Developments in Public Health and Welfare

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.

Early Modern Period (1500-1800)

  • 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.

Industrial Revolution (1800-1900)

  • 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.

20th and 21st Centuries

  • 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.

Factors influencing Developments in Public Health

  • 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.