The document provides a history of public health over the last 500 years, beginning with early public health laws in the 13th century and continuing to present challenges. Some key developments discussed include the establishment of quarantines to prevent plague in the 14th-15th centuries, John Graunt's statistical analysis of mortality rates in 17th century London, Jenner's smallpox vaccination in the late 18th century, major public health legislation and sanitation reforms in the 19th century, and establishment of the UK's National Health Service in the 20th century. The document concludes by discussing present and future challenges such as inequalities, climate change, and addressing corporate influences on health.

1. www.fph.org.uk
Where has public health been for
the last 500 years?
John Middleton, President, UK Faculty of
Public Health

2. Public health is :
The science and art of promoting health, preventing
disease and prolonging life through the organised
efforts of society
Acheson 1988, after Winslow 1920, WHO 1948

4. Health, hygiene
and councils …

5. Ruffhead ‘Statutes at large’ 1763: Public health laws from Edward
1st ‘consumer protection’
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6. 30/10/2018 5
Lazarettos of Dubrovnik
Quarantine only defence
against plague typhus,
smallpox
Effective in preventing
reach of Spanish Flu in
Australian in 1918

7. Bimaristans of old Aleppo
places of light calm, peace, reflection, mindfulness , scents and sensibility

8. 30/10/2018 7
Healthy town
planning and
sanitation
Indus Valley
Civilisation
2500BC

9. 30/10/2018 8

10. 30/10/2018 9

11. The East India
Company
10
Sir James Lancaster, first
voyage o the Spice islands,
1591; 1st voyage of the
East India Company, 1601;
understood the value of
lemon juice
Spirione Roma, The East gives up her
riches to Britannia; commissioned
painting for the East India Company

12. Elizabethan Bills of Mortality 1562
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13. John Graunt: Natural and Political observations
made upon the Bills of Mortality
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14. Graunt, along with William Petty, developed early human
statistical and census methods that later provided a
framework for modern demography. He is credited with
producing the first life table, giving probabilities of survival to
each age. Graunt is also considered as one of the first experts
in epidemiology, since his famous book was concerned
mostly with public health statistics.
His book Natural and Political Observations Made upon the
Bills of Mortality(1662 Old Style or 1663 New Style) used
analysis of the bills of mortality (weekly statistics of deaths) in
early modern London as Charles II and other officials
attempted to create a system to warn of the onset and spread
of bubonic plaguein the city. Though the system was never
truly created, Graunt's work in studying the rolls resulted in
the first statistically based estimation of the population
of London. His work ran to five editions by 1676.
1330/10/2018

15. Plague of London 1665
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16. Bills of
mortality
1665
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18. • James Lind FRSE FRCPE (4 October
1716 – 13 July 1794) was a Scottish
physician. He was a pioneer of
naval hygiene in the Royal Navy. By
conducting one of the first ever clinical
trials,[1][2] he developed the theory
that citrus fruits cured scurvy. He argued
for the health benefits of better
ventilation aboard naval ships, the
improved cleanliness of sailors' bodies,
clothing and bedding, and below-deck
fumigation with sulphur and arsenic. He
also proposed that fresh watercould be
obtained by distilling sea water. His work
advanced the practice of preventive
medicine and improved nutrition.
1730/10/2018

19. Jenner smallpox vaccination 1796
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James Gillray cartoon 1802
Painting of Jenner
administering cowpox to
James Phipps aged 8

24. The Butcher Row,
Coventry
‘an area where
contagious fevers
prevailed to a fearfull
extent’
Coventry Board of
Health 1849

27. John Snow on cholera

28. 30/10/2018 27

29. 30/10/2018 28

30. Significant Public health legislation in the ‘Victorian
Sanitary revolution’
30/10/2018 29

32. • William Duncan
of Liverpool
• The first
English
Medical Officer
of Health….

33. 30/10/2018 32
• ‘The interests of health,
and the interests of
common physical
convenience and comfort
are in various cases,
identical’
• Sir John Simon, First
Medical Officer of Health
for the City of London
1848, and First Chief
Medical Officer for the
British government , 1856

34. The Times in 1856: ‘The doctor
is no better than the meanest
herbalist, the product of the
longest conversation with a
doctor is simply to reinforce
the uselessness of medicine’.

35. Multidisciplinary public health
• 19th Century: early practitioners
were multi-disciplinary: John
Snow (Surgeon/Anaesthetist),
Florence Nightingale (Nurse);
Edwin Chadwick (Lawyer); Joseph
Bazalgette (Engineer); Mary
Seacole (nurse) William Farr,
(physician/statistician) Kitty
Wilkinson, ‘Saint of the slums’
founder of the bathhouse
movement

36. Ebenezer Howard
and the garden city
movement
30/10/2018 35

38. Post Victorian advances :
• The National Assistance Act 1909 ‘the Lloyd George Act’
• The Defence of the Realm Acts- Alcohol controls 1916.
• The Venereal Diseases Act 1917
• The 1929 Local Government Act: ‘the last poor law’
• Food rationing in WW2
• The Welfare State and the NHS 1944-1948
• Tobacco control legislation esp the Indoor Clean Air Act
2007.
• The ’Social Chapter’ 1997
30/10/2018 37

39. See 2018 Milroy lecture
Tim Allison
1918 Spanish flu
pandemic kills 50-100
million people world
wide

40. William Beveridge designed a welfare
state for the UK in the deepest point
of the Second World War.
‘We should regard want,
idleness , ignorance,
squalor and disease as
enemies of us all. That is
the meaning of a social
conscience; that we refuse
to make our separate
peace with evil.’

41. www.fph.org.uk

43. http://www.bing.com/videos/search?q=youtube+advert+
for+camel+cigarettes&&view=detail&mid=70789494855D
72F0D8BD70789494855D72F0D8BD&FORM=VRDGAR

45. http://www.bmj.com/content/358/bmj.j4443?sso=

48. Present and future challenges
• Inequalities
• Brexit
• GBD growth in diabetes/obesity related mortality,
mental ill health and violence
• Climate change
• Planetary health
• Addressing corporate greed and anti-health forces
30/10/2018 47

49. These 10 Corporations Control Almost Everything We Eat

50. 30/10/2018 49

51. The impoverishment of China: Opium exports
to China and the eventual non-payment for
Chinese goods in the ‘century of shame’
30/10/2018 50

52. The East India Company
51
• Impoverished the wealthiest most productive nations in the
world in the 1700s, India and China
• Brought price speculation on food into play during the Bengal
famine 1770 in which 1- 10 million people died
• Created a market for opium in China and created 12 million
dependent Chinese at the peak of the trade.
• Two opium wars subjected to rule by opium and the British
navy. In China’s ‘Century of shame’.
• In the name of Britain? or the interest of the Company?
• Ran a monopoly of trade criticised by Marx, Adam Smith,
Edmund Burke and Stuart –Mill
• Received government bale outs in crashes, rewarded wealthy
share holders in times of plenty.
• Bankrupted and created dependency throughout the Indian sub

53. ‘Protecting
resources from
one generation
to the next’
The Welsh
Wellbeing of
Future
Generations Act,
2015

54. www.fph.org.uk
Thank you
John Middleton
president@fph.org.uk

55. www.fph.org.uk
30/10/2018 54

57. Florence Nightingale’s polar area graph (1856)

58. • “The connection between the health and the
dwellings of the population is one of the most
important that exists.”
• Florence Nightingale on the importance of
collecting housing data in the 1861 census

59. Florence Nightingale as Statistician Author(s):
Edwin W. Kopf Source: Publications of the
American Statistical Association, Vol. 15, No.
116 (Dec., 1916), pp. 388-404

60. Present and future challenges
• Inequalities
• Brexit
• Climate change
• Planetary health
• Addressing corporate greed and anti-
health forces
30/10/2018 59

61. 60
The Marmot Review
• Early years
• Young adults
• Workplace health
• Income inequality
• Physical
environments
• Reduce the gradient
of unequal access to
healthcare

63. Rockefeller Lancet
Planetary Health
commission

64. Evidence for the Anthropocene epoch

65. BREXIT and the public’s health
Loss of health and care workers
Loss of research grants and networks
Loss of leadership role in areas such as tobacco control and
antimicrobial resistance
Loss of international agencies which protect health –European
Communicable Disease Centre; The European illegal drugs
monitoring centre; European Medicines Agency; Pulling out of
Euratom Access to Medical isotopes for cancer treatment and shared
safety procedures for nuclear power stations;
Loss of protections for health - in the workplace, the Social chapter;
environmental protections; soil, beaches and air quality; equality
provisions;
Shared Security?

66. http://www.bmj.com/content/
357/bmj.j2676
Inequalities in health cost
£65bn (€74bn; $83bn) in lost
productivity and taxes and
increased benefits payments
plus
£5.5bn for direct NHS
treatment in 2010.5

67. References
• Climate and Health Council (www.climateandhealth.org)
Global health, global warming, personal and professional
responsibility, Cambridge Medicine, Pencheon D, Vol 2, No 22, 2008
• Stott R, Healthy response to climate change, BMJ 2006;332;1385-1387
• Gill M, Why should doctors be interested in climate change?
BMJ Jun 2008; 336: 1506
• Griffiths J, Alison Hill, Jackie Spiby and Mike Gill, Robin Stott Ten
practical actions for doctors to combat climate change, BMJ
2008;336;1507
• Sustaining a healthy future: www.fph.org.uk
• Griffiths J et al, The Health Practitioner's Guide to Climate Change,
Earthscan 2009
• Pencheon D, Health services and climate change: what can be done?
J Health Serv Res Policy. Editorial Jan 2009
• UCL Health Commission/Lancet: Managing the Health effects of
Climate Change. May 2009
• The health benefits of tackling climate change, Wellcome/LSHTM, Nov
2009
• Sustainable Development Commission: http://www.sd-
commission.org.uk/pages/health.html

68. References
• Centre for Nonviolent Communication www.cnvc.org
• Galtung J (1996). Peace by peaceful means: peace and conflict, development
and civilisation. London, Prio/Sage.
• Galtung J (2002). What is peace studies? In Johansen J, Vambheim V (eds).
Three papers by Johan Galtung. Tromsø, Centre for Peace Studies, University of
Tromsø, Norway
• Large J (1997). Considering conflict. First consultative meeting on Health as a
Bridge for Peace. Les Pensières, Annecy, WHO.
• Mercy J et al. (1993). Public health policy for preventing violence. Health
Affairs. Winter:7-29.
• Merriam-Webster Online Dictionary www.m-w.com
• Rosenberg M (2003). Nonviolent communication: a language of life. Encinitas,
CA, Puddle Dancer Press.
• Santa Barbara J, MacQueen G (2004). Peace through health: key concepts. The
Lancet 364:384-5.
• WHO (2002). World report on violence and health. Geneva, WHO.
© medicalpeacework.org 2012
Author Klaus Melf, editor Mike Rowson, graphic design Philipp Bornschlegl

69. References and resources
Resources :
REWIND http://www.rewind.org.uk
http://www.quilliamfoundation.org/about/
Institute for Strategic Dialogue
http://www.strategicdialogue.org
WAVES Trust www.wavestrust.org.uk/home.html
Parent Infant Partnership http://www.pipuk.org.uk
ECPAT http://www.ecpat.org.uk
TASC http://tascwheel.com
Centre for Nonviolent Communication www.cnvc.org
Medical peace work. Online course work, course
part Health professionals, conflicts and peace.
Berlin: Medical Peace Work, 2015.
http://www.medicalpeacework.org/teaching-
resources/mpw-presentations.html
References
Bellis, M. A., Hughes, K., Perkins, C., Bennett, A. M., Protecting people,
promoting health: a public health
approach to violence prevention for England. London: NHS. and
Department of Health, 2012.
World Health Organization. (2014). Global status report on violence
prevention 2014.
http://www.who.int/violence_injury_prevention/violence/status_report/2014
/en/ update on WHO (2002). World report on violence and health.
Geneva, WHO
Galtung J (1996). Peace by peaceful means: peace and conflict,
development and civilisation. London, Prio/Sage.
Mercy J et al. (1993). Public health policy for preventing violence.
Health Affairs. Winter:7-29.
Rosenberg M (2003). Nonviolent communication: a language of life.
Encinitas, CA, Puddle Dancer Press.
Santa Barbara J, MacQueen G (2004). Peace through health: key
concepts. The Lancet 364:384-5.

70. • Middleton J, ISIS, crop failure and no anti-biotics:
what training will we need for future public health?
European J Public Health 2016;
https://eurpub.oxfordjournals.org/content/26/5/735
• Middleton J. Public health in England in 2016—the
health of the public and the public health system: a
review Br Med Bull (2017) 1-16. DOI:
https://doi.org/10.1093/bmb/ldw054 and
http://academic.oup.com//bmb/article/doi/10.1093/bmb/l
dw054/2871226/Public-health-in-England-in-2016the-
health-of-the?guestAccessKey=8f7a33a1-bdbf-4db4-
948c-fd6b6293a259

71. Who we are and what we do
• The United Kingdom Faculty of Public Health is a faculty of
the three Royal Colleges of Physicians of London,
Edinburgh and Glasgow (Physicians and Surgeons)
• FPH is a membership organisation for nearly 4,000 public
health professionals across the UK and around the world
• We also have a growing number of student, associate and
international members in more than 80 different countries
To improve and protect the public’s health: through
standards, advocacy, training and knowledge
www.fph.org.uk