Models of hygienic sanitary appliances, England, 1876-1895
Tracking down the source of disease
Public health is the population’s health. As such, the broad aims of modern public health policies have been to ensure that the health of all members of a community is protected and improved.
The influence of governments, pressure groups and individuals on public health
Governments, pressure groups and individuals can greatly influence public health through political power or through enthusiastic campaigning. They can effect change on a grand scale, but public health initiatives also work at an individual level, promoting changes in behaviour that have a mass impact on a population’s health. The idea of prevention is core to such activities and might include campaigns to dissuade us from smoking, eating junk food or having unprotected sex. With the rise of biomedicine, public health measures have become increasingly sophisticated, targeted and, at times, controversial.
'Eat right, exercise regularly, die anyway.'
Religious origins of ancient cleanliness
Around ten thousand years ago, when people began to move from a nomadic to a more settled lifestyle, the risks to health changed too. Increased contact with people and animals - and their waste products - generated new problems. But while the nature of both disease and good health was little understood, some ancient civilisations evolved rituals in which cleanliness and a healthy lifestyle were central. Usually religious in origin, some of these behaviours were effective public health measures. In Ancient Babylon, for example, religious teaching forbade drinking wells being dug near cemeteries and rubbish dumps. Cleanliness was also associated with belief in Ancient Egypt, where an emphasis on washing had public health benefits. But although extensive systems existed for agricultural irrigation, comparable systems for drinking water or sewage removal did not.
Ancient Greek links between lifestyle, environment and health
Advice on diet, exercise and cleanliness is found throughout the works of Hippocrates - the ancient Greeks understood some of the beneficial links between lifestyle, environment and health. Inevitably these Greek ideas became incorporated into Roman life. But while the ancient Greeks, as in ancient China and India, instituted some central control of public health, this greatly increased under the Romans. Piped water, street cleaning and public toilets and baths became part of everyday Roman life - for the privileged. The majority of the empire’s population remained in relative squalor.
The Islamic Empire’s public health schemes
The decline of the Roman Empire was accompanied by the loss of much of the public health infrastructure. But in the East, parts of the rising Islamic Empire were becoming renowned for health-care provision and public health schemes. Baghdad opened its first hospitals in the 800s CE and had more than 60 by the 1000s. A number of cities in the empire also had public baths and sewage systems.
Medieval laws to stop the spread of disease
From the 1000s, growing international trade renewed urbanisation in western Europe. Unfortunately, disease was commonplace in these towns and cities. Leprosy was especially widespread and laws forcing the isolation of people with leprosy were passed throughout the medieval period. Such powers were expanded in the wake of the Black Death and the subsequent waves of plague that returned over several centuries. Although plague was declining by the 1700s, epidemic diseases continued to strike. But there was less need for the strict public health measures of the plague years. Instead, a closer interest in the underlying health of populations began. Counting and valuing - characteristics of trading nations with growing empires - were now applied to populations. Censuses, disease statistics, birth rates and bills of mortality marked the earliest beginnings of epidemiology, the ‘science’ of public health.
The need for government involvement in public health
By the late 1700s, Britain was evolving into the first industrialised nation, a revolution that created public health challenges of a type still faced today as industrialisation spreads around the world. Although this new age brought medical advances, it occurred within a social climate of laissez faire, where little thought was given to ensuring people were healthy, clean or well housed. But after cholera arrived in Britain at the end of 1831, intervention became necessary. Subsequent reports by a new generation of social reformers such as Edwin Chadwick revealed the extent of the public health crisis in Britain. Pressure for health reform prompted the government to pass its First Public Health Act in 1848.
The continuing problems of housing and public health
Reforms continued with the growth of public health bureaucracies armed with new powers that were strengthened in the following decades. Yet this positive approach did not signify a quick journey to better health. At the end of the 1800s mile after mile of foul slum housing remained in Britain and the shocking physical condition of Boer War recruits paid testament to the deprivations endured daily.
Improvements in public health: personal responsibility
The 20th century witnessed radical improvements in health, although these were concentrated in the wealthier parts of the world. More focused and comprehensive approaches to public health were taken, increasingly accompanied by the idea of personal responsibility. As their activities and habits could harm others, individuals were expected to care about the health of fellow citizens as well as their own. Given the improving knowledge about the nature of specific diseases, campaigns were launched and societies formed to educate the public in adopting clean, healthy and hygienic lifestyles. The idea of prevention was central, with the targeting of human actions and behaviours known to endanger health.
Arguments against public health
This relationship between personal health and the health of the community - or indeed the nation - was a subject of much public debate. Some argued that to improve the health of a population fundamentally, intervention was needed at a biological level. Francis Galton’s research, beginning in the 1860s, became known as eugenics. Its many supporters proposed that by controlling human reproduction, mankind could take control of its own future. Eugenicists also suggested that much public health legislation encouraged the survival of those normally ‘weeded out’ by natural selection. Attempts were made to turn ideology into laws, but associations with the atrocities of Germany’s Nazi regime spelled the end of eugenics as a popular movement.
Increased government involvement after the Second World War
In the aftermath of the Second World War (1939-45), the further expansion of government involvement in health culminated with the emergence of the welfare state. In Britain this was characterised by the introduction of financial and medical assistance from the cradle to the grave, the most significant component of which was the launch of a National Health Service in 1948.
International public health programmes
Public health initiatives have now moved beyond national boundaries. Global organisations such as the World Health Organization have launched extensive international campaigns - often combining health education with practical activities such as vaccination. These have saved millions of lives. On a more local level, public health legislation continues to fine-tune the fight for better health. Prevention remains at the core of public-health thinking. But as ever, when such initiatives stray into more personal areas, some fear that personal freedoms are being lost - whether it be through water fluoridation, anti-smoking laws or when it is suggested that maybe you really don’t need that third kebab after all.
Related Themes and Topics
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BibliographyK Ashenburg, The Dirt on Clean: An Unsanitized History (New York: North Point Press, 2007)
R Beaglehole (ed.), Global Public Health: A New Era (Oxford: Oxford University Press, 2003)
S Hoy, Chasing Dirt: The American Pursuit of Cleanliness (New York: Oxford University Press,1996)
H Mikkeli, Hygiene in the Early Modern Medical Tradition (Helsinki: Finnish Academy of Science and Letters, 1999)
D Porter, Health, Civilization and the State: A History of Public Health from Ancient to Modern Times (London: Routledge, 1999)
G Rosen, A History of Public Health, expanded edition (Baltimore: Johns Hopkins University Press, 1993)
S Sheard and H Power (eds), Body and City: Histories of Urban Public Health (Historical Urban Studies Series) (Aldershot: Ashgate, 2000)
M Warren, A Chronology of State Medicine, Public Health, Welfare and Related Services in Britain: 1066 – 1999 (London: Faculty of Public Health Medicine of the Royal Colleges of Physicians of the United Kingdom, 2000)
The name given to the medical practice that is based on the sciences of the body, such as physiology (the functioning of the body).
A chronic disease that affects the skin, mucous membrane and nerves. It is now confined mainly to the tropics and is transmitted by direct contact. Previously a widely feared disease, leprosy is not highly infectious.
An acute contagious fever with high levels of mortality. Both the 'Black Death' that swept Europe in the 1340s and the Great Plague of London in 1665 are believed to have been bubonic plague.
A sudden widespread occurance of an infection with high numbers of people affected.
The study of epidemic disease, including its spread, causes and methods of control.
The science of health and how to maintain it. A condition or practice which promotes good health. The definition varies widely and differs across cultures.
The study of human improvement by selective breeding, founded in the 1800s by English scientist Sir Francis Galton. Widely discredited after its use by the Nazi regime.