PUBLIC HEALTH THROUGH TIME
Public health means action taken by governments to improve the health of their people.
The first society to recognize the benefits of public health were the Romans. Their practical skills produced the best health schemes seen to that time anywhere in the world. These did much to prevent disease.
They built sewers to take away sewage from private house and public toilets and brought fresh water through aqueducts and brick conduits. Even small towns had public baths available to anyone for a minimal charge. The baths helped rid people of fleas which spread disease. The also had public toilets and rules about burying the dead and preventing fires.
Engineers were careful to site towns forts and villas away from swamps and in areas where they were exposed to ‘health giving winds.’
To help legionaries stay fit each fort had a bath house with drains and fresh water and a hospital
This system collapsed with the end of the Roman Empire.
In the Middle Ages there was some effort made to encourage waste removal. In York in the 1300’s cesspits were lined with stone or brick and were emptied instead of just being left when they were full.
In 1332 Edward III wrote to the Council of York ordering them to cause all the streets and lanes to be cleaned of ‘dung, manure and other filth’ and to be kept clean. It was, at best, a hit and miss approach.
During and following the Black Death there was an effort made in London to enforce some standards:
1. Butchers were ordered to use a segregated area for butchering animals;
2. Rakers with horses and carts removed dung from the streets;
3. Fines were in place for people who threw litter in the street; filth outsides their houses or throwing water from a window.
4. Common privies were built in the city…one of which was built over the River Thames
5. There were regulations governing the required distance between cesspools and wells.
By this time cities were crowded and filthy; disease was rampant and it was generally recognized that something had to be done to clean them up but the local councils and government could not agree who should take the responsibility. In the 1830s cholera struck Britain for the first time. Diarrhoea, typhus and typhoid were also rampant.
In the 1830s Edwin Chadwick produced a report on the living conditions and health of the poor in towns and country areas. He concluded that the best way of reducing the cost to the ratepayers of looking after the poor was to improve their health He recommended the removal of all refuse from the streets and roads and the improvement of the supplies of water and suggested that these two measures would save money. He also recommended the appointment of a district medical officer with special qualifications.
For the next 30 years a struggle went on between towns and central government as to how to solve these problems. This was in spite of the fact that William Farr used government statistics on births deaths and marriages to compile an accurate picture of where the death rate was highest and what people died of. He was able to prove a link between unhealthy living conditions and high death rates.
In 1848 Parliament approved the Public Health Act of 1848 in order to encourage local authorities to improve conditions including enabling them to borrow money to pay for improvements. It had a very limited effect.
In 1865 cholera came back again. The link between the disease and dirty water was proved once and for all by John Snow, and then explained by Pasteur’s germ theory. As a result ratepayers were finally prepared to take action to clean up their towns.
In 1866 the Sanitary Act was introduced. All towns had to appoint inspectors to check water supplies and drainage.
In 1867 working class men were given the vote and MPs had to pay attention to the needs of poor people.
In 1870 the government made every local authority set up schools.
In 1875 the Artisans Dwelling Act was introduced. Local authorities were given the power to buy and demolish slum housing.
The 1875 Public Health Act set out all the duties that were expected of a local council including provision of clean water, proper drainage and sewage and the appointment of a Medical Officer of Health.
Despite the public health reforms of the previous century the standard of living for the poor remained very low. Surveys were carried out by Charles Booth and Seebohm Rowntree illustrated how difficult it was for the poor to afford decent housing.
Then when Britain became involved in the Boer War in South Africa, a third of the volunteers had to be turned down because they were not medically fit. This shocked the politicians and they decided that the country must take action.
The Liberal government elected in 1905, began to pass laws they hoped would improve health among the poor.
1902 – Midwives Act – All midwives have to be trained and registered
1906 – Free school meals for school children.
1907 – School Medical Service and health visitors to check on the health of young children.
1908 – Old Age Pensioners Act.
1911 – National Insurance Act – Free treatment and medicine, limited sick pay and unemployment support for some workers.
In 1919 a Ministry of Health was set up, they were concerned with the welfare of the people. They set up sanatoria to care for those with TB. These changes were making a small difference, however the influenza epidemic of 1918-1919 had highlighted the fact that there were not enough free hospital places to cope with the sick. Also as women and children were not covered by the national insurance scheme of the time, they often delayed getting treatment as they couldn’t afford to pay for a doctor.
The creation of the NHS in 1948 was a landmark event in public health in Britain. The government were now taking more responsibility for the health of the nation. They were making attempts to improve living conditions for many and the national system was now providing care ‘from cradle to grave’. However the wider understanding of both disease and effects of peoples lifestyles on health was leading to a wider role for the government, emphasising the prevention of illness.
Public health – preventative developments
Developments in vaccinations, such as Jonas Salk’s polio vaccine in 1952. Cervical Cancer vaccines 2008.
Government campaigns and laws on health issues such as smoking.
Government promotion of healthy diets
Proper and organised disposal of rubbish and treatment of sewage.
Laws to reduce air and water pollution, such as 1956 Clean Air Act (dealing with the problem of smog)
Laws to improve working conditions for example health and safety regulations about asbestos in the workplace.
The introduction of environmental health officers.
Laws on food safety.
Health Education
Smoking was still very popular, however in the mid 1960’s it became clear that there were links between smoking, cancer and heart disease.
1962 – the Royal College of Physicians called for a ban on tobacco advertising.
The Government began taxing cigarettes heavily.
1971 – health warning started to appear on cigarette packets.
2004 – It was reported that over half a million admissions to hospital and 1 in 6 deaths were as a result of smoking.
2005 – A ban was placed on most forms of tobacco advertising.
2006 – smoking was banned in public places on Scotland.
2007 – Smoking was banned in public places in England and Wales.
Similar government initiatives are taking place all the time, the latest being obesity in school children, binge drinking and the effects of drug use. Posters, messages on products and television campaigns are used to raise awareness.