What factors provided the impetus for public health reform?

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Engineering and technological developments

  • This caused public health reform because it provided a viable way of sewage disposal
  • Bazalgette pushed for reform, but his proposals were rejected six times, until the Great Stink of 1858
  • Which provided the final catalyst that to this reform and the acceptance of Parliament
  • The magnitude of this event can be seen by the Prince of Wales opening the sewers in 1865
  • Water companies and soil men had vested interests in opposing the new sewers and this often provided strong opposition
  • Newspapers also provided a great deal of opposition often reporting on accidents that occured in Bazalgette's sewers
  • One key aspect of the new sewers was the huge oval shape which allowed the sewage to be transported efficently
  • This was different to Chadwick's smaller sewers and means that Bazalgette's sewers are still in use today
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Engineering and technological developments

  • The Portland cement used allowed the structure to be incredibly strong and stable due to its quality
  • Bazalgette didn't only work using sewers as he also worked on improving public health by widening streets and bridges
  • Reducing the cramped conditions and creating the Thames embankment so the water flows faster out to sea
  • Another example is the use of kerosene lamps to light the streets as it allowed for people to walk the streets at night in greater safety
  • His achievement was also recognised for his services to the city of London as he was knighted in 1874
  • The effectiveness of his sewers can be see by the vastly reduced number of Cholera deaths in London, where the sewers were fully operational, during the 4th Cholera epidemic (14,000)
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Local authorities

  • The idea that local authorities could implement change in their own areas sparked similar change in public health within other areas
  • Best examples of local authorities implementing public health reform are Leeds and Manchester where in 1835 they took control of paving, sewerage, street cleaning and drainage
  • Liverpool also showed intiative through the Liverpool Sanitary Acy 1846- which gave the town council a wide range of powers to deal with public health
  • However there was only some change before 1848 as it was difficult for local authorities to act upon public health
  • Problems included piecemeal legislation such as that in St. Pancreas, which had 29 conflicting acts applying
  • The improvement acts also often competed physically 
  • As seen in Lancaster, where two different water systems would not connect with each other due to the competition between the acts and as a result of vested interests
  • After the Public Health Act 1848, there was a greater change in local authorities
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Local authorities

  • Although 192 towns actually for new public health regulations in their local areas by 1850
  • Therefore there continued to be huge regional variation 
  • And the quality of public health was often determined by how active the local authority was in seeking to improve public health
  • For example the appointment of medical officers in local areas was not compulsory until the 1875 Public Health Act
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Scientific developments

  • Were a key driving force behind public health reform
  • Because of understanding of how diseases were caught and spread, as well as the improvements to education that taught germs cause disease
  • Led to an increased demand for public health improvements and therefore drove reform
  • This development came from individuals such as John Snow
  • Whose detailed investigation into the high cholera death rates around Broad Street led him to the conclusion that Cholera was a water borne disease
  • Snow's thorough investiagtion and attention to detail demonstrated through the investigation into every anomaly in the area
  • Such as the local workhouse and brewery workers who didn't catch the disease
  • Helped to convince some of his theory, and set the standard for future public health inquiries 
  • However, this theory didn't come into general acceptance until 1870
  • And the discovery that drinking water in the East End of London was not filtered
  • The only place where cholera returned after the completion of the sewage system
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Scientific developments

  • The acceptance by the scientific community that Cholera was, indeed, water borne allowed the government, local authorities and local people to act to efficiently prevent it in the future
  • Helping to improve public health as a consequence
  • Another key individual in scientific developments was Louis Pasteur
  • Whose germ theory in 1861 proved that germs caused disease, revealing how diseases were spread
  • Therefore disproving the widely held view that diseasespread through miasma, and that "all smell is disease" a la Edwin Chadwick
  • The understanding in itself led to further developments such as the improvements of vaccinations and improving public health
  • Through subesquent government intervention such as the Vaccinations Act of 1871
  • Newly acquired scientific knowledge, coupled with improvements to education such as the Forster's Education Act 1870
  • Meant that people were taught germs caused disease and no longer prepared to put up with poor public health
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Scientific developments

  • This created a greater demand for public improvements from the citizens
  • Increasing the pressure on the Government 
  • Therefore driving reform and improvements to public health locally, as well as nationally
  • Due to the impact that the working classes had on elections from 1867

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The growth of democracy

  • Led to the move away from Laissez faire
  • The 1867 Reform Act, for example, mean that the working class had influence over government policies because they had the vote
  • Disraeli also had an impact through his ideology of "Two Nation Conservatism" 
  • As a result of this he pushed for public health reform, notably the 1875 Public Health Act 
  • His sympathethic view was spread and scene in his book Sybil
  • Sybil showed his geuine for the poor
  • He also commented: "The Palace is not safe, if the Cottage is unhappy"- demostrating his understanding that if the newly franchised working class were not legislated for there would be potential discontent
  • Disraeli's deep intense personsal rivlary with Gladstone also made him more determined to win the working vote by legislating on their behalf (such as the Public Health Act 1875)
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Individuals

  • Were also very significant in pushing public health reform because they proved the need for change both scientifically and practically
  • E.g John Snow and his investigation on Broad Street and as well as Pasteur's germ theory
  • These two factors showed proof that there was no link between disease and the Miasma theory
  • Edwin Chadwick made a tremendous effort in pushing for public health reform with his 1842 report in which he showed the link between diasease and poverty- disease caused poverty- as well as his reccomendations
  • And his drive to persuade the government to legislate on public health
  • In addition,his 1844 Health of Towns Association (propaganda campaign) was designed to push the government into action
  • Chadwick's work laid the groundwork for the 1848 Public Health Act (althought Cholera was the catalyst)
  • William Farr was also significant in terms of pushing the public health reform
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Individuals

  • He provided a mass of statistical data regarding ages and causes of death in every city
  • Which were used widely by public health reformers in order to try and shame local authorities into action
  • Another individual that contributed strongly to public health reform was James Kay
  • As he visited each area to investigate conditions in Manchester 
  • And wrote a report in 1832 which was one of the first detailed report on the condition of a specific group of working class
  • Moreover, James Kay was one of the first people to demonstarte the connection between dirt and disease as well as showed that dirt and diet affected the health of people
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Fear of cholera

  • Was the main factor that led to public health reform in 1848
  • Due to severity of the disease that had four major outbreaks in 1832, 1848, 1853 and 1867
  • And killed over 62,000 in 1848 there was increasing fear which was especially due to the fact that it affected everyone, regardless of class and was such a swift death
  • For example there was 500 fatal cases in days within one area of London and this fear forced the government to act
  • The PHA 1848 was the first legislative action they took to try and resolve the problem
  • It also acted as a catalyst for more people to look into public health such as Edwin Chadwick
  • And even though most people still believed in miasma (including Chadwick)
  • It still caused the impetus for improvements into public health
  • This can also be seen as the "Great Stink" of 1858 led to factors of Cholera returning as a result of the smell from the Thames
  • This led to the government finally agreeing to Bazalgette's sewers plans
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Fear of cholera

  • The government also took action over the first Cholera outbreak in 1831-2
  • By setting up a temporary Board of Health which advised local governments to set up their own Boards of Health
  • The government also passed the Cholera Acts in 1832 to allow local authorities to enforce measures without separate acts of Parliament
  • It was cholera that ensured that government became increasingly involved in legislating on public health
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