At the beginning of our first full day in London Dr. McCormick divided us into 3 teams. Each team had to navigate London’s public transportation system and meet her at the Royal College of Physicians. This was our first unguided adventure using public transportation and the London Underground (a.k.a. the Tube) for most of us. Each team plotted their own route, and we are happy to report that everyone successfully made it to our destination on time. Once at the Royal College of Physicians we met up with Charlie Forman, our guide for the day. Charlie walked us through major historical public health issues faced over the decades and described public health innovations that have occurred in response to these challenges.
The Royal College of Physicians is located across the street from Regent’s Park. Charlie did a great job of connecting the need for green spaces with improvements in physical and mental health and overall well-being of Londoners over time. Some parks and green spaces, such as Regent’s Park, were initially intended for only elite groups of people. The park became publicly available to all in 1835. Today, it is very evident that parks and spaces across London are well used. While at Regent’s Park, we were surrounded by joggers, walkers, cyclist, and families coming to spend time promenading around the park. Charlie also showed us a picture from the mid-1800’s that showed how vital these parks were to those in the “working class”. Victoria Park was used extensively by Londoners, who yet had running water in their homes, for bathing in the lake. Even today, these parks are an integral part of the community and provide a space for increased physical activity as well as an escape from the bustle of the city. During our walk, we passed multiple green spaces, big and small, that were all being extensively used.
Charlie also discussed the correlation of tobacco use and lung cancer, and the shift of the medical community to advocacy. Some members of the Royal College of Physicians did not think it was their role to tell people not to smoke or to advocate against the tobacco industry. In 1962, guided by their president, Robert Platt, the Royal College of Physicians published a report titled “Smoking and Health” which was a landmark report connecting smoking with lung cancer. This marked a new time for the Royal College of Physicians as now they began to understand their role in matters relating to public health.
Next, Charlie pointed out that the mid-1800’s was a pivotal time for London. The population had increased rapidly from 1 to 3 million, everyone was using coal to heat their homes and cook, gas lanterns were being used to light the streets, and there was no functionally sound sewage infrastructure in place. London was not a good place to live or work during this time. The stink was sometimes so bad that it was hard to breath and the air quality was sometimes so poor that people would get lost in their own neighborhood. By pointing out the chimney’s on the top of homes that have been in use since the late 1700’s, you can just image what air quality was like when they were all burning coal! Environmental conditions became so egregious that people were commonly suffering from respiratory illnesses, leading to numerous fatalities.
Walking further we learned of Lord Joseph Lister. Lord Lister was instrumental in pioneering antiseptic surgery. He did research in bacteriology and infection in wounds, which revolutionized modern surgical practices and lead to a reduction in post-op infections.
As public health students, we were able to learn many things ranging from public health policy, housing, diet and physical activity, addiction, women in public health, and much more. Being able to see these momentous sites and learn the history behind each one really opened our eyes to how much the world and everything around us affects health. Some fun facts from the day tour were:
- London has a Congestion Charge and ULEZ (ultra-low emission zone) charge for London citizens who drive motor vehicles in the congestion/ultra-low emission zone. This zone is the largest congestion/ultra-low emissions zone in the world and works to reduce noise and air pollution while investing in London’s transportation system. If you drive your personal motor vehicle any time between Monday through Friday from 7:00am-6:00pm and weekends from 12:00pm-6:00pm, you are charged ~19 USD per day that you use your vehicle. If your vehicle is over 15 years old, you are not allowed to drive in the ULEZ. This policy has lowered gas emissions throughout the city and restored cleaner air; however, this could cause inequity between those who can afford
to pay the fee and own a newer car and those who cannot.
- As you know, London is famous for its double decker buses. Back in the 1950’s, on each bus there was a driver and a bus conductor who was responsible for collecting tickets after people boarded the bus. A link between sitting and illness was found in a study of these bus drivers and conductors. A bus driver would sit for over 90% of their shift, while bus conductors stood and climb ~600 stairs per day up and down to collect tickets. Bus drivers were found to be twice as likely to have heart attacks as their peer conductors. This was the first study to established a correlation between physical activity and quality of health.
- Charlie took us to Piccadilly Circus to discuss sewage in London in the mid-1800’s, specifically, the “Great Stink” of 1858. At one time raw sewage flowed just beneath the street until it ended up in the River Thames. The Great Stink occurred over the summer months of 1858, when the English Parliament could not conduct business because the sewage stink coming from the river was so bad that people were passing out in the streets. Because of this, and the fact that the Palace of Westminster which houses the Houses of Parliament is on the River Thames, Parliament funded the design and creation of London’s current sewage system. However, Charlie noted that when the system was built, there were ~3 million people living in London, and it was designed for 6 million. However, today there are 9 million currently living in London and there is much work being done to expand their sewage treatment capacity.
Next, we walked through the narrow streets of SOHO. SOHO in the mid-1800’s was a working class neighborhood. Charlie really helped paint the picture of what it was like to live in the crowded conditions of SOHO with no sewage system and bad air quality. Poorer people could not afford low sulfur coal to heat their homes so the air quality was often worse in these crowded neighborhoods.
And finally, we ended our tour at the John Snow Pub! We were all so excited to get here. John Snow, an English physician, is know as the founding father of modern epidemiology. Dr. Snow hypothesized that cholera was being spread via water not miasma (the belief of the time that all infectious agents were spread by bad air). His work in mapping cases lead him to the Broad Street pump – ground zero for the outbreak – and where the John Snow Pub is located. And whether this action alone was responsible for ending the outbreak or not, he is famously known for removing the handle from the Broad Street pump to prevent others from drinking the contaminated water. After taking pictures at the pump, we went inside the pub to sign our names in the John Snow Society’s visitor book; which all public health professionals want to do! Then we sat upstairs in the pub and discussed Ghost Map: The Story of London’s Most Terrifying Epidemic – and How it Changed Science, Cities and the Modern World, the book by Steven Johnson. During this discussion we drew parallels with contemporary times, particularly the COVID-19 pandemic. Overall, it was a very enriching, exciting, and memorable experience for all of us.
After we left the pub, we headed to the River Thames for a boat cruise. This boat ride was full of historical facts about the River Thames and its surroundings. It allowed us to contrast Steven Johnson’s description of the river 170 years ago to today. London did a remarkable job of cleaning up the river. Just 60 years ago the river was biologically dead. Today it is known as one of the cleanest rivers running through an urban center. The boat tour operator shared that earlier in the day they had spotted dolphins, seals, and beavers in the river!
After the boat ride, we rode the London Eye. The London Eye is Europe’s tallest cantilevered observation wheel at over 430 feet tall, which enabled us to witness some of the best views of London. We had a great day and what a great start to our trip.
Areva, Grace and Tayyaba
