Public Health: 19th & 20th Century

• Throughout the 19th and 20th centuries a number of changes took place in public health, tackling the problems that had previously existed.

  Change was initially slow in the 19th century with individuals left to make changes, but from the 1850s onwards the government started to take a more proactive response. New developments were made and public health improved.
• Laissez-Faire


  Government had a hands-off attitude to public health, leaving it to individuals to improve
• Government action on public health in the 19th century

  1. Some action in the second half of the 19th century

  2. But still problems in industrial towns
• Work of John Snow and Florence Nightingale


  • Made improvements to public health
• 19th century - 1800s


  Industrial Period
• 20th century onwards - 1900s


  Modern Period
• WW1 and WW2


  Act as a catalyst for improving the state of public health
• Creation of the NHS

  Revolutionises healthcare
• Rapid improvements in public health in towns and cities

  In the second half of the 20th century
• Conditions in Industrial Towns

  Industrial towns were expanding rapidly in 1800s due to jobs and industry, but contained many problems and dangers.

  Many towns were overcrowded, leading to a poor standard of housing, where disease spread quickly.

  These towns were dirty and polluted, with factories producing vast amounts of smoke and pollution.

  Factories, mines and industrial centres could be very dangerous places to work, with adults and children being killed.
• Clean Air, New Towns & Housing

  •Killer smog’ led to 12,000 deaths in London in 1952 and the government passing the 1956 Clean Air Acts.

  •New towns were developed such as Telford and Milton Keynes to move people out of dirty, overcrowded areas into cleaner and ‘greener’ ones.

  •In the 1960s slums were cleared in old towns and cities.

  •Unfit housing was demolished and replaced with new high rise tower blocks providing better living conditions.
• What was the situation with public health in 1800?

  •Public Health in 1800 remained very poor. There was still a lack of understanding about the cause of disease, so people lived in dirty, cramped and unhygienic conditions.

  •The industrial revolution meant more people lived in these overcrowded towns and cities, which were rife with deadly diseases which would spread quickly.

  •The government did very little to improve public health and epidemics were a regular occurrence.

  •Hospitals were still dirty, unhygienic and had high death rates
• John Snow


  British physician, main work around cause of cholera and stopping epidemics
• At the time it was assumed cholera was spread by miasma (bad air)


  Snow disagreed, arguing that it entered the body through the mouth
• In 1854 Snow proved his idea


  1. Mapped out all infected individuals

  2. Discovered they all collected water from same pump in Broad Street

  3. Infected pump was closed

  4. Outbreak ceased
• Snow's theory which linked to germs was not properly accepted until Pasteur's work in the 1860s
• Florence Nightingale


  1820-1910, Nursing
• Florence Nightingale


  • Known as the 'Lady with the Lamp'
  • Crucial figure in improving hospitals and nursing
• Nightingale's background


  Born to a wealthy family, became a nurse and worked in the Crimean War
• Nightingale's work in the Crimean War

  1. Observed awful conditions in hospitals

  2. Set about improving conditions
• Nightingale's achievements


  • Emphasised the importance of cleanliness and good hygiene in hospitals
  • Greatly reduced death rates where she worked
• Nightingale's book


  'Notes on Nursing' to spread understanding about her work
• St Thomas' Hospital


  Set up by Nightingale in London to help train nurses
• William Farr


  First person to accurately link poverty to disease in 1830s
• Edwin Chadwick


  Explored in depth the link between ill-health and poverty with detailed statistical works and urged the improvement of living conditions
• Southwood Smith


  A member of the Clean Party who urged government to improve conditions in industrial towns with Chadwick
• Thomas Barnardo


  Set up a 'Ragged School' in London to give breakfasts to children in poverty and help those who were unemployed to find jobs
• Charles Booth


  Compiled a detailed report into poverty in London and suggested a number of ways to tackle these problems
• Seebohm Rowntree


  A successful businessman who investigated poverty in York by visiting every home and arguing for higher wages for workers
• William Beveridge


  A British economist who set out the Beveridge Report during WW2, highlighting the five great evils for the government to tackle
• Clement Attlee


  Labour Prime Minister post WW2 who set about introducing the NHS and the ideas of a welfare state
• Aneurin Bevan


  Attlee's Minister for Health who was responsible for the creation and implementation of the NHS
• Improvements to Hospitals

  •Aseptic surgery dressings

  •Properly trained nurses

  •Spacious, well-ventilated wards

  •Good sanitation & clean toilets

  •Overall good cleanliness•Stops disease & infection

  •Higher survival rates
• The NHS was born

  4th July 1948
• The NHS was born despite the difficulties and opposition
• The creation of the NHS was a significant example of the government improving public health
• Beveridge Report


  Set out the five evils that Clement Atlee (PM) responded to with a series of measures to tackle the problems with public health
• The creation of the NHS helped to meet the growing demand for healthcare and represented a significant step towards the welfare state that still remains today
• The NHS now faces different problems with its resources and funding stretched
• The main action


  The formation of the NHS, implemented by Minister of Health Aneurin Bevan, which brought together all forms of healthcare and revolutionised the state of public health and medicine