From past to present; the changing focus of public health
by Maria Joyce
Key sections include:
Environment, infectious disease, locating public health, the enlightenment, the Sanitarians, national provision of services, the inception of the National Health Service, ‘crisis in health’, The New Right, The Third Way, new public health.
Public health, the new ideology may be taken to mean the promotion of healthy lifestyles linked to behaviour and individual responsibility supported by government action; whereas traditionally the description tended to relate more to sanitary reform and ‘healthy conditions’. The chronological development of public health is mapped out, supported by the outlining and discussion of the emerging themes and influences pertaining to the study of public health. The approach to public health is positioned alongside the health of the population and the prevailing political/societal influence at the time. Public health is impacted on by poverty and environmental factors. Presently government policy to improve public health is delivered in a strategy that recognises the need for health improvement at times when the greatest impact on health is poverty and exclusion. The evidence reviewed demonstrates clearly that poor health without appropriate resources or intervention is cumulative and that the ‘right’ form of intervention can bring about long term health gains. Intervention from a national agenda needs to include individual’s health and the health of the community brought about through joint partnerships and multi-sectorial working.
Historically, the environment was seen to be causative of ill health and disease, precipitated by inadequacy of the air. Humid, marshy areas or toxic, rotting debris were thought to cause ‘miasmic disorders’, and it was thought best to reside in airy, well-ventilated places. The supposition being, miasma could be seen or smelt and disease produced by miasma was transported through breathing contaminated air or absorbed through the skin. The presence of disease was acutely observed in the summer season, when the smell would be particularly offensive. Unfortunately the corresponding link between rotting debris, flesh and heat with an increase in pests and rodents, which would inform later health initiatives, was not made at this time (Cipolla 1992). Belief systems were influenced by naïve sensory perceptions linking odour and miasma with overcrowded spaces as places of disease. Those financially better placed began to deodorise their environment with aromatic oils, flowers and herbs (Wear 1992). The environment was also seen as significant in humoral theories, where the body was thought to need a healthy balance of four humours: blood, phlegm, yellow bile and black bile with four elements: earth, air, fire and water and four qualities: hot, cold, wet and dry (Nutton 1992). Being cold or wet was often seen as the cause of colds or fevers; perspectives still present in popular lay discourse today.
In earlier times levels of understanding relating to infectious diseases was demonstrated with the Romans building isolation hospitals known as Leprosaria, quarantining their plague victims. Quarantine was associated with a contagionist understanding of ill health. Disease and isolation in this approach was separating the ill and infectious, to control the spread of disease (Lupton 1995). Quarantine stemmed from the belief that disease resided in places and bodies were responsible for the transmission of disease from infected to non- infected place (Armstrong 1993).
Fear and suspicion co-existed with ignorance and lack of education and the plague was construed, as a case of divine retribution in the absence of popularly understood causative indicators. The contribution of the church in leading a crusade against disease or indeed identifying causative behaviours was said to be welcomed when so little was known...
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