The government also received pressure to reform from John Snow. In 1849 he published a book saying that cholera spread through water, not in “bad air”. Although his idea was originally mocked, another cholera outbreak in 1854 allowed John Snow to do a case study and prove himself right, using evidence to support his ideas. John Snow’s evidence proved that clean water was essential for preventing the spread of cholera and, although no immediate acts or laws were passed as a result, the handle of the offending pump was removed. John Snow’s work also educated the public so that they knew what was causing cholera. This meant that they knew the government could easily treat the dirty water, unlike “bad air”, and so pressure built on the government to change something.
In the summer of 1858 it was very hot and there was little rain, causing the Thames to smell really bad. So bad, in fact, that this time period has been nicknamed “The Great Stink”. The “Great Stink” added to the evidence that more public reform was needed and the government began to feel the pressure. Joseph Bazalgette was hired to design and build a sewer system for London. The core of the work was completed by 1865, but took another ten years to finish completely as it was such a huge project and Bazalgette had made sure to plan ahead for the growth of the population.
In 1861, Pasteur published his germ theory. In 1864 he conducted a series of public experiments that convinced most scientists that diseases were caused by bacteria. This finally provided clear proof that Chadwick, Farr and Snow had all been correct. Faced with this scientific proof, people were more willing to pay taxes to cover the costs of public health reforms. These included fresh water supplies, good sewers and public toilets. This also meant that more local towns began to make these reforms.
The government still did not make public health reform compulsory, however. They only voters in general elections were wealthy landowners and the well-off middle classes, the very people who would have to pay more if public health reforms became compulsory. Governments did not want to risk losing votes, no matter what kind of pressure they were under.
In 1867, working men in towns were given the right to vote for the first time followed by men in country areas in 1884. This meant that the government now had an incentive to improve the lives of ordinary people: to win the votes of the working men. This meant that many new laws were passed in 1870s and 1880s designed to favour the working class. One of the most important was the Public Health Act 1875. This made it compulsory for local councils to improve sewers and drainage, provide fresh water supplies and to appoint medical Officers and sanitary inspectors to inspect public health facilities. It also improved standards of housing, stopped the pollution of rivers, shortened working hours in factories for women and children, made it illegal to add ingredients that mad food unhealthy and made education compulsory.
This last health reform is key in indicating the disappearance of the laissez-faire attitude. Without this, many of the reforms in the 20th century would not have been possible.
In 1901, two events make it clear that public health needed to be improved: the Rowntree report and the Boer War. The Rowntree report found that over a quarter of the people in York were living in poverty. The Boer War meant that new soldiers had to be recruited. The government was shocked to discover that 38% of recruits were unfit to serve.
In 1911 David Llyod George introduced the National Insurance Act. This meant that the worker, his employer and the government would pay into a sickness fund. This meant that if the worker fell ill, he could receive money from the fund plus free medical care. This was a huge step forward, although did no cover the families of people in work, the unemployed, the elderly or those with long-lasting illnesses. This scheme was revolutionary in theory, but in practice it was failing. This was proven by rising infant mortality rates.
In 1919 a new Housing Act became law. Lloyd George promised “Homes fit for Heroes” for the returning troops of World War One. This meant that in the 1930s 700,000 new houses replaced many old, unhealthy slum houses.
After World War Two, people’s attitudes changed to that of a more united country. The Beveridge Report was published in 1942, which indicated ways to improve people’s lives and banish poverty. He suggested the idea of a National Health Service and that everyone should pay into National Insurance in order to pay benefits and pensions.
Although met with great enthusiasm, there was a lot of opposition to the National Health Service (NHS), especially from doctors. However, Aneurin Bevan convinced many doctors to support him by agreeing that doctors could continue to treat patients privately whilst working for the NHS.
In July 1948, the NHS was introduced. Although people thought that the system was being taken for granted, it played a vital role in increasing people’s life expectancy, especially of women after childbirth.
In conclusion, although there were many great breakthroughs in the 20th century regarding public health, I feel that the breakthroughs in the 19th century had a greater significance, especially in revolutionising the way people think. As you can see from the events in the 19th century, people’s attitudes had a huge impact on public health. Although the NHS was a very important breakthrough, I do not think that it would have come around with the laissez-faire attitude still in place. This is why I agree that the biggest breakthrough in public health in Britain took place in the 19th not the 20th century.
