Introduction

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Ch. 7

Ch. 6

Ch. 5

Conclusion

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Discussion Section

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Chapter 4 Annotation

The fourth chapter to Berridges Public Health: A Short Introduction focuses on the 1800’s to the 1900’s. This time in history saw a huge explosion in population, a jump in the amount of people living in urban areas, and a jump in the industrialization of the world. The chapter starts off by noting the fact that life expectancy did not change throughout the 1800’s. They attribute this to the decreased living conditions in the newly urbanized areas. These conditions stayed relatively the same, until the 1900’s, where there were public health efforts to clean up the cities.

There was a huge jump in the field of public health in the 19^th century as a direct effort to address the issues that came with the urbanization and industrialization of the world. These came with a plethora of issues, such as the spread of cholera. This is accepted to be the driving force behind the 19^th century movement. Cholera has a high mortality rate, and is very easy to spread in close quarters, so this was a prime place for spreading. Initially, public health officials would quarantine infected people, and inspect the goods being brought through ports. Although, this was found to be ineffective, and it still killed many of the lower class individuals.

The cholera epidemics led to some changes in public health. This was mostly due to the overwhelming evidence that poor people got sick, and were living in far harsher conditions than anyone else. Edwin Chadwick was very key in this movement, and he wrote reports on the sanitary conditions of the poor. Edwin Chadwick did a study in which he compiled surveys from around 2,000 people, which then proved the likeliness of death went hand in hand with social class. This led him to create a system of waste disposal in an effort to stop the spread of disease.

It was during this time that vaccines were created. They were created from the observation that people who had been infected with cowpox could not be infected with smallpox. After proving that vaccinations were possible, it soon became one of the most important things to happen in the field of public health. In the 1840s, vaccination for smallpox was mandatory in children, and it led to a drop in the deaths due to smallpox.

At the end of this chapter, Berridge goes through public health at the turn of the century. The focus changed from improving the environment, to the individual.  The focus also changed from infectious diseases, to something known as the racial purge. AKA tuberculosis, alcoholism, and venereal diseases.

This chapter is very useful, as there was a lot of information in it. The ideas of this time period are still very well in use today, and some of the biggest steps in public health were accomplished throughout the years in this chapter. The cleaning of the cities was huge, along with the development of vaccines, and the germ theory. All of these are still in use in the modern times.  

Chapter 3 Annotation

In chapter three of Berridge’s Public Health: A Very Short Introduction, she starts off by saying that without understanding where public health started, we will not be able to understand it in the current day. Throughout the very early days of public health, around 4000 years ago, we can see traces of an organized effort to optimize the health of the people. This chapter explains that the biggest area for public health during these very early years was around building and the disposal of wastes through plumbing. Both of these ancient efforts are still a public health effort today.

This chapter then moved onto the Greeks, who permanently shifted the efforts of public health. Hippocrates changed the ideals of people, and began the shift of the ideas of disease from an idea that disease was a punishment of the gods, to the idea that things and peoples routines could cause disease. Hippocrates and his works made medicine a holistic medicine, and even though he thought that the health was in the balance of the four humors, it was still a large step in the medical field.

In the middle ages, malnutrition and disease were the leading causes of death, and this was not to change. Berridge explains that there was a huge boom in the Bubonic plague, which changed the field of public health drastically. The worst years for the Bubonic plague were from the 13^th to 14^th century.  The suffering of the people in these times was great, and it came to public health to try to stem the flow. Berridge explained that one of the key things to come out of this time was the technique of quarantine. In Italy, they would quarantine ships traveling from areas with a high amount of the plague in order to stop the spread through Italy’s ports. Leprosy was uncommon throughout the ancient times, but with the population boom, it began to become more prevalent. People who had leprosy were also subject to quarantine in the medieval times. They were often ignored or excommunicated by the community, for fear of also catching the disease.

One thing that could be very useful in this chapter would be the looking at life expectancy. It was very interesting to see the changes, and it was interesting to see that it may have been somewhat skewed due to the amount of babies that died in or shortly after birth. It could also be useful to know the history of quarantines, and the early history of public health. 

Methods Section

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CH 2 Annotations

In chapter two, Berridge explains some of the challenges within the field of public health. Specifically, she spends the chapter looking at the issues faced at the local and national levels in the United Kingdom. In 2014, a survey was completed in order to see some of the issues that public health officials thought should be priority. Some of the issues that they thought were important are pricing of alcohol, tobacco packaging, reducing the amount of personal transport, minimum wage, minimum physical activity, cutting sugar in foods, stopping the marketing of high fat and sugar foods to children, installing health education into the school system. These are issues that are not only a priority in the UK, but also throughout the globe.

One of the biggest topics in public health is the topic of behavior modification. She explains that this is what public health officials do in order to nudge people into healthier habits. Berridge says that smoking is one of the best examples of behavior modification. The biggest issue with smoking was to denormalize it. The first big step was to pass the legislation of no smoking zones. Another way of denormalizing it was to create plain packaging.

Berridge also goes over the tactics that public health officials use in order to create healthier lives. The easiest and largest example of this is vaccinations. Nearly all children in the UK are immunized against tetanus, diphtheria, whooping cough, meningitis, MMR, and most other infectious diseases. Along with this, vaccinations have started to be used for cervical cancer since 2008 in teenage girls, and since its beginning has become routine.

Another tactic used by public health officials is the screenings of the population. Screenings came into the field when tuberculosis was widespread. The United Kingdom started using screenings in 1948. The screenings would take place in either a hospital setting or in a general surgeon’s office.

In the UK, the Health and Social Care Act reorganized the health systems, and gave local authorities health related duties to achieve. This act also mandated that they appoint a local director of public health. This move began the shift from the health services region where public health had been, into the field of politics. A move that brought public health back around to its roots.

One of these biggest issues in the field of public health right now, and over the history of the fields, is looking at the health inequalities that lower socioeconomic status people face. It is much more difficult to achieve and maintain a high health status if one is in the lower socioeconomic status. In London, the closure you lived to their train system, the lower your general life expectancy. Through the use of figures, maps, and graphs it was very easy to see the difference in life expectancies throughout the different socioeconomic statuses. 

CH.1 Annotations

In chapter one, the author Virginia Berridge went into detail on what public health exactly is, and some of the origins that it has. This is quite the difficult thing to do, as public health wraps itself around a wide variety of issues throughout history and the current day. Even though public health is an ever changing field the general goal has stayed the same, to promote the health of the people. It can do this either at the local level, state level, national level, or even the international level.  

She goes over the changing definitions that public health has so commonly had. In 1988 Donald Acheson’s idea of public health was along the lines of preventing disease to elongate the lives of the citizens by using society to create change. In 2004, Derek Wanless added the idea of informing the public on their choices. In only 16 years, the definition of public health changed massively, showing how fluid the field of public health is.

Along with this, chapter one goes over the three domains of public health. The first of these is health improvement. Health improvement is the act of trying to change the determinants of health through promoting healthy lifestyles and environments. The second section of public health is health protection. This section tries to protect people. It can do this through the use of vaccines, injury preventions, screenings, and many more. The third and last section of public health is health service improvement. This section aims to provide services to all of the population, improve the services that the population has, and make sure that all services are readily available to the population.

Some of the critiques about public health are also made clear in this chapter. One of these critiques is quite simply that the definition of public health is so very broad, and what it should be doing is always under debate. Some say that because the definition of public heath is so broad, people can sometimes make large stretches to get personal gain.  Another issue surrounding public health is the question on how it should take on health issues. Should it focus on easier more technical fixes, or should it try to make much larger and more difficult social changes?  The larger social change requires a foot in politics, which some people don’t think public health should be in. Social change also requires massive social shifts, and as such is much harder to accomplish without push back. The idea of a nanny state is when public health oversteps its borders into personal freedoms, even though they may be causing a benefit to the health of the population.