Public Health in the 19th and
20th Centuries
th
19
century Britain
• The Industrial Revolution
coincided with a huge
increase in population
• Cities and towns were
overcrowded – poor
provision of sanitation
• Many supported ‘laissezfaire’ – no government
intervention
Cholera arrives!
• Arriving from the East the
spread of cholera was
helped by ignorance
• Common sense was often
over-ruled by men
wanting to protect
business interests
• The ‘miasma’ theory was
still held by many
Cholera – the facts
• Arrived in Britain in 1831 – epidemic by 1832
• Spread when infected sewage gets into drinking
water – leads to extreme diarrhoea
• Both rich & poor caught illness
• Government began by introducing regulations
about burials but then lost interest when epidemic
declined
• Epidemics occurred in 1848, 1854, and 1866
Time for change?
• 1842 Chadwick publishes his “Report on
the Sanitary Conditions of the Labouring
Classes’
• Privileged classes shocked by findings
• Government introduced Public Health Bill
which was opposed by some MPs
• Public Health Bill passed in 1848 (more
cholera!)
Public Health Act
• Central Board of Health set up in
London
• Public Health boards could be set
up where death rate was more
than 23 per 1000 per year
• Boards had power to raise money
to pay for drains & sewage
disposal
• Central Board closed down in
1854
Public
Health
Act
1848
The work of Dr Snow
• In 1854 London was again hit by a cholera
outbreak
• John Snow linked the disease to
contaminated water – removing the handle
from a water pump stopped the epidemic!
• Pasteur’s work on his Germ Theory in
1860s supported Snow’s work
Government Action
• 1872 country divided into ‘sanitary areas’
run by medical officers of health
• 1875 Public Health Act forced local
government to act on health issues
• Artisans’ Dwellings Act gave local
authorities power to buy up slums and build
better houses in their place
• Joseph Bazalgette built hundreds of miles of
sewers in London
Public Welfare
• In 1834 the first attempt to deal with
poverty on a national basis – the Poor Law
• Those who could not find work went into
the workhouse (lasted till 1929!)
• Hospitals and schools were provided by
charities – little government involvement
• Some wealth business men made a
difference eg Cadburys and Titus Salt who
created purpose built villages for workers
Government Action
• 1899-1902 the Boer War. 40% recruits unfit
for military service through poor diet and
living conditions
• 1906 Liberal Government introduced first
stages of welfare state
• 1906 Free school meals
• 1909 Old Age Pension (for 70 year olds!)
• Job centres 1909
• National Insurance Act 1909
The NHS
• Great social problems were highlighted by the
Second World War
• The Beveridge Report called for the provision of
state security ‘from the cradle to the grave’ (1942)
• Beveridge spoke of the right to be free from
the 5 ‘giants’- want, disease, ignorance, squalor, and
idleness
• National Health Service set up in 1946 by Aneurin
Bevan