History-Public Health

• Rome produced the best means of preventing disease through their 'public health' sceme. Their practical skills produced the best public health system yet seen anywhere in the world
• Fresh water was collected from springs and transported by aqueducts
• Aqueducts transported the water to reservoirs 
• Lead pipes took the water to three main sections of the public health system:

 - Cisterns and public fountains were used for drinking water and washing water

 - Baths: which helped rid people of fleas that spread disease, barracks, private houses and official or public buildings

 - Public latrines

• All waste and durty water was taken away by sewers
• There were rules about burying the dead and preventing fires
• Engineers took great care in siting towns, forts and villas

• Many rules were made to try and create a 'public health' system but it was never as effective as in the Roman period. The middle ages lost most of the roman public health system through wars
• Butchers were given segregated areas for butchering animals
• Streets had gutters for waste and sewage that lead to rivers
• There were wells for collecting water and cesspools for dumping sewage, however these were close together

• During the late 18th century and the first half of the 19th century conditions in many towns became worse than ever
• Populations was growing rapidly, towns could not provide everyone with houses, clean water or a way to remove their sewage
• Disease could spread with speed and the people's health was terrible, dieases such as Tuberculosis, Diptheria, Whooping cough and cholera became increasingly common
• Some people thought that the local governments should force them to clean up their locl towns, however many believed the government should keep out of peoples lives - this attitude was called Laissez Faire, each local government should control their own affairs
• This meant the local ratepayers made all the decisions, they did not want the government to make them pay extra to clean up their towns and help the poor, they were known as the 'Dirty Party'
• This battle coninued inconclusively until an epidemic of chloera in 1831-32

• Cholera epidemics continued throughout the century, the next major epidemics were in 1848 and 1854
• In 1854, John Snow made a breakthrough in proving that there was a link between the disease and water supply
• Snow was a London doctor and used meticulous research, observation, and house-to-house interviews to build up a detailed image of a limitted cholera outbreak which hit one particular area in central London
• Snow discovered that the water pump on Broad Street was most commonly used by the locals as they said it tasted nicer, however he realised the cess pit, where sewage was dumped, had been leaking through a hole in the water pump. The contaminated water was carrying the disease and giving it to any one who drank the water
• Once Snow had collected his research and realised the problem he was allowed to remove the handle from the pump and there were no more deaths

• Cholera was the most frightening disease but it was far from being the only danger to health, living conditions were another important factor. Conditions in the country were just as bad as in the towns, with bad water supplies, inadequate drains, damp houses and indifference to rubbish all helped spread disease
• Diarrhoea, typhus, typhoid and cholera were all common
• In 1830 civil servant Edwin Chadwick was emplyed by the Poor Law Commission, Chadwick was asked to report on the living conditions and the health of the poor in both town and country areas.
• He conluded that much poverty was caused by the living conditions in which people lived, and that the best way in reducing the cost to the ratepayer of looking after the poor was to improve their health 
• He suggested: drainage, the removal of all refuse from the streets and the roads, the improvement of the supplies water, for the prevention of disease a district medical officer with special qulaifications was appointed

• The care of the poor were normally handled by the ratepayers, they were trying to reduce the cost of looking after the poor, not increase it. Chadwicks recommendations were expensive to insigate even if they saved money in the future the ratepayers were not keen.
• The next 30 years was a struggle for the public health act to be passed, the government knew local buinessmen and politicians wouldnt pay for the changes so no imporevment was made
• After a second epidemic of cholera in 1848, the parliament reluctantly approved the Public Health Act of 1848
• However only a few local authorities took any of the new measures so no real change was made

• Joseph Bazalgette designed and built the sewer system
• The flushing lavatory was invented - instead of privies that had to be emptied by hand and then left rotting for days, the waste was instantly sent down into the sewer system
• Soap - in the 1800s soap was taxed so was raely brought or used, in 1853 the tax on soap was removed so people could afford it, washing therefore helped keep people disease free

• Passing the Public Health Act was only the begining, after that there came hard engineering work, building the new systems (sewers)
• Joseph Bazalgette was the engineer who designed and build the London sewer system after the Great Stink of 1858 - this was a when the Themes smelt awful right outside the Houses of Parliament, it smelt so bad that they were forced to do something
• The system included: - 83 miles of main sewers built underground from brick

                                     - 1100 miles of sewers for each street and connecting to the main pipes

                                     - a serises of major pumping stations to drive the flow of sewage down                                          the pipes

• The process took about 10 years to complete, fortunately Bazalgette had predicted to size of the future population so built the system big enough

• The 1875 Public Health Act included more laws which finally forced local authorities to provide clean water, proper drainage and sewers, and to appoint Medical Officers of Health
• Many factors contributed to the change: 

 - Scientific developments (Pasteur's germ theory)

 - New voters (Working-class got to vote, making the MPs make note of the needs of the poor)

 - The weakening of laissez-faire (The government realised that it was in everyones interest to          force towns to clean up)

 - Some cities lead the way (Leeds introduced an improved the public health of their city and            showed huge improvements)

 - Cholera (The epidemic in 1865, John Snow & Pasteurs germ theory)

 - Statistics (From 1837 the government started collecting the rates for births and deaths, they          could compare the highest death rates to where the person had lived)

• Better working conditions in factories
• Compulsory vaccinations
• Isolation hospitals for infectious diseases
• Laws against pollution in rivers
• Building regulations
• Food regulations

• The public health reforms were a huge step in creating clean and healthy living conditions and therefore lives
• However there was increasing evidence that poverty was causing a lot of ill-health, those who could not afford their homes had to go and work in the workhouses ran by the local council
• Charles Booth surveyed poverty in London, his work shoed that a third of famillies did not have enough money to pay for their housing, clothes and food
• Many were working but earned very low wages, the sick, unemployed and elderly recieved not help from the national government

• By 1944 teh NHS system was being planned, it would be open to all people and it would cover all medical health care
• In 1946 the Bill to introduce the NHS was passed
• Aneurin Bevan was appointed to introduce it, he faced many problems: 

 - Local authorities and voluntary organisations, they opposed the new hospitals and the way they were going to be ran compared to the way authorities and organisations originally ran them

 - The cost, many were concerned about the huge costs

 - The British Medical Association, the stiffest opposition came from the BMA, doctors didnt want to be employed by the government and told where to work becuase they could no longer sell their services. They feared this would result in a loss of income

• The NHS now provides the some of the best care in the world and it is avaliable to everyone