History of Medicine: Public Health

History of Medicine: Public Health

1. 1) Roman Public Health

   • Despite no reasoning, the Romans understood cleanliness meant good health, which was vital for a strong army to control the empire
     • What did they do to improve cleanliness?
       • Aqueducts
         • Clean and fresh water delivered straight to towns and available to all
       • Public Baths
       • Sewers
       • Public Toilets (Latrines)
         • Removes waste from human contact, reducing risk of infection
       • Saunas and Steam Rooms
         • Reducing risk of infection or spread of disease
       • Public Fountains
     • What were the limitations?
       • People still had to carry water into their homes from wells/fountains
       • Only the minority living in towns got it
       • Only Roman Soldiers could use Latrines
         • Everyone in a latrine used the same sponge
         • Little rainfall meant disease spread easily
       • The Public Baths were only cleaned once a week
         • 5000 people used them every week!
     • Why did it work so well?
       • Romans collected taxes efficiently
       • Slaves built the facilities to keep down costs
         • During peace times, soldiers would also help building
       • The Government controlled it all

2. 3) 1350 - 1750 Problems

   • What were the existing problems?
     • Rubbish including dead animals were left on the streets to rot
     • Rivers were polluted meaning very little clean water
     • Poor sanitation
     • Sewage was thrown into streets
   • What happened as a result of poor public health?
     • Outbreaks of disease
       • The Black Death 1348-9
       • The Great Plague 1665
         • How did Government try to stop spread of disease?
           • Reducing large crowds
             • Closing theatres
             • Large funerals banned
           • Dogs and cats killed
           • Carts to collect dead bodies
           • Ordering days of fasting
           • Boarded up houses for 28 days
           • Ordering days of prayer
     • Lots of death from infection

3. 4) 1750 - 1900 Action

   • What did they do to improve public health?
     • Making gin more expensive (1750)
       • Improved health of poor people
       • Improved the economy also
     • Compulsory Smallpox Vaccine (1853)
       • Dramatically reduced death by smallpox
     • Public Health Act (1848)
       • General Board of health
         • Abolished in 1858
         • Only a third of towns set it up
         • Allowed for a medical officer in towns
   • Why wasn't more done?
     • Most action was only on local authority level, not made by a national government
     • People still thought God caused disease
     • The link between dirt and disease was not discovered until 1861
     • They didn't want taxes to be spent on something that (until 1861) hadn't been proven to reduce disease.
     • Health was not seen as something that the Government should deal with

4. 5) Public Health since 1900

   • NHS 1948
     • During WW2, the importance of a healthy country was realised
       • The NHS was set up by Aneurin Bevan, then the UK Health Minister
         • The NHS, still today, gave everyone access to healthcare for free
   • Liberal Reforms
     • Old Age Pensions Act 1908
     • Free school meals 1906
     • National Insurance Acts
       • Money for seasonal unemployment (1912)
       • Money for illness or injury (1911)
     • School medical inspections 1907
       • School Clinics 1912
     • The Children's Act 1908
       • Children under 14 not allowed into pubs
       • Cigarettes not sold to children under 16
     • Limited Success?
       • Few people benefited from these changes at the time
   • Government Funding
     • Advertisements
       • 1980s AIDS Campaign
     • Vaccinations
       • Polio (1952)
       • Cervical Cancer 2008
     • Better waste disposal
     • Clearing of slums in 1930s
     • Hospitals coming under NHS ownserhip
     • Reducing air and water pollution
       • Clean Air Act 1956
     • Environmental Health Officers

5. 2) Medieval Public Health

   • Why did Roman Public Health disappear in Britain?
     • Engineers returned to Rome
       • No knowledge of building/fixing
     • No central government to control it
     • There wasn't enough money for it
     • There were other priorities
       • Food
       • Defending Land
     • People moved back to the countryside
     • Civil War in Britain
   • What did they do to improve cleanliness?
     • 1281: London authorities tried to ban pigs on the city streets
     • 1347: Sanitary Act, trying to keep streets cleaner, people could be fined for dropping waste
     • 1388: Parliament tried to improve water supplies
       • Stopping excrement going into rivers
       • New pipes or conduits into some cities and towns