Local leadership in public health: the role of the medical officer of health in Britain, 1872-1974

Abstract

The recent policy focus in British public health on the importance of local action invites consideration of historical precedent. The role and achievements of the medical officer of health (MOH), the local government official charged with public health responsibilities, is discussed. The gradual accretion of duties is traced in the first section: the mid-Victorian concern with urban sanitation; the preventive strategies adopted after the bacteriological revolution; the extension of personal health services in the early 20th century; and the more diminished role under the National Health Service (NHS), when infectious diseases retreated. The historical verdicts passed on the MOsH are reviewed in the second section. The leading role of the MOsH in the late 19th-century mortality decline has been reasserted, and although there is some justification in the argument that in the 20th century public health lost its focus, it is important to recall that the extension of personal health services under MOH direction signified a major extension of access to care. Similarly, the charge that MOsH did not redefine their role in the period before their final demise in 1974 is not entirely justified. The emphasis of the NHS on curative rather than preventive medicine, and the economic constraints on local authority health service expansion limited their room for manoeuvre. The history of local leadership in public health may offer some enduring lessons. These include the importance of monitoring local population health, acting as a public interface between medicine and the community, facilitating joined-up working and confronting vested interests.

Placing the Public in Public Health in Post-War Britain, 1948–2012

“…In the late nineteenth and early twentieth centuries these included sanitary inspection, vaccination, the collection of statistics on death and disease and directing improvements to housing. By the early twentieth century, according to Martin Gorsky, the MOH had reached the height of his (MOH were almost all men in this period) powers (Gorsky 2007). MOH had responsibility for (among other things) state welfare programmes to improve the health of children and mothers, school medical services, screening and, after 1929, the former Poor Law workhouses which operated as chronic disease hospitals.…”

“…As a result, in the early twentieth century, and especially in the inter-war period, public health practition-ers increased their efforts to educate the public in practices intended to improve their health. This can be seen in the establishment of the Central Council Health Education (CCHE) in 1927, and the efforts of MOH at the local level to educate the public in matters such as personal hygiene and good motherhood (Blythe 1987;Gorsky 2007;Welshman 1997b). These efforts, according to Welshman, were also aimed at promoting a certain standard of morality and designed to enhance citizenship, as well as health (Welshman 1997a).…”

Robert A. Askins and healthcare reform in interwar colonial Zimbabwe: The influence of British and trans-territorial colonial models

“…69 In all this push for reform, some historians have argued, medical officers of health played crucial roles as both originators and implementers of such policies. 70 Indeed, some of them, such as Arthur Newsholme, have attracted a great deal of scholarly attention because of the legacies of their ideas. 71 Going into detail about these interesting developments is outside the scope of this article; suffice to say that medical officers of health were responsible for originating programmes designed to make a radical improvement of access to medical services.…”

The public health system in England

“…However, MOsH did have formal authority to investigate any factor with a bearing on health and had security of tenure which meant that they could criticise employing authorities with impunity (Editorial 1981). And there were examples of inspired leadership where effective MOsH displayed networking skills and personal diplomacy of relevance in contemporary public health especially in the context of partnership working (Gorsky 2007). Such leadership also involved facing down vested interests thereby combining social conscience with scientific intent.…”