Public Health in the 19th Century was non-existent. Poverty, disease and overcrowding was rife. It was Edwin Chadwick that brought about the Poor Law Amendment Act in 1834. He had argued that illness and disease were strongly linked to poverty and if steps were taken to reduce illness and disease then rates of poverty would subside also, as more people would be fit to work. The Poor Law Amendment Act seen that proper sewage and drainage systems were put in place and a Medical Officer was placed in the Workhouses so that workers could get health care if they were working. Edwin Chadwick was a believer in the ‘miasma’ theory, he believed that illness and disease was airborne. Therefore, overcrowded houses and polluted cities were more likely to be rife with disease. This was generally a very popular theory. One sceptic in the ‘miasma’ theory was John Snow. He published a book in 1849 suggesting that cholera enters the body through the mouth, it is not airborne, as many people thought. In 1854 there was a large outbreak in cholera in Soho, this was following several years of cholera outbreaks. John Snow investigated the case and was able to prove his theory right when he discovered that the outbreak was down to polluted water coming from the pump on Broad Street.
He did this by comparing mortality rates in different areas, referenced his findings with what people used the Broad Street pump against those using other water pumps and plotting a map of his findings. He was able to take his discovery to his local council and have the handle of the pump removed. From then, the rates of cholera in that area dramatically declined, proving his theory right. After Edwin Chadwick’s Poor Law Amendment Act, a Medical Officer called John Simon was placed in London. John Simon had no experience in public health, as he was a private doctor. After seeing the extent of poverty and disease in London he used his diplomatic and political skills to use by writing reports to get the sanitation improved in London. In 1866 John Simon’s reports saw that the City of London stated the Sanitary Act, in which mean that there was proper sewage, water treatment and clean water available to everyone. In the 1940s Britain was at war. The Government commissioned the Beveridge Report in 1942, this was a report to have a look at what could be done to improve the public’s health and moral. Beveridge’s report suggested to providing social security, free healthcare and education as well as council housing and full employment would benefit the public and also give them something to fight for during WWII. It was this report that lead to the NHS being ‘officially’ created in 1948 Between 1948 and 1980 a number of policies, such as the New Town Act in 1942 and ensured housing would not swallow up country side by creating ‘green belts’ and the Clean Air Act in 1956 to reduce smog in cities, helped improve the public’s living conditions. In 1980 the Black Report was published. It provided the public with a look into the inequalities in public health.
The report was the first of its kind, in the sense that it showed the inequalities of upper and lower classes were down to lifestyle choices rather than treatment. The Black Report did not receive much Government attention but it set the agenda for research and policy discussions for years to come. We received the Acheson Report in 1998 which showed the inequalities that existed in public health. And demonstrated the existence of differences in health and the relationship to social class. The report outlined 39 policy suggestions for the improvement of public health. These policies were taken on board by the Government and they came up with ‘Saving Lives: Our Healthier Nation’. A campaign set up to tackle poor health and improving public health, especially those who are ‘worse off’. The Healthier Nation strategy looked at tackling the ‘big killers’ which were, cancer, CHD, stroke and mental illness. Their goals were to reduce the death rate of cancer by a fifth by 2010. They wanted to reduce the death rate of CHD and stroke by two fifths and reduce the amount of suicides in people with mental illness by a fifth by 2010. In an attempt to meet these targets, they gave the public 10 tips for better health. These were stop smoking, eat a health balanced diet, keep active, manage your stress, drink in moderation, protect yourself from the sun, practice safe sex, take regular cancer screening, safety on the roads and learn first aid. The Government believed that they had to “attack the breeding ground of poor health – poverty and social exclusion” (Secretary of State for Health, p6, 1999 ).
They did this by investing millions into things such as ‘quit smoking’ campaigns, healthy living centres and NHS Direct services. Inequality is such a big ongoing issue in the 21st century in regards to public health. In 2004 the Government produced a new strategy called ‘Choosing Health: Making Healthier Choices Easier’ which was set out to try and tackle a lot of the same problems the 1999 policy had tried tackling – smoking, obesity , drinking as well as mental and sexual health. The policy made a lot of improvements such as signposting food to indicate its fat, salt and sugar content. Also banning smoking in public places and raising awareness on the dangers of second hand smoke. They also put measures in place to try and tackle childhood obesity by working with schools to make sure the school meals are healthier and that children are active while they are at school. Improvements were also made to health care staff, the policy put measures in place to make sure all their NHS staff were trained to help people make healthier choices and information about ways to improve your health was made more readily available. We now have key agencies that produce information and advice about public health and ways to improve our health. In 2009 the Public Health Agency was formed.
The PHA do a lot of research and development, as well as provide public health support to policy makers. The HPA (Health Protection Agency) was formed in 2003 to provide integrated support and advice to the NHS, local authorities, Department of Health and other public health bodies. WHO (World Health Organisation) identify risk areas, where diseases may be more common, and then help to allocate where sources are needed most. In 2004, WHO devised a Global Strategy which objectives were to combat the risk factors for non-communicable diseases that stem from unhealthy diet and physical inactivity. They plan on doing this by increasing public awareness of the health problems that are linked to an unhealthy diet and physical inactivity. WHO also want to make sure support is provided to national and local services to tackle the problem.
