The Chadwick Report: Sanitation Reform and the Public Health Revolution

Sharon Marie Mathew Junior Division Individual Website

Process Paper

When I thought about picking a topic, I felt strongly about researching a revolution that had a lasting impact across the widest cross section of people all across the world. My interest in the field of health, led to me investigating revolutionary innovations in health care that had a global impact. I was able to appreciate the extent to which medical science has advanced as I read a New York Times science article highlighting the field of Epigenetics. I understood that developed nations with access to advanced technology could focus on genes and chronic disease research because infectious diseases that swept across nations rarely plague them anymore. As soon as epidemics start, they are contained. I started thinking about innovations in the past that had made these changes possible. Meanwhile in developing nations epidemics of cholera, yellow fever, typhoid and diarrhea continue to claim lives. Why is this? After having spent a week in London, I was shocked to read Charles Dickens description of London in the late 1800s in his novel Great Expectations. Could he be talking of the same city? As I understood the impact of John Snows discoveries, the germ theory, vaccinations, and antibiotics, I was surprised to learn that the first greatest change in mortality stemmed from changes in sanitation. Sanitation reform had perhaps the most far-reaching impact of all spanning over more than a century. The presence of selfdispensing wipes and hand sanitizers in public places has become a testament to the fact that the simple act of sanitizing your hands can prevent the spread of most common bacteria. I was intrigued by the Sanitation reform, which started in the late 19th century and able to see clearly how this led to a change in the public thinking about health and eventually led to the public health revolution. The impact of the public health revolution has restructured the world, as we know it and provided us with all our basic amenities. However it continues to be an ongoing struggle in corners of the world where clean water and basic sanitation is a luxury. None of the therapeutic innovations of modern medicine would have the same impact had it not been for the seemingly simple acts of sanitation that allowed for the gradual revolution of Public Health. I performed most of my research using Internet resources. I started with data from the center for disease control looking at mortality and disease rates from cholera and other diseases over the years from the mid 1800s. I read through early newspaper articles, scientific journals including Science, Nature, British medical Journal and the Journal of epidemiology. My research familiarized me with the various Public health acts and as I worked backwards I read the Chadwick Report in England and the Shattuck report in USA. I obtained this information using

the following resources: the BBC, The History channel, History.Com, NY Public Library and the National Library of Congress and the National Library of Medicine. I also borrowed scientific journal reading from the Health Sciences Library at Columbia University in New York and established email contact with Dr. David Rosner a leading authority in the field of public health at Mailman school of Public Health. My primary sources were the Chadwick report of 1842: The Sanitary Condition of the Labouring Population. This described in detail Chadwicks observations, conclusions and petitions. I understood how public health and sanitation came about in the United states by reading the Shattuck report of 1850: A report of a general plan for promotion of general and public health, devised, prepared and recommended by the commissioners appointed under a resolve of the Legislature of Massachusetts, relating to a sanitary survey of the state Coming from a complete non medical background, Chadwick was able to identify with astuteness the link between sanitation and disease though it was based on a faulty premise. Anther primary sources that I used the article: The untilled Fields of Public Health by C.E. A Winslow published in Science in 1920. This gave me the insight I needed to understand the inception of public health. I also read the Surgeon Generals proceedings from 1967 to get a true understanding of how sanitation and public health had made great strides and made health care and quality of life a public concern. I chose to create a website as my project since I wanted to incorporate modern technology to showcase the topic and make it easily accessible. A website was most practical to organize the material that I had collected in a simple but interactive format. After doing extensive research, I created an initial draft and over time I gradually finessed it to include all the information in a simple yet concise manner to show how the Chadwick Report of 1842 set the tone and urgency for sanitation reform. As sanitation reform measures were put in place the public health revolution of the 20th century started. The impact of the sanitation reform has extended beyond the field of health into social, political and economic arenas as well. Sanitation reform led to immediate urban re-planning and improved quality of life with an immediate decrease in morbidity and mortality. The sanitary reform changed our world. What started as a social reform movement by a simple report authored by Chadwick, ended up changing the public perception of disease by shifting the focus to public health and prevention. Without the sanitary reform we might still be living in the squalor of the Victorian era. Without the preventive measures of sanitation and clean water the treatment of disease alone is insufficient to decrease mortality, as is evident in the developing nations of the

world. Thanks to Sanitation reform and the Public Health revolution we have the answers to these problems. The focus of global public health now has shifted to global implementation of these answers.