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This assignment is going to describe the origins of public health in the UK from the 19th century to the present. It will include the historical perspectives of the public health systems ranging from the work of John Snow all the way to the present which is the National Institute for Health and Clinical Excellence (NICE).

John Snow (1813-1858) Dr John Snow was a famous physician, widely recognised as a leading pioneer in the development of anaesthesia in Britain, as well as one of the founding fathers of epidemiology.Snow’s first piece of scientific work was on the use of Arsenic in the preservation of bodies which had to be abandoned because of the toxic effects on the medical students. From his studies of Toxicology, John developed an interest in anaesthesia and cholera and first encountered a cholera epidemic in Newcastle 1831-32 when he was sent there by the surgeon to whom he was an apprentice at the time. John Snow’s first paper titled Asphyxia and the resuscitation of new-born children was presented in 1841.Five years later, he heard about the use of anaesthesia in the USA however it was not well received in the UK at first because of the way mode of administration but Snow had spotted how they could improve that.

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(http://www. johnsnowsociety. org/johnsnow/facts. html) Edwin Chadwick (1800-1890) Edwin Chadwick was born in Manchester in 1800. Whilst studying to become a lawyer in London he became particularly interested in political and social reform. He soon became one of the most important public health activists in the 1800s.He believed in using science as a means for social improvement and in 1832 he was asked to serve on a royal commission to investigate the effectiveness of the Poor Laws (something that will be further explained after this).

His work contributed to the 1834 Poor Law Amendment Act. When he started investigating living conditions of the poor, Chadwick became intrigued by the problem of sanitation. He became convinced that carrying out active measures like cleaning, drainage and ventilation would make people healthier and therefore become less dependent on welfare.

After the first appearance of cholera in 1831, there were following epidemics of influenza and typhoid in 1837 and 1838 which caused the government to ask Chadwick to carry out a new enquiry into sanitation. Chadwick then used quantitative methods to show that there was indeed a direct link between poor living conditions and disease and life expectancy. This is what inspired the Public Health Act of 1848 (which will also be explained later on in the assignment). (http://www. sciencemuseum. org. uk/broughttolife/people/edwinchadwick.aspx)The Poor Law Act Before the poor law act was established, the cost of looking after the poor was increasing every year.

The cost was paid for the middle and upper classes in each town through their taxes. After years of complaining the Poor Law Act was introduced meaning to reduce the cost of looking after the poor and impose a system which would be the same all over the country. The poor law act ensured that the poor were housed in workhouses, clothed and fed and any children that were in workhouses would receive some schooling.In return for this care the paupers would have to work for several hours a day. Believing this, many people welcomed the act with open arms; however, not everyone shared the same joy of welcoming this act. People like Richard Oastler spoke out against the act calling the workhouses ‘Prisons for the Poor’. Conditions within the ‘workhouses’ were deliberately harsh to ensure that only those who were desperate enough would ask for help.

Families were split and housed in different parts of the workhouse. They were forced to wear uniforms and the diet was monotonous.A little time after the new law was introduced; various numbers of scandals had hit the headlines, the most famous one being Andover Workhouse. It was reported that within this specific workhouse, half-starved inmates were eating rotten flesh from bones. The government introduced stricter rules for those who ran the workhouses and set up a system of regular inspections as a response to this scandal. (http://www.

nationalarchives. gov. uk/education/lesson08.

htm) Public Health Act (1848) This act was the first step on the road to improve public health.One of the individuals who played an important role in the creation of this law was (as is already mentioned before) Edwin Chadwick. Chadwick investigated the issue of sanitation amongst the poor whilst working as a secretary to the Poor Law Commissioners. After the investigation he published a book, paying the entire cost of publication by himself as the Poor Law Commission did not want to be associated with the report.

His argument was economic as he believed that if the health of the poor was improved it would result in less of them asking for help off welfare.After a lot of campaigning by the Health of Towns Association, and another outbreak of cholera in 1848 the government had been forced to act and the Public Health Act 1848 was passed. It was not a perfect act but it was an important step forward. The Act had established a central board of health though they had limited powers and no money. The boroughs that had already formed a corporation, like Sunderland, were to assume responsibility for drainage, water supplies, removal of nuisances and paving. The main limitation of the act was that it provided a framework that could be used by local authorities, but did not compel action.

(http://www. parliament. uk/about/living-heritage/transformingsociety/towncountry/towns/tyne-and-wear-case-study/about-the-group/public-administration/the-1848-public-health-act/) Beveridge report (1942) Following on from World War II, there was a strong feeling that the British people should be rewarded for their sacrifice and resolution. The government then promised reforms that would create a more equal society, asking Sir William Beveridge to write a report on what the best ways would be of helping people on low incomes.

So Beveridge published a report, in 1942, proposing that all of the people who were of working age should pay a weekly contribution and so, in return, benefits would be paid to people who were sick, unemployed, retired or widowed. (Stretch and Whitehouse, 2010) National Health Service 1948 World War II had, to some extent, changed people’s attitudes. The need to treat large numbers of civilian casualties from bombing raids gave people access to health care that they had never experienced.

The idea of the Government looking after citizen’s health did not seem too strange as the state had controlled almost every aspect of peoples’ lives during the conflict. Soon after, government ministers had noticed that as a result of rationing, the health of the poor had actually begun to improve. (http://www. nationalarchives. gov.

uk/cabinetpapers/alevelstudies/origins-nhs. htm) The original structure of the NHS had three arms, these were: 1. Hospital Services 2.

Primary Care (i. e. family doctor services)3. Community services such as maternity and child welfare clinics, health visitors, midwives, health education, vaccination and immunisation and ambulance services.

(Stretch and Whitehouse, 2010) The National Health Service has played an important role in prevention as well as cure. By the mid-1960s governments were investing in health education with campaigns warning people about the dangers of smoking and alcohol and encouraging people to eat more healthily. There were also strenuous campaigns to encourage people to exercise more, though these had mixed success.(http://www.nationalarchives. gov. uk/cabinetpapers/alevelstudies/origins-nhs. htm) Acheson Report (1998) In July 1997, Acheson was asked to review inequalities in health in England and also to identify priority areas for the development of policies to reduce them.

This had followed to famous earlier reports – the report of Sir Douglas Black in 1980 and the updated version from 1987, however because of the bleak picture they painted of widening health inequality in such a developed country and the implications for the government of the day, they had both been kept rather quiet.Acheson concluded his report with a list of 39 recommendations for addressing health inequality. The three areas that were identified as crucial to this process are: 1. All policies likely to have an impact on health should be evaluated in terms of their impact on health inequality 2. A high priority should be given to the health of families with children 3. Further steps should be taken to reduce income inequalities and improve the living standards of poor households. (Stretch and Whitehouse, 2010) Our Healthier Nation (1999) This paper sets out the government’s action plan for tackling poor health by improving the health of everyone. It sets attainable targets in priority areas.

It provides ten tips for better health and is divided into three sections. This paper looks at a new approach to saving lives and at the aims and advances in public health. It also discusses individuals and health and tackling the wider causes of ill-health within communities.

‘Saving Lives’ deals with the specific issues of cancer, coronary heart disease and stroke, accidents, and mental health whilst also looking at wider issues like sexual health, tackling drug and alcohol problems, communicable disease, genetics and improving ethnic minorities health.(http://webarchive. nationalarchives. gov.

uk/+/www. dh. gov. uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4118614) White Paper {Choosing Health: Making Healthier Choices Easier (2004)} This paper lays out the government’s approach to tackling a broad range of public health challenges from smoking, obesity and drinking to mental and sexual health. Positive aspects like signposting foods to indicate their fat, salt, sugar etc.

have been welcomed.The public are developing an awareness of the relevance of these public health issues in their lives, thanks in part to the substantial amount of media coverage of the report’s contents and of stakeholders’ responses. The paper does signal a seminal moment in terms of attention to public health and could have a profound impact. But the government must consider its blind spots and show a commitment to tackle complex environmental and personal barriers to behaviour change if it is to fulfil its pledge to make healthy choices easier. (http://www.

ncbi. nlm. nih. gov/pmc/articles/PMC534427/) Health Protection Agency (HPA)Public health England was established to protect and improve the nation’s health and wellbeing and to reduce inequalities. It will lead on the development of a 21st century health and wellbeing service, supporting local authorities and the NHS to deliver the greatest possible improvements in public health. It was established in April 2013. The agency works with national and local government, industry and the NHS to protect and improve the nation’s health and support healthier choices.

They address inequalities by focusing removing barriers to good health. (http://www. hpa. org. uk/AboutTheHPA/WhatTheAgencyDoes/)

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