History of public health in the United Kingdom

With the onset of the Industrial Revolution, living standards amongst the working population began to worsen, with cramped and unsanitary urban conditions.

A severe long-term shortage of cheap housing led to the rapid growth of slums, the death rate began to rise alarmingly, almost doubling in Birmingham and Liverpool.

James Lind's discovery of the causes of scurvy amongst sailors and its mitigation via the introduction of fruit on lengthy voyages was published in 1754 and led to the adoption of this idea by the Royal Navy.

[3] Efforts were also made to promulgate health matters to the broader public; in 1752 the British physician Sir John Pringle published Observations on the Diseases of the Army in Camp and Garrison, in which he advocated for the importance of adequate ventilation in the barracks and the provision of latrines for the soldiers.

Finallyin that year the introduction of civil registration of births and deaths enabled the tracking of infant mortality by date, location and cause.

[8] The 19th century saw substantial improvements in infant survival: A series of laws passed by Parliament and affecting England and Wales marked a shift towards proactive public health measures.

They concerned sanitation, disease prevention, and living conditions in urban areas, as well as national and local rules of oversight.

Liberal politicians tended to ridicule it, but Disraeli had a broader vision of 'sanitary' stating: "that phrase so little understood [included] most of the civilizing influences of humanity."

[14] Evangelical religious forces reflected Victorian morality by taking the lead in identifying the evils of child labour, and legislating against them.

The campaign that led to the Factory Acts was spearheaded by rich philanthropists of the era, especially Anthony Ashley-Cooper, 7th Earl of Shaftesbury, who introduced bills in Parliament to mitigate the exploitation of children at the workplace.

[19] Additional legal interventions throughout the century increased the level of childhood protection, despite the resistance from the laissez-faire attitudes against government interference by factory owners.

[21] In the first four decades of the 19th century alone, London's population doubled and even greater growth rates were recorded in the new industrial towns, such as Leeds and Manchester.

[23] Very rapid population growth from rural England, and especially from Ireland firing the famine years 1847-1852, led to severe overcrowding and very poor sanitation.

His Report on The Sanitary Condition of the Labouring Population of Great Britain caught the public imagination and was soon incorporated into English law.

[29][30][31] Chadwick argued eight main points, emphasizing the absolute necessity of better water supplies and of a drainage system to remove waste, as ways to lower the death rate.

He proposed each house would have a constant water supply, and privies would ensure that soil was discharged into egg-shaped sewers, to be carried away and spread on the land as manure, preventing rivers from becoming polluted.

It prompted Snow to map the homes of people who got sick in Soho and show they had all been drinking water that came from one neighborhood pump in Broad Street.

[38][39] Snow's great discovery decisively influenced public health policies and quickly led to the construction of improved sanitation facilities.

The term "focus of infection" started to be used to describe sites, such as one particular water pump in Broad Street that spread the cholera germs.

[41] Historians have been using quantitative models to estimate the impact of investment in sanitation and pure water supplies on health indicators.

[43] The new money permitted higher spending on food, and also on a wide range of health-enhancing goods and services such as medical care.

They were not funded by the government and ranged from major international operations such as the Rockefeller Foundation, to membership groups like the Order of Saint John, to small local charities.

The others focused on individual needs at the neighborhood level, such as helping poor families with childbirth and child welfare and dealing with tuberculosis, or providing ambulance services to hospitals for victims of traffic accidents.