Patterns of Health & Disease

University Degree Subjects allied to Medicine

Assignment 2

Health Studies

Victoria Jackson

“People in Britain today are healthier than they have ever been”

Discuss the extent to which this is true and evaluate the impact of social and medical changes on the health of the population. You should concentrate on mostly the last 200 years.

Overall standards in heath have improved since the 18th Century for a number of reasons. These include; improved living standards, nutritional and sanitary improvements, environmental changes and technological advancements. To answer this question the essay starts with three definitions of health followed by addressing the legislation changes and general impacts that have dramatically affected our health over the years.

The biomedical model was developed in the 19th Century, distinguishing health and illness to be qualitatively different with on continuum between. The model states that health is ‘the absence of disease or infirmity’ and is based on the idea that a malfunction is detected and treated.

The World Health Organisation (WHO) defines health as ‘a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity. This is also referred to as the bio-psycho-social model.

(Class Notes, 18 October 2004)

The final model is the ‘public health model’, which relates to the socio-economic model it defines; ‘the science and art of preventing disease, prolonging life and promoting health, through the organised efforts of society’. This model was highly regarded during the 19th Century; it provided the ideas behind reformation of sanitation, housing improvements and vaccination. It was also very much the junior partner to the biomedical model for the majority of the 20th Century.

Due to the change in the economy we now die from chronic illness or diseases of lifestyle compared to previous years where mortality was due to acute illness. However, patterns have now changed and all of what were known to be major ‘acute’ diseases have now been eradicated by vaccination. The definition that we generally refer to now is the bio-psycho-social model as it looks at the person as a whole, rather than the ‘you either was or was not ill’ theory of the medical model, although modern medicine remains strongly wedded to the principles of the biomedical model. This is mostly down to the failure of alternative models to displace the orthodoxy.

(BAGGOT, R. 1998)

Disease was a constant threat during the 18th Century, which was the time of the Industrial Revolution. A sudden large number of people moved from rural areas into the cities, the consequent being public health suffered especially those of lower social classes. Demands for houses were so high that small houses were constructed quickly to a very poor standard with little regard for hygiene. There were no sanitary systems, and streets were unpaved and filthy. Slums grew rapidly and overcrowding was a major problem. There was also mammoth poverty during this period.

Generally there were no services available like those we take for granted today such as; rubbish collection or basic washing facilities. This subsequently led to bacteria’s growing quickly affecting water supply, weaker people fell ill more rapidly, and disease spread. Other major factors, which led to problems, were; the lack of sewage systems, which caused polluted rivers and wells, lack of piped water, meant that people turned to unclean sources and low wages meant families were badly nourished.

In 1834 the ‘poor law act’ was passed with the efforts of sanitarian Edwin Chadwick, and in 1848 he was given the job which started the ‘sanitary reform movement’. Chadwick produced a report on the sanitary conditions of the labouring populations, the findings of which were distressing to parliament. It established the association between squalor, lack of sanitation and overcrowding to endemic and epidemic diseases. It also found that those living in the city had lower life expectancies compared to people living in the countryside. He believed this to be down to the filthy living conditions. The report also ...

This is a preview of the whole essay

(MCALEAVY, T. PATTERSON, D. WHITTOCK, M. 2002)

Chadwick was never interested in curing the sick, but to provide clean water and have drainage systems installed. Consequently, in 1848, the ‘public health act’ was passed, with the principle being the state was responsible for the health of its nation. The act contained numerous sanitary clauses including the cleansing of sewers, sanitation of houses, supervision of slaughter-houses and maintenance of pavements. This act ultimately cleaned up towns and prevented epidemics. Another crucial aspect of the public health infrastructure was the appointment of local medical officers of health. Many people opposed the act as they thought that they were being bullied into becoming clean.

The main changes that affected health in the 19th century were the increase of government responsibility. In the 1830’s following a cholera outbreak, boards of health were set up. Before 1835, towns did not have approved town councils to set these up. Local parishes came responsible for their people meaning that the ‘poor law act’ had to reform. County councils were formed and health officers appointed.

During the Victorian times, public health depended on engineering rather than medicine. Once the miracles of civil engineering came about, water and drainage were installed. This ultimately led to a drop in deaths – Chadwick had his provisional wishes.

(MCALEAVY, T. PATTERSON, D. WHITTOCK, M. 2002)

A new era of preventative medicine began; Edward Jenner pioneered the use of the coxpox vaccine to produce immunity to smallpox. Strictly speaking Jenner did not discover vaccination but was the first to do it scientifically and make it popular. The discovery did not take effect until vaccination became compulsory in 1853 by which time smallpox was declining. Once the practice was widely adopted, it controlled a disease that had previously been one of humankind’s greatest plagues.

Jenner was granted ten thousand pounds by parliament and later became appointed by the government to become the director for its newly formed institute for vaccination.

The first free health service was provided through legislation on a national scale and available to all in 1840, with the creation of the ‘Vaccination Act’. It stated that no person should, because of vaccination, be deprived of any right or privilege or be subject to any disqualification whatsoever and in 1853 introduced compulsory vaccination for all infants within four months of birth. Although this changed in 1898 when a ‘conscientious objection’ clause enabled parents to be excused the compulsory vaccination of their children. The overall effect on health of this act was mortality rates dropped especially those in infants, due to people had a stronger immune system to cope and live through the disease and illness surrounding them.

( accessed on 10 December 2004)

Another pioneer is Louis Pasteur, he combated the problem that Jenner had which was finding why disease spread. By 1865 he was convinced that disease was caused by micro-organisms or germs. His work led to a great impact on surgery and public health, people started to clean instruments and sprayed antiseptic solutions to kill germs. Robert Koch was the person who related Pastuers germ theory to human illness.

(MCALEAVY, T. PATTERSON, D. WHITTOCK, M. 2002)

In 1866 the ‘sanitary act’ was passed with thanks to Dr.John Simon, who was the medical officer of the Privy Council. In a report he put together, he wrote ‘time had come for unifying action’; subsequently leading to the creation of the act. It required local authorities to undertake sanitary regulation. Inspectors were appointed for towns and general powers set out for sewage disposal and supply water. Overcrowding was made illegal and penalties were issued to persons suffering from dangerous infectious diseases, although these powers were augmented in 1870. Simon considered the act ‘represented such a stride of advance as virtually to begin a new era’.

( accessed on 10 December 2004)

The next major landmark came about in 1928, Alexander Flemming accidentally discovered penicillium mould fought bacteria. With World War II imminent, the government realised antibiotics would be needed. A team of scientists were funded to extract a useable form of penicillin and for it to be mass produced and there was also international cooperation. Thousands of lives ultimately were saved during wartime.

(MCALEAVY, T. PATTERSON, D. WHITTOCK, M. 2002)

The 1942 Beveridge Report set out proposals for a welfare state, it looked at inequalities in health before World War II. The report was a meticulous blueprint for an assault on the ‘five giants’ hindering social progress, namely; want, disease, ignorance, squalor and idleness. Although yet to be conquered, are homelessness, ignorance, unemployment and poverty.

(BAGGOT, R. 1998)

Throughout the nineteenth century there were some attempts at providing free healthcare although it did not happen until the 5th July 1948, this marking the start of the National Health Service (NHS). They aimed to provide free healthcare for people although initially a small charge was required.

()

Britain thought that the NHS would eliminate inequalities in health but still years on inequalities still exist, clearly noticeable in the 1980 Black Report. This was one of the most influential reports showing the relationship between social class and health.

Sir Donald Acheson, in 1988, carried out a further inquiry into the problems of the public health function in England. The Acheson Report proposed for the appointment of assigned Directors of Public Health at all levels in the health service. His data tells us that we could be healthier today but still are not.

(WEBSTER, C. 2001)

In 1992, the Health of the Nation set out a health strategy for England. Its goal was to secure continuing improvement in the health of the population. Firstly by increasing life expectancy and decreasing premature death, and secondly increasing the quality of life and minimising illness. It focuses largely upon changing individual behaviour. This shows that individual behaviour plays a major part in affecting our pattern of health and the illnesses that we experience. The four risk areas identified from this were; smoking, diet and nutrition, blood pressure and sexual health.

(BAGGOTT, R. 1998)

Britain is now a relatively healthy population in comparison with those of previous centuries. Figures since 1837, when registration of births, deaths and marriages became statutory, show life expectancy in both sexes has risen to approximately 75 years old and infant mortality declined from 142 to 6.2 per 1000 live births.

The most marked trend this century must be the decline of infectious disease which were widespread through the Victorian era, such as; cholera, typhoid, measles, whooping cough and TB. Medical interventions and vaccinations programmes were of major importance in reducing morbidity and mortality rates, although their decline was already on way with improved living standards.

The local immediate environment is regarded as an important determinant of health rather than region, with rural and prosperous areas being healthier than urban areas. A number of other factors are associated with socio-economic variations in health, such as; unemployment, poor housing and homelessness.

Variations in morbidity by social class are consistent with information from lifestyle surveys. A survey reported by Blaxter (1990) found that all ages and in each aspect of health measured, health experience was poorer as social class declined. There is also considerable difference in mortality rates within social classes. Life expectancy for someone in social class I is 7 years higher than someone born into social class V.

In societies where people live longer and in that respect could be deemed more healthier, more morbidity is identified. Epidemiology is the study of the distribution of diseases, it has showed us three transitions. These include; a decline in mortality concentrated on infectious disease, a shift in the burden of illness from younger to older age groups and a change from a situation dominated by acute often fatal illnesses, to one which many people experience illness but do not result in death but may become chronic.

Birth, growth and ageing are as much a part of human life today as they were when the 20th century began. With the development of modern medicine, many of the dangers formerly associated with birth and infancy have been overcome. Despite the many advances that have been made in maintaining quality of life, maturity and old age still bring them medical problems that science has yet to resolve.

(READERS DIGEST, 1998)

All of the information in this essay tells us that we live longer today in Britain but are not necessarily healthier. Official statistics tend to measure how unhealthy we are. Health and ill health varies overtime and over an individual’s lifetime. A lifecycle is in place with certain people prone to certain illness at a particular time in life. The difference now is that, we are now cared for even before cradle to the grave. Every expectant mother has antenatal care and once the baby is born they have vaccinations and attend health clinics. As we age, our medical needs become more demanding, higher maintenance and more preventative care is required. Despite the improvements in healthcare new challenges still exist, the increasing number of elderly patients require treatment that is more expensive.

The lifestyles of people in Britain have dramatically changed over the years and we are becoming a more stress related society who crave on materialistic things. All of the findings suggest that everything has been done and is made available to us to be healthier but it is down to the individual to take it and make it happen, just as Acheson found! There will always be inequalities in health and we will always have different social classes. Those of higher class can afford to go private and have problems sorted quicker than those of lower social class, who tend to have an extremely long wait on the NHS to sort problems out.

Three points to consider are; there are clear signs of emergence or re-emergence of certain illnesses, including infectious such as TB and AIDS and conditions such as asthma. If every age has its disease-ours may be AIDS or cancer. Secondly, there are adverse trends in important risk factors such as obesity, fitness levels and smoking, and finally, most disturbingly of all, are the marked differences in class, gender and ethnic inequalities in health within the population. Overall health has generally improved but not as much as it should have.

Bibliography