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Education And Debate

Revolutions in public health: 1848, and 1998?

BMJ 1998; 317 doi: (Published 29 August 1998) Cite this as: BMJ 1998;317:587

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  1. Christopher Hamlin (, professor and heada,
  2. Pat Sidley, lecturer in history of public healthb
  1. aDepartment of History, University of Notre Dame, 219 O'Shaughnessy Hall, Notre Dame, IN 46556-0368, USA
  2. bDepartment of Public Health, University of Liverpool, Liverpool L69 3BX
  1. Correspondence to: Professor Hamlin

    Editorials by Alderslade, Palmer Recent advances p 584 Education and debate pp 592, 596

    This autumn marks the 150th anniversary of the Public Health Act for England and Wales, the beginning of a commitment to proactive, rather than a reactive, public health. The act began a series of legislative measures extending through the Victorian era and into this century in which the state became guarantor of standards of health and environmental quality and provided means for local units of government to make the structural changes to meet those standards.

    That public action can substantially improve the health of the general population now seems obvious, and it also seems obvious that public authorities owe their citizens that improvement. Both were controversial in the 1830s and 1840s. For centuries European governments had reacted to epidemics with decrees. With medical boards to advise them, they set their military forces to protecting borders and ports, whitewashed towns, fumigated dwellings, and burnt bedding. The threat of unusual disease prompted these reactions, and they were relaxed when the epidemics passed.1 Normal disease—infant mortality of more than 50% in inner city wards, annual mortality of over 30/1000 in some towns—prompted no such reactions.

    Unless we are familiar with some of the cities of the developing world, most of us are probably unable to fathom the enormity of the unplanned urbanisation of the 19th century: roughly 3 million people(slightly over 30%) were urban in 1801 in England and Wales, compared with 28.5 million (almost 80%) in 1901. Growth rates in some textile boom towns, like Bradford from 1811 to 1831, exceeded 60% per decade; this despite the fact that towns were acting as a sink for human life. In Liverpool average life expectancy by class ranged from 15 years for the unemployed or poor to 35 years for the well to do.2– …

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