Public health is a complex subject that has positively affected our communities – it is complex as it does not refer to only one illness or condition’. We exist to protect and improve the nation’s health and wellbeing and reduce health inequalities’ (Public Health England Online). The origins of public health here in the UK started with the establishment of the National Health Service by virtue of influential characters such as John Snow and William Beveridge.
The industrial revolution rapidly gained pace in England in the 1800’s because of the power of steam and by 1870 100,000 steam engines were at work throughout England. Despite growing wealth, people were not prepared for the increase of accommodation needed in towns and cities. Several families would have shared one house due to the shortage of houses. There was no clean water, anaesthetic and no sewage system. All household waste was thrown into narrow streets and black smoke from the chimneys of factories filled the air – overcrowded living and dirty streets was a perfect breeding ground for diseases. Cholera and typhoid are bacterial infections caused by ingesting contaminated food and poor sanitation. Lice would also have been common due to the crowded living situations. Until John Snows contribution to modern epidemiology – it was believed that diseases such as cholera were caused by a miasma, a form of ‘bad air’. This was known as The Miasma Theory. Snow did not accept this theory and proved his theory, that in fact it enters through mouth, through the investigation of the Broad street pump in Soho in August 1854 after another cholera outbreak.
Throughout early 19th Century, the government believed it was not their duty to maintain working and living environments and blamed the poor themselves for their conditions. However, in 1940 attitudes changed. Edwin Chadwick, an English socialist was asked by parliament to investigate living conditions in Britain. The Public Health Act of 1848 was later brought through parliament by Chadwick, it stated the principle that health care should be administered at a local level. Being such globally devastating conflicts in human history, World War I and World War II had a major impact on the development of public health. After WW2, the government constructed a report on how to rebuild Britain. William Beveridge published his report outlining ‘the 5 giant evils’ and Welfare state. Beveridge recommended the government find a way to fight - 'Want, Disease, Ignorance, Squalor and Idleness'. In 1948 systems were put in place to protect the nation from ‘the cradle to the grave’. Benefits to protect social security were put in place as well as the establishment of a National Health Service to provide free medical care for all.
There are various strategies used for developing public health policy – all of which are vital to ensure its success. For example, identifying the needs of the population. Information will be gathered on the current need in the population, which may be combined with previous trends to project future levels of need. Groups including age, gender, urban/local location etc will be considered in a basic demographic profile to further identify the needs.
The Director of Public Health issues an annual report determining the overall vision and objectives for public health that year. This strategy is important for example in relation to substance abuse. It is beneficial to know where and who is most affected by substance abuse in order to discover more trends in health care and keep people safe. The World Health Organisation states that one modifiable risk factor for suicide, especially relevant for young people at risk, is alcohol and drug use. The link between substance abuse and suicide suggests that by reducing the levels of substance abuse, levels of suicide will also go down.
Another strategy is minimising harm from the environment. This strategy is important as it protects the nation from both communicable diseases and non-communicable diseases. The Department for Environment, Food and Rural Affairs carry's responsibility for minimising harm from environmental conditions that may cause disease. ‘Poor air quality is the largest environmental risk to public health in the UK, as long-term exposure to air pollution can cause chronic conditions such as cardiovascular and respiratory diseases as well as lung cancer, leading to reduced life expectancy’ (gov.uk online) provides a summary on just how important a healthy environment is.
The study of epidemiology is used to determine patterns of ill health. The Centres for Disease Control and Prevention provides a definition of epidemiology ‘Epidemiology is the study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to the control of health problems Epidemiology is data-driven and relies on a systematic and unbiased approach to the collection, analysis, and interpretation of data’. Morbidity and mortality rates of diseases are observed to put protective measures in place. In some cases, the government will commission a report on a specific health related matter for example, the Acheson report. Acheson made recommendations organised around key populations, children, elder and ethnic and domains such as tax, benefits and employment. These factors relate to and influence each other, for example your employment will dictate your income. Studies from Making Life Better Framework- Key indicators progress update 2018 illustrates the correlation between lifestyle and health inequalities.
Our health is linked to socioeconomic determinants. These are the conditions in which people are born, grow, work, live and age. They are shaped by the distribution of power, money and resources at a global, national and local level. These determinants are mostly responsible for health inequities. Examples of a health inequity are private and public care, mental and physical health. Illnesses like stress, obesity, cancer and diabetes and the partaking in criminal activity are linked to poor background. Although obesity and drug misuse for example may be life factors affecting patterns of ill health in the UK – they may also be the result of being exposed to health inequities from a young age. The BBC states ‘Access to and the quality of local health services may not always be as good in poorer areas. In deprived areas of Scotland, GPs are more likely to have more difficult caseloads. In disadvantaged areas like this, members of the community may come together to provide facilities such as safe play parks or food banks.
Frameworks have been put in place in the UK to minimise factors affecting ill health. Making Life Better printed in June 2014, is a 168-page framework of strategic measures for public health 2013-3023. It contains themes called ‘giving every child the best start’ and ‘empowering communities’. This framework states ‘“Giving Every Child the Best Start” and “Equipped throughout Life” take account of the particular needs across the life course and have been broadened to cover childhood and adulthood. They address the key social determinants at each stage. Emphasis is given to children and young people, and to supporting individuals’ transitions into and through adulthood and older age. “Empowering Healthy Living” addresses support for individual behaviours and choices and embedding prevention in Health and Social Care services. The next two themes address the wider structural, economic, environmental and social conditions impacting on health - at population level, and within local communities. The NHS provides stop smoking services, not only do they make it easy and affordable to get stop smoking treatment, they provide one to one session with patients or drop-in services.
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