Change overview

Britain since c.1900: the setting for public health

During the twentieth century, Britain became wealthier, its population grew and the ways people worked and lived changed considerably. Political participation widened, while government took on greater responsibility for people's welfare. These changes help explain why public health increasingly became a national responsibility rather than something left mainly to individuals or local authorities.

The changes were connected. Greater wealth provided resources for public services; a wider electorate increased pressure to meet ordinary people's needs; and scientific and medical advances made more effective healthcare possible. However, rising prosperity did not mean that poverty disappeared or that everyone benefited equally.

Economic change: from making goods to providing services

In 1900, manufacturing and other manual work were central to Britain's economy. Factories, shipyards and coalmines employed large numbers of workers. Over the twentieth century, many of these jobs disappeared, while employment in service industries, including banking, tourism, retail and healthcare, became more important.

Britain also became wealthier overall, and living standards improved for many people. Compared with people in 1900, more people could afford foreign travel and had more time and choice for leisure. This matters to public health because wealth affects both what individuals can afford and the resources available to fund collective services. Nevertheless, national prosperity and individual prosperity are not the same thing: differences between rich and poor remained important.

Social change: a larger, increasingly urban population

Britain's population grew from around 37 million in 1900 to around 58 million in 2000. Most people already lived in towns and cities in 1900, but the proportion living in urban areas increased further during the century.

Employment helped drive this change. Growing cities offered jobs, while the increasing use of machinery on farms meant that fewer agricultural workers were needed. Urbanisation therefore continued, although Britain's economy was becoming less dependent on traditional industrial work.

A larger urban population made the organisation of public services increasingly important. More people needed access to healthcare and other services, so improvements depended not just on individual choices but also on effective government provision.

Political change: more voters and greater government responsibility

Voting rights expanded during the early twentieth century. In 1918, some women gained the parliamentary vote; in 1928, women gained equal voting rights with men. A wider electorate meant that governments had stronger reasons to address issues affecting working-class people and women: they needed their votes.

The Labour Party was formed in 1900 to represent working-class interests and first formed a government in 1924. Labour governments generally favoured greater spending on the Welfare State. Its most important healthcare development was the establishment of the National Health Service in 1948. The NHS provided healthcare funded through taxation and free at the point of use, making access less dependent on a person's ability to pay directly for treatment.

The expansion of public healthcare, together with advances in medicine, contributed to longer life expectancy. It also marked a major change in expectations: protecting health was increasingly seen as a responsibility of national government.

The extent of that responsibility remained contested. Conservative governments generally placed more emphasis on limiting welfare spending. Some critics argued that the Welfare State required too much taxation. Others described government intervention as a 'nanny state', claiming that attempts to protect health restricted personal freedom. These were arguments about how far government should intervene, not evidence that all intervention had the same effects.

Cultural change: religion, migration and women's opportunities

Religion became less central to many people's everyday lives. In 1900, churchgoing was common and more than half of British children attended Sunday school. By 2000, church attendance had fallen dramatically. This was part of a wider change in beliefs, attitudes and values.

Britain also became more ethnically diverse. Particularly in the second half of the twentieth century, people migrated from countries formerly within the British Empire. Communities with origins in India, Pakistan, Bangladesh, the Caribbean and Africa developed in British cities. Migration had a direct connection to public health: many migrants worked in the NHS as doctors, nurses and other healthcare staff.

Women's opportunities changed too. In the early twentieth century, paid employment for married women was unusual, and professional careers were often treated as men's work. As the century progressed, more women entered employment and built professional careers.

The development of the contraceptive pill in the 1960s made family planning more reliable. Couples gained greater control over when to have children, and the large families associated with the Victorian period became less common. Together, these changes altered family life and women's opportunities.

Change without complete equality

By the end of the twentieth century, Britain had a larger, more diverse population, a service-based economy and a much greater role for government in healthcare. Yet wealth and poverty continued to affect people's health, and disagreement continued over the balance between collective protection and personal responsibility. Public health changed substantially, but the importance of resources, attitudes and government did not disappear.

Economic and social change

• Britain became wealthier; living standards and leisure opportunities improved for many, but poverty remained.
• Employment shifted away from factories, shipyards and coalmines towards services such as banking, retail, tourism and healthcare.
• Population rose from about 37 million in 1900 to 58 million in 2000.
• Urbanisation continued: cities offered jobs, while mechanised farming needed fewer workers.

Political turning points

• 1900: Labour Party formed to represent working-class interests.
• 1918: some women gained the parliamentary vote.
• 1924: first Labour government.
• 1928: equal voting rights for women and men.
• 1948: NHS established, tax-funded and free at the point of use.

A wider electorate encouraged attention to working-class needs. Government responsibility expanded, but welfare costs and interference with personal freedom remained contested.

Cultural change

• Church attendance declined substantially.
• Migration increased ethnic diversity; migrants made important contributions to NHS staffing.
• More women entered paid employment and professional careers.
• 1960s: the contraceptive pill made family planning more reliable; large families became less common.

Public-health connection

Greater resources, wider political participation, expanded healthcare and medical advances supported improvements in health and life expectancy. Inequalities persisted.