People's Health

Question 1

Medieval Britain overview (1250-1500)

Answer 1

1. Medieval towns were small but they were busy places containing many different crafts and trades, especially busy on market days
2. Most medieval people were peasants who did hard physical work on the land with bad harvests leading to starvation
3. Almost everyone was a Christian and a member of the Roman Catholic Church
4. The medieval people were ruled by kings who taxed their people but the money was mainly used for the king’s court and to fight wars.

Question 2

Living conditions in medieval Britain (1250-1500)

Answer 2

1. In the countryside, peasants lived in houses with timber frames and a fire in the middle to allow them to cook and preserve food. The fire escaped though the thatched roof. In towns, houses were built close together in the centre of towns with only the wealthy having gardens. People were supposed to clean the drains and street near their houses, but not everyone bothered
2. In towns, conduits were lead pipes which brought spring water to some towns. Water sellers also sold water from leather sacks. There were public latrines in market squares with rakers paid to clean the streets from 1293 in London due to the unsanitary streets after market days. Cesspits were cleared by gongfermers which were used in fields. In the country, waste heaps were in the garden with some cesspits constructed near the village
3. In the countryside, people had relied heavily on the harvest. Bad harvests caused famine. Their diet was very healthy, consisting of fruit and vegetables grown from the garden, bread and pottage (vegetable soup). Sometimes they caught fish in the rivers providing lots of nutrients and drank lots of water. The bread was rye, with wet years leading to a fungus causing illness and death. In towns, rich people at lots of meat, causing an unhealthy and unbalanced diet

Question 3

Responses to the Black Death (1250-1500)

Answer 3

1. The Black Death began in Asia and spread to Europe along trade routes. By the end of 1349, it had reached the far north of England, Wales and Ireland. It was spread by fleas on rats but the people did not know this
2. They believed that the Black Death was God punishing the people for their sins. During this time, the church encouraged people to confess their sins and ask for forgiveness. Some people whipped themselves, hoping for God’s forgiveness. Other people though it was caused by miasma and burned rosemary to purify the air in their houses. The rich moved to the countryside to try and find pure air. Some people shut themselves away in their own houses

Question 4

Public health in late medieval towns

Answer 4

1. Religious communities like monasteries needed clean water for religious ceremonies as well as day-to-day washing of linen and people. Religious institutions were often rich and powerful and could pay for water pipes to be paid over long distances. Some monasteries had hospitals attached to them
2. By 1500, the standards in many monasteries had dropped and respect for the church declined. Towns grew as respect for the Church declined. As a result, some wealthy townsmen began to fund the development of new conduits and public privies
3. Town authorities paved marketplaces from taxation, moved dung heaps to the edge of towns for less spread of bacteria, named and shamed waste dumpers leading to purer water supply and guilds set standards of foods and fined producers who did not adhere to them
4. In London, in 1385, a warden was appointed to check whether London’s streets and the banks of the Thames were clear of ‘filth and dunghills’. In 1415, the Mayor of London ordered the rebuilding of a latrine in Moorgate because it had been flooding with neighbouring properties with sewage. In the 1430s the Mayor of London organised the extension of the pipes that supplied London with clean spring water. Rich citizens left money in wills to improve water supplies and build new public latrines

Question 5

Early modern Britain overview (1500-1750)

Answer 5

1. Towns grew in size and became more overcrowded. mines opened and coal for people’s fires were shipped to London. By 1750, large quantities of sugar and tobacco came to Britain from America and the Caribbean and new products were being traded from the expansion of the British empire
2. People began to search for a scientific way of understanding the world with Robert Hooke developing a powerful microscope in the 1660s
3. By 1750, parliament had become more powerful than the monarch and began to make new laws that affected different aspects of people’s lives
4. Bad harvests could still lead to hunger but by 1750, improvements in farming methods meant more people could be fed

Question 6

Living conditions in early modern Britain (1500-1750)

Answer 6

1. Rich people ate a large variety of meat and fish, drank lots of wine, ale and beer and little vegetables and fruits. Poorer people only ate bread, vegetables, eggs, cheese and fish and meat as occasional treats. Trade developed as the British Empire grew with sugar, peppers and chilies being imported. Poor harvests still lead to hunger
2. Poor families living in towns were squashed into cellars and upper storeys which were damp and draughty. The drop in the price of coal meant that more people began to burn it on their fires, contributing to respiratory diseases caused by soot and dust.
3. Rich people had water piped to their houses as well as bathtubs, soap and servants. The poor had to collect water from conduits and rarely bathed, having only one set of clothes riddled with lice and fleas. This caused typhus
4. Poor families had shared privies and cesspits which often leaked into neighbours yards and spread disease. Scavengers collected waste and sold it to farmers.

Question 7

Responses to the outbreaks of plague in early modern Britain (1500-1750)

Answer 7

1. People still believed that disease was God’s punishment for sin and the miasma theory was still accepted, although, at the end of the period, scientists began to think that close contact with infected people may be a cause of the disease spreading
2. In 1518, plague victims were isolated in their own house, however was not effective as it wasn’t enforced everywhere. In 1578, the plague orders were printed including ordering the recording of spread of disease, financial help for sick people and burning of victims’ clothing and bedding. People were isolated for at least 6 weeks and this was very effective in reducing the spread of disease. In 1604, the Plague Act increased financial help for the families of sick people and there were harsher sanctions imposed if a victim left isolation - they could be hanged
3. In Yarmouth, the local authorities banned pigs, dogs and cats from infected streets. The village of Eyam quarantined itself in 1665 to stop the disease spreading to nearby Sheffield, saving Sheffield. Some towns like Cambridge only allowed strangers into the city if they had a certificate of health with many towns producing weekly records of plague deaths
4. Many people went to church as they believed God would take away the plague. The rich ran away from infected towns and some people found cures such as smoking tobacco

Question 8

Impact of local and national government on public health (1500-1750)

Answer 8

1. Local government officials were aware that clean streets would help improve public health. People in York were told to clean the area outside their houses and not to put waste for scavengers outside until 7pm with a fine system for any household which threw human waste into the street at night
2. In London, wate companies brought piped water into people’s homes. In the period 1670-1750, local authorities made big improvements to the centres of their towns with large houses for the wealthy and streets lit with lamps. In some areas, streets were paved but conditions did not improve in the poorer areas of town. Privies and cesspits were still a typical feature of life.
3. The craze for gin from the 1720-1751 began because it was cheap. Gin allowed the consumer to escape from the dreadful drudgery of life at the time leading to an increase in crime, the ruin of many families and a big increase in the death rate. Many women were also addicted to gin, drinking while pregnant leading to babies being deformed.
4. Alehouses were made to have a licence which had little effect as there were many smaller alehouses which weren’t regulated. The Gin Act in 1729 introduced a £20 licence fee for sellers and a 5 shilling tax per gallon for producers but was impossible to enforce because of the number of small gin shops. In 1736, the Gin Act increased the licence fee to £50 and the producers’ tax to 20 shillings. It also failed as people began for the same reasons as the first act and people started illegally distilling gin in their homes. In 1751, the Gin Act imposed harsh punishments on anyone selling illegal gin which worked and the consumption fell

Question 9

Industrial Britain overview (1750-1900)

Answer 9

1. People moved from the countryside into towns and cities in search of work
2. More and more men were given the right to vote and governments had to take more notice of the needs of the poorer people
3. Religion declined and scientists discovered that germs caused disease
4. The middle classes had grown in number and power with the working class being ignored as their living conditions worsened. by 1870, children under 10 were given free education

Question 10

Living conditions in industrial Britain (1750-1900)

Answer 10

1. Large old houses were divided up into smaller rooms which were filthy and overcrowded. Typhus spread quickly and chest infections and tuberculosis spread quickly due to the lack of ventilation
2. Working class families bought food off small shops and street families, living off butter, bread, potatoes and tea. They were malnourished which made them prone to sickness and disease and there was little control of production of food resulting in adultery such as chalk and water added to milk, meat painted with red paint and copper added to butter
3. Rapid expansion put water supplies under severe pressure. Water companies sourced their water from dirty and unhealthy ponds, rivers and streams causing typhoid and cholera.
4. Working class people used privies, often shared by 10 families which collected into cesspools. Sometimes, they overflowed into neighbour’s yards and could contaminate water supplies

Question 11

Responses to cholera epidemics (1750-1900)

Answer 11

1. In the 1830s, people still believed in the miasma theory which said that the disease was spread by poisoned air with the church saying that it was a punishment from god. During this time, people cleared rubbish from the streets to stop the stench and quarantines stopped poor people entering towns
2. In 1848, Edwin Chadwick produced his ‘Sanitary Report’ containing shocking details of the public health crisis. The Public Health Act of 1848 set up the General Board of Health and encouraged councils to set up health boards to clean up towns. However, this caused limited change as it was permissive so town leaders thought it would be too expensive
3. In 1848, John Snow proved that cholera was spread by infected water when he removed the tap for the Broad Street pump which laid the foundation for modern epidemiology
4. In 1861, Louis Pasteur had proved that germs caused disease and a Sanitary Act in 1866 made local councils responsible for sewers, water supply and street cleaning. Bazalgette’s 1300 mile new London sewer which opened in 1865 revolutionised public health and significantly improved sanitation. After 1866, there were no more cholera epidemics, after 4 major epidemics

Question 12

Public health reform in the nineteenth century: Public health Acts and local initiatives (1750-1900)

Answer 12

1. In 1848, the Public Health Act created the General Board of Health which gave authorities permission to take action but the government could only force local councils to make improvements if the death rate was higher than 23 per 1000. By 1853, there were only 163 places with a local board of health. The General Board of Health was also abolished in 1854, having limited long-term impact
2. In 1865, Bazalgette’s sewer was opened. The 1300 miles of sewers stopped the ‘Great Stink’ in 1858, and took the waste to a treatment plant. This greatly reduced the spread of waterborne diseases and was vital in stopping the spread of cholera
3. In 1866, the Sanitary Act was passed after a cholera outbreak. This forced local authorities to take action to provide fresh water, sewage and waste disposal, maek all houses connected to a main sewer, defined overcrowding and if they didn’t do this, they were billed by the central government who did for them
4. In 1875, the second Public Health Act was passed after the 1867 Reform Act where working class men were able to vote. Local councils were forced to clean up towns and provide clean water and proper drains and sewers. A medical officer had to be appointed by local councils and sanitary inspectors had to be appointed, leading to many improvements in Public Health

Question 13

Modern Britain overview (c.1900)

Answer 13

Britain in 1900:
1. Lots of work in heavy industry with the majority being the working class. There was no welfare state and women could not vote with the life expectancy being only 50 years old
2. There were no aeroplanes, few cars and electricity was becoming popular
Britain in 2000:
1. Lots of service industry jobs with the majority still in the middle class. There’s a comprehensive welfare state, everyone aged 18 can vote and the life expectancy is 77
2. Cars and air travel are a normal feature with telephones and internet leading to instant communication. Electricity exists in almost all homes

Question 14

Living conditions in modern Britain (c.1900)

Answer 14

1. During WW1, the government took responsibility and promised 50% of the 500,000 homes promised. The 1930 Housing Act led to final slum clearances. During WWII, there was cheap high-rise accommodation with gas and electricity and under Thatcher, people were encouraged to buy their council houses
2. During the WWII, imports fell so food was rationed. People were encouraged to grow food and keep animals and this improved people’s health. Refrigeration and canning improved supply and made food cheaper, people became richer after 1950 and could afford this new technology but there were new fears on BSE disease in 1986 affecting cattle, leading to fear about modern farming methods. Fears in artificial ingredients lead to demand for fresh local produce
3. In 1950, Britain consumed 200million tonnes which caused smog and led to pneumonia or bronchitis. After appalling smog in 1952 which killed 12,000 people, the government passed the 1956 Clean Air Act which made people burn smokeless fuels and created smoke-free zones which helped solve the problems of smog. However, with the huge increase in car ownership since 1980, air pollution has increased
4. After WWII, new technology caused changes in lifestyle. During WWI and after, people were far more active, walking everywhere but with the development of motor cars, technology such as watching tv on sofas, robots and machines doing heavy work in factories and less demanding household jobs has led to unhealthiness. In 2013, almost 75% of people with no qualifications take little or no exercise, 40% of men and 33% of women are classified as overweight and the army has been forced to change standards to accept volunteers

Question 15

Responses to Spanish influenza and AIDS (c.1900)

Answer 15

1. The Spanish Flu epidemic from 1918-1919 had killed almost three times as many people worldwide as WWI. It caused cold-like symptoms which developed into pneumonia and the skin turning blue. The reactions to Spanish flu had mainly positive effects such as face masks which prevented contamination and newspapers, films and posters which gave advice on preventing contamination. This included Dr Wise on Influenza
2. The Spanish Flu epidemic also had different responses in other countries, such as the Western and American Samoa. In the Western Samoa, 25% of the population died (8,500 deaths) due to the Spanish Flu, however, American Samoa imposed a strict 5 day quarantine and ended up having no deaths
3. In the 1970s and 80s, people believed that the disease was caused by gay men having intercourse, and so people were therefore stigmatised. Some churchgoers refused to share the cup from which everyone drank wine at the service of Holy Communion.
4. After 1986, there was better understanding of AIDS after Diana shook hands with AIDS victims and publicity campaigns were produced to educate the public. TV and media embraced the needs to publicise the disease and charities were supported for research, including the Freddie Mercury tribute concert raising £20m. From 1996 onwards, educational campaigns stopped and HIV cases rose again

Question 16

Growing government involvement in public health (c.1900)

Answer 16

1. In 1906, the Education Act was passed which provided free school meals. In 1907, another Education Act was passed giving children free compulsory medical examinations. After WWII, the government became more active, with 1999 being the first official 5 a day campaign for fruit and veg consumption. From 2000, there was national campaigns on smoking cessation, alcohol awareness and obesity. In 2010, there were new laws on food content and exercise and healthy eating promoted
2. In 1948, the National Health Service (NHS) was created, giving free medical care for all British citizens. This meant that healthcare was no longer a luxury that only few could afford, with the budget spent on the NHS in 1955 being 11.2% compared to 2016 where it was 30.1%. This bought down tuberculosis deaths from 4.7% in 1948 to 0% in 2018
3. In 1800, Britain consumed around 10million tons of coal each year. By 1950, that had risen to 200 million tons, causing skies almost permanently filled with a haze of smoke from factory and household chimneys. Between 4 and 12 December 1952, 12,000 Londoners were killed by the hazardous smog, leading to the Clean Air Act passed in 1956. After the 80s, car ownership increased, causing smog from exhaust fumes which meant that in 2014 and 2015, athletes were warned not to train outside from the dangerously high levels of pollution
4. In the 1950s, smoking was part of everyday life and after 1947, the government offered free smoking tokens to pensioners to buy cigarettes. By 1950, 80% of men and 40% of women smoked but at this time, scientists suspected that smoking caused cancer. Government decided to take no action, while acknowledging the harmful effects of tobacco. Slowly, action was taken with health warnings printed on packets in 1971, free nicotine replacement therapies for anyone trying to quit smoking in 1998 and by 2016, all cigarette packages were blank with no attractive colours