Even diseases now referred to as tropical, such as malaria and leprosy, were once problems as far north as Scotland and Ontario, Canada. Cholera was formerly a dreaded scourge in Europe.

The question relevant to South Africa today is what caused IMR in Europe and the United States to drop to their present levels. This dramatic decline is sometimes credited to medical breakthroughs, such as the discovery of antibiotics and vaccines.

However, the evidence suggests otherwise. Studies have found that in England and Wales the drop in IMR was mainly due to fewer deaths from infectious disease, but this decline in infectious disease occurred well before the discovery of antibiotics and vaccines.

The death rate from tuberculosis, the single biggest killer in 19th century England and Wales, fell sharply before the development of any effective drug treatment or a vaccine. Similar patterns exist for the decline of diarrhoea, measles, whooping cough, and others of the current major killers of children in developing countries (other graphs).

Historically, the declining death rates in the north coincided with improvements in nutrition and the living and working conditions of working class and poor families.

The Agricultural Revolution, which peaked between 1760 and 1812 saw a rapid migration of people from the rural areas to the cities. The shanty towns these families flocked to had deficient housing and grossly inadequate water and sanitation. The rural exodus leading to overcrowding and poor hygiene in these urban ghettos, mirrors Third World squatter settlements today including those in the Cape Town Unicity.

In the early days of the Industrial Revolution (which followed the rapid urbanisation), malnutrition was the norm.

In 19th century England hunger, poverty and unemployment led first to widespread discontent, then to strikes and riots.

The awareness-raising induced by these demands eventually led to some influential figures among the middle and upper classes calling for measures to improve the situation of the poor.

In short, the actions led to better wages and working conditions, the creation of local committees responsible for sanitary measures, health initiatives including environmental regulations governing the water supply, sewage disposal, housing standards, livestock slaughtering, quarantine hospitals, and the creation of parks and open spaces, as well as a move for more universal education.

Since the early 1800s the huge fall in illness and death resulted from the following in order of importance:

– improved living standards

– improved hygiene

– specific preventative measures (eg. Smallpox vaccination)

– much later, curative measures (eg. anti-bacterial drugs)

(SOURCE: THE STRUGGLE FOR HEALTH ‘€“ DAVID SANDERS & THE POLITICS OF PRIMARY HEALTH CARE AND CHILD SURVIVAL – DAVID WERNER AND DAVID SANDERS)