Essays on the history of public health

The public's view of public health in mid-Victorian Britain | Urban History | Cambridge Core

With a professional engagement that deals mostly with issues involving the provision of personal health services, it is not surprising that public health history that is largely, but not completely, located outside personal health services issues is neglected. Thirdly, the rapid turnover in the public health workforce that has been provoked by multiple NHS organisational changes has meant that many practitioners whose professional lives have spanned several eras have taken early retirement. This loss of personal knowledge has not been compensated for in the production of written and documented historical analysis.

According to Carr history offers a dual function, to enable men and women to understand the society of the past and to increase their mastery over the society of the present. One of the characteristics of public health practice is that the timescale within which ill or beneficial health effects are seen, is often protracted.

There are, of course, exceptions to this, such as with some acute communicable diseases. However, if we are to improve our mastery over the present it should not be forgotten that there are historical changes in the nature and ecology of communicable diseases that are of relevance to planning for the future. The re-examination and updating of historical datasets has been used as a means of elucidating the effect of early life events on long term health experience.

Such epidemiological archaeology may, however, lead to a concentration on individual orientated causative factors of separate diseases and ignore the social and political content in which human communities exist. The understanding of how public health practitioners can influence the health of human communities requires a knowledge of how public health practice has evolved, its successes and failures, its highs and lows.

The design of interventions such as health action zones, projects aimed at improving the health status of the population in the most deprived areas, in England has strong parallels with the innovative approaches introduced by the Public Health Acts, the first national public health legislation in Britain, and there are many other historical parallels to contemporary public health initiatives.

Yet the notion of a network of organisations collaborating to promote health, prevent ill health, and provide health services was not new—there was simply a fresh emphasis being placed on its importance. Before the introduction of the NHS in , a network of services existed that relied on their interaction with each other and included: the private sector in the form of voluntary hospitals, private medical practitioners and commercial organisations; the public sector in the form of municipal hospitals and community health services run by local government alongside sanitary and environmental health services; and the voluntary sector that provided health services.

The complexity of the pre-NHS era in Britain is a reminder that while the political, social, legislative, and organisational landscape may look considerably different now, taking action on the determinants of health still requires negotiating a complex network of organisational and political structures. In chronic disease epidemiology greater attention has been paid in recent years to possible risk factors in childhood rather than solely concentrating on adult risk factors, particularly aspects of lifestyle such as smoking, diet, and lack of physical exercise.

In the early post-war period adult risk factors tended to be emphasised because of the interests of cardiologists and physiologists initiating cardiovascular epidemiology. An appreciation of what has gone before enables us to see why similar approaches lost favour in the past and assess the validity and appropriateness of revisiting old approaches and using them to stimulate new innovations.

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An understanding of the rich and diverse history of public health cannot only support contemporary innovation but can help reduce the risk of public health practice being too narrowly focused on specific influences on the health of individuals rather than maintaining an overview of the full range of factors at work across a population. It is, however, important to remember that what history provides is a useful benchmark and knowledge base rather than a fit for purpose solution.

She has portrayed a field of endeavour buffeted by political and structural changes, undergoing rapid changes of title and suffering from a lack of professional status.


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Berridge has highlighted the tension between the duality of the role of public health with its focus on prevention and health promotion and its inability to escape from its link to planning and management of personal health services. Understanding the factors behind this duality and placing current practice, organisational structures, political and public health philosophies within a historical framework can help us to resolve the tensions that exist within our field and increase our sense of identity and purpose. Increasing our understanding of public health history can improve our insight into the way in which we fit into the wider picture and serve to embolden us in our navigation of the political and organisational structures that exist today.

Action on Smoking and Health is a UK based public health advocacy organisation with a strong sense of the importance of practitioners understanding the history of the campaign to reduce smoking related deaths. Its web site contains a wealth of documents, including a useful chronology, that gives practitioners a sense of their contribution to a historic struggle while also providing practical information to enable them to learn from the efforts of others. Deepening professional understanding of the past can assist the process of developing such a vision for the future.

Health historians Berridge 7 and Porter 10 have both called for greater attention to be paid to the asking of broader questions when looking at the history of public health with the object of generating a greater depth of understanding of issues. Porter, in particular, has highlighted the need to consider population health as a political phenomenon in different periods. It is interesting to look back at chronologies of public health history and then explore the political and social factors at work behind surges in legislative activity, action on a particular issue and swings in public opinion that have translated into health improvements.

Understanding the factors at work behind significant developments can teach us a great deal about the many influences we need to consider and the timescale of change that we may face in delivering health improvements.

Health and Medicine

From a 21st century standpoint, there often seem to be long gaps between advances in knowledge or shifts in public opinion and the taking of action that results in health improvement. In recent years things have moved on considerably in terms of action to tackle health inequalities with the publication of Our Healthier Nation: A Contract for Health in , which acknowledged the influence of adverse social, economic, and environmental factors as causes of health.

London physician John Hill performed possibly the first clinical study of tobacco effects and warned snuff users that they were vulnerable to cancers of the nose as far back as The Lancet was debating the health effects of tobacco in and UK parliament passed the Railway Bill mandating smoke free carriages to prevent injury to non-smokers in Yet the second half of the 20th century is a story of real strides being made by anti-tobacco activists through new evidence, innovative and well organised campaigning, changes in public opinion but still the inability to deliver end goals because of the power, influence, and global reach of the tobacco industry.

Most public health campaigns entail overcoming the resistance of vested interests whether political, commercial, or social. History provides many important examples of the factors that contribute to policy change including seat belts and the car industry, and silicosis and asbestos and industry. It also highlights the different approach taken to health issues affecting a particular population group such as industrial workers and that taken by an issue relating to a broader population such as asbestos.

Although, as noted above, communicable diseases declined in importance in western countries in the 20th century the problems did not disappear and the lessons learned are of contemporary relevance. Perdiguero and colleagues have used the examples of malaria and influenza in Spain to argue that the use of history can improve epidemiology and the design of causality models.

This is particularly true for the continent of Africa where the problem is devastating. In South Africa the issues of causation and treatment have been at the centre of political debate.

General Health and Medicine topics

The ability to learn from domestic and international historical examples has been explored by political scientists in relation to health policy reform. One of the ways they overcome the challenges of comparative historical studies is to focus on a limited number of variables. The conclusion drawn by Marmor is that there are two benefits from this sort of comparison, what can be learned from countries where conditions are comparable and policy generalisation that holds over many divergent cases where there is some powerful factor at work. If we look at the history of public health campaigns common factors emerge, which need to inform our own work.


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The key ingredients for any policy change that leads to improvements in health are: dissatisfaction, reformers, political support, and public awareness. Historians also need to consider the policy considerations occupying the attentions of practitioners to assist them in learning from the past. As editor of the American Journal of Public Health , Rosen urged public health workers to play a political part and to collaborate with social scientists while Sigerist also tried to inspire doctors to be activists to improve social conditions.

The history of public health provides a very useful vehicle for teaching the principles of public health. An understanding of the broad sweep of that history should be a component of the basic training of all health professionals. This is particularly so in respect of those who will have a population and preventative aspect to their work, such as environmental health officials, general practitioners, health visitors, school nurses, and midwives.

Considering the interplay of fact and interpretation in history provides good training for analysing currently accepted belief and practice, which can assist professionals in challenging that which is no longer appropriate or relevant. For those intending to pursue a long term career in public health, history should be an important component of postgraduate academic training.

Part of the curriculum for examinations of professional bodies in the public health field;. The subject of specialised postgraduate programmes, available for those with a particular interest. Those privileged to have been taught by the late Sidney Chave at the London School of Hygiene and Tropical Medicine as part of masters level programmes will be aware of how interesting and informative such teaching can be. His engaging style and fund of detailed knowledge impressed students from successive generations. However, the provision of such excellent teaching needs to be universal if masters level programmes are to fulfil their role in producing educated practitioners.

There should be an expectation of those responsible for the setting of curriculums for public health professional examinations that they will include a historical component. It is regrettable that none of the mainstream public health journals based in the UK contain a regular strand of papers on public health history. During his tenure as editor of the American Journal of Public Health George Rosen routinely included papers on public health. The Journal of the Royal Society for the Promotion of Health is a rare example of a UK public health journal that carries historical material and the themed issue of the British Medical Journal that marked the anniversary of the Public Health Acts showed how informative and stimulating public health history can be.

There needs to be a greater appreciation of history as an academic discipline within the broad field of public health.

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Awareness of the principles of historiography would also serve to encourage professionals to consider how the present skews our view of the past and question the objectivity of different sources of information. The history of occupational disease policy is a good illustration of the way historians place different weights of responsibility on vested interests and political and economic factors. It is rare for historians to be working within a public health organisation.

More often it is an individual public health practitioner or academic who develops an interest in the history of their professional field. While there is no doubt whatsoever that we owe a collective debt to such individuals, the application of the professional skills of a professional historian would better place the historical analysis in a broader social political and economic context. It has been argued that there are real advantages in having a professional historian integrated with public health practitioners and academics.

The tensions between the different disciplines of public health practice and historical inquiry need to be recognised with one focused on delivering change in the present and the other focused on identifying the barriers to change in the form of economic or political structures. A historic perspective does, however, provide practitioners with the insight that over a longer time frame change of some sort is inevitable. It may be that involvement in a particular aspect of contemporary public health practice stimulates an interest in the history of that particular topic. On the other hand a desire to acquire an overall picture of the health of the population down the centuries and the public health response to problems of ill health may be the starting point.

There are only a small number of books that provide the broad perspective. Membership will give practitioners access to a wealth of resources and its MedHist function provides a guide to medicine resources on the internet, including public health. Nor is it here to massage the preconceptions of the present….. Key points. A better understanding of the history of their subject would improve the practice of public health professionals. Educators and journal editors should include more historical content in courses and journals.

Policy implications. The contemporary history of public health should be captured so as to facilitate future study. Building up a specialist library, whether of current or historic texts and documents, can be one of the most intriguing and fascinating aspects of developing a historical interest. Acquiring a personal copy of a book that is perhaps over a years old or is long out of print has been greatly facilitated by the internet. There are several computer linked international networks of second hand and antiquarian booksellers.

Regular searching over time will often locate a rare and sought after book, perhaps on the other side of the world. More dedicated collectors may seek to possess copies of all editions or reprints of a particular book. There is however the ever present danger of the books becoming more valued than their contents. If a more formal approach to study is required, the London School of Hygiene and Tropical Medicine runs a History and Health study module. It aims to help students develop their ability to take a critical and long term perspective in analysing current health issues.

Introduction to Public Health

This two year programme provides competency in both public health and historical analysis. An international network of those interested in public health history has been developed in recent years. It brings together both the professional historians and public health practitioners from 43 countries, organises regular conferences, and publishes an online journal.

The history of public health has important implications for how we should react to the challenges of contemporary public health practice. Its study and teaching are both neglected and deserve to be given more attention as we invest in the development of the public health workforce. Similarly, the editors of professional journals in the field of public health should give serious consideration to the inclusion of a strand of papers relating to public health history.

In our current public health activities we need to be conscious of how our recording of contemporary events will help or hinder the understanding of those events by future students of public health history. You will be able to get a quick price and instant permission to reuse the content in many different ways. Skip to main content.