two - The origins of health promotion

Summary

Diseases in Britain before and during the 19th century

Public health becomes the concern of governments when disease becomes widespread and when there are good grounds for believing that something can be done about it. In Britain, as in many other countries, epidemics have a history of causing death on a huge scale. Between 1348 and 1350, the Great Pestilence, which became known in the 17th century as the Black Death, killed an estimated 40–60% of the population of England (Campbell, 1991). This pestilence returned in 1361, and again in the 15th century. Unfortunately, there was no known cause other than the wrath of God for sin or the disastrous conjunction of planets. London was the worst affected part of England, but the disease spread to other areas including Bristol and Cumbria, and the plague eventually engulfed most of the country. It was only several centuries after its first appearance that the cause was identified as bacteria from fleas carried by rats.

This information, which would come to be known as the aetiology of disease, heralded the beginnings of a public health movement, which gained momentum throughout the 19th century. At this time cholera was the most prevalent life-threatening disease, but others gained much more than just a foothold (Harris et al., 2012). Typhus – caused by bacteria transmitted to humans via parasites such as lice, fleas and ticks – was rampant in English prisons, where men were crowded together in dark and filthy rooms in which lice could spread easily. The complaint started in Ireland but crossed to England after a short while. Cholera and typhus were not the only pervading diseases in the 19th century; smallpox and tuberculosis were also responsible for thousands of deaths. Smallpox is caused by viruses and tuberculosis by airborne bacteria transmitted by coughs and sneezes.

Shortly after the traumas of the Second World War in Britain had subsided, the government turned its attention to a form of health education through its propaganda cinema film entitled Coughs and sneezes spread diseases (British Pathé, 1947). The threat of tuberculosis had not been eliminated. This short film, which portrayed a middle-aged man being shown the way to reduce the spread of disease by means of using a handkerchief every time he anticipated sneezing, was a prime example of a public health message that stressed personal responsibility as one way of avoiding unnecessary harm to others.