The Medical Officer of Health (MOH) reports provide evidence that behind the high-profile medical advances of the 19th and 20th centuries, the vast improvement in the nation's health was largely the result of the bread and butter of public health: clean water, adequate sewerage, immunisation, better housing and improved diets.
And yet, despite their pivotal role in improving Britain's health, MOHs were always the poor cousin within the world of medicine. The early reports paid more attention to details of soil type, drainage and "atmospheric and meteorological peculiarities" than they did to medical concerns. This was not the world of London's leading hospital surgeons: it took a certain kind of doctor to accept that it was unpolluted water and decent housing rather than medical skill which would benefit the bulk of the populace.
In insisting on the link between public health and the politics of poverty, MOHs commonly faced fierce local opposition. Local politicians were often also the traders, industrialists and landlords that MOHs were trying to act against. As late as 1919, one anonymous MOH complained in the professional publication 'The Medical Officer' that:
one of the most vexatious incidents that can occur… is the censoring or attempted censoring of his annual report by members of the council… but in matters of public health the private feelings of interested parties should be of less than no account.
In the second half of the 19th century, public health became increasingly professionalised: the Association of Metropolitan Medical Officers of Health was formed in 1856, a year after new legislation reorganised London into 48 districts, each with its own MOH. Professional knowledge was disseminated in the often lively exchanges in 'Public Health' and later in 'The Medical Officer'.
The creation of the Ministry of Health (1919) ushered in what we can now see as the zenith of MOHs' influence and responsibility. A series of permissive Acts passed over the next decade allowed councils for the first time to create 'cradle-to-grave' provision of health and welfare benefits, including:
These years saw proactive councils (often Labour), supported by energetic MOHs, overseeing large departments that managed slum clearances and new hospital and clinic building programmes and an ever-widening range of municipal health professionals, such as midwives, health visitors, school doctors, sanitary inspectors, pathologists, bacteriologists and tuberculosis specialists.
During World War II, the government assumed an unprecedented and pivotal role in all areas of the Home Front, with the creation of the Emergency Medical Service giving it a degree of power it had never before possessed. Although forged in war, the new ascendancy of central government was carried through into the postwar construction of the welfare state.
The creation of the National Health Service not only indicated a profound shift in the balance between central and local government, but also precipitated the decline in the influence of MOHs. Shorn of their active medical functions, local authority health departments were reduced to managing a rump of sanitary, housing and environmental health services, with occasional forays into the issue of 'problem families'. Indeed, the last years of MOH reports, with their discussion of unfit properties, housing improvements, food sampling and disinfestation, share more in common with their mid-19th-century counterparts than the heady days of the 1930s.
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