History- Public Health

1350-1750

•  A huge increase in the population had led to cramped conditions and serious health problems.
• Local authorities passed laws to stop people throwing waste in the streets.

1750-1900

• The pace of change started to increase in the late 19th century as the government began to pass laws to insure the provision of fresh water supplies, the disposal of waste and improvements in hygiene.

1900-Present Day

• n the second half of the 20th century the government became increasingly involved in health education so that people came to know more about the dangers of smoking, drugs and alcohol and the need for a healthy diet.
• The National Health Service (NHS) was created in 1948
• The government was starting to pass welfare reforms to improve the country's health.

• King Edward III- The government (king) did not see it was his responsibility, he was responsible for war.
• Lord Mayor of London- Town countries did not have enough money to punish people who broke the laws. People did not want to pay more tax.
• Londoners in 1300s- People didn't understand how disease was caused therefore they tried to explain it with supernatural explanations. e.g. crosses on doors

Problems

• people putting sewage piping into others houses
• bathing in dirty rivers
• sale of putrid meat
• leeches used for bleeding

Solutions

• given 40 days to remove sewage piping
• muck rakers
• bin men
• ordered to sell meat only in daylight.

In 1665 the plague hit London, killing a quarter of the population. The Lord Mayor of London passed orders to prevent the spreading of the plague. These included:

• Victims and their families were shut up in their house and watchmen stood guard to stop anyone going in or out
• Bodies were examined by 'women searchers' to check that plague was the cause. Their findings were confirmed by surgeons
• Bedding had to be hung in the smoke of fires before being used again. Fires were lit in the streets to cleanse the air of poisons.
• Householders were ordered to sweep the street outside their doors
• Pigs, cats, dogs and other animals were banned inside the city
• Play, bear baiting and games were banned to prevent the assembly of large crowds

The streets-clean or dirty?

• 1350- Poor paving, dirty muddy streets, open drains, horse&animal dirt, not enough rakers to keep streets clean
• 1750- Still lots of animals, streets cobbled or paved but haphazard with more mud than paving, many streets sloped to a central drain, but often blocked with rubbish and animal manures, still not enough rakers, law that householders had to sweep outside their homes every day.
• Progression- Streets were cobbled or paved. There were the beginnings of government making laws. Some streets had been sloped to a central drain rather than open sewer. 
• Stagnation or Regression?- The streets remained dirty. Attempts to pave or cobble the streets unsuccessful as they were often haphazard. There were even more animals causing even more dirt, and still not enough rakers. The central drains on the sloped streets were often blocked.

Water Supplies

• 1350- Drinking water from rivers, collected in barrels or public pumps in the streets, water bought from men who carried it around the streets.
• 1750- People still got water from the public pumps, water carriers or barrels. People with larger gardens dug wells, but there was a danger of them being too close to the family cesspit, which could leak into the water. Network of wooden pipes under much of London. Wealthier families got water from reservoirs, but they stored it and it sometimes went bad
• Progression- Wooden pipes put under much of London. Well were made. Wealthier families had access to resevoirs
• Stagnation/Regression- People still got water from public pumps, water carriers or barrels. Wells could sometimes be to close to cesspits. Stored water went bad

Public Toilets

• 1350- Public toilets, but not enough. People used street corners, the river or anywhere quiet. In the 1420s Richard Whittington (Lord Mayor) gave money to build a public toilet but the government did not look after it.
• 1750- Still some public toilets, but most Londoners used toilets in taverns, friends houses or quiet corners or doorways that became known as '******* places' 
• Progression- Most Londoners used Taverns, friends houses etc.
• Stagnation/Regression- People used ******* places, only some public toilets, government didn't look after public toilets.

Sewers and Waste Disposal

• 1350- Open sewers taking away dirt and human waste. People also used the rivers or simply emptied chamber pots into the street
• 1750- Night soil men carried away human waste from cesspits, but not regularly. Overfull cesspits spilled into nearby water tanks or homes. Many people could not afford night soil men, so still emptied their waste into the rivers or drain or out the window. Law passed for rubbish collection every Wednesday&Saturday, but this was not enforced
• Progression- Night Soil men. Law passed for rubbish collection
• Stagnation/Regression- Cesspits over flowed into homes and water tanks. Those who couldn't afford soil men emptied waste into rivers and streets. Law for rubbish collection not enforced. 

Renaissance- Plague (1665)

• Central govt- Left the city
• Local Authorities- closed theaters to prevent crowds. Dogs and Cats killed. Tar barrels burned. Carts collected bodies daily and burned them in mass graves. If there was a case of plague the whole household was boarded up for 28 days. Ordered days of fasting and prayers.
• Effectiveness (/10)- 4/10, the disease wasn't caused by human contact, so stopping large crowds wasn't effective.

Industrial Revolution- tackling alcohol abuse;The Gin Craze (1700s)

• Central Govt- Made gin more expensive
• Effectiveness- 6/10, poorer people couldn't afford gin, therefore making less people abuse alcohol. However, Richer people could still afford it.

Date:1800-1890  Background Info: Chadwick was a civil servant who worked for the Poor law commission in the 1830s and 1940s. In 1948 he became a member of the national board of health but it was disbanded in 1854 because it was unpopular. He believed in miasma not germ theory. Progressive:

• Hard-worked produced a mass of evidence supporting public health reforms
• 1842 report influenced the government and persuaded people that a reform was needed
• His report recommendations were the basis for the 1848 Public health act

Regressive

• 1842- Report did not lead to immediate reform. The public health act came in 1948.
• The 1848 health act did not force councils to reform public health. 
• His personality antagonised people and did not win support for his course
• His influence faded in the 1850s 
• He believed he was the only reason for the government making a public health acts.

Judgement: He did influence the government decision to pass a public health act, however he wasn't the main reason for the governments decision. He didn't improve medical knowledge or practise but he did contribute to improving public health.

1)1831 First Mayor Cholera Epidemic

2) 1834 Edwin Chadwick commissioned by the Poor Law Commission to write a report into working class living conditions

3) 1842 Chadwick's report was published, and drew attention to the link between unhealthy living conditions and disease.

4) 1837: William Farr used all the information registered (births deaths and marriages) to build an accurate picture of where the death rate was the highest and what people died of. This proved the link between high death rate and unhealthy living conditions. This therefore put pressure on local and national government to make changed.

5) 1848 Second Major Cholera Epidemic

6) 1848 Public Health Act- Set up system to encourage local autorities to improve conditions in their are, if local ratepayers agreed- VOLUNTARY

7) Summer 1858 The Great Stink: There was no rain to fill the rivers so river level fell- especially the Thames in London. As a result, the smell from the rivers grew worse, one of the worst places was at the Houses of Parliament which are on the river bank. The Great Stink added to the evidence that more public reform was needed. In London an effective modern sewer system was built, but there was no new Public Health Act to enforce improvements throughout the country

8) Technology: Joseph Bazalgette and Sewers- Bazalgette was the engineer who designed and built London's sewer systems after the great stink. The system included-83 miles of main sewers, 1100 miles of sewers for each street and connecting to main sewers, a series of major pumping stations to frive the flow of sewerage along the pipes. It was mostly completed in 1865 but it was such a large project it took another 10 years

9) 1854 Third Major Cholera Epidemic

10) 1854- John Snow proves there is a link between filthy water and cholera (he can't prove it though)

11) 1861- Louis Pasteur publishes his Germ Theory 

12) Voting Reform 1867&1884- In 1867 working men in towns were given the right to vote for the first times. The numbers of voters doubled. It increased again in 1884 when many working men in country areas got the vote. If politicians wanted to win elections they had to promise laws to win the votes of working men, not just wealthy and middle classes.

13) 1865 Fourth Major Cholera Epidemic 

14) 1875 Public Health Act Passes COMPULSORY- The 1875 Public Health Act made it compulsory for local councils to improve sewers and drainage, provide fresh water supplies and to appoint Medical Officers and sanitary inspectors to inspect public health facilities. Other Laws were pass that:

• improved standards of housing
• stopped the pollution of rivers
• shortened working hours in factories for women and children
• made it illegal to add ingredients that made food unhealthy
• made education compulsory

The attempt to control the plague failed because:

• Parliament refused to turn orders into laws because members of the House of Lords refused to be shut in their houses
• People ignored the laws
• The king and his council left london
• Nine men were put in charge with the plague, six of them left as soon as possible
• Rick making laws so they just leave
• People go back to supernatural ideas (i.e. whipping, praying)

Industrial Revolutions- smallpox (1800s)

• Central govt-Vaccination made compulsory in 1852. 1871- act of parliament forced local authorities to register everyone who was vaccinated.
• Local Authorites- registered everyone who was vaccinated.
• Effectiveness- 9/10, vaccination made number of death fall but only when authorities registered vaccinated people 

Booth was a successful Liverpool businessman and friend of Octavia Hill and others who were trying to improve living conditions for the poor. In 1886, Booth collected detailed and accurate evidence that would prove or disprove that 25% of Londoners lived in poverty. 

Booth's researched discovered that 35% of people in London were living in poverty. Booth was appalled by these results so he continued his work building up evidence of poverty and ill health in London. One of his suggestions was the creation of an old age pension. 

Rowntree investigated poverty and living conditions in York where his family had been in business for many years. In 1901, he published Poverty: a study of town life, providing detailed evidence that more than a quarter of the people in York were living in poverty, even though they were in work, and that poverty was having a serious impact on their health. In 1941 he published a new report progress and poverty which showed a 50% reduction in poverty since 1901 and that poverty in the 1930s was mostly the result on unemployment rather than low wages.

In 1906, a new Liberal government was elected with a landslide majority of votes. Many people expected this government to make major reforms to improve everyday life. Here are some of the measures the government took:

1902- Compulsory training for midwives

1906- Meals provided free for school children in need

1907- All births had to be notified to the local medical officer of Health. A health visitor visited each mother to make sure she knew how to protect her babies health

1907- Nurses or doctors had to carry out medical check on children in schools

1908- Old age pensions were paid to people over 70 who did not have enough money to live on

1909- Back to back housing was banned. Now regulations enforced higher standards of house building

1911- National Insurance Act providing help for the sick if they fell ill

1912- Clinics were held in schools to give children free treatment

David Lloyd George was one of the most inspiration politicians in British History.

He became a liberal MP in 1890 and was chancellor of the Exchequer in the Liberal Government which introduced the reforms above.

He insisted on raising taxes on the well off to pay for old age pensions and the National Insurance Act of 1911.

He became prime minister in 1916 during WW1  

One of the greatest changes introduced by Lloyd George and the liberal government was the National Insurance Act of 1911. The aim was to give workers medical help and sick pay if they could not work through illness. Until then, workers who fell ill had a choice- carry on working or get no pay. 

However, it only included people in work, not their families. Most women and children were excluded. So were the unemployed and elderly and anyone who had a long lasting illness.

1)Surveys carried out at the end of the 1800s and early 1900s by individuals such as Charles Booth and Seebohm Rowntree showed how difficult it was for the poor to afford decent housing and food.

2)A third of volunteers for the Boer War (1899-1902) had to be turned down because they were not medically fit. This shocked politicians and made them decide to take action.

3)1902- MIDWIVES ACT all midwives have to be trained and registered

4)The Liberal government elected in 1905 began to pass laws they hoped would improve health among the poor

5)1906- free school meals for poor children, 1908- old age pensions act, 1907- School medical service and health visitors to check on the health of children. 1911- National Insurance Act, every worker earning less than £160 a year was expected to join the scheme, in which contributions by the worker, employer and government were made to a fund that then entitled workers to free medical treatment and medicine also sick pay for up to 6 months and support payment while unemployed.

6) People resisted government on the grounds of cost as well as objections to the government's increasing involvement in their lives. There was a crisis in parliament when the Chancellor, David Lloyd George, needed to raise taxes to pay for the National insurance act

7) In 1912 a Ministry of Health was set up and the government began to build sanatoria to care for people with TB, but there were still problems

8) An epidemic of influenza in 1918-1919 showed there were not enough free hospital places to cope with the sick. Also Women and children were not covered by the National Insurance Act and so they often delayed getting treatment because they could not afford to pay for a doctor.

9) People became more willing to accept government intervention and people's expectations of medicine increased because of a better understanding of vaccinations and the development of better treatment for disease.

10) By 1931 the average life expectancy had risen to 58 for men and 62 for women, and the government was doing much more to help improve the health of the nation

11) Secondary school pupils received medical inspections, free milk for poor primary school children was introduced in 1934, Many hospitals were brought under the control of local authorities, health clinics gave vaccinations and sold baby food cheaply.

12) 1939-45 the second world war: this increased awareness of the effects of poverty on health, shocked people who received evacuees from towns who were not used to running water or proper toilets and often had nits lice or skin infections, led to the setting up of the emergancy hospital scheme which promised to treat everyone for free, saw the publicatoons of the Beveridge report which promised to slay the five giants, allowed people to see the advantage of government intervention e.g. rationing, improved people's health as they ate healthier because of rationing, contributed to the election of the 1945 labour gov who promised to establish a NHS 

Progression

• 5 july 1948- The 1st day of the NHS: the nationalization of hospitals, the creation of health centres, the better distribution of doctors around the country, a new salary structure for doctors.
• 1958- 1st mass polio vaccination- before 8000 died per year
• Early 1970s- Single issure health campaigns begin against smoking, AIDS and diet
• 1988- Breast screening introduced all over country
• 1992- 'The health of the Nations' initative sets the NHS 5 targets to hep prevent and reduce death and illness in heart disease, cancer, mental illness, HIV.
• 1998- NHS direct began, this 24 hour phone advice service meets the original aim of the NHS to provide health care to all
• 1999- NICE began work- the national institute for health and clinical excellence, providing guidelines and recommendations for effective health care.
• 2000- NHS public drop in centres introduced.

Regression

• 1958- Patients started being charged on shilling for prescriptions
• Early 1970s- heart transplant goes horribly wrong after a patient dies

Snow was a pioneer in surgery as well as in public health, immproving medical methods and using detailed evidence to challenge old theories. In 1849 he published a book saying that cholera spread through water not 'bad air', his suggestion got mocked by many doctors. In 1854 another cholera epidemic allowed him to prove his theory.

Cholera killed 500 people around Broad Street, near Snow's surgery in 10 days. This led Snow to map out the deaths in detail and write a report detailing his evidence 'On the mode of communication of cholera'. 

Snow's evidence was so strong that the handle of the Broad Street water pump was taken away, stopping people getting water from the pump. There were no more deaths. It was later discovered that a cesspool, only a metre away from the pump was leaking into the drinking water.

Snow had proved that clean water was essential for preventing the spread of cholera but even this did not lead a new Public Health act enforcing change. Many Scientists still clung to the bad air theory (Pasteur had not published germ theory)

Bevan left school at 13 and began working in a local colliery. He became a trades union activist and won a scholarship to study in London. It was during this period that he became convinced by the ideas of socialism. During the 1926 General Strike, Bevan emerged as one of the leaders of the South Wales miners. In 1929, Bevan was elected as the Labour member of parliament for Ebbw Vale. 

During World War Two, Bevan was one of the leaders of the left in the House of Commons. After the landslide Labour victory in the 1945 general election, Bevan was appointed minister of health, responsible for establishing the National Health Service. On 5 July 1948, the government took over responsibility for all medical services and there was free diagnosis and treatment for all.

In 1951, Bevan was moved to become minister of labour. Shortly afterwards he resigned from the government in protest at the introduction of prescription charges for dental care and spectacles. Bevan led the left wing of the Labour Party, known as the 'Bevanites', for the next five years. In 1955, he stood as one of the candidates for party leader but was defeated by Hugh Gaitskell. He agreed to serve as shadow foreign secretary under Gaitskell.

In 1959, Bevan was elected deputy leader of the Labour Party