The Age of Liberalism

1. THE AGE OF LIBERALISM
MOHAMMAD ASLAM SHAIEKH
MPH - 3RD BATCH
SCHOOL OF HEALTH AND ALLIED SCIENCES (SHAS)
POKHARA UNIVERSITY (P.U)
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2. Phases of public health
 Public health has undergone changes in the developed countries
mainly in the last two centuries. These can be divided into three
phases under the evolution of concepts into:
1. Age of liberalism (1790 - 1880)
2. Golden age of Public health (1880 – 1970)
3. Return to liberalism (1970 onwards)
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3. The age of liberalism: health in the
name of the people, 1790-1880
 Age of the anti-slavery movement and rise of methodism
 Liberty develops a biosocial vision – laws of sanitation by Sir
Edwin Chadwick
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4. Cont…
 Social and intellectual movement
 Included a wide range of philosophical, political ,
economical and religious ideas, but at its heart
were notions of individual freedom and
responsibility and usually of equality in some
form.
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5. Cont…
 In 1890, when John Simon, England’s first chief medical officer
surveyed progress in public health during the past two centuries, he
found that the granting of equal political and economic rights and
responsibilities, it had become impossible to see health status as
appropriately constrained by class, race or sex. Particularly women,
children and the poor still suffered ill health disproportionately.
 But they saw such consequences as incidental, accidental and
increasingly unnecessary.
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6. Cont…
 In revolutionary France, the first instinct was to free the market in
medical practice by abolishing medical licensing.
 World’s leader in epidemiology (France) found it difficult to
conceive how their findings of the preventable causes of disease
could be translated into proposals for preventive legislation.
 Thus, France was the scientific leader in public health for the first
half of the nineteenth century without finding a viable political
formula for translating that knowledge into prevention.
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7. Cont…
 In early nineteenth century Britain, the ideas of T.R. Malthus stated
that disease was among the natural checks that kept population
within the margins of survival. Successful prevention of disease
would be temporary only; it would postpone an inevitable
equilibrium of the food–population balance that would then need to
occur through some other form of catastrophe.
 Malthusian sentiment blocked attempts to establish foundling
hospitals.
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8. Cont…
 By 1850, in both France and England, it was no longer possible to
maintain a completely free society. A number of factors shattered
this faith.
 First, no government ever adopted the programme of the early
nineteenth century liberals in full.
 Second, working-class parties, saw no advantage in economic
liberalism.
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9. Cont…
 Many liberals recognized that it was impractical, inhumane, and
injudicious to impose economic and political responsibilities on
people who were biologically incapable of meeting those
responsibilities.
 These considerations were central to debates in France and Britain
in the 1830s and 1840s.
 Governments in both countries were apprehensive of revolution and
wary of an alienated underclass of people who could not be trusted
with political rights and seemed immune to the incentives of the
market. Such people represented a reservoir of disease.
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10. Cont…
 Edwin Chadwick, Secretary of the English Bureau, was against
such political background . He developed ‘the sanitary idea’ in the
late 1830s.
 Chadwick’s technologies and deadlines, sanitation achieved
remarkable popularity in nineteenth-century Britain.
 In treating insanitation as the universal cause of disease, Chadwick
hoped to establish a public health that was truly liberal.
 He sought to deflect attention from other causes of disease, such as
malnutrition and overwork
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11. Cont…
 For about a generation, from 1850–1880, sanitation was
unchallenged in Britain as the keystone of improved health.
 Chadwick’s campaigns led to a series of legislative acts—beginning
with the Public Health Act of 1848 and culminating with a
comprehensive act in 1875—that established state standards for
urban sanitation and a bureau of state medicine, staffed by medical
officers in central and local units of government and charged with
detecting, responding to, and preventing outbreaks of disease.
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12. Cont…
 Through the 1880s, the United States remained an exceptional case,
coming closest to following a policy that an individual’s health was
a private matter alone.
 The national government maintained a system of marine hospitals
along the coasts and navigable rivers, less for controlling the spread
of epidemics than for relieving ports of the burden of caring for
sick seamen.
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13. Cont…
 Many state legislatures had little enthusiasm for public health.
 Towns and cities were more active, but often only sporadically,
taking steps when faced with epidemics.
 States that did establish boards of health usually focused on specific
problems rather than on public health in general.
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14. Reference
 Roger Detels et.al. Age of liberalism Oxford
textbook of Public Health volume 1, fifth edition.
Oxford university press. 2009; p28-30.
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