Public Health Over Time

• In this century public healthcare was almost non-existent 
• Housing for the poor was overcrowded and dirty meaning that disease was rife 
• Clean water was not readily available so beer was drunk more often, as it was cleaner than the water due to the water being boiled in order to make it 
• The main reason for poverty was being the poor were poorly more often than the rich

• Was a British physician 
• During the cholera outbreak in 1854 he was recognised as one of the founders of epidemiology 
• He didn’t accept the fact that cholera was thought to be an airborne disease 
• He realised that it was really due to the water pumps. 
• He went to Soho where there were many cases of cholera. 
• He replaced the main pump and instantly the cases of cholera reduced 
• When he put his finding to the board of health he was not believed and was told that his hypothesis was “nonsense” and “we see no reason to adopt this belief” and shrugged off Snow’s evidence as mere “suggestions.”

• Was one of the most important figures when it came to public health legislations 
• Was a lawyer
• Believed that the living conditions needed to be improved for the poor as illnesses were spreading through the air
• He influenced the changing of the 1834 poor law
• He influenced the Poor law of 1848
• His report sparked a debate as to whether or not the government should clean up the streets in poorer areas

• Was slow to happen
• Sparked by Chadwick’s report
• Supporters were known as the “Clean Party”
• Health of Towns Association was founded in 1844
  • They campaigned for better living conditions
  • Set up local branches in some parts of the country
  • Each branch produced evidence of the streets being dirty, there not being enough sewage facilities and there not being enough supplies of fresh drinking water
• In 1847 the “Public Health Bill” was introduced to parliament
• The opposing group of MP’s (known as the “Dirty Party”) thought that the government should not interfere with the issue and allow tings to take their course as the streets were not seen as the responsibility of the government
  • As well as this it was said that if the government cleaned the streets then it would give them too much power as well as costing them too much
  • They thought that the poor should look after themselves as they were looked down on
  • It was thought that as the poor did not have the right to vote then those richer than them should not have to help them out
• Although, Chadwick’s report clearly showed a connection between the streets being dirty and disease, nobody knew exactly what was causing the disease
• It was not until another outbreak of Cholera that the Public Health Act was passed 

• Was the amended version of the “Poor Law” Act in 1815
• Was designed to reduce the cost of looking after the poor People had to go to the workhouse if they wanted the money 
  • Stopped money going to the poor unless in exceptional circumstances
• People had to go to the workhouse if they wanted the money 
  • Poor were given food and clothes in return for several hours of manual labour each day 
  • Were given a uniform and a poor diet that mostly consisted of bread and watery soup 
  • The workhouse split families up 
  • Only those in desperate need would go there 

• Encouraged local authorities to appoint a “Medical Officer”, provide sewers, inspect housing conditions and put in certain conditions for the sale of food 
• Was one of the first steps to improving public health 
• Set up the “General Board of Health” 
  • If over 10% of a local population asked for a local board of health or the death rate was over 23 in every 1000 people, then a local board of health would be set up in that place 
• Sir John Simon was the “Chief Medical Officer” for London 
• The act helped to prove that by simply cleaning the water supply and improving sanitation then the national death rates could be lowered 

• The government finally accepted that it needed to care for all of it’s citizens throughout their lives 
• Began to focus on the health of the nation more than ever before
• After the 1st world war (1918) a target of 500,000 homes was set to be built by 1933 for the war veterans
• In 1919 the “Ministry of Health” was set up to look after;
  • Sanitation 
  • Health care/Disease 
  • Maternity and Children’s welfare 
  • The training of doctors, nurses, dentists 
• In 1934 the “Free School Milk” Act was set up 
• In 1942 the “Beveridge Report” was commissioned leading to the “Welfare State” being set up 
• The 5th July 1948 was the day that the NHS was officially opened 
• In 1956 the “Clean Air” Act was imposed to help improve the quality of the air in cities 
• The 1980 “Black Report” stated that although many steps had been taken to close the gap of inequality in health between the rich and poor there was still a way to go 

• The author was Sir William Beveridge
• Was presented to parliament in November 1942
• It proposed a system of social security that could be implemented after the war and funded by the state 
• Was not until 1945 when Clement Atlee became the first Labour Prime Minister that the suggested changes in the report (benefits on the welfare state for the poor) were actually implemented 
• Another change suggested was the addition of the NHS so that the government were able to look after all citizens “from cradle to grave” 
• The report provided social security for all 

• Was launched by the health sectary Aneurin Bevan on July 5^th 1948
• For the first healthcare services were free for all
• The included services were:
  • Hospitals
  • Doctors
  • Nurses
  • Pharmacists
  • Opticians
  • Dentists
• Was to financed entirely by the tax that was collected

• By 1952 a 1-shilling charge was introduced for prescriptions
  • By 1^st June 1952 a £1 charge for ordinary dental work was introduced
  • In 1965 prescription charges were abolished and reintroduced in June 1968
• On April 25^th 1953 the structure of DNA (deoxyribonucleic acid) was discovered by to scientists from Cambridge
  • This allowed a better understanding of diseases caused by defective genes and hereditary conditions
• The link between lung cancer and smoking was made in 1954 meaning that the NHS could begin to warn people on the dangers of smoking
• Until 1954 children were only allowed to visit parents for an hour a day on the weekends and there would be no attempt to explain what was wrong with the parent
  • Paediatricians eventually managed to prove that separation was traumatic to children and so the visiting times began to increase reducing the risk of those children developing mental health problems later in life
• In 1958 the vaccination programs for Polio and Diphtheria were introduced
  • This meant that everyone under the age of 15 was given the vaccination and soon the number of people concreting the diseases dramatically reduced 

• Published November 1998 
• Was an independent inquiry into the inequalities in healthcare
• Was written to inform the government on their public health strategy
• The report made many specific recommendations including: 
  • Introducing health impact assessments for all policies so that it was clear to see what direct and indirect impact the current policies were having on health and health inequalities 
  • Having a director of health for every local authority 
  • Having a partnership between the government and local authority so that they both have an equal amount of responsibility for the health of a region 
• All suggested proposals were not costed individually but the potential price was all added up and included 

• Was a law that was passed in 1999
• Set out the governments steps to improve health 
• The government thought that poor health was actually caused by extra factors e.g. the environment and economic issues 
• The government said they would: 
  • Establish the Health Development Agency (HDA) to guarantee that high standards were kept in all public health provisions
  • Have a person in charge of promoting public health information in each region
  • Have a fund ready for the development of public health
• Targets for the improvement of local health was implemented by the government 
• National targets were also set. Relating to: 
  • Cancer
  • Coronary Heart Disease
  • Accidents
  • Mental Illness

• Rather than not having enough the new threat to public health is that we have too much 
• Another 21st challenge is the UK’s aging population
  • Before the worry was that people were not living long enough now the new worry is that we are living for too long. With this comes more complex health problems e.g. Alzheimer’s 
• Some public health aims for 2015 were: 
  • Reduce Child Mortality Rates 
  • Improve Maternal Health
  • Combat HIV/AIDS
  • Combat Malaria and Other Diseases 
  • Promote Gender Equality

• In the modern world we have unhealthier choices than ever before 
• Many foods are filled with salt and sugar and although there is a way of monitoring what we are eating many of us don’t 
  • As a result of having more choice in 2013 it was estimated portion of 34% of boys and 39% of girls aged 13-15 were obese
  • 42% of females age 11-12 and 54% of 13-15 year-old girls achieve less than 30 minutes of exercise per day
  • Teens are not getting enough calcium and iron in their diets 
  • Eating disorders are typically seen in girls and young women, in particular in females aged 12-20
  • It was found that nearly a third of 12 year-olds and half of 15 year-olds have dental caries (scientific term for tooth decay/cavities)

• With technological advancements we have become lazier than ever before e.g. you can now do your weekly shop online 
• With the rate of inflation constantly going up and wages staying the same many people can also no longer afford to go out for recreational activities e.g. go to the gym 
• Convenience food/ready meals are easily available to all at cheap prices meaning that we don’t cook proper, healthy meals as much now so we don’t exactly know what is in our food and how much of it 
• Alcohol consumption is also a problem with many people drinking over the recommended 3 units a day (for women) and 4 units a day (for men)
  • Social tends (2009) reported that 44% of men and 40% of women where over the limit in 2007

• The government has launched many initiatives e.g. “Change 4 Life” to try and improve the health of the nation
• Smoking is also another large problem for the nation if the lower classes smoking almost twice as much as the upper classes
  • Smoking is the biggest cause of lung cancer as well as contributing to many other illnesses including:
    • Heart disease
    • Strokes
    • Heart attacks
    • Mouth cancer
    • High blood pressure
    • Cardiovascular disease
  • The government has launched “Stoptober” to help people stop smoking 

• Currently battling against the outbreak of Ebola in West Africa 
• They do this by testing new treatments e.g. vaccines and tests to see if a person has got the disease 
• They also determine how ethical each treatment is 
• As well as this, they raise awareness on Ebola and the symptoms 

• Currently working on new medications for specific illnesses as ordered by the Department of health. 
• Currently doing research on trying to find the new medications 

• Similar work to the WHO but only in the UK 
• They help advise the NHS on how to treat certain diseases 
• Also forecast which illnesses are going to be a problem next and try to tackle them before they surface 

It is clear to see that public health has come a long way since the 1800’s. From the poor having almost no care and proper healthcare being too expensive, to healthcare being free for everyone in the UK with only a small price to pay for medications. Over time many illnesses have been either cured (smallpox) or the number of cases drastically reduced (cholera) due to a few simple steps being taken.