PUBLIC HEALTH P2 M1

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Describe the origins of public health in the UK. (P2) Compare historical and current features of public health. (M1)

Public health refers to all organized measures, whether it is public or private, to prevent disease, promote health, and prolong life among the population as a whole. Its activities aim to provide conditions in which people can be healthy and focus on entire populations, not on individual patients or diseases. Thus, public health is concerned with the total system and not only the eradication of a particular disease. It encompasses the science, the art and the politics of preventing illness and disease and promoting health and well-being. Public health also addresses inequalities present in health which frequently explain large variations in health locally, nationally and globally.

The industrial revolution is the name given to the period of the 18^th and 19^th century where Britain transitioned to the development of new manufacturing techniques making more food available. This meant that by 1901 the population had increased to about 30 million and people began to migrate to urban locations also known as urbanisation. Due to a large amount of the population moving at once, it created problems such as overcrowding as they couldn’t build enough houses for the large increase in population. Communities lacked facilities and were deemed unsanitary as there was no sewage system, drainage and no clean water. Due to the living conditions, communicable diseases where very common and could spread quickly.

The Board of Health was set up to give advice on preventing the spread of fever in February 1805. The early 1830’s had seen the following activity which was prompted by the threat of a cholera epidemic and in June 1831 the consultative Board of Heath was again set up. The regulations where to prevent the spread of cholera and by November 1831 the Central Board of Health was established and local boards began to set up. In 1834, the Poor Law Act was passed by parliament which ensured that poor people had housing, were clothed and also fed. However, if they wanted this they had to go into a workhouse to receive it. They were given these things in exchange for several hours of manual labour each day. The conditions were made harsh and so that only people who desperately need it would go there.  

In 1842, Edwin Chadwick had published a report on the ‘Sanitary Condition of the Labouring Population of Great Britain’. Chadwick argued that disease was directly related to living conditions and that there was a desperate need for public health reform. He noted that people lived in dirty, overcrowded conditions and this caused illness, leading to people becoming too sick to work and a higher tax expenditure on helping them. Due to this Chadwick introduced a set of solutions which would help improve public health. He suggested that sewers should be improved, rubbish should be removed, clean water should be provided and medical officers should be appointed to check each area. This helped because with an improved sewerage system, human waste would not contaminate the water supply and therefore a fall in cholera and other related communicable diseases would be noticed.  Removing rubbish would stem the increase in pest and the development of disease and the medical officers would check that all these reforms were being obeyed. At this time there was an attitude of lazzise-faire, which was the belief that the government should not interfere in the lives of ordinary people or business. However, another cholera epidemic in 1848 causing 21,000 deaths, led the government to try out some of Chadwick’s ideas.

The public Health Act was then finally passed in 1848 and it set up a General Board of Health, Chadwick being one of its three commissioners. This allowed local Health Boards to be set up in towns, however, this was only where the mortality rate is higher than 23 per 1,000. The Act also encouraged a local medical officer to be appointed and also allows them to organise rubbish removal and to build a sewage system. However, only one third of towns set up a Board of Health and even fewer appointed a medical officer. The terms of the act were only temporary and by 1854 the three commissioner had to resign and the General Board of Health was done away with in 1858.

In London, 1854, John Snow mapped the cholera epidemic and had discovered an infected water pump on Broad Street as the source. The result of this discovery was that cholera was now identified as a water borne disease and Snow then became recognised as a pioneer of epidemiology.

As a result of people disposing their human toxic waste into the river, it lead to The Great Stink in London when the river Thames was full of raw sewage. This smell was overpowering and it had permeated Parliament to be adjourned. Joseph Bazalgette (1819-91) however, eradicated this by designing and building a sewer system.

In 1861, the upper class realised that they too had just as much reason to be concerned when Prince Albert dead as a result of typhoid. This then proved that the wealthy people, could also be susceptible to infectious disease. The first stage in the development of social housing was when Octavia Hill began her campaign in 1864, to improve the housing of working people to a decent standard.

There was a fourth Cholera epidemic in 1866, which caused 6,000 deaths. The Sanitary Act made sanitary inspectors compulsory in cities and demanded that the local governments provides fresh water. Overcrowding, which was a major cause of disease, became classified as being a ‘nuisance’. Also in 1869, the Peabody trust had built cheap flats that provided good living conditions and are of a good quality in London. These buildings are still used to this day.

By the time of 1914, the basic legislative framework had been created to improve the health of the population and the government had accepted a share of the responsibility for this. During the Second World War, in 1942, William Beveridge had written a report on how Britain ought to be rebuilt. The report was designed to encounter the five great evils which included, want, disease, ignorance, squalor and idleness.

The welfare was formed when the government changed in 1945, which aimed to provide free medical treatment and social security so that people are protected from the cradle to the grave. The government had now accepted responsibility for promoting and protecting the health of the public.

When comparing historical and current features of public health we are able to see that there has been many changes. In the 19^th Century the diseases that were prevalent were known as communicable diseases. Communicable diseases are caused by micro-organisms, such as viruses and bacteria. These diseases can be transmitted from one individual to another (Walsh et al). An individual may use the words 'contagious' or 'infectious' when they are talking about communicable diseases. They usually include virus, fungus, bacteria and protozoa. Examples include small pox, TB, typhoid and also diseases which are associated with malnourishment. These diseases were so prevalent due to a number of reasons. Firstly, there was a lack of knowledge and education. This meant that people were unable to learn about the different types of communicable diseases and so couldn’t try and prevent it. They may not have even known what the disease was, how it was caused or what the symptoms of it were. Another reason why the diseases were so prevalent was because of the poor living conditions. People were living in cramped conditions with a large number of people and so disease was easily spread, this meant that if one person got it, everyone around them would also get it. There was also no health service to help prevent disease and so vaccinations or medicine was unavailable, there was a lot of poverty and also a lack of government intervention.

Studies of disease were carried out particularly by John Haygarth and John Snow. These studies mapped diseases and showed a link between the spread of the disease and the area. John Snow found the link between bacteria and living conditions. He found that bacteria caused disease within the body of people rather than their living conditions. The government eventually listened to Chadwick and decided to then try out his ideas. His report led to the Public Health Act being passed in 1848 and local Health Boards where set up, encouraging the appointing of a medical adviser and also allowing the organisation of rubbish remover and the building of a sewage system. In the mid 1900’s, the Beveridge report then furthered the involvement of the government and they began to take responsibility of the health of the public. He also suggested the establishment of the National Health Service and this was then development in 1948.

In 1822, Pasteur and Jenner came together in the development of the vaccination process and this combined with the invention of antibiotics e.g. penicillin. The focus was on infection, and immunisation programmes were set up improving the knowledge of the population.

In the early 20^th century there were environmental reforms meaning that there was the clearance of slums and the population was being provide with a clean water supply. This then prevent disease and the number of infections therefore decreased.

Non communicable diseases such as heart disease and cancers became the big killers in the mid-20^th century. This was link to the lifestyle of the individuals and they were then blamed for their own ill health, which was often the reason for the behaviour being ignored. This led to the New Public Health order, which approached and addressed the causes of the causes e.g. poverty, poor housing and unemployment in a bid to improve the health and well- being of the population.

In the UK the most prevalent non communicable disease is lung cancer and there are 42,026 people who have lung cancer, 23,175 in men which are 55% and 18,851 in women, 45%. This gives a ratio of male to female of more than 12:10. The crude incidence rate shows that there are 76 new lung cancer cases for every 100,000 males and 60 for every 100,000 females. Lung cancer is so prevalent mainly due to the lifestyle choice in which people choose. Smoking accounts for 80-90% of global lung cancer deaths in males. Non-smokers on the other hand account for only around 10-20% of lung cancer.  Altogether around 41,000 people are diagnosed each year in the UK with lung cancer. In addition a further 3% of lung cancer cases are caused by exposure to second hand smoke in non-smokers.

Public health is now managed by a number of different agencies such as the Department of Health, NHS, Public Health Agency, DHSSPSNI and also GP.

The PHA was established in 2009 under a major reform of health structures in Northern Ireland. They were set up to provide a renewed and more enhanced focus on public health and well-being by bringing together a wide range of public health functions under the one organisation.

The DHSSPSNI has a mission to improve the health and social well-being of the population in NI. They had three main responsibilities including HSC, including policy and legislation for hospitals, family practitioner services and community health and personal services. Public health is another responsibility which covers policy, legislation and administrative action to promote and protect the health and well-being of the population and also public safety, which cover policy and legislation for fire and rescue services.

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