Developments in Public Health and Welfare

Medieval Period (c.500-1500)

Public health in towns: Towns were generally dirty places with little understanding of hygiene or public health. Waste and sewage often went into streets or the local river.
Role of Church: The Church was central to healthcare, opening hospitals attached to monasteries where they provided care mostly for the poor and elderly.
Leprosy: Around 1200, there were about 200 leper hospitals in England. Leprosy declined inexplicably from the 14th century.

The Plague: The Plague or ‘Black Death’ struck in 1665, killing a quarter of London’s population. Despite attempts to quarantine the sick, public health measures were largely ineffective.
Poor Law of 1601: Aimed to provide support for the poor, sick and elderly, funded by local taxation. The law’s efficacy was variable depending on the local parish’s willingness to pay.

Public Health Act of 1848: Response to a severe cholera outbreak, the Act aimed to improve conditions in towns and cities by providing clean water, sewage systems, and improving housing conditions.
Role of sanitation reformers: Individuals like Edwin Chadwick and John Snow made significant contributions. Chadwick published a report on sanitary conditions, and Snow discovered cholera was waterborne.
Creation of workhouses: The Poor Law Amendment Act (1834) led to the creation of workhouses where the poor, sick and elderly were provided with minimal support.

National Health Service (NHS): Established in 1948, the NHS provided free healthcare for all. This was part of wider welfare state reforms by the Labour government after World War II.
Beveridge Report: Published in 1942, this report by William Beveridge highlighted ‘five giants on the road of reconstruction’: want, disease, ignorance, squalor and idleness, leading to major welfare reforms.
Public Health Acts: Further legislation passed in the 20th century aimed to regulate food and drug safety, environmental health hazards, and communicable diseases such as TB and HIV/AIDS.

Changing knowledge and understanding: Understanding of disease and health has evolved significantly leading to changes in public health practice.
Role of individuals and government: Reforms are often driven by the work of key individuals and enacted by government policy.
Social and economic factors: Social attitudes towards the poor, elderly, and sick often drive reforms in public health and welfare. Economic prosperity or hardship can also influence legislative change.