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This chapter discusses the historical development of a national public health system. Under the 1848 Public Health Act, Edwin Chadwick succeeded in setting up under his own direction the first General Board of Health. In the early 19th century, the sustained contempt for medicine he manifested was not difficult to justify; he looked instead to engineering for technical support. Medical practice was then entirely unregulated, excepting the mild self-regulation of their members by academic bodies, the Royal College of Physicians and, later, the Royal Colleges of Surgeons and of Obstetrics and Gynecology. It was near mid-century before professional organizations had formed and assumed the power to set standards for themselves, and later still before John Simon himself established training for public health professionals.

This chapter examines the origins of health promotion in the UK. It begins with a discussion of diseases in Britain before and during the nineteenth century that made public health a major concern of governments, followed by an analysis of the role of William Farr in establishing a system that recorded the cause of death, along with three important pieces of legislation: Poor Law Amendment Act 1834, Public Health Act 1848, and Public Health Act 1875. The chapter then considers disease monitoring and surveillance before describing Charles Booth's work on poverty in the late nineteenth century, Benjamin Seebohm Rowntree's poverty surveys, and the consequences of the Boer Wars for public health. Finally, it explores key legislation in the twentieth century prior to the establishment of the NHS, the emergence of a new public health, and the impact of health promotion on the social determinants of health.

Dental diseases affect a large number of people, cause much discomfort and pain, and are costly to treat. Their impact is therefore considerable, to both the individual and wider society (see Chapters 3 and 21 for a more detailed overview of oral health impacts). A particular concern is the pervasive nature of oral health inequalities with the burden of oral diseases now increasingly experienced amongst less educated and socially excluded groups in society. The causes of dental diseases are well known and effective preventive measures have been identified. However, treatment services still dominate oral health systems around the world. There is growing recognition within the dental profession that treatment services will never successfully treat away the causes of dental diseases (Blinkhorn 1998). In the Lancet , one of the top medical journals, an editorial on oral health highlighted the need to reorient dental services towards prevention (Lancet 2009). What type of preventive approach should be adopted to promote oral health and reduce inequalities? It is essential that preventive interventions address the underlying determinants of oral disease and inequalities to achieve sustainable improvements in population oral health. Effectiveness reviews of clinical preventive measures and health education programmes have highlighted that these approaches do not reduce oral health inequalities and only achieve short-term positive outcomes. A radically different preventive approach is therefore needed. If treatment services and traditional clinical preventive approaches are not capable of dealing effectively with dental diseases, then other options need to be considered. In recent decades, the health promotion movement has arisen, partly in response to the recognized limitations of treatment services to improve the health of the public. With escalating costs and wider acceptance that doctors and dentists are not able to cure most chronic conditions, increasing interest has focused on alternative means of dealing with health problems. The origins of health promotion date back to the work of public health pioneers in the 19th century. At that time, rapid industrialization led to the creation of poor and overcrowded working and living conditions for the majority of the working classes in the large industrial towns and cities of Europe and North America.

This chapter examines the incidence of coal smoke in fogs in and around London and the pattern of such fogs over time. Brodie attributed these fogs to intense coal smoke emissions between 1871 and 1903. Brodie's limited data and additional information on coal consumption per capita, gas and electricity use, abatement legislation, and mortality from respiratory diseases is reconsidered. A reverse event study, using spikes in mortality to predict severe fogs and then compare those predictions against other evidence regarding their occurrence is constructed. Between 1855 and 1910, there were recurring fogs, but none after 1900. The smoke density in London fell for a variety of reasons: the city's population became more dispersed; the inhabitants became richer; and associated regulations, such as the 1891, Public Health Act instituted fines for dense smoke emissions, promoting a shift to the use of gas and hard coal that burned more cleanly. The chapter concludes that Brodie was correct in his assessment of the source of London's killer fogs and that the city had to reach a threshold level of income and technological advancement before it could address the problem of coal smoke.