Sir William Savage Chief Medical Offer for Somerset, 1909-1937 SIR WILLIAM SAVAGE’S SOMERSET The Annual Report of the Director of Public Health 2016 TABLE OF CONTENTS Table of Contents CHAPTER 1: INTRODUCTION ..................................................................................... 1 Taking the long view ................................................................................................................................ 1 Responsibilities of Public Health ............................................................................................................. 1 Leading Public Health ............................................................................................................................. 1 1936 – County Medical Officer of Health ............................................................................................. 1 2016 - Director of Public Health........................................................................................................... 3 Health Protection ................................................................................................................................. 3 Health Improvement ............................................................................................................................ 5 Healthcare Public Health ..................................................................................................................... 5 CHAPTER 2: THE POPULATION, THEN AND NOW ................................................... 7 CHAPTER 3: INFECTIOUS DISEASES ....................................................................... 9 Tuberculosis ............................................................................................................................................ 9 Extent in 1936 ...................................................................................................................................... 9 Treatment in 1936 .............................................................................................................................. 10 Decline in Tuberculosis ...................................................................................................................... 11 Re-emergence of Tuberculosis .......................................................................................................... 12 Other Infectious Diseases and Vaccination........................................................................................... 12 Immunisation ..................................................................................................................................... 17 Sexually Transmitted Infection .............................................................................................................. 18 Gonorrhoea and Syphilis in 1936 ...................................................................................................... 18 Sexually transmitted infection in 2016 ............................................................................................... 18 Summary ............................................................................................................................................... 19 CHAPTER 4: PREGNANCY AND EARLY YEARS ...................................................... 21 Maternity and Infant Mortality ................................................................................................................ 21 Maternal deaths..................................................................................................................................... 24 Contraception ........................................................................................................................................ 24 Contraception in 1936 ....................................................................................................................... 24 Contraception in 2016 ....................................................................................................................... 24 Teenage Conceptions and Abortion ...................................................................................................... 25 Legitimacy ............................................................................................................................................. 26 Midwives and Health Visiting in 1936 .................................................................................................... 26 Ante-natal work .................................................................................................................................. 26 Midwives ............................................................................................................................................ 26 Infant Welfare Centres ....................................................................................................................... 28 TABLE OF CONTENTS Home Visiting ..................................................................................................................................... 28 Midwives and Health Visitors in 2016 ................................................................................................... 29 Working with Schools ............................................................................................................................ 30 Public Health and Schools in 1936 .................................................................................................... 30 Public Health and Schools in 2016 .................................................................................................... 30 Fostering ............................................................................................................................................... 31 Fostering in 1936 ............................................................................................................................... 31 Fostering in 2016 ............................................................................................................................... 31 Child protection ..................................................................................................................................... 32 Summary ............................................................................................................................................... 32 CHAPTER 5: MAJOR NON-INFECTIOUS DISEASES ............................................... 33 Death Rates and Major Causes of Death ............................................................................................. 33 Diabetes ............................................................................................................................................. 35 Lifestyles ............................................................................................................................................... 36 Malnutrition and Obesity .................................................................................................................... 36 Overweight and obesity ..................................................................................................................... 37 Smoking, Alcohol, Drugs and Physical Activity ................................................................................. 38 CHAPTER 6: HEALTH SERVICES AND WELFARE ................................................... 39 The Institutions of Health and Welfare in 1936 ..................................................................................... 39 County Council Health Services in 1936 ........................................................................................... 39 Health Infrastructure in 1936 ............................................................................................................. 42 The Arrival of the NHS and the Health Service in 2016 ........................................................................ 43 Benefits and welfare reform 2016...................................................................................................... 44 Summary ............................................................................................................................................... 45 CHAPTER 7: SOCIAL INFLUENCES ON HEALTH .................................................... 47 Food Supply .......................................................................................................................................... 47 Milk and slaughterhouses .................................................................................................................. 47 Obesogenic environments .................................................................................................................... 49 Health Promotion in 1936 ...................................................................................................................... 51 “Propaganda” ..................................................................................................................................... 51 Health Promotion in 2016 ...................................................................................................................... 53 Housing ................................................................................................................................................. 53 Utilities ..................................................................................................................................................