Public health
Public health has been defined in Scotland as the protection of the community from infectious diseases, contamination or other such hazards which constitute a danger to human health.[1] More widely, the provision of clean water, control of pollution, disposal of refuse and monitoring of standards of hygiene were used along with vaccination and fever hospitals to improve people’s health.
In medieval and early modern Scotland, people dealt with plagues and contagious diseases by isolating places, preventing contact by stopping trade and commerce, burying bodies quickly and cleaning and disinfecting contaminated homes. One example of this approach is found in the appointment by parliament of a commission to contain the outbreak of plague in Bo’ness.[2] Justices of the Peace were given responsibilities for dealing with plague and most burghs used similar methods of containment and disinfection.
The 19th century saw several outbreaks of cholera, but medical opinion was divided on how diseases were transmitted and resulting legislation reflected this uncertainty. The Cholera Prevention (Scotland) Acts 1832 gave the Privy Council powers to prevent the spread of disease, funded by assessments in burghs and parishes.[3] In 1840, Professor W P Allison of Edinburgh University claimed that poverty was the root cause of ill health and this led to the reform of the poor law.[4] The Nuisances Removal (Scotland) Act 1856 focused on improving living conditions.[5] The Vaccination (Scotland) Act 1863 made vaccination against infectious diseases compulsory.[6]
The Public Health (Scotland) Act 1867 tackled every identified possible source of infection and transmission.[7] The Board of Supervision could conduct inquiries, but the main responsibilities fell on local authorities, which were generally burgh commissioners or town councils or parochial boards. These local authorities were to appoint medical officers of health and sanitary inspectors and to remove nuisances that could affect human health, such as poor ventilation, drainage, lack of privies or other facilities, accumulations of manure or rag and bones, badly operated fireplaces, furnaces, chimney smoke, ashpits and overcrowded cemeteries. Contamination was controlled by preventing the sale of ‘unwholesome meat’ and regulating offensive trades and local authorities were to provide sewers, drainage and water supplies. Transmission of disease was to be prevented by burying bodies rapidly, visiting house to house to dispense medicine and medical aid to infected persons and by providing hospitals and transport for infected persons. Local authorities were also to provide public toilets and to ensure that ships and ports were cleansed and disinfected. There were also restrictions on infected persons and local authorities were permitted to cover the costs of vaccination where necessary. Local authorities were also empowered to provide and maintain grounds for public recreation.
From 1889, infectious diseases had to be notified to the medical officer of health.[8] The Public Health (Scotland) Act 1897 followed a similar approach to the 1867 act but gave more power to the central authority, now the Local Government Board for Scotland, to authorise inquiries into local areas. Local authorities (i.e. town councils, police commissioners, district committees and county councils) were still required to appoint a medical officer of health and a sanitary inspector. The removal of nuisances remained a key method of control with regulation and licensing of offensive trades and an emphasis on cleansing and disinfection. Additional rules were put in place for water supplies, sewers and drains, lodging houses and provision of hospitals. Further steps included putting infected people without adequate accommodation into hospital free of charge, keeping infected children off school and inspecting dairies with powers to prohibit the supply of milk.[9] In 1929 public health responsibilities were allocated to county councils and the town councils of large burghs.[10]
The 1897 act remained essentially in force with amendments until 2008. One significant development was that in 1945 the Secretary of State for Scotland was empowered to make regulations to treat infected persons, to prevent the spread of diseases and prevent danger to public health from ships and planes, both entering and leaving Scotland.[11] However, provisions regulating hospitals, water supplies, sewers, drainage, lodging houses, and licensing of offensive trades were overtaken by the development of the National Health Service, the nationalised water industry and environmental health regulations.
In 2008 public health provision was consolidated and Scottish Ministers, health boards and local authorities were each given duties to protect public health, appoint competent staff and co-operate. Scottish Ministers were made responsible for identifying and amending the list of notifiable diseases (including coronavirus) and regulating public health investigations as well as using regulations in connection with international travel to protect public health from risks. Health boards were made responsible for dealing with infected individuals including examining them, placing restriction or quarantine orders, detaining them in hospital and compensating them where there was voluntary compliance. Local authorities were made responsible for disinfection, disinfestation or decontamination of premises or things and for compensating businesses and individuals affected.[12]
Compiler: Elspeth Reid (2021)
Related Knowledge Base entries
Sanitary Inspection & Environmental Health
Food Labelling, Standards and Hygiene
Cleansing, Refuse Collection & Disposal
Hospitals and local health provision under the NHS
Bibliography
Bell, James, and James Paton, Glasgow: Its Municipal Organization and Administration (J. MacLehose and Sons, 1896)
Brunton, Deborah, ‘Health, Comfort and Convenience: Public Health and the Scottish Police Commissions, 1800-70’ Scottish Archives 17 (2011), pp. 85-96
Evans, A. A. L., ‘Health’ in Source book and history of administrative law in Scotland ed. by M. R. McLarty (Hodge, 1956) pp. 130-47
Ferguson, Keith, An introduction to local government in Scotland (The Planning Exchange, 1984)
Guy, John (Dr), ‘The development of the Public Health Department’ in Historical studies in the development of local government services in Edinburgh Series 2 (National Association of Local Government Officers, Edinburgh and District Branch, 1936-37), pp.33-41
Whyte, W. E., Local Government in Scotland (Hodge & Co, 1936)
References
[1] Public Health etc. (Scotland) Act 2008 (asp.5).
[2] Commission anent the plague in Bo’ness, 1645. The Records of the Parliaments of Scotland to 1707, ed. by K.M. Brown and others (University of St Andrews, 2007-2021), 1645/1/22. <http://www.rps.ac.uk/trans/1645/1/22> [accessed 28 July 2021].
[3] Cholera Prevention (Scotland) Act 1832 (2 & 3 Will. IV c.11); Cholera Prevention (Scotland) Act Amendment Act 1832 (2 & 3 Will. IV c.27).
[4] W. P. Alison, Observations on the Management of the Poor in Scotland and its effects on the health of the great towns (Edinburgh: 1840).
[5] Nuisances Removal (Scotland) Act 1856 (19 & 20 Vict. c.103).
[6] Vaccination (Scotland) Act 1863 (26 & 27 Vict. c.108).
[7] Public Health (Scotland) Act 1867 (30 & 31 Vict. c.101).
[8] Infectious Diseases (Notification) Act 1889 (52 & 53 Vict. c.72).
[9] Public Health (Scotland) Act 1897 (60 & 61 Vict. c.38).
[10] Local Government (Scotland) Act 1929 (19 & 20 Geo. V c.25).
[11] Public Health (Scotland) Act 1945 (9 & 10 Geo. VI c.15).
[12] Public Health etc. (Scotland) Act 2008 (2008 asp 5).