Geography Reference
In-Depth Information
prepared, except in a few cases, to subsidize patients to attend what were expen-
sive courses of treatment. Although there has been a recent revival of some spas in
Britain and the development of many new private ones, it has been concluded that
they are based primarily upon methods of treatment, rather than the particular place
properties of climate or water (Adams
2012
). However, in continental Europe there
has been a much greater continuity and use of many of the old spas, as health pro-
viders were more likely to prescribe such courses of treatment for all classes. The
bracing qualities of sea air was also recognized and promoted from the late eigh-
teenth century, providing a healthy alternative to the stink, noise and fevers found
in cities. Again it was the upper classes who led the initial growth of these centres.
With increasing affluence by the end of the nineteenth century, the middle classes,
and eventually the working classes after the introduction of paid holiday time, also
found temporary solace in these seaside places. Bodily emersion in the sea, exercise
by swimming, and the apparently beneficial effects of tanning, were added to the
initial atmospheric benefits, although the fear of skin cancer from over-exposure to
the sun has reduced the time people spend on tanning in the last 20 years.
134
The Biomedical Approach and Its New Challenges
13.4.1
Medical Improvements and Dominance
By the end of the nineteenth century the changes described above began the health
transformation of many urban places in developed countries that led to a rapid de-
cline in premature deaths. Soon after, a new phase of improved medical knowledge,
training, surgical techniques, the use of new technologies, and the discovery of anti-
bacterial drugs and vaccinations for many diseases, increasingly played a major part
in reducing deaths. Although advances in sanitation and environmental improve-
ment were still being made, what became known as the biomedical model became
dominant in health care. This model
attributes morbidity and mortality to molecular level pathogens brought about by individual
life-styles, hereditary biology, or genetics, and it altered public health to personal 'risk' fac-
tors such as smoking, diet and exercise. (Corburn
2009
, p. 49)
Although local government continued the progress of ensuring improvements in the
physical fabric, and Public Health officials monitored local health conditions, the
growth and dominance of what amounted to germ theory ideas and the success of
individual cure and care approach by doctors and hospitals meant it was the medical
profession, not city officials, as in the engineering and regulation phase, that in-
creasingly became the main decision-makers in health care. In addition, there was a
move away from what is usually called the 'urban field view' in health terms, where
residents and professionals searched for the particular qualities of place, caused by
the interactions between the various elements, that caused ill-health. This was seen
in the early sanitary phase, which led to more context-specific and localized policy
