Public Health in UK

The history of public health in the United Kingdom is long and very rich. The idea of public health seeps into every corner of British history and forms the foundation of modern society.

What did public health look like in medieval times? What about in the early modern or modern period? We'll learn all of this before discussing the state of public health in the present day and its importance in society.

History of public health in the UK

As you can imagine, public health has changed a lot over time. Ideas surrounding health have changed, as have living conditions, government policies, and our ability to treat injury and disease.

Public health in the medieval period (c. 1000-1500)

In the medieval era, the modern-day idea that germs and bacteria caused disease was non-existent. In this period, people believed that illness was spread by miasma and could be a punishment from God.

Theory of the Four Humours:

Another of the central theories about health in the medieval period was the Theory of the Four Humours. In this theory, popularised by the Ancient Greek scientist Galen who built on the work of Hippocrates, diseases were not caused by outside forces but by imbalances within the human body. It was believed that the body was made up of four 'humours':

• Blood
• Yellow Bile
• Black Bile
• Phlegm

What did this mean for public health? Physicians would treat patients by attempting to restore balance between the humours - this could be through recommendations of exercise or diet, or most famously in the case of excess blood, 'bleeding' via leeches. Importantly, this theory represented the first time physicians considered symptoms and attempted to cure them.

This theory was believed until the beginning of the early modern era.

Figure 1. 16th-century illustration of the four humours.

The Medieval Environment

Medieval towns were often extremely unhygienic places. They did not have clean running water or any kind of sewage system. Rubbish and human waste were normally thrown out into the streets and rats, lice, and fleas flourished in this environment.

Cleanliness was not an alien concept to the people of medieval England but to keep properly clean was a luxury few could afford. Bathhouses existed in bigger cities, where people could go to have a hot bath; however, these cost money and were not affordable for every member of the population.

There were very few advances in public health during this era. Muck-rakers were employed by towns to clean the streets and public latrines (toilets) were built but much of this waste ended up going back into the rivers which were also used as a water source, allowing diseases to flourish.

Quarantine was enforced in cases of plague, and for those with particularly infectious diseases.

Overall, public health was very bad in the medieval period. There was little knowledge of what caused diseases or how to treat them, the environment people lived in was unhygienic, and efforts made to clean up towns and cities had little effect. The result was a low life expectancy and high infant mortality rates.

Public health in the early modern period (c.1500-1800)

The early modern era saw the growth of new ideas about the human body and public health thanks to the Enlightenment. In addition, the country was becoming wealthier thanks to the growth of the British Empire. However, ideas of germ theory did not appear in this period and there was little government intervention in public health, as it was not seen as their responsibility.

17th Century

In the 17th century, people began to make links between dirt and the spread of disease, although the true link between the two was not established.

In 1665, London was struck by a plague epidemic, known as the Great Plague of London. This was the last major outbreak of the Bubonic Plague in England.

An unintentional improvement in public health came from the Great Fire of London in 1666. After the fire, the city was rebuilt to make the houses further apart and the streets wider. In addition to stopping the spread of fire, the new spaced out streets helped stopped the spread of disease as well, resulting in better public health.

Figure 2. The Great Fire of London, 1666

18th Century

The 18th Century brought the Enlightenment to England, which helped the growth of new ideas and theories about the body, disease, and health. There was an increase in the number of hospitals, changes in medical education, and the professionalisation of medicine.

Three main types of medical institutions came about in the 18th century; the hospital, the dispensary, and the operating theatre.

• A hospital or infirmary was a place for people with long-term illnesses - there were many wards and many rooms. These were often set up through the charity of the wealthy.
• A dispensary was more like a modern-day 'Walk-In Centre' - they catered for patients with minor illnesses and did not have beds. They would dispense medicines and give inoculations.
• An operating theatre was where surgery would take place. As its name suggests, these operations would be watched, usually as a means for those in training to learn about the human body.

Figure 3. Guy's Hospital, Southwark, London.

The different medical professions of this era can be nicely divided into three categories as well. They were:

• Physicians: A physician's role was to diagnose illness and prescribe remedies. They did little physical work and did not do surgeries. This role was seen as the most senior in the medical profession.
• Surgeons: Surgeons performed surgeries and attended to any work that needed to be done on the body. They did not diagnose illness or prescribe remedies. They were considered secondary in importance to physicians.
• Apothecaries: An apothecary was someone who ran a shop that supplied medicines and remedies. This job required no training and was looked down upon by both physicians and surgeons. They did not diagnose illnesses or perform surgeries.

Conditions in towns and cities during the early modern period had improved but were far from hygienic. The government still did not take responsibility for public health as they considered health an individual responsibility. However, professional healthcare became more accessible and more advanced thanks to enlightened ideas about science and the body.

Public health in the modern period (c.1800-present day)

The 19th and 20th centuries saw rapid progress in the advancement of medical science and the growth of public healthcare. From the discovery that germs caused diseases to the creation of the National Health Service, the shift in medical knowledge and public health provision was huge.

19th Century

The 19th century was a period of great change in Britain as the Industrial Revolution accelerated advancements in science and technology whilst also expanding towns and cities all over the country.

However, due to this, public health worsened. Increased urbanisation thanks to people moving into cities to find work led to overcrowding and poor living conditions. Urban slums, combined with a lack of good diet and no access to clean drinking water meant diseases like Typhoid fever, Cholera, Dysentery, and Tuberculosis (TB) spread like wildfire through the population.

For the first half of the century, the government did little to help; they were still set in the idea that public health was not their responsibility. However, things changed in the second half of the century when it became evident just how appalling conditions were.

In 1842, Edwin Chadwick published a report entitled 'Report on the Sanitary Conditions of the Labouring Population'. In it, he made the link between poor living conditions and the spread of disease and suggested reforms to combat the issue.

The Cholera Epidemic of 1848 made the government realise they needed to take responsibility for public health. This led to important legislation like the 1848 Public Health Act, which set up local boards that were responsible for improving sanitation in their area. Later in the century, London's first sewage system was built and more legislation was passed to improve living conditions and public health.

The most significant advancement came in 1861 when the French chemist Louis Pasteur made the discovery that germs caused disease. This revolutionised the way people thought about diseases and allowed for huge improvements in public health.

Figure 4. Louis Pasteur, whose 1861 discovery of germ theory revolutionised public health.

20th Century

Despite the progress that had been made during the 19th century, it was evident that there were still issues concerning public health leading into the 20th century.

The Liberal Governments of the early 20th century introduced lots of legislation to support the population; a minimum wage, old-age pensions, free school meals, and school medical inspections all improved living conditions and therefore public health. Later on came the building of council houses, which had running water and electricity.

The most significant development in public health during the 20th century was the creation of the National Health Service (NHS) in 1948. This provided free healthcare to every member of the British population, as well as giving health advice, vaccinations, and campaigning to stop unhealthy habits like smoking. The NHS has continued to support the British public since its creation and is an incredibly important asset to public health.

In addition, legislation was passed during the 20th century to improve living conditions, such as the building of council housing, creating a system of benefits, and improving air quality.

The current changes in the UK's public health

Public health in the UK today is strictly maintained and is controlled by the government Department of Health and Social Care. The NHS provides healthcare to all permanent residents free of charge. There are strict regulations surrounding the conduct and training of medical professionals to ensure everyone gets the best care possible. The UK is also involved in international organisations like the World Health Organisation, to share medical knowledge and help improve public health all over the world.

The government is putting increasingly more focus on the environment - improving air quality and creating more green spaces to help stop climate change and improve public health. Programs of building adequate housing and ending poverty are also a top priority.

The importance of public health in the UK

Public Health is incredibly important - it is the basis of society in Britain. Through public health, millions of lives are saved from preventable diseases and epidemics. It allows us to live longer, accomplish more, and demonstrates how much we have achieved. Public health also helps reduce inequalities by ensuring that everyone has equal opportunities and that no one will be disadvantaged due to their socio-economic background.