Britain’s health has changed throughout history and what was considered healthy in the past has been proven to be unhealthy today. Some stark examples are that the average life expectancy at a time in nineteenth century Britain for wealthy adults was around 45, while this was lower in the poorer classes, and the percentage of children reaching the age of 5 was much lower in the 19th century than now.
Amy Chandler explains looks at how health and diet has evolved over time.
Sir William Beveridge in 1943.
In society today, individuals are able to take control of their health, if they wish, through the development of apps and trackers that monitor health and lifestyle. The World Health Organisation (WHO) states “social factors, including education, employment status, income level, gender and ethnicity have a marked influence on how healthy a person is”. (1) While the development and innovation of the National Health Service (NHS) in Britain has offered opportunities of free and equal access to medical services, the strain on the economy still limits the capabilities and progress of creating accessible medical treatment for all in Britain. The NHS celebrated 75 years this July and despite the innovations of the health service, the need for funding, treatment and staff equality, limits the good that the service can provide in Britain. This article explores the social, political and economic changes that impacted Britain’s health throughout the nineteenth and early twentieth century to the emergence of the NHS.
Diets, health and lifestyle
The industrial revolution between the years 1760 to 1840 created a boom in industry and manual labour employment in major cities such as Manchester, Liverpool and London. This industrial revolution increased social mobility into the cities and a rise of poverty and disease for the working classes. Despite the rise of infectious diseases and poor living and working conditions, the diet of the working class was not as unhealthy as historians once believed. Those who worked in manual employment, such as factories and docks, were constantly active and needed to consume more calories to sustain themselves during long working hours. The majority of the poorer classes ate food that was in season such as fruits, vegetables and less fatty meats. In comparison, wealthy classes weren’t as active and had access to an abundance of food, alcohol and sugary sweets causing rotten teeth and gout.
For the poor, food supplies were uncertain, basic in diet and didn’t provide the nutrients for a healthy body creating a prevalence of malnourished adults and children. Few had access to personal ovens and relied on open-fires, buying hot food out or eating cold meals. There was limited access to cooking utensils, with many households only using one pot for their cooking. This meant that the access and availability of hot food was scarce or expensive.(2) Many relied on buying off-cut pieces of meat that were rotting or poor quality, and these meals were small and far between. The upper classes indulged in dinners with several courses and had access to the freshest qualities of meat. Usually, household cooks would order their meats, fish, vegetables and other ingredients on the day that they were needed to ensure fresh meals, whereas the poor did not have access to the same expensive food. Furthermore, the overindulgence of rich and decadent food created a rise in obesity amongst the men of the upper class. The obese, rich male figure was seen as a symbol of high status and a display of their wealth because they could afford an abundance of sweet and fatty foods. Wealthy women were not usually obese due to the beauty standards of society, where women wore tight corsets and were expected to be fragile and thin. In modern society, the rise and health implications of obesity are impacting on the NHS.
The British Empire increased the transportation and access to many new foods, sugars and a variety of ingredients such as canned fruits and condensed meat. These new foods became widely available and impacted the health of all classes in Britain. Sugar and fatty foods were only previously available to the wealthy, who could afford the price. (3) The rise in consumption of sugar caused damage to the nation’s teeth and a frequent dental complaint reported by 1900 was the inability to chew tough foods, nuts, vegetables and fruits. The fall in nutritional standards impacted future generations, especially during times of army conscription. Furthermore, the living conditions in poverty-stricken areas created a decline in health with poor sanitary conditions, unclean drinking water and the lack of sunlight in urban slums creating a Vitamin D deficiency. The slums had dense, thick fog as a result of pollution and poor air quality, cramped, filled with rubbish, unsanitary living conditions and contaminated drinking water. These areas were also subjected to communicable diseases such as tuberculosis (TB), cholera and smallpox, to name a few. This also created a large gap between the health of the poor and the wealthy. The wealthy were not immune to these illnesses, but were less susceptible to dying of consumption or poor living conditions, but were more likely to suffer heart attacks from their rich and fatty diets. Therefore, the lives of the working class are considered healthier in terms of fitness levels, eating less fatty and sugary foods, but on the flipside many lived in unsanitary housing, likely to become unwell from the spread of fatal diseases in crowded areas and many could not access medical care.
London’s pollution also contributed to a number of respiratory health conditions coupled with the turn of the century popularity of smoking. The rise of smoking in the 1880s with the growth of industrial cigarette production created accessibility to cigarettes. The preference to using snuff declined and was replaced with cigarettes which was only encouraged during the first and second world war when soldiers were sent cigarettes in their rations. The commercialisation of smoking was seen as a good habit for people and was most commonly used by King George VI to overcome his stutter. The lack of medical knowledge on cancers and what caused these diseases meant that many became addicted to smoking without knowing or understanding the impact on their health. It is only in recent history that the UK government has attempted to tackle smoking in the population, with their strategic plan towards a ‘smoke-free generation’ in England.
The formation of the NHS
After the devastating impact of the Second World War, the health of the nation was deteriorating with rationing, war injuries and the economic burden of the war effort. These factors emphasised the long-term need for a strategy to strengthen the country. The British government needed to find a solution to improve the nation’s health, strengthen the economy and navigate post-war life. In December 1942, Sir William Beveridge compiled a report, Social Insurance and Allied Services, on the health of the nation. Beveridge’s report identified the five evils that permeated society; disease, want, ignorance, squalor and idleness.(4) In a Parliamentary debate in 1944, Members of Parliament (MPs) suggested the NHS would be a “comprehensive and unified health service for the people”, which is part of a “process of reshaping the background of individual life” in Britain. (5) The NHS was seen as a “counter-process to all the destructiveness of war”. (5)
Throughout history, class and wealth defined people’s health, diet, lifestyle and quality of life and these differences were a continual reminder of social hierarchy. However, war was an equaliser that did not discriminate. Every member of society was impacted from conscription, bombing raids and the emotional and physical scars of war. Arguably those with money could live comfortably and safely, but everyone was equal with a collective desire for the war to end. Services that offered medical treatment like charities were fragmented and not unified. Therefore, there was a sense of openness to the idea of a national health service that was for the many not the few, however there was still opposition to a free health service. As stated in a Parliamentary debate, the service was “no scheme [designed] for giving charity to individuals or state help to particular classes or groups” and it “does not concern itself with poverty or wealth.” (5) This was a scheme that aimed at raising the nation’s health to a “higher plane and keep it there.” (5) This was a step towards equality in post-war Britain under the Welfare State. Under the umbrella of the Welfare State, each member of society was expected to pay a contributory amount of money as National Insurance. (4) The reason that Beveridge insisted on National Insurance was to ensure that the NHS did not damage an individual’s sense of pride, independence and personal responsibility. (4) The NHS created a sense of accountability for one’s health and offered the opportunity for those in poverty to better themselves.
The NHS was officially formed in July 1948 and 75 years later, the NHS is still providing a variety of care and treatment to the public. However, the nation’s health is not where it could be, the COVID-19 pandemic placed a strain on public health services and was economically struggling. NHS workers are striking for better pay and working conditions, while patients are placed on waiting list months in advance. Health issues such as smoking, obesity and mental health are areas that still need improvement, coupled with the changes in lifestyle. Many people work remotely and are not commuting in the same way causing a change in routine and in some cases causing a negative impact on their health. The introduction of the NHS in 1948 was a massive step forward in improving the nation’s health that came after education and housing reforms that cleared the slum areas, that were bombed heavily during the blitz. Since 1948, many have benefitted from the treatment, care and expertise of health care professionals.
Conclusion
The perception of health has changed throughout history and one treatment that was once seen as effective is now seen as poisonous or ineffective. Illness was prevalent in all areas of society but the type of diseases differed depending on the living conditions, diet, lifestyle and access. What was once seen as healthy, such as smoking is now widely acknowledged as severely damaging to health and quality of life. The advancement in technology in identifying risks to increasing disease and health implications is far greater than in the past. The formation of the NHS was a changing point for Britain’s health and the desire to offer medical treatment to all classes of society in a bid for health equality. Historians often present the poor and working classes as malnourished and in poor health, however in the modern standards exercise and eating less sugar is seen as ideal and due to their lack of accessibility to fatty foods and sugar they were less susceptible to high cholesterol and other illnesses. The health and lifestyle of the working class should not be romanticised as a healthy way to live, as they were far from healthy. A digital age has allowed for more accountability, responsibility and opportunity to take our health into our own hands through fitness apps, healthy recipe boxes and ways to monitor our bodies through forms of artificial intelligence (AI). Progress is still slow in solving major health issues such as cancer, but the rise of technology can provide new ways of treating, curing and progressing our health.
What do you think of Britain’s health over time? Let us know below.
Now read Amy’s article on the history of medicine at sea here.
References
WHO, ‘Health inequities and their causes’, 22 February 2018, World Health Organisation, Available at < https://www.who.int/news-room/facts-in-pictures/detail/health-inequities-and-their-causes > [accessed 27 July 2023].
A. Whol, ‘What the Poor ate’, July 2022, VictorianWeb, Available at < https://victorianweb.org/science/health/health8.html >[accessed 27 July 2023].
P. Clayton., and J. Rowbotham, ‘How the mid- Victorians worked, ate and died’, Int J Environ Res Public Health, vol. 6 (2009). Available at < https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2672390/ >[accessed 31 July 2023].
The National Archives, ‘1940’s origin of the Welfare State’, 2023, The Cabinet Papers, Available at < https://www.nationalarchives.gov.uk/cabinetpapers/alevelstudies/1940-origins-welfare-state.htm >[accessed 1 August 2023].
HC Deb, 16 March 1944, vol 398, cols 428 - 429.
