Changes & Improvements in Public Health

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

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

Cholera - The 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.

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

• 1858: Great 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..

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