By George W. Boudreau

It's safe to say that January 2017 will go down as historic for many reasons, perhaps most significantly for the ways the new Congress and administration have moved to quickly dismantle the Affordable Care Act and replace it with a still-undisclosed system that we may come to call "Trumpcare." With the health care of 20 million Americans in question, we're left to ponder the long-term effects that this change may bring.

For Philadelphians, our own Benjamin Franklin provides a historical precedent to consider.

Public health was a topic that frequently concerned Franklin. His alter ego Poor Richard chastened readers in 1758 that they would be "healthy, wealthy, and wise" if they went to bed and woke early. But Franklin, who was certainly among the wisest people in colonial America, knew that good health was much more available for those with wealth to pay for it.

Franklin lived his life in overcrowded cities. Death by contagion - a concept they could only barely understand in that era - was a constant presence. Franklin's older brother waged a war of words against their native Boston's Harvard-trained oligarchy over smallpox inoculation. First explained by enslaved African servants, inoculation came to be regarded as a rich-man's preventative. Poor people couldn't afford the procedure or the idle time required to recover from introducing the virus into their bodies.

No funding for public treatment existed; no welfare state protected individuals, families, and fellow citizens. Inoculation saved some but put many others at risk. A sadder but wiser Franklin would finally be convinced of its efficacy in 1736, when he delayed having his son Francis inoculated, and the little boy died of the highly infectious disease. He regretted delaying the treatment for the rest of his life.

The growing concern with public health would continue to influence Franklin after he moved to Philadelphia in October 1723. He found that the people who settled along the Delaware in Philadelphia's first decades followed Old World patterns, crowding into alleys and digging their wells and privy pits in close proximity to one another. Illness and disease was the frequent result.

Franklin journeyed to London in 1724, and while the empire's capital was a city of power, ideas, and entertainment, it was also crowded, smoky, and dirty. As he walked to and from the printing houses where he worked for more than a year, he encountered a climate of contagions that might kill a modern visitor at first breath. Decades later, Franklin would recall the bad food and heavy alcohol consumption of Britain's working poor. Deciding the colonies had better opportunities for wealth (as well as health, probably), he sailed for America in 1726, but nearly succumbed to an illness before his ship reached Philadelphia.

In the following decades, Franklin and Philadelphia prospered, but the concern for the public health was always with him, a topic that filled his newspaper and other writings.

Franklin retired from being an active printer on Jan. 1, 1748. He did so for the most logical of reasons: He'd neared the end of the life expectancy that most "urban" Americans would reach in that era. He didn't know he'd live another 42 years.

Biographers often point to the decade after that retirement as among the most productive of his lifetime, including the creation of the lightning rod and the University of Pennsylvania. But health, especially in Philadelphia, remained an important concern until his death.

The organizers of Philadelphia's annual Benjamin Franklin birthday celebration on Jan. 13 focus on those concerns this year by honoring Dr. Anne Case and Nobel laureate Sir Angus Deaton. The similarities between Franklin's concerns about 18th-century public health and today's are striking. Deaton and Case have discovered that middle-class Americans are facing a rising mortality rate of epidemic proportions, succumbing to addiction and depression in an era of prosperity despite scientific advances. Franklin, who loved intelligent discussion, would likely enjoy the two economists' work even as its conclusions would concern him.

Franklin lived in a world where disease and epidemic could strike at any time, had little prevention, and where "cures" were often as risky as the disease itself. The "middling people" had little hope in the face of these illnesses, and Franklin could see the ways illnesses devastated and destroyed the poor people who lived in cities.

Knowing all this, Franklin used his publications to share information for better health. His clubs, library, and college worked to provide better information. He corresponded with scholars throughout the Atlantic world. He worked tirelessly to make each of his communities a healthier, smarter place. He joined with other Philadelphians to create America's first hospital, where people with physical and mental illness could find care and some comfort, and helped stop the spread of disease into the increasingly crowded city.

Philadelphians still benefit from the work of Franklin and his peers on public health. The question now is, how will future generations be affected by the incoming administration's proposed changes to health care in America?

George W. Boudreau is a history professor at La Salle University and author of "Independence: A Guide to Historic Philadelphia."

A seminar, "Prosperity and Rising Inequality," and the presentation of this year's Franklin Founder Award to Anne Case and Sir Angus Deaton, is scheduled for 9 a.m. to 1:45 p.m. Friday at Benjamin Franklin Hall, 427 Chestnut St.