The organizational structure of Public Health in Trinidad can take its origin as of January 1st, 1917 when the Public Health Ordinance Chapter 12 No 4 was enacted. A similar act, the Public Health and Local Government Act, was previously passed in the United Kingdom in 1858, which established the practice of Public Health within the realm of Local Government bodies.
The very next year, 1918 the pandemic of swine flu killed some 20 million people. At that time Public Health was seen as a discipline, with studied and implemented measures for control of communicable diseases primarily by sanitation and vaccination. The sanitary movement was launched in European Countries in the 1820s, inspired in Britain by Benthamism.
This revolution came before the development of bacteriology and made an enormous contribution to improved health. The roots of Public Health in Trinidad, as in the United Kingdom, are deeply implanted in Local Government Bodies.
The status of City was reconferred on Port of Spain and the creation of a City Council was restored in 1914; it had been previously revoked because the City Council was alleged to have granted itself powers reserved for the crown. The restoration of the Port of Spain City Council and the passing of the Public Health Ordinance had set the foundation for 86 years of eminent Public Health Practice in Trinidad.
Indeed, Dr Lenox Pawan as City Medical Officer of Health performed several studies on the causation of rabies. Another eminent City Medical Officer of Health was Dr Roderick Marcano who may be deserving of the accolade of Father of Public Health in Trinidad. Surprisingly, apart from minor changes in 1941, 1944 and 1950 there has been no major revision or alteration to these statutes.
The first Public Health Ordinance created a Central Board of Health. This consisted of nine (unelected) members, all appointed by the Governor, who were required to hold office for two years. This section (4) and the subsequent sections 5-10 which dealt with structure and function of the Board were repealed by the Water and Sewage Act (WASA), 6th schedule.
This further divided the island into the City of Port of Spain, Boroughs and rural sanitary districts. It has been subsequently repealed by the Municipal-Corporations Act (1990). This created 14 regional corporations, two Cities (Port of Spain and San Fernando), three Boroughs (Arima, Chaguanas and Point Fortin) and nine Corporations (Diego Martin, San Juan/Laventile, Tunupuna/Piarco, Sangre Grande, Mayaro/Rio Claro, Princes Town, Couva/Tabaquite/Talparo, Penal/Debe and Siparia).
In all, 14 regional corporation councilors are elected by the process of Local Government elections, imminently due, which are held every five years and are similar in scope to the election of members of parliament.
At the first sitting of the corporations, a fixed numberof aldermen is elected; and subsequently from among the councilors and aldermen a mayor is elected in the two cities and chairmen are elected in the others.
At present, corporations may appoint a public health committee of which the County or City Medical Officer of Health is an ex-officio member and is required to provide technical expertise to the corporations. The function of these committees is embodied in the Public Health Ordinance, which is devoted to the following tasks:
o To scavenging, the collection and disposal of "all refuse, rubbish, night soil and waste matter ".
o The approval of building plans for the purpose of construction.
o The enhancement and maintenance of parks, squares and public places as well as public markets, abattoirs, slaughterhouses, cemeteries, ports of entry and public conveniences.
o The monitoring of restaurants including all other food establishments and itinerant vendors, barber shops and cinemas to ensure compliance with the sale of food bye-laws and bye-laws controlling barber shops and cinemas.
o The provision of services for the disposal of night soil and the emptying of cesspits, insect vector control, rodent control, bat (anti-rabies control) control and canine control.
o The sweeping, cleansing and watering of streets.
o The investigation and correction of nuisances is a major activity overseen by these committees.
Such nuisances include " any premises or part thereof decayed, ruinous, filthy or in an unwholesome state or condition in addition any street, ditch, sink, cistern, pool, barrow-pit, water course, drain, gutter, privy, dustbin, cowshed, pig-sty, kept in such manner or m such numbers as to be a nuisance or injurious to health". A nuisance may also include any offensive trade or business. In the discharge of this function, a public health inspector conducts an investigation and a notice signed by the secretary of the local health authority is served upon the person to abate the nuisance within a specified time. The most common use of this process is to ensure restaurants and other food establishments conform to standards.
One of the most misunderstood sections of the Public Health Ordinance is section 110, short titled "power of entry" This section is the only instance in which a public officer is empowered without a warrant "at any time to enter and inspect premises in the district in which he has reason to believe an infectious disease exist and may examine any person found on such premises with a view to ascertaining whether such person is suffering or has recently suffered from any infectious disease ".
Finally I wish to highlight section 105, which provides ^he Minister of Health with the authority to make regulations with regard to the control of any dangerous infectious disease. In this regard the Minister is empowered to restrain and isolate persons suffering from any dangerous disease, cause the removal to a hospital and the administration of treatment, the destruction of personal effects, goods, houses and any other property exposed to infection and the speedy disposal of the dead. This section was used in 1994, captioned the Public Health (Cholera) Regulations (1994), the Yellow Fever Regulations (1954) and again in 1979.
In conclusion, public health practice in Trinidad is still confined to the old public health practices aimed at the control of communicable diseases and the environment as espouse! in the now outdated Public Health Ordinance (1950) The challenge to public health professionals in this new millennium is far more demanding It emerges from a world ill rapid transition, mass air travel, enormous increase m international trade, occupation)} health and safety, changes in global environment, poor housing, inadequate water supply, poverty, unemployment, the emergence of new diseases, traffic density, air pollution increasing fears about crime and food policy to iterate a few.
1. Public Heath Ordinance Ch 12 no 4 (1917)
2. The Public Health (cholera) regulations, 1974 Legal supplement Part B- Vol
33, no 34.25th January 1994.
3. Act No 54 of 1975: An Act to amend the Public Health Ordinance, Ch 12
No 4,1st December 1975.
4. The Public Health (Yellow Fever) Regulations, 1979 Suppl. Trinidad and
Tobago Gazette, Vol 18, No 52, 16th February 1979
5. Rosen G. 1993: A History of Public Health Balimore The Johns' Hopkins
CARIBBEAN MEDICAL JOURNAL Vol., 65, No. 1 June 2003