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Public health history in Britain

See a little public health history in the context of Great Britain in this video.
The industrial revolution began in the 18th century, which led to rapid overcrowding in cities and people living in poor conditions with lack of sanitation, conducive to the spread of disease, such as cholera. In the UK, multiple cholera epidemics were experienced in the 19th century, with thousands and thousands of lives lost. In 1842 Edwin Chadwick published a report emphasising the links between poverty and health, calling for public health action which led to the 1848 Public Health Act. The Public Health Act called for better sewage systems and improvements of structural conditions to better public health. The work of John Snow demonstrated that there was a connection between contaminated water and cholera.
John Snow is by some considered as one of the founders of modern epidemiology as he studied the origins of a cholera outbreak in London in 1854 and discovered that all victims utilised the same water pump. Now understood that cholera was waterborne, rather than caused by ‘bad air’, miasma, which was the common belief at the time. Snow removed the water pump. His work is incredibly important to the development in epidemiology, please do watch the videos about his contribution to epidemiology. In particular the building of his case, looking at cases and non-cases, was really exceptional and what we now perceive as fundamental to epidemiological methodology.
The ‘Laissez-faire style’ of the 19th century meant people believed that governments should not interfere in public health. Unfortunately, despite Chadwick and Snow’s efforts, scepticism and misunderstandings about the origins of cholera caused cholera to return to Britain, which continued for many years, resulting in thousands more preventable deaths. Only in 1875 another Public Health Act was passed. This Act made it compulsory for councils to improve their sewage systems and sanitation. The Artisan’s Dwellings Act in 1875 also instructed local councils to rebuild their slums to improve housing standards. Change was slow and poor living and working conditions very still all too common.
Real change only came after the 1900s when the Liberal Social Reforms continued to make efforts to demonstrate the link between poverty and ill health and calling for Government action to improve people’s living and working conditions. The laissez faire attitudes regarding the role of the government was changing, resulting in Liberal Reforms (1906-1914), with examples such as the Free School Meal Act in 1906, free medical inspections for school children (1907), old age pensions (1908) and the national Insurance Act (1911). Not all rosy yet, for example the free school meals Act gave local councils the power to offer free school meals, raised by local taxes, but again this was not compulsory, and therefore this was not universally adopted.
World war I and World war II highlighted social and health inequalities in Britain and encouraged more reforms and improvements to public health. This was not all out of the good of politicians’ hearts, but it became evident that army recruits from impoverished backgrounds, were in poor health, which in turn could impact on the quality of the army. At the same time, although new housing estates were built, these were not always affordable for poor people, and so a large proportion of the population was still living in difficult conditions. This situation was worsened by the destruction in World War II, when many houses were destroyed. Sir William Beveridge, who was a social economist and reformer, delivered in 1942 The Beveridge
report, which included a focus of Five Giants: Want, Disease, Ignorance, Squalor and Idleness, which reflected a summary of principles to tackle poverty. The Beveridge report led to the creation of the Welfare state and in 1948 the NHS, with free medical treatment at the point of access, for all. These historical movements demonstrate to us already how poverty, inequality and political factors are underpinning public health, something we will see time and time again during your MPH. The Covid-19 pandemic is still highlighting these factors, and although we have come a long way in public health, the pandemic has made it so clear that we still have such a long way to go.
More than ever we need people like you to become involved in public health!

In this video we explore a little public health history in the context of Great Britain.

The scope of public health is vast and widening all the time (Detels, 2009). Organised community efforts to promote health and prevent disease go back to ancient times.

Throughout history, medicine and public health have evolved often according to what was needed in times of public health crises (Riegelman & Kirkwood, 2015). Even looking at religious text we can see references to public health in the Bible and the Quran, encouraging people to practise good hygiene and sanitation and to take responsibility for their health.

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