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Long live the public health movement!

Lynn Young
Primary Healthcare Adviser for the RCN

The government is going all out to improve public health. Perhaps it is embarrassed over the current level of health inequalities in this prosperous nation of ours. All nurses, even those utterly devoted to the acute sector, must think and act "prevention of ill health and health improvement" as much as care and treatment. This is challenging, but not for the thousands of nurses who constantly strive to improve their practice and push traditional boundaries and hierarchies when it is in the public interest to do so.
Florence Nightingale, probably the first effective public health nurse, was certainly happy to do battle with the ministers and other officials of the day when it came to taking action to achieve improvements to public health. But public health is a strange beast and infuriatingly complex to tackle as it entails doing business with all sorts of agencies - voluntary, private and state. Dealing with the NHS alone is simple, even child's play, by comparison. We know impoverished social conditions cause huge disadvantage to people, even before they are born!
So, while public debate becomes heated over smoke-free public places and limiting the advertising of certain foods to children, it is interesting to recall the public health battles fought by Florence Nightingale in the 19th century.
Florence was fascinated by the benefits of good sanitation and other factors promoting good health - clean water, nutrition, a secure family breadwinner, activity, education and fresh air. In 1892, "she supported district nurses and Lady Health Missioners [the original health visitors] to teach village mothers the elementary principles of health in the home,"(1) adding that, "the Health Missioners were not to lecture the village women but to work with them".(1)
In 1897 there was an alarming increase in venereal disease, which Florence believed could be prevented in the longer term only through better living conditions and improved education standards.
So, what is the current state of public health? Despite an unbelievable growth in prosperity, compulsory education and heaps of public money being spent on a sexual health strategy, the UK still has the highest unplanned teenage pregnancy rate in Europe as well as an epidemic of chlamydia, not to mention a population that is rapidly becoming as obese as the USA's.
The UK population may have access to clean water, but we still have far too much substandard housing. GPs and health visitors constantly make referrals to the housing department for people who live in damp housing and suffer from chronic chest conditions.
Then there's MRSA. As you would expect, Florence had one or two things to say about hospital infections, and collected a daunting amount of data to explore the level and cause of postpuerperal infection - the major cause of maternity mortality at the time. Even the poorest mother was more likely to survive if she gave birth at home rather than in hospital. In hospitals where each room had a small number of beds, the rate of infection was lower than where many beds were squeezed together in cramped conditions. Florence also, to her great credit and against huge medical hostility, noted that thorough and constant handwashing helped to reduce infection rates and protect patients.
Over 110 years ago, Florence Nightingale, in the midst of great poverty and human deprivation, led a massive public health campaign to help improve the lives of desperate people. It is tragic that, despite unprecedented wealth, democracy, a comprehensive welfare system and freely available education, the problems, causes and solutions of 100 years ago closely resemble those of today.
Long live the public health movement - there is still much work to do.

1. Woodham S. Florence Nightingale. London: Book Club Associates; 1972.