Public Health

Public Health

1. Edwin Chadwick

   • Government took action in 1839 and set up an enquiry
     • Appointed Chadwick, government official, in charge
   • 2 year enquiry
     • Doctors sent to major towns and cities to question people and fill out questionnaires
     • 1842 - published report that shocked British people
       • 10,000 free copies to anyone who could help (politicians, journalists etc.)
       • 20,000 copies sold to public to raise awareness
     • Conclusions
       • Improve drainage, water supply, streets and roads
       • Remove rubbish from houses
       • A healthier workforce could work harder
       • Bad ventilation is killing people
         • Miasma
   • Believed in miasma theory
     • Conclusions drawn were correct though
   • Government didn't take action
     • Laissez faire - Government's job to keep the law not to keep the people clean

2. Problems in 1850

   • Overcrowding (back-to-back housing) - disease spread quickly
   • Sewage water ran into rivers where people washed and drank from
   • No waste or rubbish disposal
     • Sat in the streets
   • Badly ventilated housing
   • Government's 'laissez faire' attitude
   • Cholera
     • Caused by contaminated food/water
     • 1831 - killed 50,000 people
     • No knowledge of the way it spread or the cure

3. Return of Cholera 1848 led to the 1848 PUBLIC HEALTH ACT

   • What it did
     • Local councils given power to spend money clearing towns if they wanted
     • National Board of Health created
       • Power to set up local health boards in areas with high death rates
         • They have power to make sure new houses have drains/toilets
         • Charge local tax to pay for improvements
         • Appoint medical officers to 'inspect nuisances'
   • Limitations
     • No obligations
       • Only 103 towns set up boards of health by 1853
     • Didn't end cholera
       • 1854, 20,000 more people died
     • Could use taxes for other things
     • Paid for by people who can least afford it
     • Improvements required constant funding which was often lacking (i.e. public toilets)
     • Only committed some towns to change
     • No money set aside to investigate causes
     • Rich people less inclined to set up/pay rates as it doesn't affect them
   • Changed very little due to voluntary nature

4. John Snow (1854)

   • Famous surgeon who worked in Soho
   • Decided to try and find cause of cholera
   • Observed Broad Street, where he worked
     • Found all victims of cholera got their water from a certain pump
       • He removed handle to prevent people from using it
     • No more deaths in the street
     • Street toilet had a cracked lining that was leaking sewage into the water source
   • Proved...
     • Cholera was not carried through the air (miasma)
     • Spread through contagion
   • Government
     • Maintained laissez faire approach

5. Public Health Acts

   • Working Class Vote (1867)
     • Politicians wanted improved public health to be a reason to vote for them
     • 1874 Conservative win was mainly due to working class
   • 1875 Public Health and Housing Acts
     • Sewers must be clean and rubbish cleared from streets
     • Councils have power to pull down substandard housing and build improved homes
   • 1853 Compulsory smallpox vaccination
     • Every baby
     • Soon, deaths dramatically dropped
   • Boer War 1899-1902
     • 40 out of 100 men who applied unfit to serve
     • Liberal Party (1906) decided to introduce free school meals
   • 1907 - School clinics
   • 1908 - Children and Young Person's Act
     • Made children 'protected persons' (i.e. neglect was illegal)
   • 1909 - back to back housing banned
   • 1911 - pensions for the elderly introduced
     • No workhouse
   • Post WWI reforms
     • 1918 - local councils must provide health visitors, pregnancy clinics and day nurseries
     • 1930 - Slum clearance programme
       • Improving children's lifestyle who lived there
     • 1919 - local councils to build new houses for poorer families

6. Great Stink

   • A heat wave in 1858
     • Thames smelled worse than before
     • Stink reached parliament and so...
       • Government were affected for the first time
   • Change of attitude
     • Government wanted to implement health reforms to get poor's votes
   • Sewer system
     • 1855 - Joseph Bazelgette designed a new sewer system for London
       • It would collect all of the waste from nearly 1 million London houses
     • Waste would be pushed by pumps towards the sea
     • Given £3m by government
       • Equivalent of £1bn today
     • Finished in 1866 and would remove 420 million gallons of water a day
   • New acts were introduced that forced people to comply from the Great Stink onwards

7. By 1940...

   • death rate had dropped
   • life expectancy had risen
   • government more interested in Public Health (political motivation)

8. The Beveridge Report

   • William Beveridge - liberal politician
   • Government commissioned to find out what people wanted Britain to be like after the war
   • 5 things that Britain needed were concluded...
     • poverty
     • disease
     • ignorance
     • idleness
     • squalor
   • Proposed setting up a welfare state
     • social security
     • NHS
     • free education
     • council housing
     • full employment
     • Labour government tried to make this vision come true after the war