Public Health 1250 to Present

1250-1500

Overview of society

• Religion was central, almost everyone was Christian, believing in God and fearing the Devil. Most of society was Catholic (under the leadership of the pope).
• It was believed that kings were given their power by God. They taxed the people, resulting in their own wealth, but kings did little in return for the general population.
• Below the king were Barons who were given land provided they controlled this area on the king’s behalf → this land may be further shared out between knights.
  • In the 13th century, knights were able to sit in Parliament, but still had little control
• The lowest tier of society was the peasantry, who did manual labor. Most worked under a knight (Lord of the Manor) who gave them a house and a small amount of land or a small wage.
  • 90% of the population lived in the countryside
  • They had no impact in the control of society
• Technology was limited- the most heavy machinery being windmills
  • Printing presses were first seen in England after 1470
  • Extremely limited scientific understanding
• Muslim influence reintroduced ancient Greek and Roman ideas to Medieval Europe.
  • The most relevant being the ‘Four Humours’ an ancient Greek idea suggesting the human body is made up of 4 aspects (like the ancient elements air, fire, earth, water): blood, phlegm, black bile and yellow bile. Disease was an imbalance of these humors, so correcting them could ‘cure’ the disease.
• England was known for its wool trade in Medieval Europe
• Towns were small, but became lively on market days. Controlled by a mayor and town council rather than lords. Town councilors were also typically guild members that regulated goods produced in a town.
• Drinking was common especially on Holy Days.

Living conditions

Food and drink

• Harvest quality was very important, if poor then there would be less food resulting in starvation and death.
  • The Great Famine happened in 1315-16 due to poor weather, and continued due to disease in livestock, causing problems until 1322. Approximately 10% of the population died in the great famine.
• Damp conditions could lead to fungi growing on rye - a grain only used for bread eaten by poor people, resulting in ergotism (symptoms included pustules, burning feelings, and hallucinations). Medieval people believed this was caused by demons. Rich people rarely got it as they would consume bread made of wheat instead of rye.
• The most common food was Pottage, a type of soup containing peas, beans, onions, and various types of meat.
• Villages were constructed near a stream or spring. The textile industry leads to pollution of many streams due to the use of human urine during processing. Fish were also caught from streams, and were the only form of meat allowed on Fridays due to religious beliefs.
• Villagers drank more water than those in towns, but other drinks included cider, mead, or ale. Ale was called ‘small beer’ which was less strong than ale is today, but prevented spoiling, and brewing unknowingly killed any bacteria present in the water too.

Housing

• Villages typically had shared land for livestock.
• The largest house was that of the lord of the manor.
• Most houses had a central open wood fire, but lacked a chimney except for a hole in the roofs.
• Animals such as cows were brought into the house to provide warmth at night
• Many houses had gardens to grow vegetables and fruit. They often had a rubbish tip too, while some houses had a cesspit. Cesspits were collected by a cart to be used as fertilizer on crops.

Town life

• Carts were used to transport goods to be sold at market, often the same cart used to carry waste. Livestock was usually taken into town on foot rather than butchered in nearby villages. Country roads were muddy whereas those in town were paved or cobbled (usually). Drains were often damaged.
• Some towns had conduits in the center of the marketplace, a fountain providing spring water. Earliest conduits constructed by the church and later town council
  • Water sellers sold water from these conduits to nearby houses
• Streets were dirty - after 1293 rakers were employed to clear the streets, most towns had these by 1500.
• Trades such as butchering worsened pollution and mess in towns, so councils forced it to take place outside of town to prevent rubbish building up. The same went for tanners, brewers, dyers, washerwomen, masons, and lime burners.
• Rich merchants may have a large house with a thatched roof, with storeys that jut out to save money on land tax. Those with gardens grew flowers to purify and prevent Miasma (see below).
• In town, several people typically shared a latrine and cesspit, and those poorly made often leaked into nearby cellars. A gong farmer had the job of removing the waste out of town, either selling it as fertilizer or dumping it in rivers

The Black Death

Arrival + Spread

• First hit England in 1348 at a port in Dorset, quickly reaching London and Bristol. By 1349 it had spread to the North, Wales, and Ireland.
• It is a disease caused by the bacteria Yersinia pestis, residing in fleas which bite a person to cause the infection. Fleas travelled via rats, having migrated on trading ships from Asia and other parts of Europe
• The plague was split into three different types:
  • Bubonic Plague - formed buboes (swellings) in armpits, groin, caused fever and death within days
  • Septicemic Plague - plague reaches the blood causing sepsis, the victim bleeds and has their extremities turn black and degrade.
  • Pneumonic Plague - inhaling contaminated air from victims coughing lead to severe pneumonia, causing blood to be coughed up and swift death days later.
• There were no cures at the time, but those tried included camomile lotion, tying live toads or chickens to buboes and blood letting (restoring the blood humor).

Religious response to the plague

• Many believed the plague was God punishing them or the Devil testing their faith in God. Many prayed for recovery in a variety of ways including:
  • Confession of sins
  • Consumption of holy bread
  • Processions of priests to confess sins in the nation
• Flagellants were groups from Northern Europe who whipped each other with metal studded leather as a form of self-sacrifice and suffering to hope God would revoke the plague.

Beliefs about the causes of plague

These are some other beliefs about what caused the plague at the time:

• Planetary movement or earthquakes
• Miasma, ‘bad smells’ that caused plague infection as an invisible poison. Resulting in carrying of flowers, burning herbs, or avoiding exercise or hot baths to mask smells or prevent excessive sweating.
• Looking a plague victim in the eye
• An out of balance humor, caused by eating a poor diet most often.

Impact of the Black Death

• Killed 60% of England’s population, or 3.5 million people between 1348 and 1350
• Reduced the availability of giving the ‘last rites’ to those dying, and towns produced mass graves rather than individual funerals.
• Rich people often escaped to the countryside while others hid in their homes, throwing waste directly onto the street
  • The only impact King Edward III had was writing a letter to the Mayor of London asking for the streets to be cleaned to reduce miasma.
• By 1350 the peak of the pandemic had passed, however it returned in 1361 and 1362, and up to 20 outbreaks before 1500. After 1400 most cases of the plague occurred in a town

Public Health in Towns and Monasteries

Church authorities and health

• In the 1200’s the best hygiene was found in churches, such as abbeys and monasteries.
• They usually contained pure water from the hills rather than using river water, for use in baptisms, wine dilution, washing cups and linen, regular washing, and drinking. Unlike the general population, the Church had the money needed to obtain pure piped water.

Town authorities and health

• Carlisle (1345) - streets full of filth, consistent raids by the Scottish, and livestock disease
• York (1301) - King Edward I enacted the cleaning of the streets and rules for town cleanliness.
• Norwich (1287-1289) - 16 people shamed by the court for pollution of water and dumping of waste, causing miasma.
• Shrewsbury (1276) - money raised from rich citizens after permission from King Edward I to pave the market place, the same happened in over 50 other towns.
• Bristol (1300s) - bylaws passed requiring the removal of dung heaps, lepers, and prostitutes from the town
• Winchester (1329) - butchers’ guild started checking meat quality, with fines for all members if they were not of a good standard.

London - Case studies

• Population grew from 25,000 to 100,000 between 1250 and 1500
• 1351 - spoiled meat pies sold by vendors burned by jury in front of those guilty (intention to cause miasma as punishment!).
• 1381 - Jury inspect herring brought up Thames - ‘putrid and corrupt’.
• 1385 - Warden employed to check cleanliness of the streets and river
• 1393 - Jetty built in Thames by authorities to carry away carcasses via boat, fined if other disposal methods were used.
• 1415 - Mayor of London rebuilding latrine due to flooding nearby houses
• 1417 - Closing of London public baths (often brothels)
• 1419 - Regulations kept in official White Book
• 1421 - Jury found trader William Atwood guilty of throwing waste into the streets
• 1430s - replacement and extension of pipes supplying London with spring water, money given to the city by the rich to improve water supplies and build public latrines.
• 1478 - expulsion of animal skinners from the city for putting waste in Thames. Problem moved to the suburbs.
• 1479 - Gongfermors and pavers formed own guild
• 1488 - Butcher’s guild built underground passage to carry waste from The Shambles to the Thames.

1500-1750

Overview of Society

• Most people still lived in the countryside and relied on a good harvest to ensure their livelihoods continued. Approximately 1/5th of the population lived in a town.
• Wool production continued to be the largest industry in England - industrialization had not yet occurred.
• Coal began to be used during the latest part of the Early Modern period, with the steam engine being invented in 1712 by Thomas Newcomen. It was used in breweries, glass production, fuel, and salt production.
• In the 1600’s and 1700’s colonization occurred in North America, leading to the transatlantic slave trade and arrival of good such as gold, tobacco, and sugar. The East India Company began to ship spices, dyes and luxury fabrics from 1608.
• Many Catholic spaces such as monasteries and convents were destroyed between 1536 and 1540 due to the Reformation and formation of the Church of England by Henry VIII as a result of his excommunication.
• The microscope was discovered in the mid 1600’s, and germs were discovered in 1683 - this did not cause the discovery of them causing disease however.
• The printing press, introduced in the late 1400’s had revolutionized Europe, meaning literacy increased. However this still allowed old ideas to be spread such as the belief that witches caused disease and poor harvests in the 1500’s and 1600’s.
• The structure of parliament had grown, with more MPs and power, despite the monarch having overall control. By the early 1700’s only 3% of adults were able to vote - the peasantry had little influence in society.
• Justices of the Peace were introduced - landowning men enforcing the law and managing it. Other wealthy people who did not own land such as merchants often worked in the council as aldermen or mayors.
• Ale-drinking was still popular, with a large rise in alehouses across towns and villages.

Living conditions

Food

• Large divide between wealthy and poor individuals in diets.
  • Rich could afford exotic and high quality foods such as a wide variety of meat (including lamb, pork, chicken, beef, goose, pigeon, rabbit etc) and white wheat bread, while relatively low on fruit and vegetables. They drank wine, beer, mead, and ale.
  • Poorer people were more likely to eat rye bread and vegetables, cheese, eggs, pottage, and occasionally meat. They were reliant on good harvests or the price of food could lead to starvation.
• New trade routes meant the introduction of new foods and drinks such as tomatoes, potatoes, peppers, sugar, coffee, hot chocolate, and tea.
  • By 1750 there were over 500 coffee houses in London.

Town environment

• Live animals were typically herded in the streets for selling or butchery, as well as dogs, cats, rats and mice.
• Streets were often just dirt or gravel, some may be paved or cobbled.
• Open fires in houses were very common, and by the 1600s coal became cheaper and was used, leading to smokey streets and respiratory diseases.
• Houses were similar to that of the Medieval period with multiple overhanging storeys. Lots of overcrowding among poor families, often damp or cold.

Water use and supply

• Regular bathing was not common, as indoor baths typically required a bathtub, good water supply, firewood, and servants. Only the rich could afford good soap for the skin. Water was also dirty.
• Water in the countryside was from streams, springs, or wells, whereas in towns it was supplied by:
  • Paying for piped water via a reservoir.
  • Conduits - public fountains created by town councils or wealthy individuals.
  • Water Sellers - collect water from rivers or conduits, taking water to a person’s house.

Waste disposal

• In towns, household waste collected from a basket outside their homes weekly by ‘scavengers’ selling it as fertilizer to those in the countryside.
• The first flushing toilet was invented in 1596 but was not common.
• Most people instead had a privy with a cesspit, which could sometimes leak, and were emptied every year or so.

Responses to plague

• The plague had recurrent outbreaks within the Early modern period, less severe than the medieval period - at least 8 between 1500 and 1670. One of the last notable outbreaks was the Great Plague in 1665 which notably affected London.
• The bubonic plague was the most common, and only 1/5 victims survived. Often killed 10% of communities in a year when it hit.
  • Poorest areas were most affected
• Medical knowledge had not improved, and there was little understanding of how the plague was caused, the belief in miasma still common (bad air).

National response to the plague

• 1518 - Henry VIII introduced isolation, where houses containing plague are identified by bundles of straw out the windows, and carry a white stick if leaving the house. Pesthouses also set up outside town walls containing plague victims.
• 1578 - Elizabeth I’s privy council printed plague orders including:
  • Justices and aldermen meet periodically during outbreaks, and appoint searchers of the dead to report on infection development.
  • Aldermen collect money to help the sick
  • Special prayers read in church
  • Streets cleaned and barrels of tar burned, no dogs or cats.
  • Bedding and clothes of victims burned.
  • Funerals occur at dusk → fewer people attend.
  • Infected houses shut for at least 6 weeks, no one allowed to leave including healthy people.
• 1604 - Plague act passed, providing help to families affected by collecting money in town. Hanging became a punishment for breaking isolation and seeing other people if infected, those not would be whipped.

Local response

• More towns constructed pesthouses
• In Cambridge, early news of the Plague in London meant they were able to prepare - strangers only allowed into town with health certificates, streets cleaned, and stray animals killed.

People’s responses

• More people went to church. Protestant behaviors were adopted including prayer, good behavior, and fasting, as opposed to Catholic ones, such as pilgrimage.
• Many upper class, rich individuals fled affected towns to friends or houses in the countryside, whereas the middling sort and poor could not.
• By the late 1500’s apothecaries and doctors were more common, albeit many physicians fled. They wore hoods, beaks filled with pleasant herbs, and heavy cloaks. Apothecaries sold tobacco and pain treatments, but neither could cure plague.
• Many avoided the sick, avoiding delivering food, writing wills, or going to funerals.
• Community was still central, immediate family took care of each other, elderly often looked after orphans, and people looked out for their neighbors too.

Impact of National and Local Government on Public Health

1500-1670

• Public health measures were not solely taken during times of the plague
• Case study of York during the 1500’s - rules enforced by aldermen included:
  • Pigs not allowed in streets
  • Household waste not left outside until evening
  • Cesspits must not overflow - pay for emptying
  • Formation of dunghills in yards lead to a fine
  • Fines for throwing human waste into the street
  • No construction of privies over the main river
  • People had to clean outside their homes twice weekly.
  • No blocking of gutters in main streets.

1670-1750

• Plague is no longer a public health concern.
• Improvements made to large towns, such as increased piped water and construction of terraced houses in towns for wealthy people.
• More streets paved with stone, with footpaths.
• Streetlamps were in use in London by 1680, most towns had lighting by 1750.

The Gin Craze

• By 1660, alcoholism became an issue as the laboring poor swapped ales for spirits. Gin was initially imported from Holland.
• In 1689, imported gin was banned to increase production in England → gin became very cheap, and London saw huge increases in gin consumption among the poor.
• 1729 - gin act. Gin distillers had a tax of 5 shillings per gallon of gin, and those selling had to pay a license of £20- difficult to enforce among small gin shops.
• 1736 - another gin act. License became £50, tax was 12 shillings. Still difficult to enforce
• 1743 - gin act, restricted sale only to establishments already selling wine and beer. Little effect.
• By 1750, London drinking over 11 million gallons of gin annually.
• 1751 - gin act. If selling gin illegally, individuals would be imprisoned. Second offense whipping, third offense transportation to Australia. This finally had an effect on reducing gin consumption.

1750-1900

Overview of society

• Population grew from 6 million in 1750, 21 million in 1850 and 37 million in 1900.
• Diet of laborers and their families was poor as wages were low
• Between 1750 and 1850, the industrial age had hit, with the introduction of steam engines, textile mills, coal mining, and canal construction. There was an increase in smoke and pollution in cities.
• Working conditions in factories were poor, with child labour, long working hours, no protective equipment, and few breaks.
• Colonization had continued, and the British Empire had been formed - by 1900 Britain was in control of 1/5 of the world’s land and ¼ of its people.
• Railways were introduced and by 1850 covered a large area of Britain, allowing movement between towns, coast, and countryside.
• New scientific beliefs were introduced including evolution, and while controversial, began shifting the impact religion had on society.
• In 1861 Louis Pasteur discovered germs caused disease.
• In 1870, an education act was passed providing education to all children under 10, increasing literacy and newspaper reading.
• Democracy had improved - the 1832 reform act gave the vote to men with property, and in 1867/1884 this extended to working-class men.
• Social classes were heavily divided, between professionals and factory owners who lived in the suburbs and countryside, and working class people in slums near factories.
• Alcohol continued to be an issue, with most social classes engaging in drinking, despite the end of the Gin Craze. Poorer people typically drank in pubs rather than their homes.

Public health crisis in the early industrial period

• Public health was a particular problem in working towns in the north - in 1842 57% of children in working class areas of Manchester died before they reached 5.
• Town growth was faster than the construction and regeneration of infrastructure
• This included a lack of houses relative to demand, leading to poor quality houses.
• Local town governments were poorly organized, and worked in the wealthiest best interests rather than the common people.
• There were few protective laws. Governments had a ‘Laissez-faire’ (leave alone) attitude which meant little was legislated to protect health or create adequate housing.
• It was only after 1861 that germs were known to cause disease, and even then the belief was not widely accepted.

Housing

• Large towns typically had lodging houses, which were often overcrowded and filthy for single people to leave, or new families. They allowed diseases to spread quickly, as people were often packed together, sharing a bed or sleeping on the floor.
• The best houses for working people to have was a ‘through house’ with a back yard, despite most houses being ‘back to back’ where terraces were arranged in double rows to fit as many houses into a space as possible.
  • They had poor ventilation leading to more respiratory conditions.
• The poorest may simply live in the cellars of other’s houses.

Food

• People working in factories could not grow their own food, and instead bought from small sellers, their income often too low for sufficient food. A typical diet was bread, butter, tea, and potatoes, and occasionally offal meat. This leads to malnourishment.
• The Laissez-faire attitude meant there were few regulations of food being sold, leading to adulterated (badly altered) products such as adding lead and chalk to bread to make it whiter, milk watered down, and copper added to butter. Diarrhea and food poisoning were common.

Water

• Piped water is still uncommon in poor areas. Water typically supplied via a communal pump in the street - often shared by the entire street, and may only be available for a few hours per day.

Waste

• New slum areas did not have sewers and therefore polluted water often drained in the street.
• Privies were still used during the early 1800’s, often shared with neighbors.
  • Some connected to a cesspool, which may or may not be watertight - some leaked close to a pump causing fatal disease
• Wealthier people started using flushing toilets that emptied into sewers that then emptied into the river, often where water companies got their water.

Responses to Cholera

• Common diseases during the industrial period included typhus, typhoid, diphtheria, influenza, and tuberculosis.
• A cholera epidemic hit from 1831 from Sunderland after arriving from India. Leeds was particularly badly affected in 1832. Despite believing the cause was miasma, Dr Robert Baker (a surgeon) believed there was a link between dirty living conditions and disease by mapping out the cases across Leeds.
  • The epidemic killed 32000 people in Britain over the two years.
• At the time, the cause of cholera was not known, but some beliefs included:
  • Being caused by God as a punishment for sins
  • Doctors thought it was contagious between healthy and sick people
  • Miasma, bad smells, from waste.
• Responses of the epidemic included:
  • Burning of tar in streets to remove bad smells, and addition of chloride of lime to sewers to improve the smell
  • Towns encouraged (not enforced) to set up voluntary health boards that inspected outbreaks of cholera and provide public health guidelines
  • A national day of fasting, humiliation, and prayer on 2nd of March 1832
  • November 1832 - Central Board of Health established.
  • Some local areas introduced quarantine, preventing people entering towns, or establishing a cholera hospital or burial ground.

Public health interventions 1830-1900

Edwin Chadwick and the 1848 Public Health Act

• Produced a report in 1842 ‘Report on the Sanitary Condition of the Labouring Population of Britain’ compiling evidence that poor sanitation was linked to poverty and disease. It also introduced proposals for improvements, which had some controversy by water companies due to an increase in cost.
• However, the Heath Towns association formed that had a lot of Parliamentary support.
• As a result, in 1848 the first public health act was passed. It:
  • Was permissive rather than compulsory → had limited impact beyond a change of attitude away from Laissez-faire.
  • Introduced a General Board of Health, with powers until 1854. They were able to connect houses and sewers to provide clean water.
  • Allowed a local board to also be established if funds were available → were forced if death rates were above 23 per 1000.
  • Did not apply to London or Scotland

Further public health interventions

• 1854 - Cholera was linked to dirty water by John Snow, who noticed a link between infections and a pump in Broad Street, London. He removed the handle, and cases reduced significantly. Despite this, miasma theory was still popular
• 1854 - Cholera germ identified by Italian doctor Filippo Pacini. Overlooked.
• 1858 - The Great stink happened, as a result of hot weather and sewage in the Thames, preventing MPs from being able to meet, therefore commissioned Joseph Bazalgette to construct 1300 miles of sewers in London between 1858 and 1865, which had a massive public health improvement.
• 1860 - Pure food act, preventing adulteration of food, a stronger act introduced in 1872 then giving more power to inspectors.
• 1861 - Louis Pasteur published Germ Theory that germs caused disease.
• 1866 - another cholera outbreak - less severe in London due to the new sewers.
• 1867 - Working class men now able to vote due to the Reform act.
• 1867 - Pail privies introduced, removing the cesspool and instead had a bucket emptied regularly by local authorities.
• 1873 - Price of food began to decrease as imports from America increased. Working class incomes also increased.
• 1874 - Benjamin Disraeli became Prime Minister and made public health a key priority
• 1875 - Public health act - forced not voluntary
  • All local authorities required to set up medical officer and sanitary inspector
  • Local authorities responsible for sewers, rubbish, public toilets and parks, and water supplies
  • All new houses are required to have piped water, toilets, sewers, and drains.
  • Sanitary inspectors in charge of stopping the sale of spoilt foods.

1875-1900

• Laissez-faire was much less common in governments, instead they were responsible for protecting public health and welfare.
• Women’s co-operative guild established in Hebden Bridge in 1883, as an example of many organizations established by the working class to demand change. They campaigned to improve women’s influence in society, and government improvement for health regarding maternity care, free school meals, and improved housing.
• More money spent by local authorities to improve civil pride, including galleries, concert halls, shopping areas, town-halls, and public squares. There was also improved construction of housing by local authorities.
• By 1900 most people had clean water, clean air, safe food, but not entirely decent housing.

1900-Present

Overview of society

1900

• The government began to introduce free school meals and state-funded pensions - overall known as the welfare state.
• Science and technology had improved, the first cars were used, cinemas built, radio communication and telegraph had developed.
• Society was growing less religious - formation of the British Humanist Society in 1896, despite most people attending church.
• Workforce was mainly men, and was usually hands on manual labor.
• By 1900 half of the population of the UK lived in cities
• In 1900 average working hours were 54 per week, but leisure activities were improving including football, parks, gardening, or socializing in a pub.

2000

• By 1928 everyone over the age of 18 was able to vote.
• Creation of the National Health service in 1948
• Technology had skyrocketed in forms of medicines, digital communication, transport, war tech, and agriculture to name a few.
• 1948 - UN declaration of Human Rights.
• By 2001 less than 10% of people in Britain attend church
• Fewer jobs are considered manual labor due to automation, and new jobs have been created in service industries such as education, healthcare, tourism, and business
• Family planning has improved since the contraceptive pill introduced in the late 1960s.
• British society is more diverse, particularly after the post-war period where there was a labor shortage, leading to the immigration of lots of people to the UK.
• By 2000, fewer hours were worked per week, approximately 39, with improved holidays. Leisure has boomed.

Living conditions

Housing

• 1909 - government banned construction of new back-to-back housing
• 1919 - Parliament’s housing act:
  • Councils act as landlords by producing new rented housing for working class, using money from taxes
  • Provided the standards of the size, water supply, and drainage.
• 1830 - another housing act, where councils forced private landlords to sell slum housing to them, where they could be cleared and rebuilt into council houses.
• Post war construction of high rises above 6 storeys were funded in the 60s and 70s by the government - over 4500 created by 1980, since the innervation of electric and gas cookers/heaters
• 1979 - 42% of people in the UK lived in a council house relative to 1% in 1900.
• 1980 - Conservative PM Thatcher produced a housing act giving the ‘Right to Buy’ where tenants could buy their council houses. Approximately 1.5 million have been sold in this way. Increase in private landlords- decrease in quality.

Food

• 1905 - first tin of Heinz baked beans on sale - canning as preservation more reliable.
• Chain grocery shops became more popular around 1900, such as J. Sainsbury.
• Food was more affordable over the first few decades - 1914 a family would spend 60% of its income on food, 1937 this was down to 37%.
• War, especially WWII impacted the diets of people in Britain:
  • Food rationing was introduced, leading to fair distribution of nourishing food - health of poor people improved as diets in this class became more balanced.
  • Post war led to the compulsory fortification of foods such as margarine and white flour with vitamins and iron to reduce the prevalence of diseases like rickets.
• After 1950, families generally became richer, more owned fridges and freezers. Foods were able to be preserved longer. Microwaves were invented in the 1950’s and by 2000 93% of people in the UK owned a microwave.
• Public health scares due to food - 1986 BSE (Bovine Spongiform Encephalitis) or ‘Mad Cow Disease’ had been discovered in cows and while rare, by 1996 sales of beef decreased. Eventually all animals with BSE were destroyed, and systems put in place to detect this.
• Rickets - lack of vitamin D, a problem pre-war when children were living in slums, decreased as food became fortified and living conditions improved. Increasing numbers however since 2014 as children spend less time outdoors - sedentary lifestyle.

Air

• Coal use in the UK had grown - by 1950 200 million tonnes used per year.
• 4-12th December 1952 ‘The Great Smog’ - thick smoky fog filled with sulfur due to factories and other pollutants meant people struggled to breathe, or developed bronchitis or pneumonia. It led to the deaths of 12000 people. As a result, 1956 the Clean Air Act was passed - people and factories in certain areas had to use ‘smokeless’ fuels → lead to better heating systems using oil, gas, and electricity.
• Cars continue to cause pollution currently, with diesel cars being the worst.

Inactivity

• Since the end of the war and rationing, the lifestyle of people in the UK has changed dramatically
  • People exercise less
  • Use public transport or cars more frequently
  • Had a disposable income to spend on non-essential foods that are high in fats and sugars
  • Increase in labor-saving equipment in the home and industry
  • The use of indoor activities such as watching TV and gaming have increased.
• In 2013 44% of men and 33% of women were considered overweight, and this continues to rise. This leads to another public health problem - the increase in non-communicable (non-contagious) diseases such as coronary heart disease, diabetes, and stroke.

Responses to epidemics

The Spanish flu (1918-1919)

• Across the world, it killed 50 million people, and 228,000 people in the UK. It killed more people than the first world war did.
• Trench warfare in the first world war (1914-1918) led to rapid infection.
• It peaked at the end of the war when people crowded together to celebrate on the 11th of November 1918.
• The disease could kill quickly, causing flu, pneumonia, or hypoxia.
• Case study - Dr Niven. Manchester’s chief medical officer, who wrote a report on the Spanish flu in 1919 setting the standards for public health awareness and action, greatly reducing the number of deaths. His actions included:
  • Recording the patterns of spread
  • Sharing advice in newspapers and cinemas, using simple language.
  • Encouraged more research into influenza by the government.

AIDs

• First seen in the 1970s, only called AIDs by 1982 - Acquired Immune Deficiency Syndrome. It was discovered to be caused by a virus called HIV (Human Immunodeficiency Virus) in 1984. It is transmitted via contact of blood or bodily fluids.

Phases of responses to AIDS:

• Phase 1 (1970s-1983) - Seven people in the UK had died of AIDs by 1982. Few people were concerned about AIDS until 1983 where many people got it due to a blood transfusion → lead to gay people and people taking drugs to stop giving blood. Heavily stigmatized - one newspaper article called it the ‘Gay Plague’ and some churches called it a punishment towards those who were gay or took drugs.
• Phase 2 (1984-85) - knowledge of transmission not yet known, so drastic measures were taken including stopping mouth-to-mouth resuscitation, and the ordering of hospitals to detain anyone with AIDS, preventing them leaving, while medical professionals had to wear heavy PPE (personal protective equipment like gloves and gowns)
• Phase 3 (1986-87) - better measures were taken. These included:
  • Charity groups providing clean needles for drug taking.
  • HIV screening of blood transfusions.
  • AIDs prevention campaign ‘Don’t die of ignorance’ leaflet to every house as well as on TV. Myths about AIDS spread had decreased.
  • April 1987 - Princess Diana photographed shaking hands with someone with AIDs, reassuring that simple contact could not lead to AIDs, and that people needed respect and dignity.
• Phase 4 (1988-95) - more widely understood. Freddie Mercury died of AIDs in 1991, and a tribute charity concert raised £20 million for AIDS charities. The rate of transmission had slowed - 25,000 people had been diagnosed as HIV positive by 1995 → 12000 of these had developed AIDs → 8500 of these had died
• Phase 5 (1996-now) - 1996 drugs introduced that slowed the progression of HIV to AIDS called antiretrovirals which were funded by the government. This did lead to an increase in cases as people became complacent, and about ¼ of people with HIV are unaware and may continue to spread it.

Government Involvement in Public Health

New laws since 1900

• 1902 - midwifery is regulated, training improved.
• 1906 - free school meals for poor children
• 1907 - school medical inspections
• 1908 - pensions for over 70s
• 1911 - national insurance, giving sickness and unemployment pay
• 1919 - required slum clearing by local councils
• 1929 - councils in charge of old workhouse hospitals
• 1940 - major vaccination programmes introduced for diphtheria (1940) and tuberculosis (1948)
• 1948 - National Health service introduced providing free healthcare.
• 1956 - Clean air act
• 1974 - Health and Safety at work act

The NHS

• Introduced in 1948 by the Labour government.
• Uses taxpayers money to equally distribute healthcare among everyone who needs it.
• More recently grown to produce public health awareness campaigns and work with prevention as well as cure.

Smoking

• Health risks of smoking were only discovered in the 1950s while 80% of men and 40% of women smoked.
• Initially the government did little about it, particularly due to the fact they received a large income from tobacco companies and their taxes. They also wanted to avoid becoming a ‘Nanny State’ where individuals’ responsibility is given to the government.
• In 1962 more scientific evidence about the harm smoking causes was publicized, and this lead to the slow increase in anti-smoking legislation:
  • 1964 - cigarettes no longer advertised on TV
  • 1971 - health warnings on cigarette packets
  • 1986 - cinema advertisements for smoking banned
  • 1998 - government funding of nicotine replacement therapies
  • 2007 - smoking banned in public places as passive smoking could also cause disease
  • 2016 - all packaging had to be blank.

Healthy lifestyles

• Along with the NHS, the government produces a large amount of public health advice detailing recommendations about exercise, drugs, food and nutrition, sexually transmitted infections, mental health, and alcohol, using a variety of mediums such as TV, posters, social media, and newspapers.