Describe the origins of public health in the UK
M1- Compare historical and current features of public health Public Health has been developing from the 19th century and is still developing in the present day.
Public health was best described by the Yale professor Winslow in 1920 who described it as ‘the art of preventing disease, prolonging life, and promoting physical health and efficiency through organized community efforts for the sanitation of the environment, the control of community infections, the education of the individual in principles of personal hygiene, the organization of medical and nursing services for the early diagnosis and preventive treatment of disease, and the development of the social machinery which will ensure to every individual in the community a standard of living adequate for the maintenance of health’.
Public health covers a range of areas, and is constantly having to be changed to keep up with the changing health needs of the public. (Fleming, M. and Parker, E. (2009) An introduction to Public Health Churchill Livingston Elsevier: Australia) During the Victorian Era, public health was not an issue that was dealt with by the government. There weren’t public hospitals, and only those from a wealthy background were able to access medical care. There was no such thing as vaccinations as there was very few educated on health, and many people died from diseases and infections in all classes, that now a day are easily treated.
The people of this time were very uneducated about personal hygiene care and knew nothing about the spread of diseases. The people based their beliefs on their interpretations of what they saw going on around them. Due to the lack of knowledge it was believed if someone died it was because they were, for example, possessed by a daemon or they were a witch. In today’s society we have the understanding and science to allow us insight into the real reasons that people die and get unwell, we know that illness are not caused because someone is a witch.
During the 19th century there was many factories built which offered jobs to many people, so many people moved from the country to be near the factories as the transport systems were so poor. This meant that there was large numbers of people living in small areas. Though when the people began work in the factories, they soon realised that all was not as good as they had hoped for. In today’s world we have a far better transport network which means people can live in less confined areas, and they can travel easily to reach their places of work.
Long working hours, poor wages and bad nutrition meant that people’s health started to decline, and it was in fact the more rural living people that lived longer. People were paid such bad wages and there was no benefits system in place, so when people were unable to afford a house for them and their families they were sent to the workhouse which was a last resort, in the workhouse people never got out alive, all dying shortly after they entered due to the vast amount of sickness that was there.
Children went to work in the factories as soon as they were old enough, about 8 years old, and the woman also went to work in the factories as well as caring for the sick. This meant that the death rate in woman and children was especially low. In 1833 the Factory Act was put into place. This act was to regulate the working hours of woman and children, it took a long time to be implemented but it was a step towards the regulation of working conditions. (victorianweb.org 2006)
Today is it illegal for a child to work until they reach the age of 16, and woman get paid leave from their jobs when they have a baby, this has meant that children are able to go to school and get an education and grow physically and intellectually instead of going to work from they can walk. During this time there was no such thing as building controls, so the homes in which people lived were of bad conditions, they were overcrowded and did not have any sanitation such as running water or sewage facilities. A six bedroom house would have had 6 large families living in it, one family per room.
This meant that people had to take turns sleeping and infection spread easily, due to lack of sanitation. In today’s society we have building control who ensure that ll homes are fit for purpose and most people have their own bedroom, rather than one family to a bedroom. The life expectancy of someone living at this time and working in one of these factories was around the age of 22. The life expectancy for tradesmen was 27, men had a higher life expectancy that woman, and the upper class had a life expectancy of 45 as they were not subjected to the reality of the slums and factories.
In today’s society the life expectancy of woman is 5 to 10 years longer than it is for men. This is mainly due to the fact that woman look after their health better and are more regular users of going to the doctors than men are. Woman are also more likely to talk to their friends if they think that they have something wrong where as men are not big talkers when it comes to their health. During the Victorian Era 60’000 to 70’000 people during every decade from tuberculosis and the numbers dying from it decreased and in recent years it was thought to completely be eradicated.
The health service then made the decision not to vaccinate people for the disease because there had been no numbers of death from it, but this has not been the case and people have begun to tract it again and there are people dying from it. (bbc 2011) In 2011, 8,963 cases of TB were reported in the UK. (NHS 2012) No toilet facilities or sewage system meant that people chucked their waste out to the street, not knowing the consequences that untreated waste would have on their health.
The water that the waste was thrown into was the same water that vermin and other animals lived in; this water was also used by the families for cooking and drinking which meant there was a serious spread of infections. Cholera is a water born disease which claimed the lives of thousands of people living during the 19th century, the symptoms include; stomach pains, vomiting, diarrhoea and the skin turning blue. Dr John Snow, who is now a famous figure in history, was the first person to make the connection that cholera spread through the water.
He was a working class man, and he went on to study the people and how they were becoming ill, and discovered how cholera was spreading, and so epidemiology began. Epidemiology is the study of the spread of diseases and it is something that is ongoing today with the many new diseases that are being found. (bbc) Cholera is a disease was thought to have been eradicated but due to the recent weather disruptions across the UK and Ireland, the government are concerned that there could be another breakout.
Thousands of homes have become flooded and the sewage from these homes is running up and down the streets, this being a vast resemblance to the 19th century. Microbiologists testing water in Moorlands, Somerset, found it contains 60,000 to 70,000 bacteria per 100 milliliter. Water should contain no more than 1,000 per milliliter, according to the World Health Organisation (WHO). The towns and cities were not a pleasant place to be, the streets were filthy, and the drains and sewers which ran in the streets were blocked and overflowing.
Rubbish was also just threw out to the street which meant there was a lot of vermin attracted, which also carried many diseases, this caused national concern. More and more housing was being needed, so poorly built houses were erected on top of rubbish piles, this rubbish did not provide solid founds, and made the houses very dangerous for living in. The poor people could not get help, the middle class saw them as immoral as they were all living in such cramped housing.
There were charities set up, such as the Peabody Trust in 1862 and The Guinness Trust in 1890 which aimed to help the people but these failed to meet the needs of the people most desperate in society. In 1866 after a fourth case of cholera killed 6000 people; the government put the first piece of legislation in place that actually made changes to the peoples lives, The Sanitary Act. This law meant that authorities had to provide fresh water, sewage and waste disposal. This law took a long time to be implemented into all houses within Britain but it meant that life expectancy was slowly on the rise.
All of the towns had to have a Sanitary Inspectors and the Home Secretary was empowered to take proceedings for the removal of nuisances where local authorities failed to act. Today all homes in Britain benefit from the Sanitary Act as they have running water and sewage facilities, and also a better knowledge on personal hygiene. By the end of the Victorian Era, treatment of illness started to become more advanced and surgery became more effective as there was a better knowledge. Moving into the 20th century there was still many of the problems which existed during the 19th century.
These on-going problems included housing and slums, poverty, lack of hospitals, nutritional issues, and the same sanitation problems. One piece of legislation that ensured a better quality of life for the people was the House of the Working Class Act, this began the building of council houses, a development which is still being used in present day, especially sue to the recessionary times that we are currently in and the increasing amounts of people that are becoming homeless due to reduced jobs and opportunities.
In today’s society we still have problems with many of these issues. In the recent economic climate and the recession, people have become unemployed and living has started to back track to these times, a lot of people have not been able to keep up repayments on their mortgages and homelessness has become a booming issue. This homelessness has meant that there has been a small rise in the numbers of council houses being built. Another problem which is still ongoing in today’s society is peoples nutrition.
In the 19th and 20th centuries people suffered from bad nutrition as they did not know about vitamins and nutrients and people were badly malnourished and underweight which added to many health problems such as rickets, and in today’s society we still have nutritional problems. Fast food and fatty foods are so easily accessible and people find them to be handier than cooking nutritious meals and so people are becoming increasingly overweight and many suffer from obesity.
According to the World Health Organisation, in 2008 there was 1. 4 billion adults over 20 who were classified as obese and in 2011 there was over 40 million children suffering from obesity also. (WHO 2013) Free school meals for children were also introduced in 1906; these free meals are still available to some children today. They ensure that the children are getting the proper nutrients and vitamins that is necessary to encourage growth and to also help them concentrate and learn.
The health and wellbeing of children was one of the main aspects of public health that the Ministry of Health were trying to protect, and in 1907 a school nurse was assigned to all schools, and her main role to begin with was to check the children’s heads for nits. The role of the school nurse then developed to carry out examinations on all aspects of the children’s health, growth and development. In 1911 National Insurance was first introduced.
This new system meant that working people had a small amount taken out of their wages which was put into the health care system, and if the worker was to fall ill then they would be able to avail of free health care, this was only for the worker though and not their spouse or children. (bbc) The First World War was one of the key events in the 20th century that highlighted the poor health of people living in Britain. The war put in place a need for an army of healthy young men as recruits, but this proved hard.
The recruits were sent to war malnourished, meaning that they did not last long, and if they suffered an injury they were not strong enough to live. As no one knew how long the war was going to last there was a concentration on the health of pregnant woman and young men’s, as these would be the military of the future if the war was to continue. There were not many hospitals available for the people who needed them and it was only the wealthy that had access to them, as there no health care service like we have today, and the people had to pay for their medical care.
The military were starting to come back from the war so there was an expansion in the number of hospitals being built as the conditions were still very poor in Britain, but these were solely for the use of the military soldiers. The Prime Minister at the time, Lloyd George promised a ‘home fit for heroes’ in 1918 and so the government set out the building of half a million homes by 1933. (bbc) A year later in 1919 the Ministry of Health was set up to look after the sanitation, health care and disease as well as the training of doctors, nurses, midwives and dentists.
Dental care at the time was a huge issue, due to the malnourishment, people’s teeth were very poor and dental care did not really exist especially for the poorer people in society. Malnutrition continued to be a huge public health concern up until the Second World War with the introduction of rationing. This was a huge change to people’s lives and was implemented by the Ministry of Food in 1940. Rationing meant that each person could only buy a fixed amount of certain foods each week, and you had to hand over coupons from the family’s ration book.
This reason behind rationing was because most of the food consumed in the UK and Ireland were imported from other countries, and this war proved to cause problems to this happening. During this war planes were used to drop bombs on ships and quite often the ships importing the fresh foods were bombed and the food destroyed, so this new rationing idea meant that everyone was able to gain access to the same amounts of fresh foods. Rationing is a concept that is still widely used today throughout the world by the army soldiers.
(bbc) The use of planes to drop bombs also caused a lot of destruction to people’s homes, many of them being destroyed, sometimes whole towns or cities were destroyed. During these troubling times people were expecting for their homes to be bombed so the government put in place a scheme for the children to be sent to the country where it would be safer for them. This was organised through ‘billeting officers’ and the children’s new homes were called ‘billets’. The children went to school and lived together until the war was over.
The destruction, as bad as it was, gave the cities the opportunities to rebuild their homes to a better standard. In 1941 the British government commissioned a report into the ways that Britain should be rebuilt. William Beveridge, the director of the London School of Economics, was put in charge of the rebuilding. His report which was published in 1942 identified that there were five giant evils which would have to be overcome, these included; squalor, ignorance, want, idleness and disease. The Beveridge report has since formed much of the social legislation that we use today.
(bbc) Beveridge wanted to create a ‘cradle to grave’ health care system. The working people and the employers would still pay national insurance and for the service to be sustained more jobs would have to be created. In 1948 the NHS which we still have to this day was established. The NHS was an ambitious plan to bring healthcare to all people regardless of their social class or wealth or gender, and the healthcare would be free at the point of delivery. This was the first time that doctors, nurses, pharmacists, opticians and dentists would all work together. (NHS 2012)
The 20th and 21st centuries saw a huge decline in the number of infectious diseases mortalities, and an increased life expectancy. One of the main reasons for this was the discovery of antibiotics in 1929, and the use of these in the 1940’s showed their true potential. Immunizations also came into practice and people had a better understanding of foods, and what foods improved health all contributing factors to people having better health. The NHS is still working to improve the health of its service users and it is working with many researching companies to find cures for the new diseases
that are developing. Although it is a great concept which has been active for over 60 years, the NHS is under a lot of stain and financial pressure. Due to the economic downturn there is less people working and so there is less national insurance being paid so there the NHS has less funding to provide the outstanding services that it does to the UK for free. The doctors and nurses are under almost intolerable pressure, and this is due to cuts in hospital beds, growing admissions and staff shortages. On 24th February, the Royal Victoria Hospital in Belfast became under so much pressure in its emergency department that extra staff had to be called in to deal with the escalating number of people seeking treatment, at one point there was more than 100 people waiting. This does not conquer the goals that the NHS had initially set out to achieve in 1948. (bbc 2014)
- Books Fleming, M. and Parker, E. (2009) An introduction to Public Health Churchill Livingston Elsevier: Australia Webpages http://www. nhs. uk/Tools/Pages/NHSTimeline. aspx Accessed Feb ‘14
- http://www. victorianweb. org/history/legistl. html Accessed Feb ‘14
- http://www. bbc. co. uk/history/historic_figures/snow_john. shtml Accessed Feb ’14
- http://www. who. int/mediacentre/factsheets/fs311/en/ Accessed Feb ‘14
- http://www. bbc. co. uk/history/british/victorians/overview_victorians_01. shtml Accessed Feb ‘14
- http://www. bbc. co. uk/schools/gcsebitesize/history/mwh/britain/liberalreformsrev1. shtml Accessed Feb ‘14
- http://www. bbc. co. uk/news/uk-northern-ireland-26328301 Accessed feb ‘14
- http://www. nhs. uk/conditions/tuberculosis/Pages/Introduction. aspx Accessed feb ‘14