History - Public Health

• Poor people needed work and housing, they had to live in close proximity to their work, leading to low quality housing that were built quickly e.g. the slums.
• Coal-fired factories caused smoke to fill the air.
• Cramped houses did not have running water or toilets.
• Overcrowding caused disease to spread quickly.
• Cholera epidemics in London affected both the rich and the poor, due to being spread by the water supply.
• Life expectancy was much lower in towns than countrysides, due to such poor conditions.
• Prior to the germ theory, people didn't know what caused disease, they mostly blamed it on miasma (bad air).

• 1820, only rich men had the right to vote, therefore only people with good living conditions had a say in government.
• People still believed in laissez-faire - this means that the government should not interfere with ordinary people's lives, they were free to run their own life, poor people should fend for themselves, and the government should steer clear of social issues.

1842: Chadwick published his report into poor people's living conditions, showing poor people lived in dirty conditions, causing a large amount of illness, making people too sick to work.

He suggested improved drainage and sewers, waste removal from streets, clean water and appointed medical officers would improved the health of the working class.

1848: These recommendations led to the first Public Health Act, towns were told to clean up but it was optional, so many ignored this act due to believing in Laissez-faire.

• Public Health Act 1848: Optional for towns to clean streets.
  Nuisance Removal Act: Made overcrowding illegal.
• Factory Act: Made unhealthy factory conditions illegal.
• Artisans Dwelling Act: Landlords had to keep houses in good condition, councils can demolish homes that were not. 
• Food and Drugs Act: Made selling food and drugs that are "not of the proper nature" illegal.
• Public Health Act 1975: Became compulsory for towns to keep streets and sewers clean, they could charge taxes to do so.
• River Pollution Prevention Act: Made factories dumping their waste into rivers illegal.

• 1848 Public Health Act was voluntary, but the 1875 Act was compulsory - therefore towns were made to clean streets and sewers.
• Rich People Died of Cholera: They paid the taxes for new systems because it also benefitted them.
• Poor People Got the Vote: Laissez-faire ended because the government had to win over the lower classes votes.
• Germ Theory: People saw a goal when cleaning streets, prior to this they saw no point because they thought illness spread through water and air.

• Snow did not believe the miasma theory, he thought cholera spread through infected water, however Pasteur had not proved his Germ Theory yet.
• 1852 Cholera Epidemic: Snow maps the deaths in an area of London, finding that those who died of cholera shared one water pump, the one on Broad Street.
• He decided to remove the handle of this pump, and the deaths dropped significantly. 

• Birmingham, Joseph Chamberlain: He became mayor in 1873, and transformed the city by 1890. He bought the companies providing water and gas light, and then providing them for all of the city. He used the Artisans' Dwelling Act to clear large slum areas and build a new city centre. The problem was rehousing people whom had their homes demolished.
  
  
• Birmingham, Cadbury Family: Built the model town of Bournville, this had well-built houses and amenities such as sports fields and community centres.
  
  
• North Wales, Levers Family: Built the model village of Port Sunlight, this contained an art gallery as an aim to educate their employees.

• Charles Booth in London, and Seebohm Rowntree in York, carried out surveys into the living conditions of the poor. 
• These showed 1 in 3 people lived below the poverty line, and ill, unemployed, young or very elderly could do nothing to help themselves.
• 1902 Boer War: Showed two-thirds of volunteers were unfit to fight. However, Germany had a very strong army, and they had introduced social reforms e.g. sickness insurance.
• Trade Unions and Labour Party supported workers and were gaining power, whilst the Liberal Party needed their votes.
• New Liberalism: Now emphasised the government should address social issues, rather than Laissez-Faire, politicians genuinely cared for the poor.

• 1906: Free school meals provided for children in need.
• 1907: Workers Compensation Act - compensation for injuries at work.
• 1908: Children's Charter - People punished for neglecting children, children sent to borstals instead of adult prison. Old Age Pensions Act - Over 70s given pension. Coal Mines Regulation Act - Maximum of 8 hours a day for miners.
• 1909: Labour Exchanges - Unemployed people find work.
• 1911: Shops Act - Weekly half-day holiday for shop workers. National Insurance Act - Free medical treatment and sick pay for workers in return for 4d a week. Unemployment pay for 15 weeks in return for 2 1/2d a week.
• Parliament Act: Payment for MPs, working men could stand for election.

• School meals were not compulsory, so many councils ignored this system and some children did not get them.
• Pensions were refused to people who had not worked.
• Some labour exchange jobs were temporary.
• National Insurance Act was only for the wage earner, not for his family.
• Amount paid in return for the dole was high, benefits were not enough for a family to live off, also stopping after a number of weeks.

• Economic Depression: Many more people were unemployed, and could not afford medical care.
• Poverty: Poor people could not afford good housing or healthy food, causing ill health.
• Towns and Cities: Death rate rose between 1928 and 1938.
• Family remedies: For example, vinegar and brown paper for whooping cough, or patent medicines from pharmacies.

• 1942: William Beveridge wrote a report which called for a Welfare State.
• Welfare State: Would provide free education, free healthcare, unemployment benefits and pensions. For funding, Beveridge called for contributions out of everyone's wages.
• 1945: Labour Party won the election and immediately began creating the Welfare State.
• NHS: Established in 1948, all medical treatment was free, doctors were paid by the government.
• Doctors opposed the NHS because they thought they'd lose income from patients paying for private services.
• Aneurin Bevan allowed doctors to work for the NHS and have private paying patients.

Causes: Epidemic diseases, living conditions, poverty.
Healers: Doctors, Government now took responsibility.
Explanations: Germ theory, unhealthy lifestyles and environments.
Treatments: Improved water supply and housing.
Factors for Change: Science and Technology, Germ theory, Individual Genius, Government.
Impact: 19th century - only wealthy had toilets and piped water, majority shared outside toilets and water from street pumps. 
20th century - everyone had fresh water and all new houses had toilets. NHS made improved medical care available to all.