The women who pioneered public health
According to a 2021 consensus taken of the Public Health Specialist Workforce, which included DsPH and PH consultants, 69% of the workforce was female[1]. However, whilst women are highly represented in the PH workforce in the present day, historically, they have fought much opposition and discrimination, often for their seemingly radical views yet many key PH developments and milestones are attributable to the work and campaigning of women.
One such example is in the field of immunisation. Although Edward Jenner is widely recognised for being the inventor of the vaccine, the scientific practice he based his work upon existed for many centuries before he developed the smallpox vaccine using cowpox material.
In fact, Lady Mary Wortley Montagu, an English aristocrat and writer, is believed to be the first person to introduce, and advocate for, smallpox inoculation in Britain, through the practice of variolation. Variolation, which prevented rather than cured smallpox, involved introducing pus from a smallpox blister into a scratch on the arm or leg of the patient. Having first witnessed the practice in Turkey in 1717, she insisted her children went through the procedure and following the outbreak of a smallpox epidemic in England, Lady Montagu controversially campaigned for smallpox inoculation across England. She even convinced a member of the British Royal Family of the practice and published an article of its merits under a pseudonym.
Despite the controversy Lady Montagu had caused, it was her findings which formed the foundation of Jenner’s work and ultimately led to the development of vaccines. In the present day, DsPH play a vital role in ensuring vaccines are available to as many people as possible, leading local community engagement in programmes and targeting minority or low-uptake groups, to improve both individual and population health.
In the 1860s Octavia Hill, an English social reformer, helped to establish social housing in the poorest areas of London, due to a lack of suitable working-class housing across the city and a failure of landlords to adequately provide for their tenants. Octavia became a landlord and believing in self-reliance, she built personal relationships with all her tenants encouraging them to better themselves through tenants’ associations and societies. Through this work, Octavia, and her assistants, served as early social workers. Only women collected rent and properties were thoroughly inspected on a regular basis and due to the successes of her expanding social housing project, Octavia was commissioned to develop slums in South London.
A strong believer in open spaces for the poor, she was heavily involved in work to prevent building on Hampstead Heath and Parliament Hill Fields and was one of the founding members of both the National Trust and The Charity Organisation Society, which organised charity grants and pioneered a home-visiting service.
Today, DsPH work alongside colleagues in local government to deliver the principles that Octavia Hill worked so tirelessly to establish. As explored in the ADPH ‘Housing and Health’ policy paper, housing is a key social determinant of health throughout life, and the provision of social housing acts as a preventative intervention, integral to local plans for improving health and wellbeing. Similarly, equal access to green, open spaces is a priority for DsPH and local councils in healthy neighbourhood planning in support of good physical and mental health.
Where Octavia focused on the health benefits of improving social housing, Florence Boot, an American businesswoman, was concerned with good work – a concept DsPH are heavily invested in today.
Boot ran the pharmaceutical chain Boots alongside her husband and set the modern standard for the wellbeing of workers. Florence provided free education and training for employees, as well as arranging outings to the beach and beauty spots for women in the Boots workforce – many of whom could not have afforded such outings without her support. Florence also encouraged employee sports and social clubs, founding the Boots Athletic Club, and insisted workers informed her of particular hardship or financial strain.
In 1934, Boots was the first company in the UK to introduce the five-day working week and Florence’s work set industry standards for the treatment of workers. Living and working well is a key focus of DsPH work in the present day as a healthy and happy workforce has far reaching benefits for individuals and society; for health, productivity and the economy. Another female public health pioneer, Josephine Butler, social reformer and champion of women’s rights, was concerned with the education and rights of women, particularly regarding prostitution. She set-up hostels for women in the terminal stages of venereal disease and provided alternate work such as sewing or envelope manufacturing.
Josephine was a prominent figure in the successful campaign to repeal the Contagious Diseases Act in 1886, having cofounded the Ladies National Association for the Repeal of the Contagious Diseases Acts. The Act was introduced to reduce venereal disease in the armed forces, but by legalising prostitution, it placed the women involved under police and medical control. Any woman suspected of undertaking such acts was subjected to an intrusive examination in an attempt to identify and detain infected women and thus curb the spread of disease. The repeal, largely brought about by Josephine’s relentless campaigning, ended the brutal treatment of prostitutes, and in the years that followed doctors found that voluntary submission for treatment for sexually transmitted diseases was much more effective than the original methods used.
In the present day, DsPH work with other local authority organisations and wider government to deliver a whole systems approach to sexual health services, recognising the importance of sexual health on both an individual and population level.
Thirty-five years later, women’s rights activist Marie Stopes, also concerned with sexual health, was an instrumental figure in the birth control movement. Marie founded the first birth control clinic in Britain in Holloway, a working-class area of North London. The clinic, called the Mother’s Clinic, opened in 1921 and was free and open to all married women seeking education around birth-control methods and reproductive health.
By the 1930s, a network of regional clinics was established as well as two horse-drawn caravan clinics which travelled to smaller towns – the first mobile clinics of their kind in the world. To this day MSI Reproductive Choices, formerly known as Marie Stopes International, provides reproductive advice, services and support for women globally. Although Marie’s motivations were based in eugenics, there is no doubt that her controversial work laid the foundations for widespread provision of reproductive advice, services and support for women globally.
Nowadays, DsPH are integral in sexual health service provision, with networks such as the English HIV and Sexual Health Commissioners’ Group working to improve sexual health outcomes and disseminate their expert knowledge and practice throughout the country to the most vulnerable in society.
Advocating for ‘good work’, healthy living environments, equal access to sexual health services, and protection from disease are just some of the areas of public health that women have played a pivotal role. In the 21st century, 58% of DsPH and 73% of public health specialists are female and this significant majority continue Montagu, Hill, Boot, Butler and Stopes’ pioneering work to improve the lives of everyone.
[1] Public health specialist capacity review, Health Education England, Available at: https://www.hee.nhs.uk/our-work/public-health-specialist-capacity, Accessed February 2023.