The Faculty of Public Health defines public health as the ‘science and art of promoting and protecting health and wellbeing, preventing ill-health and prolonging life through the organised efforts of society.’
Public health is about helping people to stay healthy and protecting them from threats to their health. ACTS is currently researching the history of public health in South Tyneside from its origins to 1940's.
In the 19th Century many British cities experienced a rapid increase in population as a result of the Industrial revolution. Towns became more overcrowded and houses were built close together and there was no sewers. As a result disease was major problem as infectious diseases could spread rapidly including smallpox, tuberculosis, typhoid fever and cholera. in 1865 14,000 people were killed by Cholera. It was outbreaks like these that eventually forced the government to take responsibility for the welfare of its people. In 1848 the government introduced the first public health act. The Public Health Act of 1848 was the outcome of Chadwick's Sanitary report and the pressure applied on Parliament by the Health of Towns Association
What is Public Health
Sometimes public health activities involve helping individuals, at other times they involve dealing with wider factors that have an impact on the health of many people (for example an age-group, an ethnic group, a locality, or a country).
It does this through its work in three main 'domains':
health protection - protecting people's health (for example from environmental or biological threats, such as food poisoning or radiation)
health improvement - improving people's health (for example by helping people quit smoking or improving their living conditions)
healthcare public health - ensuring that our health services are the most effective, most efficient and equally accessible
History of Public Health
In simple terms, efforts to improve public health in the UK can be seen as having had four ‘waves’ of activity.
The first wave, in the nineteenth century, was concerned with improving environmental conditions, for example by providing clean drinking water, safe sewage disposal, and safer working conditions.
The second wave (dated to around 1890-1950) concentrated on preventing and treating disease using vaccines and antibiotics
The third wave (dating roughly from 1940 to 1980) saw improvements in our understanding of the link between lifestyle and disease, such as the identification of smoking, high blood-pressure, and high cholesterol as the leading risk-factors for heart disease. This knowledge led to efforts to target people at high risk with information about lifestyle improvement.
From the 1960s, a fourth wave focused on working out the economic and social factors that affect people’s health.
(Source: health careers - https://www.healthcareers.nhs.uk/about/resources/brief-history-public-health )
Public Health Act 1848
In 1848 the government introduced the first public health act. This act:
- set up a national General Board of Health to advise on disease prevention and epidemics
- allowed towns the right to set up local boards of health
- gave towns the right to borrow money to build sewers and reservoirs
- organise removal of rubbish
- appoint a local medical officer
The act only made recommendations and was not compulsory and many towns were reluctant to make improvements because of the expense.
In 1854 the General Board of Health was abolished.
Hansard (1848). Public Health Act of 1848. HC Deb 09 March 1853 vol 124 cc1349-57.
Lumley WG. (1859) The new sanitary laws. London: Shaw and Sons.
Public Health Act 1875
In 1848 the government passed a second Public Health Act that made all of the original recommendations in the 1848 Act compulsory.
The act established named local authorities as rural and urban sanitary authorities, replacing local boards of health. These sanitary authorities would have jurisdiction over the newly created urban and rural sanitary districts.
All councils had to :
- provide clean water
- dispose of all sewage cleanly
- clear away rubbish
- appoint a medical officer to keep an eye on the health of the population
- make sure that food for sale was not adulterated
- clear slums, of they wanted to
By 1900 the death rate had fallen dramatically and most towns had effective sewers and water systems.
Legislation.gov.uk (1875) Public Health Act 1875.
List of local boards
South Shields First Board of Health
South Shields suffered a massive cholera epidemic in 1831 and a board of health was formed to prevent the outbreak or spread of the epidemic. The board consisted of clergy, medical men, and principal inhabitants. In December 1831 the board wrote to the Improvement Commissioners, requiring them to appoint extra watchmen to restrict the entry of vagrants into the town and assist in the board in whatever they may need. They requested that more efficient means for cleansing the narrow lanes and other part of the town were undertaken.
The Commissioners resented the interference replying " they felt it within their duty as well as their inclination not to permit any nuisance to exist, that having a street surveyor as well as other paid official, they think will be more properly employed under the direction of the Commissioners". They did employ more street sweepers and took measures to cleanse the courts in town.
January 11 1832 was a fast day where all business was suspended, all shops closed and services of intercession were held at St Hilda's and various chapels.
In 1843 the government appointed a royal commission to inquire into the health of large towns and populous districts. A South Shields committee was formed to prepare the fullest possible information for the commission. Rev James Carr was chairman and J Barker honorary secretary. Its report stated that the older parts of the town the houses were 2 or 3 stories high, many back to back and closely built narrow street. In other parts of the town houses were chiefly single cottages were two or three rooms. The number of families in each house varied from one to seventeen, the average number of persons to each room being three. The tenement houses were badly ventilated and conditions had led to disgusting and unwholesome habits. The supply of water to the poor was inadequate and provision of cheap public baths was required. there were some sewers and drains bit arrangement for under drainage was defective. The nuisances most commonly complained about was the smoke from the glassworks and manufactories the exhalation from the alkali works, the overcrowded condition of St Hilda's graveyard and want of suitable slaughterhouses.
South Shields County Borough Medical Officer of Health
South Shields was one of the last towns to appoint a Medical Officer of Health [MOH]. The first Medical Officer described 1875 as "the first real year of sanitary work", and in the middle of that year his "periodical reports on the health of the district, which before that time had been listened to late in the evening by a committee already tired by the arduous work of the Building and Town Improvement Committees, and then at once forgotten, were ordered to come up for consideration as the first business on alternate meetings, and afterwards read before the Council."
From 1875 to 1880 he presented his annual reports to the Sanitary Authority, from 1882-1899 "to the Sanitary Committee of the Corporation of South Shields", and from 1900 to the Health Committee. The department headed by the MOH was until 1912 known as the Health Department, from 1913-1918 as the Medical Officer's Department, becoming the Public Health Department in September 1919.
Before 1912 the MOH was officially called Medical Officer of Health, Medical Superintendent of the Borough Isolation Hospital, Bacteriologist to the Borough. In 1913 he became also Principal School Medical Officer and Chief Tuberculosis Officer, but these responsibilities were to become the province of separate assistant Medical Officers in 1920. In January 1973 the Medical Officer of Health became the Chief Public Health Officer.
The first sanitary inspector was appointed in about 1872. An Inspector of Nuisances joined the staff in the 1890s, and an Inspector of Food about 1894. The Isolation Hospital was built in 1883. The staff of the department grew slowly, until about 1910, when increased responsibilities and activities such as the provision of maternity and child welfare clinics led to expansion.
In 1930 the transfer of certain functions from the abolished Board of Guardians led to the Medical Officer of Health being appointed Chief Medical Officer by the Public Assistance committee, with responsibility for the Poor Law Medical Staff, including Harton Hospital and district medical officers. In 1948 control of hospitals and medical clinical work passed to the new National Health Service.
In the years after the introduction of the NHS act in 1948 the annual reports comment on the "increasing social work of the health visitor" as their duties began to encompass "problem families, prevention of break-up of families and care of the aged". The home help service grew rapidly in the mid 1950s. In June 1965 both Health and Welfare Departments were amalgamated and under the Medical Officer of Health.
In 1972 "All three nursing services became attached to general practices .a new management structure in the nursing service as recommended by DHSS was accepted by the Health Committee.Director of Nursing Services appointed to commence duty in the New Year". This paved the way for "the pending reorganisation of local Government and the NHS" with regard to "the Community Services provided by the NHS". In 1974 the majority of the responsibilities of the Public Health department (the exception being those nursing services transferred into the NHS) were transferred to the new South Tyneside Council. (source: Tyne & Wear Archives & Museums)
From the 1890s the work of the public health department included detailed investigation of and dealing with a wide range of particular nuisances.
Particular achievements included the provision of the public abattoir in 1906 (slaughtering in the public slaughterhouse became compulsory on 29 Nov 1906) and the "conversion of the privy system of conservancy to the water carriage system", begun in 1923, and by the end of 1925, 4273 privies had been converted. New ash-bins were provided with each closet.
This was also viewed as a significant problem: smoke abatement appears in the report as a section by 1931. In 1948 a survey of the sources and incidence of atmosphere pollution was carried out and a report submitted to the National Smoke Abatement Society. During 1951, three local stations were established for the purpose of estimating atmospheric pollution, at Stanhope Road School, Harton Junior School and the Town Hall. Under the Clean Air Act 1956 notification of the installation of new furnaces and approval of the height of new chimneys was required. Work on the preparation for a smoke control order began more than once and was interrupted by staffing shortages in the office of the Chief Public Health Inspector, and a change of policy from national government on open grates and smokeless fuel in 1964. The first order was actually made in 1966.
Tuberculosis was a problem in urban areas and in 1908 powers were given to the local authority to make the disease notifiable. From 1909 patients in poor law institutions or under the care of the poor law medical officer had to notify the LA . Patients were entered into a confidential register kept by the Medical Officer of Health and were usually visited by the Health Visitor for education, investigation of possible contacts and disinfection.
In 1912 a Tuberculosis sub committee deliberated in a scheme for the borough under the 1911 National Insurance Act. The decision was taken that the available capital was insufficient to build a sanatorium or hospital. From 1911 the Medical Officer had seen TB patients at his office. In November 1913 a TB dispensary clinic was established with an additional nurse and assistant medical officer to deal with TB cases.
In May 1921 the duty of providing treatment for insured persons suffering from TB was transferred from the Health Insurance committee to the council. This lead to the provision of hospital accommodation for early cases in the Mansion House at Cleadon Park. In 1948 provision was transferred to the national health service.