1. Starter
Which factors are significant to the development of public health throughout history?

2. Public Health through the ages
Aim: To explain (B) and evaluate (A) the impact of public health and how it has changed through history

3. Prehistoric Era
There is no written evidence to inform us of ideas about public health in this period.
Aim: To explain (B) and evaluate (A) the impact of public health and how it has changed through history

4. The Egyptian era
The Egyptians developed a system of writing which meant that knowledge could be used by later generations. They did pray to the gods who was thought to cause and cure epidemics and wore scarab brooches to frighten away the evil spirits who caused disease.
They must have seen the connection between dirt and disease because both rich and poor washed frequently. Simple toilets and latrines have been found but it seems that the sewage was stored, later dug out and removed. It does not seem that water was used to flush it away.
Aim: To explain (B) and evaluate (A) the impact of public health and how it has changed through history

5. The Greek era
We know that the Greeks picked up many Egyptian ideas. They came to believe that disease had natural causes and could be prevented.
They also believed in keeping themselves clean. They tried to eat the correct food for the time of year and to exercise. They did not use water for flushing away sewage. The Romans in turn were influenced by the Greeks.
Aim: To explain (B) and evaluate (A) the impact of public health and how it has changed through history

6. The Roman era
The Romans are important because they went much further than any other people in the Ancient World.
The Romans wanted clean water and good drainage for people throughout their empire. In other words the Romans were the first people to plan and carry out a programme of public health on a large scale.
The Greek idea which most influenced the Romans was the importance of staying healthy. To the Romans it seemed much more practical to spend time keeping fit than to spend money on doctors for the sick. "We must pray for a healthy mind in a healthy body” wrote Juvenal, a Roman poet.
The Romans believed it was important to build their settlements - their cities, villas, villages and army forts - in healthy places near good springs, rivers or wells. They built conduits (channels) to bring water into their settlements. When the water had to go over hills and valleys the Romans built the conduits (channels) on top of arches. These looked like bridges and were called aqueducts.
They were so well built that a number are still standing today 1700 or more years later. Besides clean drinking water, the Romans the Romans also believed in the importance of personal cleanliness. They set about making daily bathing a possibility for all citizens. Wherever the Romans settled, they built public baths.
The Roman interest in public health also led to them building latrines. They used water to flush away the waste products. Rome had huge sewers which emptied into the River Tiber. Romans took their drinking water from other rivers and springs.
The Romans were able to provide these facilities because they were well organised, could enforce peace, could raise money through taxation and could use slaves as a cheap labour force.
Aim: To explain (B) and evaluate (A) the impact of public health and how it has changed through history

7. Britain in the Middle Ages and the Renaissance
When the Roman Empire collapsed about 500AD, practical measures for public health disappeared. There was no one to repair the baths and the aqueducts, and medieval governments did not have the money or the power to do anything about public health.
Medieval towns were left to sort things for themselves.
Towns and councils did not like to spend money on public health as they did not see it as their responsibility. As towns grew, rubbish and sewage piled onto the streets. People often drank the same water their dumped their thesis into.
During the Black Death in the 1340s, people who lived in the monasteries were less likely to get ill and more likely to survive if they did not get poorly. The government did very little to stop the plague spreading, partly because they blamed superstitious causes for the disease and partly because they were not rich or powerful enough to make the towns healthier.
Aim: To explain (B) and evaluate (A) the impact of public health and how it has changed through history

8. The Renaissance
There was little improvement. Towns remained dirty. Rich people had better hygiene than the poor.
During the Great Plague 1666, when bubonic plague came back to London, there was more of an understanding that poor hygiene caused poor health. The Lord Mayor ordered the streets to be cleaned and although it made London a healthier place, it did little to stop the Great Plague spreading.
Aim: To explain (B) and evaluate (A) the impact of public health and how it has changed through history

9. Industrial Britain
From 1750, Britain industrialised and population increased rapidly. Towns became overcrowded, housing was poor and there were inadequate water supplies. There were few proper sewers and no system for collecting rubbish. There were no planning and building regulations as the government believed in laissez-faire. There was little understanding of the true causes of disease. As a result there were real problems with diseases such as typhoid and TB.
In 1831 a new disease hit Britain and forced the government to take action - cholera. The government asked Edwin Chadwick to look into the links between poverty and bad health. His report, The Sanitary Conditions of the Labouring Population of Great Britain', proved the links between poor living conditions and bad health and recommended that government action should be taken.
This resulted in the Public Health Act of The 1848 law allowed towns to set up a Local Board of Health but these boards could not force towns to take any action.
Aim: To explain (B) and evaluate (A) the impact of public health and how it has changed through history

10. Industrial Britain 1750-1900 Further developments took place:
• 1848 & 1854 = Further cholera epidemics
• 1853 = Free vaccination for smallpox
• 1854 = John Snow proved a link between cholera and poor water supply.
• 1861 = Pasteur published his work on 'Germ Theory'
• 1867 = Working men got the right to vote.
These factors put pressure on the government to do something about public health and the
1875 Public Health Act was passed. This Act forced councils to take responsibility for public health.
Streets, sewers and water had to be kept clean and healthy and all councils had to employ inspectors to enforce the laws.
Aim: To explain (B) and evaluate (A) the impact of public health and how it has changed through history

11. The 20th Century
By 1900 most governments in Britain accepted that it was part of their job to organise good public health systems with pure water and effective sewers.
However living conditions were still poor and between 1886 and 1903 individuals like Booth and Rowntree carried out surveys which linked poor health directly to poverty.
In 1902 the nation was shocked to find that 40% of the men who had volunteered for the Boer War were suffering from malnutrition and other diseases linked to poverty.
Aim: To explain (B) and evaluate (A) the impact of public health and how it has changed through history

12. The 20th Century
The Liberal government and Lloyd George brought in a series of reform to help poor people that became known as the Liberal Social Reforms.
1906 Local authorities given right to provide free school meals.
1907 School medical inspections.
1909 Old Age Pensions Act, Labour exchanges
1911 National Insurance Act gives help to the sick and the unemployed.
1919 Housing and Towns Planning Acts.
Aim: To explain (B) and evaluate (A) the impact of public health and how it has changed through history

13. The First and Second World War
The First and Second World Wars showed the government the importance of keeping the working class people healthy and fit.
Evacuation brought many social problems to the attention of the authorities.
After the Second World War ended in the new Labour government introduced National Health Service of NHS, this introduced:
• Free hospitals
• Free Doctors
• Free Dental services
• Social Services - care of the elderly and children
Many people were against the idea of the NHS because it would cost a lot of money in taxes. Although it was a success, it proved to be very expensive and not long after the NHS began, charges had to be introduced for adult dental services and prescriptions.
Aim: To explain (B) and evaluate (A) the impact of public health and how it has changed through history

14. Evaluation technique
Which factors were the most important to the development of public health?
Which factors were the least important to the development of public health?
Remember to explain why…
Aim: To explain (B) and evaluate (A) the impact of public health and how it has changed through history

15. Examination technique
Public health changed at different times for different reasons.
Why was this? (8)
Aim: To explain (B) and evaluate (A) the impact of public health and how it has changed through history

16. Source work
Source A - 'The Preservation of Health'
When you get up in the morning, stretch your limbs, so that the natural heat is stimulated. Then comb your hair because this removes dirt and comforts the brain.
Wash your face with cold water to give your skin a good colour and to stimulate the natural heat. Clear your nose and your chest by coughing, and clean your teeth and gums with the bark of some scented tree.
Exercise in moderation, because it is good to be tired; it stimulates the natural heat.
Taddeo Alderotti, 'On the Preservation of Health' (13th century) (Alderotti was an Italian doctor)
What does the Alderotti source tell us about health in Medieval times? (4)
Aim: To explain (B) and evaluate (A) the impact of public health and how it has changed through history