Changes & Improvements in Public Health

Public Health before 1850s

Why Wasn't Anything Done?

  • The key belief of the government was laissez-faire (leave it alone)
  • The rich didn't want any new schemes being made as it would come out of their pockets in the form of taxes
  • Some people believed that they should fend for themselves to avoid becoming dependant on others

Edwin Chadwick

  • By 1830 the government had finally realised that something needed to be done on Public Health.
  • 1838 - Edwin Chadwick was given the job to investigate the living conditions in East London 
  • 1942 - His report:  'The sanitary conditions of the Labouring Population' was published with his ideas about the link between disease and poor living conditions.

Limitations of Chadwick's work

  • 1842 report - did not lead to immediate reform - 1848 Act only introduced following Cholera outbreak.
  • His influence faded in 1950s partly due to his arrogance and refusal to accept Germ Theory
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1948 Public Health Acts

1848 Public Health Act - Influenced by Chadwick's report: triggered by Cholera epidemic. 

This act encouraged but didn't force councils to:

  • Collect taxes for Public Health improvements eg. Improving water supplies
  • Appoint a medical officer of health
  • It also enabled local authorities to borrow money to pay for improvements

The act was permissive & expensive:

  • £11 million borrowed between 1848-72.  Only a few local authorities took measures to improve conditions.
  • By 1872 only 50 councils had appointed Medical Offices of Health
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Impact of Cholera & the work of John Snow

CholeraThe most feared infectious diseases of the industrial age, first arrived in England in 1831 in Sunderland where it killed 30'000 people - those who had no provisions of clean water:  

  • Suffering: horrible symptoms such as vomiting, cramps, skin turns blue/black
  • Speed: you could be dead within 24hrs & spreads through towns rapidly

John Snow - pushing the government into intervention with the 1848 Public Health Act

  • 1832 - first encountered at a coal mine in Killingworth where he noticed the poor sanitation.  
  • 1836 - When he received his degree; he then began to look into Cholera. 
  • Unconvinced by the miasma theory of how Cholera was spread as it did not affect the lungs - instead, it caused dehydration & diarrhoea.  
  • Snow's theory; spread through the ingestion of polluted water.  Londoners received their water from the Thames, as well as disgorging their waste there!
  • 1849 - Snow published a medical pamphlet: 'On the Mode of Communication of Cholera' in which he outlined his theory.
  •  1854 - Epidemic allowed Snow to prove his theory. His map showed those living near the Broad Street pump were suffering.  Whilst those who drank at the brewery never got infected: due to not drinking out of the pump.
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1875 Public Health Act

A Move Towards Government Intervention - Laissez-faire attitude weakening in 1850-60s 

  • 1858Great Stink, plans were being made for sewer system in London as hot weather & low level of River Thames exposed sewage.  The Smell was so bad, parliament couldn't meet.
  • 1866: another outbreak of Cholera least affected towns where improvements were made, reinforcing link between hygiene and health. 
  • 1867: Working class men received vote: pressure on government & councils to take action 
  • 1866 Sanitary act - appoint inspectors to check water supplies.
  •  1875 Artisans Dwelling Act - gives local authorities power to buy & demolish slum housing

1875 Public Health Act - A mechanism for consolidating all previous acts of parliament relating to Public Health during 19th century. Responsible for ensuring the following to be provided:

  • Clean water & public toilets 
  • Sewers & Drains and Rubbish removal 
  • Appointed Health & Sanitary Inspectors & a Medical Officer of Health 
  • Quality of food in shops & quality of new housing

Some towns were still living in bad poverty & ill health.  1881: infant mortality began to increase..

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Liberal Reforms

Why did the Liberals introduce Public Health Reforms

1906 - Liberal Party won the general election and promised to make changes to improve conditions for the poor, the old, the children, & those in poverty through illness or unemployment

There were several reasons why the Liberals made these changes:

  • The history of social reform in Britain where governments have tried & failed to improve conditions.  The Liberals wanted to succeed where others have failed.
  • The social reformers eg Charles Booth influenced the government to take action by showing their proof of bad living standards: approx 30% of the public live below the poverty line
  • Attitudes to the poor had changed by 1906: most people no longer believed that poverty was their fault.

What did the liberals do?

  • Help for children
  • Help for old people
  • Help for working people
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