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Awaiting moderation 17831 Article |
Preventive medicine: history and significant stages PREVENTIVE MEDICINE: HISTORY AND SIGNIFICANT STAGES
The significant step forward in preventive medicine came with the alarming realization that health was not just a middle-class luxury. In other words the middle and upper classes began to realize that whether they liked it or not their own health and wealth was deeply involved with the health of the ordinary working people. It is perhaps surprising that industrialists did not see the economic link between the poor and unhealthy working classes and low productivity earlier, but they did not and in 1848 when parliament was debating the first Public Health Bill even the Economist magazine did not see the connection between the two. As we have seen, Petty had been talking about exactly this link over a century beforehand but an Austrian, Johann Peter Frank, was the first to make the assertion that governments were strengthened by healthy, happy workers. His thinking produced the world's first government medical system, in Germany in 1883.
The growth of preventive and public health measures in any industrialized country appears to follow a fairly predictable pattern as the country becomes industrialized. First, there is a rush for power, then an increase in exploitation which is difficult to control. Along with this, rural people and even those from outside the country migrate to the major cities, become separated from their own food supply and depend on cash as wages. At the same time death rates rise dramatically and the value placed on individual life is low. But such a system, whether it occurs in nineteenth-century England or twentieth-century Third World countries, produces wealth and makes money available for those who want to spread it around. Historically, individual philanthropists started creating better conditions for their workers and indeed for whole communities and this, combined with the new egalitarianism born as a result of the French and American Revolutions, made the upper classes more aware of the value of keeping the masses healthy.
At the turn of this century another truth began to dawn. About 60 per cent of all the men who volunteered for the British army's fight in the Boer War were unfit for service. This appeared to shake people's long-held attitudes almost more than any other single factor and led Sidney Webb to write:
We have become aware, almost in a flash, that we are not merely individuals but members of a community, nay and citizens of the world. . . . In short, the opening of the twentieth century finds us all, to the dismay of the old-fashioned, individualist, thinking in communities!
Slowly, the notion that society was a collection of communities began to develop-rather more slowly in the US than in the UK, partly because of the individualistic frontiersman thinking in the former. But things were on the move and the time was ripe for the second phase in the development of preventive medicine -the scientific approach.
Until this time facts and figures about health were poor, so few lessons could be learned. Simple 'Bills of Mortality' had been collected in London since 1603 but it was not until the establishment of the office of the Registrar General in 1837 that guesswork was replaced by real statistics. The availability of verifiable facts now made it possible to enact regulations to prevent frankly harmful behaviour and to promote healthy behaviour and practices. Ordinances to abate noise, control sewage and dispose of decayed matter, dead bodies, filth and stagnant waters go back as far as 1388 and in colonial times several American communities enacted laws to quarantine ships and isolate smallpox. Baltimore organized America's first board of health in 1793. But effective public health administration was impossible in either country because local parishes and communities overruled national goals. As so often occurs in history, the activities of one man changed all this.
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