.
   G. Routledge and sons.
   Lankester, E. (1866)