PROMOTING PUBLIC HEALTH

Introduction What is Public Health? According to Smith and Jacobson, 1988, public health ‘involves the promotion of health, the prevention of disease, the treatment of illness, the care of those who are disabled, and the continuous development of the technical and social means for the pursuit of these objectives’. During the past years in Victorian times, outbreaks of cholera, typhoid and influenza killed thousands and the Great Stink of London, when raw sewage filled the Thames, forced politicians to move Parliament. Edwin Chadwick demonstrated the link between poor living conditions and disease and reduced life expectancy. The government realised that they would have to organise a public approach to health and from these beginnings, public health was born. In 1842, Edwin Chadwick one of the Poor Law Commissioners published a report called ‘Report on the Sanitary Conditions of the Labouring Population of Great Britain’ highlighting the dreadful conditions people were living in. People refused to work and go outside due to infectious diseases, most of them were from working class. Due to the little attention given by the government to controlling diseases, he concluded that it would be cheaper to spend local taxes on improving housing and hygiene instead of running workhouses. The report also suggested the provision of access to clean water, removal of sewage and rubbish from the streets. However, the report also received negative comments from the middle-class taxpayers saying they ‘did not see why their money should be spent on better living conditions for the poor who did not pay anything towards the improvements themselves’. In 1854, there was another outbreak of cholera. The outbreak convinced Dr John Snow to investigate a theory. He concluded that cholera was spread through water. He marked on a map all the deaths in one particular area of London’s East end and later discovered that there was a clear concentration of deaths around a water pump on Broad Street. Snow had the handle removed so people couldn’t use the infected water. As a result, the number of deaths fell dramatically. Snow’s investigation had a massive impact on public health as it helped people change their minds about Chadwick’s suggestion of providing clean water. In 1942, the Beveridge Report produced by Sir William Beveridge identified five ‘Evil Giants’ in society. These are as follows: Squalor (Dirtiness), Ignorance, Want (Poverty), Idleness and Disease. These has impacted most of the poor people negatively. The report was published during the World War II, but in 1945 when the war ended, the government decided to act on Beveridge’s suggestions. In order to overcome (1) Squalor, they built council houses with bathrooms and flushing toilets. To overcome (2) Ignorance, they introduced free education up to the age of 15. To overcome (3) Poverty, the government introduced a system of benefits. People in work had to contribute, as did employers, but in exchange people got sick pay when they were too ill to work. To overcome (4) Idleness, the government introduced Labour Exchanges, now called Job Centres. Finally to overcome (5) Disease, they set up the National health Service (NHS). In 1875, an act was promoted to ensure that local councils provide the best for people’s health. This includes the provision of clean water, public toilets, rubbish removal, sewers and drains. By then, councils also managed to check food shops around the areas to ensure food safety, ensuring quality of new housing and enforcing laws against polluting rivers. As technology and the understanding of disease control were refined, interventions against health threats were developed by public organisations and agencies. Public authorities introduced new tasks including sanitation, immunization, regulation, health education, and personal health care to the public.