Recent Advances in Public Health Flashcards
(143 cards)
1
Q
Which towns had the best public health standard - Roman, Medieval or Renaissance?
A
Roman.
2
Q
What happened to public health standards in towns when the Industrial revolution started?
A
They got worse.
3
Q
When was the Industrial Revolution?
A
About 1750.
4
Q
What were medieval towns like?
A
Not densely packed like now - gardens for growing vegetables, keeping pigs and chickens, and orchards.
5
Q
How did the Industrial Revolution change towns?
A
More people moved to the towns, so the spaces were filled up with factories, or cheap housing.
6
Q
What governmental controls were there on building?
A
None - a policy of “laissez-faire”.
7
Q
What was the system for providing fresh water, or removing sewage?
A
Inadequate - sewage went into the river, or cesspits, or into the street. Smoke went into the street. Fresh water could be contaminated.
8
Q
What diseases were common in towns?
A
Smallpox, influenza (flu), typhus, typhoid fever.
9
Q
Where did cholera come from?
A
Introduced from the east in 1831.
10
Q
When was the cholera epidemic?
A
1832
11
Q
How does cholera spread?
A
Infected sewage getting into drinking water.
12
Q
How does cholera kill?
A
Diarrhoea that causes dehydration and loss of minerals.
13
Q
What class of person caught cholera?
A
All, rich and poor.
14
Q
What did the government do?
A
Started to introduce regulations about burial of the dead,
but the epidemic declined so interest was lost.
15
Q
What epidemics of cholera were there?
A
1832, 1848, 1853-54, 1866.
16
Q
What was Chadwick’s report?
A
“Report on the Sanitary Conditions of the Labouring Population of Great Britain”.
17
Q
When did Chadwick publish “Report on the Sanitary Conditions of the Labouring Population of Great Britain”?
A
1842
18
Q
What was Chadwick’s idea?
A
Improved public health, and a healthy workforce, would save money.
19
Q
What was the effect of Chadwick’s report?
A
Some people in the privileged classes were shocked at the sickness and mortality statistics. They campaigned for improvement, in 1844 the “Health of Towns Association” was set up.
20
Q
How did the government respond to the Health of Towns Association?
A
It introduced a public health bill. It was opposed, then passed (1848) when another cholera epidemic broke out
21
Q
What was the main provision of the Public Health Act 1848?
A
Central and Local Health boards were set up. Local boards had to be approved by ratepayers. Central board was dismantled in 1854.
22
Q
Who linked cholera to contaminated water?
A
Snow (1853-54), in London
23
Q
How did Snow work out how cholera and water were linked?
A
He looked at a map, and realised that all those affected by cholera used one pump. He removed the handle and stopped the outbreak.
24
Q
When did “The great stink” hit London?
A
1858
25
Why did the great stink happen?
London's human waste was collected in cesspits; expensive to empty, they would overflow; flush toilets increased the volume of ****, so more overflowed; summer of 1858 was very hot, so water level of the Thames dropped; bacteria grew in the waste, producing gases.
26
What was the effect of the great stink on government?
The houses of Parliament are right next to the river, so parliament stopped meeting.
27
What ended the great stink?
Heavy rain.
28
What was the governments response to the great stink?
They acted to improve the sewerage system, more quickly than planned.
29
What was London's new sewage system like?
It transported sewage to the Thames estuary, away from houses; design copied over Western Europe; 1300 miles of sewer.
30
Who designed London's sewage system?
Bazalgette.
31
When was London's sewer system officially opened?
1865.
32
What discovery proved John Snow correct in his theory about the spread of cholera?
Louis Pasteur's germ theory.
33
What happened to the policy of "laissez-faire" in the matter of public health?
It was felt that the government had to take more action, so in 1871 and 1872 they formed the Local Government Board and divided the country into "sanitary areas" administered by medical officers.
34
What act allowed for compulsory purchase of slum dwellings, and rebuilding by the council?
Artisan's Dwellings Act
35
Who co-founded the National Trust, and why?
Octavia Hill, she felt people needed access to green spaces.
36
What was the impact of Victorian engineering on public health?
Brick lined sewer system - no sewage leaked out. Steam driven pumping systems - can pump water from further away.
37
What was the 1867 Reform Act?
It gave 1 million more men the vote. Mostly working class men, often living in poor conditions.
38
What did the new voters of the 1867 Reform Act do?
They put pressure on the government and local councils to listen to public concerns about health.
39
What did the 1875 Sale of Food and Drugs act do?
It stopped the sale of certain drugs, and banned the sale of food that contained harmful ingredients.
40
What was the act that stopped the dumping of sewage or industrial waste into the rivers?
The River Pollution Prevention Act 1876
41
Where were the poorest people housed at the beginning of the 20th century?
Tenements. Damp, no running water, no proper sewage. Families had one room, and shared toilets with other families.
42
What is a slum?
An overcrowded area inhabited mainly by poor people, with poor facilities/housing standards.
43
Why was/is poverty a health problem?
Unable to afford doctors or medicine; working long hours; poor housing; struggling to afford food; unable to heat house
44
What is a patent medicine?
A medicine available without prescription, made to a recipe that only the patent holder may use. Usually ineffective, can be harmful.
45
Why would the poor use patent medicines?
Unable to pay for doctor; patent medicine cheaper.
46
What was the infant death rate at the beginning of the 20th century?
140 per 1000 births. Now down to less than 5.
47
What happened to people who could not work, in the absence of a benefits system?
The workhouse. (Oliver Twist is set in one).
48
What benefit would there be to going to the workhouse?
Medical care; food; shelter.
49
What effect did war have on the health of the poor?
Boer War 1899: 40% of volunteers unfit for military service, mainly poverty related illness. Similar for WW1. Britain went back to the Roman idea of needing a healthy population for a healthy army.
50
Who wrote 'Life and Labour of the People'?
Charles Booth
51
When did Charles Booth write 'Life and Labour of the People'?
1889
52
What did 'Life and Labour of the People' state?
30% of people in London in severe poverty. Sometimes impossible to work. Wages for some jobs so low that could not support a family.
53
Who was Seebohm Rowntree?
A factory owner in York (sweets).
54
What did Seebohm Rowntree do because he believed that the conditions in York were better than London?
He did a survey - "Poverty, a Study of Town Life".
55
When was Seebohm Rowntree's survey published?
1901
56
What did Seebohm Rowntree's survey show?
28% of people were too poor to afford basic housing and food.
57
Who did Seebohm's survey influence?
David Lloyd George. (Politician, important in welfare state creation)
58
Would it have been possible to alleviate poverty using the workhouse system?
No, 30% of the population is too great a number.
59
What was the role played by authors in changing public opinion on the poor at the end of 19th/ beginning of the 20th century?
Charles Dickens - Oliver. Also HG Wells, George Bernard Shaw. Books helped changed the rich people's view of the poor.
60
What was the opinion of the professionals working in health and medicine at the beginning of the 20th century?
There was a feeling that the government needed to pass laws to help the poor.
61
What was the argument of the socialists (beginning of the 20th century)?
Wealth should be more evenly spread between the richest and the poorest. (Also communists, eg in Russia).
62
What was the only socialist party?
Labour (started 1900)
63
What was the name given to rich people who gave to the poor?
Philanthropists.
64
Why was Port Sunlight built?
A "model village" with 800 homes for the workers at the Lever Brothers factory.
65
Who built Port Sunlight?
Lord Lever.
66
What did Port Sunlight have?
Art gallery, church, schools, hospital, even a swimming pool.
67
Were there other similar villages built?
Yes - Cadbury built Bournville; Salt with Saltaire.
68
What did the workers do for themselves?
Friendly Societies, often linked to trade uions - workers paid a small amount every week and the society paid for medical treatment.
69
Who was Joseph Chamberlain?
Mayor of Birmingham (1873)
70
What did Joseph Chamberlain do for Birmingham?
Got the city to buy the gas and water companies to make sure the city had both provided properly; Created the Drainage board and made drainage systems; Used the Artisans Act to clear slums; contributed £10000 of his own money.
71
What did the political parties feel about poverty?
Liberals and Conservatives: Government should interfere as little as possible; Taxes wrong, people had the right to spend their own money; Giving poor people money is wrong as it undermines their independence.
Labour: Poor should get government help; Money for the poor should come from taxes; government should take over (nationalise) the major industries and make use or profits.
72
Why did some liberals and conservatives also want to help the poor?
Vote winner!
73
When was the Royal Commission to investigate poverty set up?
1905
74
What did the Royal Commission find?
Could not agree.
Majority report:
Poor made themselves poor by gambling and drinking
Don't deserve help
Minority report:
Poverty caused by illness, old age, job shortage
More needed to be done to help the poor.
75
Who drove the new laws against poverty of the Liberal Government of 1906?
Two MPs, David Lloyd George and Winston Churchill worked hard to bring in the new laws to deal with poverty.
Partly wanted to help the poor, partly wanted a political career.
76
What was introduced by the liberal government of 1906?
```
Free school meals (1906)
Free medical inspections (1907)
Old Age Pension Act (1908)
Labour exchanges (job centres) (1909)
National insurance act (1911)
```
77
Who opposed the Reforms of the liberal government of 1906?
The House of Lords, David Lloyd George had a lot to overcome.
78
What did the School Meals Act 1906 say?
Local Education Authorities (LEAs) were permitted to provide free school meals, paid for out of the rates (council tax).
79
What were the free medical inspections introduced in 1907?
LEAs started giving children at their schools free medical inspections, many built clinics.
80
What was the Children and Young persons act (1908)?
Known as "Children's charter". Illegal for children under 16 to buy cigarettes or go into a pub.
81
What did the Old Age Pensions Act (1908) do?
Introduced a pension for poor old people over 70. Single people got 5 shillings per week (25p), married couples 7 shillings. (35p). Poor was having an income of less than £21 per year. More than £21 was a smaller pension, or nothing at all.
82
Who was William Beveridge?
Economist, social reformer, worked with Winston Churchill to create a minimum wage in 1909. (Beveridge report in 1942 was the basis of the modern welfare state(
83
What did the Labour Exchanges act 1909 do?
Set up Labour exchanges (now called job centres). Unemployed could go there to find out about jobs. Within 5 years there was a network of them across the country.
84
What did the National Insurance Act 1911 do (Part 1)?
Modelled on Germany.
Each week workers, employers and government paid into a central fund. Sick workers would get paid money if they could not work - men 10 shillings, women 7s 6d. Doctors had "panels" of workers that they were responsible for.
85
What did the National Insurance Act 1911 do (Part 2)?
Unemployment benefit for workers in shipbuilding, iron founding, construction. (Long periods out of work in those industries). Workers got 7 shillings per week for up to 15 weeks in any one year.
86
How were Lloyd George's reforms to be paid for?
He had to raise taxes. 1909 budget (people's budget) taxed the rich more than the poor.
Income tax went up from 5d in the pound to 6d (240d in the pound)
Super tax of 1s 2d in the pound if you earned over £3000 per year.
87
Why did the peoples budget of 1909 not get through parliament?
House of Lords (mainly conservatives) blocked it.
88
What did the Liberals do when they could not get the 'people's budget' through?
Called a general election - 1910. They were elected and the budget was passed in 1910.
89
Were the Liberal reforms funded by the 'people's budget' an answer to poverty?
Not completely. The workers family was not covered by the medical care provided by the National Insurance Act. Only a few industries were covered by the unemployment benefit.
90
Did the Liberal Reforms replace the Poor Law?
No, workhouses remained until 1930.
91
Why are the Liberal reforms important?
The first time national taxes used to help poor;
| The state took responsibility for helping the sick, the old
92
Why were women not permitted to be doctors in the early 19th century?
They were not allowed to attend university. Men considered them less able to work in jobs requiring intelligence of professionalism. Women would be too delicate to cope with the blood etc of doctors.
93
How did Margaret Ann Bulkley qualify as a doctor?
She pretended to be a man. Qualified at Edinburgh university 1812, joined the army, served at the Battle of Waterloo, was promoted to assistant surgeon. Only found out after she died.
94
How did Garrett Andersen and Sophia Jex-Blake qualify as doctors?
They had to go abroad - 1870/1874.
95
How did the wars help women?
They were needed for traditional male roles - doctor, pilot
96
When was sex discrimination at work outlawed?
1975 Sex discrimination Act (I was at school).
97
What proportion of doctors are female today?
About 45%
98
What proportion of consultants are female today?
About 28%
99
What happened in the UK between the wars (1918-1939)
```
Lloyd George promised to make Britain a 'land fit for heroes'.
Ministry for health set up 1919
Grants for council houses
but - UK poor due to war
1920s rising unemployment,
1930s "Great Depression"
```
100
What did World War 2 do to social attitudes?
Evacuation made people realise how poor some children were
| Broke down social distinctions
101
What did the government do to help casualties of the Blitz?
Emergency Medical Service set up 1940.
102
What caused the Labour victory at election in 1945?
People wanted a better society.
103
Date of WW1?
1914-1918
104
Date of WW2?
1939-1945
105
When did Beveridge publish his famous report?
1942.
106
What is the famous phrase from the Beveridge report?
'From the cradle to the grave'.
107
What did Beveridge say?
People have the right to be free from: want; disease; ignorance; squalor; idleness.
108
What politician is famous for introducing the National Health Service?
Bevan.
109
How was the NHS funded?
Compulsory National Insurance payments introduced 1948.
110
How were doctors and dentists paid?
A fixed payment for each registered patient.
111
Did all doctors join the NHS?
No - in 1948 still 8% were private.
112
What were the arguments for the NHS?
The EMS during the war put hospitals under government control, very popular and successful;
NHS would benefit everyone, especially the poor;
NHS was free, people would not get sicker while saving up to see the doctor;
NHS guaranteed that hospitals would get money from government, before that they were charities
113
What were the arguments against the NHS?
Conservatives thought the cost would be huge (they were right);
BMA (doctors organisation) were worried about doctors losing income, and the freedom to be independent professionals;
Doctors did not want a change in doctor/patient relationship
114
What has the NHS introduced?
childhood vaccinations;
ante and post natal care which has reduced infant/maternal mortality;
Long term there was an increase in life expectancy... through whether this was due to the NHS is still debated.
115
What were the problems of the early NHS?
Cost - much higher than expected.
1951 prescription charges and dental charges were introduced - Bevan resigned.
116
What is the problem with the current NHS?
Cost.
| Patients have no say in the service being provided... eg GP surgeries are only open during work hours.
117
Why is the cost of the NHS rising faster than inflation?
Longer life expectancy - older people need more treatment
New, expensive treatments
Cost of modern equipment - eg MRI scanner
118
What is WHO?
World Health Organisation - part of the United Nations.
119
What has WHO achieved?
Eradication of smallpox due to vaccination. Aiming to eradicate polio, malaria, tuberculosis.
120
What is DNA?
DeoxyriboNucleicAcid
121
Where is our DNA?
In the nucleus of our cells
122
Who discovered the structure of DNA?
Crick and Watson, 1953
123
What is the shape of DNA?
Double helix
124
What is the Human Genome Project?
A project to identify all human genes - between 20,000 and 25,000
125
What is a genetic condition?
One that is passed on through the generations via the genes.
126
What is the value of genetic research?
Tests for genetic conditions, either in the womb or after birth. Earlier treatment can prevent damage.
Produce a synthetic protein to replicate the work of the faulty gene.
127
How could genetic diseases be cured?
Gene therapy.
128
Where does the pharmaceutical industry have its roots?
The chemical industry, which made it possible to make drugs in bulk by the late 1800s,
129
Name some early drugs that needed to be mass-produced to help lots of people?
Aspirin (1899)
Insulin (1921)
Sulphonamides (1932)
Penicillin during World War 2
130
As well as producing drugs, what else do pharmaceutical companies manufacture?
Vaccines.
Smallpox - eradicated.
Polio - almost eradicated.
131
What was thalidomide?
A drug released to treat morning sickness in pregnancy. It caused limb malformations in the baby. (Early 1960s)
132
What has happened to speed up research?
Communication is much better and faster, as it travel, so people can exchange information. Of course drugs companies also want to keep their secrets to make money!
133
What is the impact of modern technology on diagnosis/treatment?
Ultrasound - visualise the inside of the body - used for the last 50 years.
Dialysis - used to "wash blood" in kidney failure.
MRI scanners (1973) - radio waves/magnets visualise internal body
Fibre optics - endoscopes.
134
What is HIV?
Human Immunodeficiency Virus.
135
Where did HIV originate?
Africa, but AIDS first identified in USA in 1981.
136
How many people world wide are HIV positive?
33 million (estimate), 2/3 in sub-Saharan Africa.
137
What treatment is there for HIV?
Antiretrovirals - expensive, complicated drugs regime, not suitable for everyone.
138
What has caused the rise of alternative medicine?
Distrust of modern medicine.
139
What do most doctors feel about alternative medicine?
Do not believe it works. Some prepared to look at some aspects.
140
How has the role of the nurse changed?
Since 1919 nurses have to be registered, and have a recognised nursing qualification.
Since 2001 have to update their skills with CPD (continuing professional development)
141
How has the role of doctor changed?
1900 - very few drugs available
Very little diagnostic equipment, so patients visited at home.
Now home visits getting very rare, even for seriously ill.
142
How has advancing technology enabled patients to take responsibility for their own health?
Diagnostic kits - home pregnancy kits; home blood pressure monitor.
143
What is the modern government's role in preventing disease?
Introducing vaccines;
Passing laws/leading campaigns against for instance smoking;
Raising taxes on unhealthy products, eg cigarettes;
Passing laws on pollution (Clean Air Act), working conditions (Health and Safety at work), food safety (1990 food safety act);
Education - binge drinking, cigarettes, childhood obesity
