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History of Public Health Timeline

Explainers | December 1, 2022

To celebrate the 175th anniversary of the first public health official's appointment in 1847, we have compiled a timeline of significant dates for public health.

The first idea that a medical appointee should give direction to local authorities originated in Edwin Chadwick’s report on the sanitary condition of the working population of Great Britain.
Thomas Fresh became Liverpool’s first public health officer.
The Liverpool Sanitary Act passed which led to the establishment of the role of ‘Medical Officer of Health’ (MOH) in Liverpool.
January 01 - William Henry Duncan appointed as Britain's first MOH for Liverpool.
The first Public Health Act passed which gave every town the right to appoint a MOH. The Act established a General Board of Health which was responsible for managing local boards of health as well as the overall health of the public. Dr John Simon is appointed as the first MOH for the City of London.
John Snow first identifies Cholera as a water-borne disease, pinpointing the source of the outbreak and curtailing the epidemic in London.
London is split into 46 Metropolitan Districts - each required to appoint a MOH. Dr John Simon is appointed as first Chief Medical Officer to her Majesty's Government and Dr Henry James Payne is appointed as the first MOH for Cardiff. Henry Letheby is appointed as MOH and analyst of food for the City of London.
April 23 - Dr Pavy (MOH St Luke, Middlsex) called a meeting to propose founding a London-based society. May 13 - Inaugural meeting held with 30 MOH across London - Metropolitan Association of Medical Officers was formed. John Burdon Sanderson appointed as first MOH for Paddington, London, he took a special interest in the ventilation of work places and helped advance the acceptance of Germ Theory in Britain. Edwin Lankester appointed as first MOH for Westminster, London, his vaccination policy almost halved the incidence of smallpox in the parish.
Dr John Simon published the first public health annual report which became common practice for all MOsH/DsPH.
MOsH outside of London were allowed to join the Association.
Sir Henry Duncan Littlejohn is appointed as the first MOH for Edinburgh.
Dr M K Robinson is appointed as the first MOH for Leeds. The Sanitary Act of 1866/PH Act 1866 was passed making it compulsory for local authorities to improve sanitation - leading to the formation of drainage districts and better home drainage.
John Leigh is appointed as first MOH for Manchester. He helped tackle cellar dwellings, back-to-backs and midden privies.
‘Metropolitan’ dropped from the Associations title to acknowledge the important membership from across the country and became the Association of Medical Officers of Health. Thomas Stevenson is appointed as the first MOH for St Pancras, London. He served as President of the Society of Medical Officers of Health at various times and helped to raise the status of the analytical chemist.
The Public Health Acts of 1872 and 1875 made it a statutory responsibility for all districts to appoint an MOH. Dr James Burn Russell is appointed as Glasgow's first full time MOH. The American Public Health Association is founded. It is now the oldest and largest organisation of PH professionals globally.
The Association became the Society of Medical Officers of Health. By this point, the Society had 115 members: 40 were metropolitan 33 were extra-metropolitan 10 were alumni 32 were Associated or Honorary
The Births and Deaths Registration Act was passed. This was vital in allowing MOsH to collect information on different causes of death in their district.
Several provincial associations of MOsH were formed: North Western Association Yorkshire Association Birmingham and Midland Association Northern Counties Association The University of Dublin (Trinity College) was the first to recognise the increasingly important work of MOsH and created a post-graduate Diploma in Public Health (DPH).
Koch’s postulates – 4 criteria designed to establish a causal relationship between a microbe and disease. It is considered to be the one of the founders of bacteriology.
Arthur Newsholme is appointed as full time MOH in Brighton and wrote a textbook on vital statistics ‘The Elements of Vital Statistics’ (1889) which became a standard textbook for MOsH. An amalgamation of the society with the three surviving provincial associations became ‘branches’ (North-Western, Yorkshire, and the Birmingham/Midlands). By 1888, there were 1,490 MOsH outside of London, of which only 90 were full time. They set the standards, determined the course of public health activity and were responsible for over half of the population.
Arthur Newsholme appointed as full time MOH in Brighton and wrote a textbook on vital statistics ‘The Elements of Vital Statistics’ (1889) which became a standard textbook for MOsH.
William Johnston MOH for Leicester developed a method to prevent the transmission of Smallpox. The diffusion of the disease was drastically reduced and any major outbreak was prevented until 1982.
The Society became the Incorporated Society of Medical Officers of Health (ISMOH) and membership was between 500-600. The Metropolitan and Northern Branches were formed.
Formation of the West of England and South Wales Branch. The British Institute of Public Health was established.
Dr Edward William Hope appointed as MOH for Liverpool and served as the longest MOH in the UK until his retirement in 1924. James Niven appointed as MOH for Manchester and served a 28 year term. Niven's most notable work was in restricting the impact of the Spanish Influenza in Manchester. Formation of the Home Counties and Southern Branches
The Society of Medical Officers of Health of Scotland (formed in 1891) joined the Society as the Scottish Branch.
Boer War - The Committee on Physical Deterioration was set up in 1903 after the war’s culmination in 1902. It made the following recommendations: compulsory medical inspections of children in schools, free school meals for the very poor, training in mothering skills for working class women.
The Association of County Medical Officers of Health of England and Wales (ACMOH) broke from the ISMOH.
Formation of the Eastern Branch of the ISMOH.
The Society moved into its first office: 1 Upper Montague Street, Russell Square. The North Western Branch accepted its first female member.
The welfare state is launched with a series of welfare reforms to provide provisions for free school meals and medical treatment for children, old age pensions, compulsory health insurance for low-paid workers, and unemployment insurance for those out of work. This legislation is greatly expanded over the next 40 years.
Arthur Newsholme was made CMO until 1919. He oversaw the initiation of national health insurance and the national programmes introduced to combat TB, venereal disease and infant mortality.
All cases of TB were required to be reported to the local MOH so that patients could be kept under observation. Each reported case was visited, their living conditions noted, and advice issued. Most MOH saw the improvement of general housing as the central fight against TB.
Jessie Gellatly is appointed as assistant MOH for Cambridgeshire.
The outbreak of WW1 – also called The Great War, there were around 40 million casualties and 20 million deaths.
The Local Government Board issued the Public Health Venereal Diseases Regulations based on recommendations by the Royal Commission on Venereal Diseases. These regulations led to the development of a nationwide network of clinics based in hospitals in heavily populated areas offering free confidential diagnosis and treatment for syphilis, gonorrhoea and chancroid.
Spanish flu pandemic infected an estimated 500 million people. LA's played an important role in running hospitals, keeping essential services open and ensuring care for vulnerable people. Dr James Niven (MOH Manchester) was the first to introduce preventative measures that slowed the spread of the diseases.
Maternity and Child Welfare Act was passed which gave LA’s the power to provide services supporting the health of pregnant and nursing mothers, and children under 5, under the supervision of the MOH. Joseph Priestley (MOH Lambeth) initiated a number of practical measures to prevent epidemic diarrhoea in infants (Lambeth Maternity and Child Welfare Scheme).
WW1 ends. Motorised ambulances, the development of new antiseptics and advancements in anesthetic medicine are all credited to WW1.
1919 Housing Act made housing a national responsibility and saw the beginning of mass council house building. Veitch Clark (MOH Croydon) introduced the Scheme of the Croydon Town Council for the provision of New Houses, which converted empty houses into flats for the working class. The Welsh Branch is formed. July 3: The society approved a new constitution which consolidated its position as the ‘central representative body of the Public Health Service’.
Formation of the County District Medical Officers of Health Group. William Wilson Jameson appointed as MOH for Finchley. He went on to become the first Professor Public Health at the London School of Hygiene and Tropical Medicine.
Marie Stopes opens the first sexual health clinic in Britain, the Mothers' Clinic for Constructive Birth Control. It was the first time qualified clinical staff gave contraceptive advice and it marked the beginning of Sexual Health Services (SHS) being a medical speciality rather than a social or commercial activity.
By 1922, 7 specialised groups of MOH had been formed, including the Tuberculosis Group; County District Medical Officers Group; Maternity and Child Welfare Group. MOHs could no longer be dismissed from their post without the active consent of the Minister.
John Parlane Kinlock appointed as MOH for Aberdeen. He pioneered the removal of public hospitals from the Poor Law which held that only the voluntary sector should provide acute care.
Doctor George M’Gonigle appointed as MOH for Stockton-on-Tees. He opened the Ragworth Open Air School in Norton which took in sick children, nursed them back to health with lessons held outside, regular meals and daily provisions of milk and fruit.
1924 Housing Act gave substantial grants to local authorities in response to acute housing shortages.
The responsibilities of MOsH were extended in parallel with the Local Government Act of 1929, to include school health services, food control and hygiene, and housing. The East Midlands branch is formed.
1930 Housing Act forced local councils to clear all remaining slum housing and provide further subsidies to re-house inhabitants. This single Act led to the clearance of more slums than at any time previously, and the building of 700,000 new homes.
The National Birth Control Council (NBCC) was formed from 20 SH clinics so ‘married people may space or limit their families and thus mitigate the evils of ill-health and poverty’. Unmarried and working-class women were offered little support to seek advice.
Catherine Crane appointed as assistant MOH for York and Chief Medical Officer for maternity and welfare in the city.
NBCC member societies merged into The Family Planning Association (FPA).
Outbreak of WW2.
WW2 ends. The Emergency Health Service was established and gave central government the right to control the voluntary and municipal hospitals. The EMS showed the British government that working on a large scale meant that major challenges such as the Blitz or the aftermath of Dunkirk could be dealt with effectively as a collective and gave an insight into the potential successes of a national, joined-up health service.
Catherine Crane appointed as the UK's first female MOH for York.
Creation of the NHS. This removed hospitals from the remit of MOsH, leaving them with residual public health and social care functions. Membership eligibility of the Society was extended to Professors and Lecturers in social medicine. The Northern Ireland branch is formed.
The WHO is established.
Sir Richard Doll conducts a study to demonstarte that smoking was a cause of cancer.
The British Doctors Study commences, based on Doll's preliminary evidence from the investigation the previous year. The study lasted 50 years and proved beyond reasonable doubt the relationship between smoking and the risk of death from lung cancer.
Catherine Crane's pioneering work bought together the local authority and mental hospital medical staff to form the York Mental Health Service, she was later responsible for establishing one of York's first cervical screening services.
Dec 1952: London's Great Smog. John Brown (MOH Greenwich) reported the smog killed approximately 4000 people "indicating a catastrophe of the first magnitude".
FPA clinics begin to offer pre-marital advice to women.
Robert Wolfinden is appointed as MOH in Bristol. He enhanced Bristol's reputation as a model for health services a decade before they became popular.
The Clean Air Act 1956 granted local authorities the power to control emissions of smoke, grit, dust and fumes from industrial premises and furnaces.
The first oral contraceptive is introduced.
Cigarettes were banned by the Government from being advertised on television and taxation on cigarettes slowly began to increase.
Dr J Adrian Gillet is appointed as MOH for the newly created London Borough of Barking and Dagenham. Only one other DPH Matthew Cole has been responsible for this borough since then. This is unique in London.
The Abortion Act legalises abortion in certain circumstances. The Family Planning Act enabled local authorities to give contraceptive advice and supplies under the NHS.
Plans to build new town Milton Keynes were approved. John Reid MOH Buckinghamshire was closely involved in town planning and the establishment of the health services.
The Road Safety Act 1967 made it an offence to operate a vehicle with a blood alcohol concentration of over 80mg of alcohol per 100ml of blood.
The WHO announced the Intensified Smallpox Eradication Programme which aimed to eradicate smallpox in more than 30 countries through surveillance and vaccination.
The Local Authority Social Services Act was passed. This seperated social services from LA PH departments, leaving MOsH with largely environmental responsibilities.
Establishment of the Faculty of Community Medicine by the Royal Colleges of Physicians of the United Kingdom. The formation of new associations and decrease of the Society's representation on the British Medical Associations Public Health Committee contributed to its decline in size and activity.
The ISMOH was renamed to the Society of Community Medicine.
The post of MOH was abolished and replaced with Community Physician. The newly renamed Society replaced its branches with 17 new 'regions' congruent to the NHS. The ACMOH became the Association of Area of Medical Officers. Dr Spence Galbraith is appointed MOH for Newham. He had long argued for a centrally financed/ co-ordinated national epidemiological service and in 1977, the Communicable Disease Surveillance Centre (CDSC) was set up under Galbraith.
The Association of District Community Physicians was formed.
33rd World Health Assembly declares the world free of smallpox.
The Association of District Medical Officers (ADMO) was formed from the merger of the Association of Area Medical Officers and the Association of District Community Physicians.
BSE (bovine spongiform encephalopathy), commonly called Mad Cow Disease, infects the UK food chain, and causes a PH crisis.
The Worldwide Polio Eradication Initiative is launched led by the WHO, Rotary International, CDC and Unicef.
The ADMO became the Association of Directors of Public Health (ADPH) and The Society of Community Medicine became the Society of Public Health. The newly named Society set up the Faculty of Community Health to support the community health doctors and promote academic excellence in the field of preventative medicine.
HIV/AIDs crisis erupts globally. According to the WHO, as of 2021, HIV/AIDS has killed approximately 40.1 million people.
The ADPH logo was drawn up and added to the medal.
A combination of antiretroviral drugs, known as triple combination threat therapy (HAART), became standard treatment for HIV infection.
The Education Act 1996 stipulates that maintained schools must provide free school meals to disadvantaged pupils aged between five and 16 years of age.
The Society formally merged with the Royal Institute of Public Health and Hygiene.
H5N1 influenza starts spreading and global outbreaks begin to become a common occurrence.
The CDC establishes the Global Health Programme.
The Rough Sleepers Unit is set up. It aims to reduce the number of rough sleepers by recognising its causes. Numbers have falled by 56% since 2003.
The National Chlamydia Screening Programme was established to ‘prevent and control chlamydia through early detection and treatment of asymptomatic infection; reduce onward transmission to sexual partners; and prevent the consequences of untreated infection’.
The congestion charge is introduced in London. It enforced a mandatory fee for vehicles entering specific zones. Congestion has been reduced by 30% within these zones as well as reducing CO and NO pollution.
The Licensing Act 2003 replaces earlier controls of alcohol and introduces a more permissive, flexible regime, moving responsibility and licensing from local magistrates to local councils.
Scotland is the first country in the UK to enforce rules which banned smoking in public, passing the Smoking, Health and Social Care (Scotland) Act 2005.
"Scores on the doors" food hygiene ratings are introduced and information is collected by local authorities. The scheme is standardised by the Food Standards Agency and in 2012 is rolled out as the Food Hygiene Rating Scheme. The UK becomes a Party to the WHO Framework Convention on Tobacco Control
The Health Act 2006 is passed, affecting the sale of tobacco products. The Act places a ban on smoking in enclosed public places and increased the age of purchase for tobacco products. Bowel Screening Programmes began in England (2007 Scotland, 2008 Wales and 2010 in NI). Over 25,000 cases of bowel cancer have been detected as a result of the scheme.
Ofcom bans advertisement of foods high in fat, sugar and salt during television aimed at children under 16.
The HPV vaccine is introduced for girls aged 12-13. Boys of the same age are now also eligible for the vaccine.
Swine flu pandemic began. The virus is first identified and causes a global flu outbreak.
The Marmot review is published, a government-commissioned report looking at the landscape of health inequalities in England, and what could be done about them. The review made a strongly evidenced case that health inequalities have social determinants, and that health and wellbeing were just as important measures for society as economic growth.
The Alcohol Minimum Pricing Scotland Act 2012 passes introducing a minimum unit pricing (MUP) and setting a baseline price at which a unit of alcohol can be sold. The Health and Social Care Act 2012 is passed, extensively reorganising the structure of the NHS in England. Responsibility for the operation of the public health system moved from the NHS to local authorities.
The childhood flu vaccine is introduced. The success of the programme led to the roll out in 2019-20 of flu vaccines for all primary school aged children in the UK every year. Traffic light labelling on packaged food is rolled out. It encourages the nutritional content of food to be colour coded on packaging. Public Health England (PHE) is established. Responsibility for commissioning PH services was moved from the NHS to local authorities. Drug safety testing at UK festivals is first piloted, allowing anonymous substance testing. In 2016, two UK festivals saw nearly 1 in 5 users dispose of their drugs once aware of the content.
Soft Drinks Industry Levy taxes manufacturers based on the sugar content of their product. It forces product reformulation and recognises the role of the food and drink industry in the public making healthier choices. The UK government reduces the maximum stake on fixed odds betting terminals from £100 to £2.
Abortion is decriminalised in Northern Ireland. Junk food advertisement is banned across the entire Transport for London network.
Covid-19 is declared a pandemic by the WHO.
The UK Health Security Agency (UKHSA) is formed, an agency under the Department for Health and Social Care. It transferred health improvement functions from Public Health England (PHE) to the DHSC.
The Khan Review is published. The report considers what is needed to achieve the Government's 2030 Smokefree target, making 15 recommendations, including the promotion of vapes as an effective ‘swap to stop’ tool to help people quit smoking.
ADPH celebrates 175 years since the first DPH was appointed. Monkeypox outbreaks occur in non-endemic countries, including the UK, with cases mainly concentrated in London.
ADPH celebrates 175 years since the first Public Health Act was passed in 1848.
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