Health systems of
some sort have existed for as long as people have tried to protect their health
and treat diseases. Traditional practices, often integrated with spiritual
counseling and providing both preventive and curative care, have existed for
thousands of years and often coexist today with modern medicine. But 100 years
ago, organized health systems in the modern sense barely existed. Few people
alive then would ever visit a hospital. Most were born into large families and
faced an infancy and childhood threatened by a host of potentially fatal
diseases – measles, smallpox, malaria and poliomyelitis among them. Infant and
child mortality rates were very high, as were maternal mortality rates. Life
short – even half a century ago it was a mere 48 years at birth. Birth itself
invariably occurred at home, rarely with a physician present.Health
systems have undergone overlapping generations of reforms in the past 100
years, including the founding of national health care systems and the extension
of social insurance schemes. Later came the promotion of primary health care as
a route to achieving affordable universal coverage – the goal of health for
all. Despite its many virtues, a criticism of this route has been that it gave
too little attention to people’s demand for health care, and instead
concentrated almost exclusively on their perceived needs. Systems have
foundered when these two concepts did not match, because then the supply of
services offered could not possibly align with both.
18th century saw rapid growth in voluntary health care services in European
countries. The practice of vaccination
became prevalent in the 1800s, with the onset of the Industrial Revolution,
living standards amongst the working population began to worsen, with cramped
and unsanitary urban conditions. In the first four decades of the 19th century
alone, European population doubled and even greater growth rates were recorded
in the new industrial towns. This rapid urbanization exacerbated the spread of
disease in the large conurbations that built up around the workhouses and factories.
These settlements were cramped and primitive with no organized sanitation.
Disease was inevitable and its incubation in these areas was encouraged by the
poor lifestyle of the inhabitants.
Unavailable housing led to the rapid growth of slums and the per capita
death rate began to rise alarmingly, almost doubling in most part of the
states. The Poor Law Commission reported
in 1838 that “the expenditures necessary to the adoption and maintenance
of measures of prevention would ultimately amount to less than the cost of the
disease now constantly engendered”. It recommended the implementation of
large scale government engineering projects to alleviate the conditions that
allowed for the propagation of disease.
The first attempts at sanitary reform and the establishment of public health
institutions were made in the 1840s.