Public Health in the 19th and 20th Centuries

19th century Britain

• The Industrial Revolution coincided with a huge increase in population

• Cities and towns were overcrowded – poor provision of sanitation

• Many supported ‘laissez-faire’ – no government intervention

Cholera arrives!

• Arriving from the East the spread of cholera was helped by ignorance

• Common sense was often over-ruled by men wanting to protect business interests

• The ‘miasma’ theory was still held by many

Cholera – the facts

• Arrived in Britain in 1831 – epidemic by 1832• Spread when infected sewage gets into drinking

water – leads to extreme diarrhoea• Both rich & poor caught illness• Government began by introducing regulations

about burials but then lost interest when epidemic declined

• Epidemics occurred in 1848, 1854, and 1866

Time for change?

• 1842 Chadwick publishes his “Report on the Sanitary Conditions of the Labouring Classes’

• Privileged classes shocked by findings• Government introduced Public Health Bill

which was opposed by some MPs• Public Health Bill passed in 1848 (more

cholera!)

Public Health Act

• Central Board of Health set up in London

• Public Health boards could be set up where death rate was more than 23 per 1000 per year

• Boards had power to raise money to pay for drains & sewage disposal

• Central Board closed down in 1854

Public Health Act

1848

The work of Dr Snow

• In 1854 London was again hit by a cholera outbreak

• John Snow linked the disease to contaminated water – removing the handle from a water pump stopped the epidemic!

• Pasteur’s work on his Germ Theory in 1860s supported Snow’s work

Government Action• 1872 country divided into ‘sanitary areas’

run by medical officers of health• 1875 Public Health Act forced local

government to act on health issues• Artisans’ Dwellings Act gave local

authorities power to buy up slums and build better houses in their place

• Joseph Bazalgette built hundreds of miles of sewers in London

Public Welfare• In 1834 the first attempt to deal with

poverty on a national basis – the Poor Law• Those who could not find work went into

the workhouse (lasted till 1929!)• Hospitals and schools were provided by

charities – little government involvement• Some wealth business men made a

difference eg Cadburys and Titus Salt who created purpose built villages for workers

Government Action• 1899-1902 the Boer War. 40% recruits unfit

for military service through poor diet and living conditions

• 1906 Liberal Government introduced first stages of welfare state

• 1906 Free school meals• 1909 Old Age Pension (for 70 year olds!)• Job centres 1909• National Insurance Act 1909

The NHS

• Great social problems were highlighted by the Second World War

• The Beveridge Report called for the provision of state security ‘from the cradle to the grave’ (1942)

• Beveridge spoke of the right to be free from the 5 ‘giants’- want, disease, ignorance, squalor, and

idleness• National Health Service set up in 1946 by Aneurin

Bevan