Public Health in Early Modern Britain

12 Key excerpts on "Public Health in Early Modern Britain"

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  Healthy or Sick?

  Coevolution of Health Care and Public Health in a Comparative Perspective

  • Philipp Trein(Author)
  • 2018(Publication Date)
  • Cambridge University Press

    (Publisher)

  Yet, many of the interventionist public health policies in the United Kingdom went unopposed, because the government intro- duced most of these policies at the end of the nineteenth century based on the findings of bacteriological research. Therefore, the discretion of the national government to regulate individual lives augmented during this period. For example, the Local Government Act of 1875 allowed public health officers to remove sick individuals from the community and place them in homes (Porter, 1999, 134–135). Around the end of the nineteenth century, the United Kingdom’s public health sector was a very important part of health policymaking. MOsH (medical officers of health) were appointed throughout the country. They were part of the public health system and essentially responsible for a population-oriented health system. MOsH were United Kingdom: Health Care and Public Health 87 hired by the local and municipal public health services, which the national government coordinated. In that period, the power of the medical profession declined with respect to preventive health and administrators’ roles became more important (Porter, 1999, 137). According to Dorothy Porter, “[the public health movement] was a movement much broader than state medicine, outside the central corridors of power and beyond the elite province of the medical and scientific communities. It was not, however, a ‘lay’ organization, but was associated with the growth of prevention as a professional practice distinct from cure” (Porter, 1999, 138). Prevention efforts involved a group of doctors focusing on community health issues supported by a “community” of interests surrounding preventive medicine, communicated through journal literature and high-profile conferences, and embodied in a variety of institutions set up for edu- cational and research purposes (Watkins, 1984; Porter, 1999, 138).

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  Governing Systems

  Modernity and the Making of Public Health in England, 1830–1910

  • Tom Crook(Author)
  • 2016(Publication Date)
  • University of California Press

    (Publisher)

  21 A third aspect is the way historians have recov-ered the disciplinary and civilizing dimensions of public health reform in England, which were by no means the preserve of imperial endeav-ors, whether in India or Egypt, Hong Kong or Singapore. 22 Quite the contrary, they were just as pronounced at home, in the “metropole,” where they played a role in the realization of a broadly liberal society. In brief, no longer a neutral enterprise driven by science and humanitar-ian sentiments, public health is now considered part of a wide-ranging attempt to order society according to various norms regarding race, gender, and class, and the moral requirements of respectable citizen-ship. 23 This is partly based on the work of Michel Foucault, but also on recovering the ways public health was enmeshed in a patriarchal, strat-ified, and still largely Christian society. Finally, the causal role once played by the epidemiological pressures created by urbanization and pronounced demographic growth has faded, amid a recovery of the plurality of options that might have been pursued, and the contingency of those that were. No one disputes the enormity of the demographic transformation that took place. The fig-ures speak for themselves. The population of England and Wales rose from roughly 6.5 million in the mid-1750s to roughly 9 million in 1801, before beginning a remarkable course of expansion: by 1851, it had doubled to 18 million, about half of which lived in urban areas; by 1901 it stood at 32.5 million, at which point more than 80 percent lived in towns and cities. 24 The argument is that no necessary solutions fol-lowed, even if it was clear to most that something had to be done.

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  The public health system in England

  • Hunter, David J., Marks, Linda(Authors)
  • 2010(Publication Date)
  • Policy Press

    (Publisher)

  Emergence of the new public health From the late 1970s, tensions and reorganisations surrounding the public health function in England were concurrent with a broader, international movement that came to be known as the ‘new public health’. This movement threw into relief the aridity and reductionist nature of narrow, professional debates. The period was also marked by a sense of growing exasperation among many involved in public health with the neglect of public health and preventive initiatives.These perceptions and developments were instrumental in fostering a broad, and some would say political, movement concerned to put in place what came to be known as ‘the new public health’. This movement drew on the spirit of the early pioneers in public health but within the context of the new health challenges (Unit for the Study of Health Policy, 1979; Ashton and Seymour, 1988). Webster (1992: 10) argues that,“as in the 1930s, much of the impetus for the New Public Health has emerged from outside the ranks of public health organisations, initiatives in other western nations, or lay and scientific pressure groups”. The movement also reflected critiques of the scope of clinical medicine 51 The evolution of the public health function in England (1): 1974–97 in improving population health when compared with the impact of better nutrition and healthier environments (McKeown, 1976) and an emerging body of literature that underlined the interplay between health and social and environmental factors, and emphasised the role of public policy, intersectoral collaboration and community action. As such, it prefigures later attempts to interpret and define a broad public health system.A key influence was the publication of a Canadian policy document called A new perspective on the health of Canadians (Lalonde, 1974), which became known as ‘the Lalonde report’, after the Minister of Health and Welfare at the time, Marc Lalonde.

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  Public Health in Asia and the Pacific

  Historical and Comparative Perspectives

  • Milton J. Lewis, Kerrie L. MacPherson, Milton J. Lewis, Kerrie L. MacPherson(Authors)
  • 2007(Publication Date)
  • Routledge

    (Publisher)

  4 History of public health in modern India

  1857–2005

  Radhika Ramasubban

  Introduction

  Public health interventions and reforms, by their very nature as expensive and large-scale undertakings, have historically been the domain of governments. Their success depends upon a state’s capacity to demonstrate a strong political will, based on enlightened understanding that financial resources and administrative competence invested in public health measures can produce long-term and self-multiplying economic and social gains.

  The nineteenth and early twentieth centuries were a period when the developed countries of today successfully achieved control over preventable infectious diseases causing high and premature mortality. This they did through public health reform: state-led improvements in water supply, sewerage, drainage, air quality, housing and town planning backed by legislation, and accompanied by health education, often in response to public pressures. By the time the era of revolutionary clinical medicine based on antibiotics set in, these countries had virtually won the battle against killer communicable diseases. This transformation took place in, by and large, culturally homogeneous societies, in tandem with economic growth (urbanization, industrialization, a skilled and educated workforce, and rising incomes that facilitated improved nutrition) and considerable national wealth generated by an extensive engagement with overseas colonies.

  It was during the peak of this phase in Britain’s history that India became its flagship colony. It was inevitable that the rising tide of the new metropolitan sanitary science would have an impact on Britain’s engagement with India. The challenge for the European constitution of coping with the Indian climate and its perceived propensity for generating disease had understandably been a preoccupation since the earliest days of the East India Company. This intensified during the nineteenth century when the Company’s armies claimed new parts of the country. The colonizing project matured after the Sepoy Mutiny of 1857 – better known in India as the First Indian War of Independence – and the takeover of the country’s administration by the Crown. The decision that Britain would relocate a third of all its armed forces in India, and not develop India as a Crown settlement colony but only exploit its natural resources for repatriation and international trade, set off economic, social and political currents that shaped the mix of public health solutions that evolved for the enclave community and the general population. For India – many times the size of Britain, geographically more heterogeneous, predominantly rural, socially highly stratified and culturally complex – the colonial encounter marked a unique moment in its public health history.

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  The Evolution of the British Welfare State

  A History of Social Policy since the Industrial Revolution

  • Derek Fraser(Author)
  • 2017(Publication Date)
  • Bloomsbury Academic

    (Publisher)

  © Derek Fraser 2017 Derek Fraser The Evolution of the British Welfare State https://doi.org/10.1057/978-1-137-60589-4_4

  Begin Abstract

  4. Public health

  Derek Fraser

  1  

  (1) Leeds, United Kingdom

   

    Derek Fraser

  Email: [email protected]

  End Abstract

  Summary

  The rapid growth in population and its concentration in industrial cities lacking the basic infrastructure of water supply and sewerage created new public health problems. Medical science had not yet discovered the germ theory of disease, but Edwin Chadwick was able to demonstrate in his famous 1842 Sanitary Report that there was a causal relationship between the urban environment and life expectancy. He advocated new legislation and the water-borne disposal of sewage and was partially successful in the passing of the 1848 Public Health Act. Public health reform raised important ideological issues about the rights of property, centralisation and local self-government. In the mid-Victorian years much progress was made in public health administration, mainly at the local level, under the leadership of Simon, effectively the first national Medical Officer of Health. By the end of the century there was comprehensive legislation and local public health institutions, and the death rate fell. Historians debate the role of public health in increasing life expectancy, as against rising wages and improving diet and living standards.

  4.1 I The nature of the problem

  In many ways, despite periodic visitations of bubonic plague, there was no real public health problem in pre-industrial England. London and the centres of some of the provincial market or cathedral towns contained cramped houses, but the vast majority of the population were spread thinly over the rural areas. It was the Industrial Revolution, accompanied by a massive shift in population from rural to urban areas, which created a public health problem. As with so many other social questions, it was the very concentration of people which caused the difficulty. It was only in the so-called age of great cities that society needed that essential combination of preventive medicine, civil engineering and community administrative and legal resources known by the generic term ‘public health’.

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  The Development of Modern Medicine

  An Interpretation of the Social and Scientific Factors Involved

  • Richard Harrison Shryock(Author)
  • 2017(Publication Date)
  • University of Pennsylvania Press Anniversary Collection

    (Publisher)

  254. 28 Quoted in B. L. Hutchins, The Public Health Agitation, 1833-1848 (Lon., 1909), pp. 109, 110. 218 DEVELOPMENT OF MODERN MEDICINE gram of health reform. Not even the Poor Law or the Factory Question, declares a modern English historian, go so deep into the national life. 29 The first stage in the public health movement was one of investigation on a grand scale. Governmental authorities must learn the worst about living conditions and disease among the masses, in order to inaugurate improvements. While the rank and file of physicians were rarely much con-cerned with public hygiene, the lead in investigations was taken by individual medical men who combined humane sen-timents with a scientific interest in disease prevention. Vir-chow's report on Silesia was paralleled by more sweeping inquiries made in Great Britain and in the United States between 1835 and 1850. In the former nation, Drs. Arnot, Kay, and Southwood Smith submitted striking reports on the causes of fevers in London. These were followed in 1842 by a comprehensive survey of national health as a whole. This took the form of a report to the Poor Law Board from all the poor law physicians in England, on the disease conditions in their respective unions. 30 In the United States the National Institute at Washington tried for several years to secure a similar national survey. Failing in this, the Institute persuaded the newly formed American Medical Association to examine conditions in the larger American cities. The resulting reports indicated clearly that just such poverty and disease as obtained in London, Manchester, and Glasgow also disgraced Boston, New York, and Philadelphia, and that the death rates were even higher in the American cities. 81 In some cases medical investigators cooperated effectively 2» Hutchins, op. cit., p. 58. The Poor Law Act of 18)4, of course, had itself possessed public health significance. See Sir Allen Powell, The Relation of Public Assistance to Public Health, Amer.

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  Public Health

  Local and Global Perspectives

  • Pranee Liamputtong(Author)
  • 2019(Publication Date)
  • Cambridge University Press

    (Publisher)

  A common thread in the history of public health is this tension between individual and collective responsibility for health. As you read about health in different times and places in this chapter, ask yourself: why does this tension persist? 26 Introduction All knowledge is a product of its time, culture and context. Often, histories are presented as the result of progress, a linear path of discovery. The social philosopher Michel Foucault (1926–84), however, argued that histories typically overlook the accidents and struggles that take place over time (Foucault, [1969] 2002). Examining these frictions can offer insight, challenging us to question what we take for granted. This chapter explores the assumptions and struggles of public health’s long history. It is an opportunity to question what public health is and where it is going, based on where it has come from. A comprehensive history is outside the scope of a single chapter. Instead, this chapter takes a critical approach to examining public health’s history, depicting current public health principles and practices resulting from the actions of heroes and innovators as much as chance and folly. Through a critical examination of its history, this chapter shows that public health is more than a health discipline. It is a scientific profession, a social science and a political endeavour committed to empowering individuals and health through organised collective intervention (see also chapters 1, 5, 9 and 13). This chapter introduces readers to the different lenses through which public health has been viewed and practised, from indi- vidualist, behaviourist and biomedical perspectives through to socio-environmental; from ancient Greece to 19th-century Prussia. Australia’s and New Zealand’s histories are also explored, showing how different approaches to public health throughout history have (de) emphasised the importance of collective action.

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  Public Health

  Local and Global Perspectives

  • Pranee Liamputtong(Author)
  • 2016(Publication Date)
  • Cambridge University Press

    (Publisher)

  To what extent is your health a reflection of government policies and practices? Perhaps you recently required treatment in a hospital and, despite your student income, you were able to access treatment because of a universal health insurance system. A common thread tying public health’s history together is this tension between individual and collective responsibility for health. As you read about health in different times and places in this chapter, ask yourself: why does this tension persist? Introduction All knowledge is a product of its time, culture and context. Often, histories are pre- sented as the result of progress, a linear path of discovery. The social philosopher Michel Foucault (1926–84), however, argued that histories typically overlook the acci- dents and struggles that take place over time (Foucault, [ 1969] 2002). Examining these frictions can offer insight, challenging us to question what we take for granted. This chapter explores the assumptions and struggles of public health’s long history. It is an opportunity to question what public health is and where it is going based on where it has come from. A comprehensive history is outside the scope of a single chapter. Instead, this chapter takes a critical approach to examining public health’s history, depicting current public health principles and practices as the result of the actions of heroes and innovators as much as chance and folly. Through a critical examination of its history, this chapter shows that public health is more than a health discipline. It is a scientific profession, a social science and a political endeavour committed to empowering individuals and health through organ- ised collective intervention (see also Chapter 1 ). This chapter introduces readers to the different lenses through which public health has been defined and practised, from individualistic, behaviourist and biomedical through to socio-environmental; from ancient Greece to 19th century Prussia.

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  Public Health

  Policy and Politics

  • Rob Baggott(Author)
  • 2010(Publication Date)
  • Bloomsbury Academic

    (Publisher)

  Although Parliament was a key battleground between public health reformers and their opponents in the Victorian era, local government was also an important arena. The 1848 Act was permissive in all but the most exceptional circumstances. This meant that decisions about public health were delegated to local communities, stimulating political divisions at this level. Efforts to impose a central framework for regulation were vigorously resisted. Indeed, according to some (Szreter, 1995, cited in Baum, 2002, p. 19) the 1840s were ‘a false dawn’ for the public heath movement, which failed to win over the governing classes. In the longer term, however, the impetus proved too powerful. The crucial change was the 1866 Sanitary Act, which imposed obligations on localities to cleanse their communities, although local communities continued to have considerable autonomy within this framework.

  The Public Health Act of 1875 represented the culmination of the sanitary reformers’ campaign. Although a consolidating measure, it set a clear framework for public health for the next fifty years. It also signalled the end of an era, for although legislation would still be used to improve the physical environment, attention was shifting towards other means of intervention aimed at improving social welfare generally and personal hygiene in particular.

  Victorian Public Health: Preventive Medicine

  In the latter part of the Victorian period, ‘preventive medicine’ replaced the ‘sanitary idea’ as the dominant philosophy of public health (see Armstrong, 1993; Kickbusch, 1986; Fee and Porter, 1992; Lewis, 1992). This was manifested in the ‘medicalization’ of public health; in a shift in the focus of attention from the general population towards specific subgroups and individuals, and in an increasing emphasis on access to health services. At the same time, the activities of the sanitary movement, while still contributing to public health debates, became more closely integrated with broader issues of social welfare.

  It should be noted that Chadwick had a ‘deep-seated distrust of curative medicine’ (Finer, 1952, p. 157). Indeed, the early Victorian public health programme was ‘fundamentally environmentalist’ (Sheard and Donaldson, 2006, p. 1). Medicine played a secondary role to other professions, such as engineering for example. As already mentioned, medical professional bodies were less than enthusiastic about central government intervention. Nonetheless, individual members of the medical profession were an important driving force behind the sanitary revolution. Much of the early evidence about the extent of the problem was documented by individuals with a medical background, such as Farr, Southwood Smith and Simon.

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  The Origins of the British Welfare State

  Society, State and Social Welfare in England and Wales, 1800-1945

  • Bernard Harris(Author)
  • 2018(Publication Date)
  • Red Globe Press

    (Publisher)

  Public health in the nineteenth century 8 Although the nineteenth century witnessed many improvements in therapeutic medicine, most medical historians have tended to accept the view that these improvements made only a small contribution to the decline of mortality. McKeown argued that approximately one-third of the overall decline in mortal-ity during the second half of the nineteenth century was caused by a decline in the incidence of water- and food-borne diseases, which he attributed to the impact of Victorian sanitary intervention, and that approximately 44 per cent of mortality decline was associated with a reduction in the death rate from air-borne diseases, which he attributed to improvements in diet and nutrition. 1 This chapter explores the history of this debate, and examines the development of the campaign to improve public health from the late-eighteenth century onwards. 8.1 The origins of sanitary reform As Dorothy Porter has recently demonstrated, there can be few societies, if any, which have not attempted to make some provision to protect themselves against the threat of disease. In the ancient world, both the Greeks and the Romans prescribed detailed and highly ritualised codes of individual behaviour to main-tain health, and doctors working within the Hippocratic tradition used the medicine of ‘airs, waters and places’ to draw up detailed recommendations for the location of new settlements. During the Middle Ages, municipal authorities attempted to identify and isolate lepers, prohibited the dumping of animal car-cases and other refuse in local rivers, and introduced quarantine measures to ward off the threat of plague. In sixteenth- and seventeenth-century England, straw was placed over the windows of houses containing plague victims, and household members were required to carry a white stick if they ventured out-side.

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  The New Public Health

  An Introduction for the 21st Century

  • Theodore H. Tulchinsky, Elena A. Varavikova(Authors)
  • 2000(Publication Date)
  • Academic Press

    (Publisher)

  This had a profound impact on approaches to health and societal issues. The late eighteenth century was a period of growth and development of clini-cal medicine, surgery, and therapeutics, as well as of the sciences of chemistry, physics, physiology, and anatomy. From the 1750s onward, voluntary hospitals were established in major urban centers in Britain, America, and on the continent. Medical–social reform involving hospitals, prisons, and lazarettos (leprosy hos-pitals) in Britain, led by John Howard (who published On the State of Prisons in 1777), produced substantive improvements in these institutions. During the French Revolution, Philippe Pinel removed the chains from patients at the Bicetre mental hospital near Paris and fostered reform of insane asylums. Reforms were further carried out in Britain by the Society of Friends (the Quakers), who built the York Retreat, providing humane care as an alternative to the inhuman conditions of the York Asylum. Although Ramazzini’s monumental work on occupational diseases was pub-lished in 1700, little progress was made in applying epidemiologic principles to this field. However, in the latter part of the century, interest in the health of sailors and soldiers led to important developments in military and naval medicine. Stud-ies of diseases in various trades, such as metalworkers, bakers, shoemakers, and hatmakers, identified causative agents and methods of prevention. Observational 1. A History of Public Health 17 studies of Percival Potts on scrotal cancer in chimney sweeps (1775), and Baker on the Devonshire colic (lead poisoning) in 1767, helped to lay the basis for development of investigative epidemiology. Pioneers and supporting movements successfully agitated for reform in Britain through the parliamentary system. The antigin movement, aided by the popular newspapers (the “penny press”) and the brilliant engravings of Hogarth, helped produce legal, social, and police reforms in English towns.

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  Plagues and Politics

  Infectious Disease and International Policy

  • A. Price-Smith(Author)
  • 2001(Publication Date)
  • Palgrave Macmillan

    (Publisher)

  However, it does not view the relation- ship between capital and labour as being purely antagonistic nor as being of overwhelming significance in determining the historical out- comes that are possible (although the relationship of ‘competitive interdependence’ between capital and labour is certainly a condition of primary importance in market-oriented economic systems). 8 The chapter focuses instead on the importance of the politics of the public health movement in determining historical outcomes. It is argued that Britain’s historical evidence indicates that rapid economic change necessarily brings widespread and pervasive disruption. Of all the dimensions of disruption mentioned above, the most important in influencing possible health outcomes is the scale and nature of political disruption. For it is this that critically determines the capacity of the society, the state, its citizens and its various associations and administrative units to devise successful strategies to manage the disruptions of economic change without incurring the other three Ds. Hence, this points to the essential importance of the history of the pol- itics of public health in explaining how mere economic growth and its attendant ‘four Ds’ can come to be harnessed into economic and social ‘development’. Economic growth and the health of the populace in Britain, circa 1750–1870 Our knowledge of the course of economic and demographic change across the entire period of industrialization in Britain is now consid- ered to rest on a relatively firm empirical foundation. Economic growth was occurring throughout the eighteenth century at a steady, if gradual, rate of approximately 0.67 per cent per annum. In the last two decades of the century the rate of growth doubled to about 1.35 per cent and thereafter continued on its upward trend, reaching a plateau 80 Plagues and Politics: Infectious Disease and Policy

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