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Smoke Alarms

As Britain gets used to the ban on smoking in public spaces, Virginia Berridge looks at the way attitudes to public health have changed in the last fifty years, particularly among the medical profession.

'Government to consider prosecuting parents who give alcohol to their children before the age of fifteen’; ‘Eat five portions of fruit and vegetables a day – it’s good for you, says Chief Medical Officer’. In 2007 we have all become used to headlines such as these, and to the alliance between doctors and government that lies behind them. We accept that it’s the individual citizen’s duty to adopt a healthy lifestyle – one founded on professional advice from doctors and scientists – and the government’s duty to change our behaviour when it runs contrary to such advice. The ban on smoking in public places is only the latest example of such government intervention.

For doctors to advise about individual habits and behaviour is a relatively new development: government, too, initially had qualms about intervening in these areas. What drove change in the 1950s and 1960s were emerging new styles of public health, new ways of communicating with the public and changes in the patterns of disease. In the years following the Second World War it seemed that the fight against epidemic disease had been won. Previously high rates of death from bronchitis and tuberculosis were falling as housing conditions improved and the BCG vaccine became widely available in the 1950s. Diptheria and scarlet fever were also in decline. Instead, cancer and heart disease mortality started to dominate the statistics, and public health practitioners began to speak of an epidemic of affluence rather than one of deprivation. Here were new problems for public health.

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