Hello everyone and welcome to this week's blog post. Today, I am publishing the second post in a series about public health. This week I will be talking about the early stages of public health in the UK between 1848-1905. Next week, I will move on to talk about the formation of the NHS and its implications to society.
Before 1848, public health provision was very limited, however, public health provision changed significantly in the years 1848 - 1905. The change was uneven between these years though, due to the slow change of the attitude of the government before 1875. After 1875, however, public health improved drastically especially with regards to reducing the spread of water-borne diseases. One must also note that the work of key individuals such as Edwin Chadwick and John Snow, as well as the development of new technology allowed change throughout the whole period to be much more rapid as they gave specific objectives for the government to target and the technological means to do so.
One clear change in health provision was in the attitude of the government towards public health issues which moved from minimal intervention in 1848 to much larger intervention in 1905. In the 1840s, the government's attitude towards public health provision was one of laissez-faire. This attitude, based on the ideas of self-help and individualism, meant that the government resisted taking public steps to improve the health of the citizens.
Furthermore, low taxation only helped to reduce government funding and investment in healthcare. It was still the case that little was done to improve public health until 1858 when the Great Stink proved to be a turning point. Encouraged by the rotting sewage on the banks of the Thames and the Reform Acts which increased the franchise and encouraged MPs to act in the interest of all citizens, not just wealthy ones, Parliament decided to take action to combat the spread of disease.
In 1866, the Sanitary Act was passed by parliament, forcing all towns to employ health inspectors to check up on drainage in the towns and generally improve health in the towns. For example, Chamberlain, the mayor of Birmingham, improved water supplies and demolished slums in the city, reducing the spread of disease. Furthermore, in 1875, parliament passed another Public Health Act, which made local authorities legally responsible for public health, in particular for the supply of clean water and dealing with sewage to prevent the pollution of drinking water. As part of this act, local authorities also built public toilets and inspected food on sale to ensure it was safe for human consumption.
Overall, the shift in the attitude of the government in the years 1848 - 1905 was dramatic. In these years it went from minimal intervention with a laissez-faire attitude in 1848 to passing legislation which demanded that local authorities involve themselves with public health.
The work of key individuals such as Chadwick and Snow, fuelled by many cholera epidemics in the preceding years, meant that as the attitude of government changed and it became more open to improving public health, it was able to do so in a much more effective way. In 1842, Chadwick published the report on the Sanitary Conditions of the Labouring Poor. In this report, he illustrated how the poor couldn’t be blamed for the high death rates (the average life expectancy was 20 years less for a labourer in Liverpool than a rich gentleman). Instead, he said that it was due to overcrowding and poor sewers and drains in the cities.
While there was no immediate reform due to resistance from the rich and the government, parliament did eventually pass the limited Public Health Act in 1848. As part of this, a national board was set up to supervise local boards which would improve drains, sewers and toilets, as advised by Chadwick. However, as the government was still unwilling to get involved with public health, the effects of this were very minimal.
This however changed after the work of Snow in 1854. Following a cholera epidemic in 1854 which killed 60,000 people, he investigated the cause of cholera, focusing on the Broad Street Pump where many victims drank water from. From this, he suggested that cholera was transmitted by water polluted with sewage. He also pointed out that flushing sewage into the Thames only exacerbated the problem. This work was key to the Sanitary Act of 1866 and the Public Health Act of 1875 which had a specific focus on preventing the spread of contaminated water.
The work of Chadwick and Snow was key to the change in public health provision in the years 1884 - 1905. While change was limited in the 1840s, when the government decided to do something to improve health in the 1850s, the work of Chadwick and Snow allowed them to specifically target contaminated water and dramatically improve public health much faster than they would have been able to otherwise.
The improvements in technology in the years 1848 - 1905 also helped drastically improve public health provision in the years 1848 - 1905. Due to Snow’s work on cholera, frequent cholera epidemics and the Great Stink in 1858, the government was greatly encouraged to improve public health. The improvements in technology at the time were key in constructing a suitable way to reduce contaminated water, namely with a new sewer system underneath London. The chief engineer of this project was Joseph Bazalgette, who spent £6.5 million on 2000km of new sewer tunnels, designed to bring the waste to the lower stretches of the Thames where tides would flush the waste out to sea. Key to this design was a new form of pipes which were large and oval in shape so that sewage was less likely to get stuck. New steam-powered engines were also used in the sewer pumps that pumped the sewage out to sea. The construction of the sewer system facilitated by improvements in technology helped significantly advance public health provision between 1848 - 1905 as it removed sewage from the city and made drinking water much cleaner, reducing the spread of water-borne diseases such as cholera.
In conclusion, the change in the provision of public health in this period was dramatic and far-reaching. In this period, the attitude of the government towards public changed enormously, allowing for much-needed reform. However, the change was uneven, as even with the work of Chadwick in 1942 and the cholera outbreaks in 1848, the role of government in addressing public health issues was slow to change. Not only was the 1848 Public Health Act not compulsory, but it also didn’t provide a national policy for combating health issues. This reduced its effectiveness as local authorities didn’t have enough funding or expertise to solve the problems.
Nevertheless, 1875 proved to be a turning point. The 1875 Public Health Act made it compulsory for local authorities to act, as well as giving them the authority to raise taxes to pay for improvements and providing clear guidelines to follow. It is important to note, however, that the role of Chadwick and Snow and the improvements in technology were very vital in accelerating change once the government began changing its attitude as it allowed the government to target issues such as water pollution effectively and facilitated better improvement in the years 1848 - 1905.
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