Public health

• statistics that show the health of the British population in 1900

  life expectancy = below 50. in 1899, 163/1000 babies died before 1. cost half a week's wages for a working class man to visit doctor. no knowledge of blood chemistry or antibiotics. no national system for vaccine administration
• the boer war


  (1899-1902) between Britain and the Boers in South Africa over control of Cape Colony (part of the empire). needed volunteers for army- discovered poor health of lower class. took 45,000 3 years to defeat Boer army of 35,000
• inter-departmental committee on physical deterioration

  40-60% of volunteers = too unfit to be soldiers. many suffered from rickets (malnutrition). the report stated that poor living/working conditions contributed to poor health.
• why does the British government want to improve the nation's health

  threat of war (Germany growing in strength) and the loss of the empire
• Charles Booth


  social reformer. late 19th century- investigated the poor of London. found that 30% could not afford basics of living and 85% were poor due to unemployment/low wages. undermined laissez faire
• Seebohm Rowntree


  social reformer. investigated poverty in York, published findings in 1901. found that 1/3 of pop could not afford basics of living. showed that income of less than 22 shillings = poverty. created poverty line which showed you were most likely to experience poverty for reasons out of your control e.g. old age, sickness
• help for mothers & children

  1902- training for midwives becomes complusory. 1906- local councils can provide free school meals for kids. 1907- births must be registered with a medical officer of health. schools for mothers opened. 1912- clinics in schools give kids free treatment
• help for the sick and unemployed

  1911- national insurance act passed by liberal gov. set up compulsory insurance scheme for all low-paid workers. gov paid 2d, employer paid 3d and worker paid 4d a week into scheme. resulted in 10 shillings a week & free medial care for up to 26 weeks
• issues with national insurance act


  only included workers not family members, unemployed, elderly or those with long-term illnesses
• housing improvements


  1908- back to back housing banned. 1919- Housing Act which states that local councils must provide good homes for working people to rent. 250,000 new homes built & many Vic slums cleared
• failure of national insurance act by 1930s

  initial flaws (only working men being covered) meant only half of pop had health insurance. by 1930s, Britain had experienced an economic crash and unemployment reached 3 mill so many could no longer afford insurance. death rate increased in 1930s!
• the vote


  1918- men and women over 30 could vote. 1928- all adults over 21. pressure to improve lives of the poor became immense as the working class now had a say in who won the elections
• 2nd WW- evacuation


  working class children evacuated to middle-class families in country side who were shocked to find how under-nourished, dirty and unhealthy they were. persuaded many people that something needed to be done
• 2nd WW- reward


  working class had made a huge sacrifice (equal to that of upper classes) during the war so many felt that a reward was necessary
• 2nd WW- co-operation


  people from diff classes and backgrounds collaboratively achieved victory over the Nazis and during this, differences in social class had been ignored, creating a feeling that everyone should have access to free health care
• 2nd WW- medical care in wartime


  during the war free medical treatment had been available to everyone and many wondered why this should not continue after the war
• Sir William Beveridge


  a leading civil servant. asked by gov to write a report on how to improve people's lives after the war. he recommended setting up a national health service (free at point of use & paid out of taxes, all hospitals nationalised) & that workers pay national insurance out of their wages
• election of Labour party

  Labour party elected in 1945 after promising to carry out Beveridge's ideas. launched the NHS in 1948. labour minister of health Aneurin Bevan was responsible for introducing the NHS
• opposition to the NHS

  conservatives- too socialist, didn't want to pay higher taxes, laissez faire. doctors- didn't want to lose rich private patients. councils- opposed nationalisation of hospitals
• dealing with the opposition


  compromise- allowed doctors to keep private patients but charged them a fee while they also worked for the NHS
• NHS phase 1- access to care


  1st NHS hospital = Trafford General opened Jully 1948. 1st patient = Sylvia Diggory. 1142 voluntary and 1545 city hospitals nationalised. lack of funding after war so for now access for all was main focus.
• NHS phase 1- range of services supplied


  hospitals, dentists, blood transfusion, maternity & child welfare, health centres' family doctors, ambulances, medicines & appliances
• how was the NHS organised

  3 main branches: hospitals (managed by regional hospital boards), primary care (general practitioners and dentists), additional services (ambulances, health visitors etc.)
• initial issues with NHS

  most hospitals located in London and southeast and had been built in 19th century (need modernisation). long waiting times and delays (v. busy). many GPs had not kept up with the many developments
• solutions


  gov promised to build more hospitals and introduced the GPs charter in 1966 to encourage group practices and give incentives to keep up to date with developments. many hospitals were rebuilt and provided with improved equipment
• NHS phase 2- high tech medical and surgical treatments in hospitals


  many advances- 3 major barriers to surgery have been removed meaning they can be much more complex and specific. many staff in hospitals now specialise in certain medical fields like cancer
• blood transfusions


  Karl Landsteiner (1901) discovered blood groups. solution to storage if blood found in WW1- add sodium citrate
• X rays


  Wilhelm Rontgen (1895) found that rays of light could pass through some materials e.g. flesh. x-ray machines were installed in major hospitals on Western Front. used for diagnosis of cancer
• radiotherapy & chemotherapy


  Marie and Pierre Curie discovered radium which is used to diagnose and treat some cancers
• transplant surgery


  1954- kidneys. 1963- liver. 1967- South Africa, Dr Christian Barnard, 1st heart transplant
• microsurgery


  e.g. rejoining blood vessels or nerves. endoscope- instrument containing necessary equipment to perform these surgeries through small openings in the body
• plastic surgery


  horrific injuries in the wars led to improvements e.g. WW2- many burn patients from tanks and aeroplanes. surgeon Archibald Mclndoe individually carried out 4000 burn case operations
• improved anaesthetics


  1800s- anaesthetics inhaled through mouth/nose so difficult to control dosage. 1930s- Hlemuth Wesse developed ability to inject anaesthetic into blood stream
• developments after NHS- technology

  microscopes (see human cells), endoscopes (see inside body), nuclear medicine (radioactive tracers), blood tests (diagnose diseases), scans and monitors (catch diseases early e.g. MRI)
• mass vaccination programmes carried out by the NHS after the war

  1954- Polio, 1964- Measles, 1988- MMR, 2008- HPV, 2015- Meningitis B
• clean air act of 1956


  response to London smog of 1952- caused by pollution. established smoke free areas and introduced smokeless coal
• clean air act of 1968

  updated version of 1956 act
• health act of 2006


  outlawed smoking in public and work places and changed the legal smoking age from 16 to 18
• laws limiting emissions from cars

  1991- vehicle exhaust tests 2000- leaded fuel banned 2030- diesel cars banned
• cancer causes and stats

  1911-6%, 2011-29% of deaths are caused by cancer (living longer) caused by smoking