Promoting the Public Health: Continuity and Change over Two Centuries

This chapter explores the origins of public health in the UK, documenting the political influences which led to the passing of the first public health Act in England and Wales in 1848. Although heralded as a turning point in the recognition of the role of poverty and environment in determining health status, the initial permissive public health act had to be strengthened by compulsory legislation and the development of a public health infrastructure which then became dominated by biomedical perspectives. The chapter will outline the more recent development of the ‘new public health’ and track the emergence of health promotion from the Ottawa Charter (WHO, 1986) to the Bangkok Charter (WHO, 2005). In exploring definitions of health promotion from the USA, Canada, and the UK, it will demonstrate the contested nature of health promotion, the divergence in understandings of health promotion and the relationship of health promotion to the ‘new public health’. Charting the renaissance of public health in the UK from 1988 to the present, the chapter looks at the development of modern multidisciplinary public health. The publication of UK public health strategies heralded a resurgence in public health, changes in the Faculty of Public Health Medicine to become the Faculty of Public Health and the development of competencies for public health. The influence of reports such as the Wanless Reports is explored and the relationship of health promotion to public health as part of multidisciplinary public health is examined. The conflicts and tensions that have emerged as a result of differences between policy and practice are interrogated as is the role that politics has played in developing public health in primary care organisations, local authorities and voluntary organisations. The origins of public health in the UK Politics and public health are inextricably linked. The origins of the first Public Health Act – An Act for Promoting the Public Health, 1848 – lay outside the health considerations and Douglas-3453-C 9/16/2006 5:15 PM Page 12 Promoting the Public Health: Continuity and Change over Two Centuries 13 instead with the report of Edwin Chadwick on the state of poor people in England. Critics argue that Chadwick, as the architect and enforcer of the 1834 Poor Law, was not so much concerned with inequalities in health but with reducing costs caused by the death of male breadwinners from infectious diseases, which left families dependent on relief, and that it was in fact the Poor Laws themselves which caused ill health (Hamlin and Sheard, 1998). Whatever the historical reasons, the Public Health Act was passed in England and Wales in 1848 and was stimulated by a concern to improve sanitary conditions in thriving urban areas. A Central Board of Health was established which oversaw the implementation of the Act, although it had few powers and few resources. The Act did enable local people to get involved in health action, however, by allowing local health boards to be established if more than 10 per cent of the population petitioned for one. The Act therefore witnessed one of the first social movements of lay people in public health. Failing to produc