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History of public health in the United KingdomHistory of public health in the United Kingdom covers Public health in the United Kingdom since about 1700.
18th centuryWith the onset of the Industrial Revolution, living standards amongst the working population began to worsen, with cramped and unsanitary urban conditions. Unavailable housing led to the rapid growth of slums and the per capita death rate began to rise alarmingly, almost doubling in Birmingham and Liverpool. Thomas Malthus warned of the dangers of overpopulation in 1798. His ideas, as well as those of Jeremy Bentham, became very influential in government circles in the early years of the 19th century.[1] The latter part of the century brought the establishment of the basic pattern of improvements in public health over the next two centuries: a social evil was identified, private philanthropists brought attention to it, and changing public opinion led to government action.[1] The 18th century saw rapid growth in voluntary hospitals in England.[2] The practice of vaccination began in the 1800s, following the pioneering work of Edward Jenner in treating smallpox. James Lind's discovery of the causes of scurvy amongst sailors and its mitigation via the introduction of fruit on lengthy voyages was published in 1754 and led to the adoption of this idea by the Royal Navy.[3] Efforts were also made to promulgate health matters to the broader public; in 1752 the British physician Sir John Pringle published Observations on the Diseases of the Army in Camp and Garrison, in which he advocated for the importance of adequate ventilation in the military barracks and the provision of latrines for the soldiers.[4] 19th centuryUrban crisisIn the first four decades of the 19th century alone, London's population doubled and even greater growth rates were recorded in the new industrial towns, such as Leeds and Manchester. From 1801 to 1851, the proportion of Englanders living in cities over 20,000 more than doubled from 17% to 38%.[5] This rapid urbanization exacerbated the spread of disease in the large conurbations that built up around the workhouses and factories. These settlements were cramped and primitive with no organized sanitation. Disease was inevitable and its incubation in these areas was encouraged by the poor lifestyle of the inhabitants. Not enough new housing was built, and people squeezed into small, dirty apartments, and drank dirty water. One result was high rates of tuberculosis, which became leading cause of death.[6] Chadwick and sanitation solutionsEdwin Chadwick (1800–1890) identified the public healthissues in crowded cities and led major reforms in urban sanitation and public health. He pioneered the use of systematic surveys to identify all phases of a complex social problem, and pioneered the use of systematic long-term inspection programmes to make sure the reforms operated as planned. Following a serious outbreak of typhus in 1838, Chadwick convinced the Poor Law Board that an enquiry was urgently required. Chadwick sent questionnaires to every Poor Law Union, and talked to surveyors, builders, prison governors, police officers and factory inspectors to obtain additional data about the lives of the poor. He edited the information himself, and prepared it for publication in 1842 at his own expense. It became a best-seller. His Report on The Sanitary Condition of the Labouring Population of Great Britain caught the public imagination and was soon incorporated into English law.[7][8][9] Chadwick argued eight main points, emphasizing the absolute necessity of better water supplies and of a drainage system to remove waste, as ways to lower the death rate. He saw that every house needed a permanent water supply, rather than the intermittent supplies from standpipes that were often provided. He proposed each house would have a constant water supply, and privies would ensure that soil was discharged into egg-shaped sewers, to be carried away and spread on the land as manure, preventing rivers from becoming polluted. Chadwick understood that both water supply and drainage were important, since there had to be enough sewers to carry the waste away. Chadwick later helped to ensure that the Waterworks Clauses Act of 1847 limited profits, and required them to provide a constant supply of wholesome water for houses, and a supply for cleansing sewers and watering streets.[10] Germs caused choleraChadwick was working on a solution but exactly what was causing the disease was not known until the work of John Snow in 1854.[11] That year there was a severe outbreak of cholera in Soho, London. It was part of the 1846–1860 cholera pandemic happening worldwide. It killed 616 people in England, and prompted Snow to map the people who got sick and show they had all been drinking from one pump in Broad Street. He then deduced that one specific source of germ-contaminated water was the source of all the cholera cases. On outsider who carried the disease had used the pump and somehow made its water poisonous. Previously doctors assumed that cholera was not cause invisible particles in the air --this was the "Miasma theory"). Snow's maps were a powerful confirmation of the Germ theory of disease, and explained how the germs spread. [12][13] Snow's great discovery decisively influenced public health policies and quickly led to the construction of improved sanitation facilities. The term "focus of infection" started to be used to describe sites, such as one particular water pump in Broad Street that spread the cholera germs. [14] Impact of sanitationHistorians have been using quantitative models to estimate the impact of investment in sanitation and pure water supplies on health indicators. One study of 16 cities outside London indicates that for 1845–1884, the first round of sanitation investments were associated with sharp declines in infant and child mortality, and a 13% decline in overall mortality. However subsequent rounds of spending in the same cities gave a much smaller decline.[15] 20th centuryThe number of nurses rose rapidly in the 20th century in the 1901 Census, there were 64,000 women nurses, along with 5,000 men. Of the total 12,500 were trained or registered. By 1921 there were 110,000 women and 12,000 men in nursing, 25,000 were trained or registered. By 1939 there were 160,000 nurses in all, of whom 60,000 were trained and registered.[16] Role of philanthropyIn the 1920s government public health funding concentrated on upgrading public infrastructure and helping wounded war veterans. Meanwhile, a number of private philanthropies took roles in public health. They were not funded by the government and ranged from major international operations such as the Rockefeller Foundation, to membership groups like the Order of Saint John, to small local charities. Rockefeller sponsored training programs for visiting nurses. The others focused on individual needs at the neighborhood level, such as helping poor families with childbirth and child welfare and dealing with tuberculosis, or providing ambulance services to hospitals for victims of traffic accidents.[17] See also
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