Edinburgh’s Health: Bridging History and Modern Challenges

Today, we had an early start with a foggy Edinburgh morning. After breakfast, we took the tram to travel to the Port of Leith, which is on the coast of Edinburgh. The tram reminded us of the New Orleans streetcar, but more modern and a smoother ride, running through the city connecting Edinburgh airport to the city center. After getting off the tram and a short walk, we reached Victoria Quay, one of the Scottish Government buildings.

After going through security, we met with three representatives who work for directorates concerned with population health within the Scottish government.   Each shared great insights about the Scottish public health and healthcare systems and policy they are working to implement to improve health outcomes across Scotland.  Kai Stuart, Senior Policy Officer, gave us an overview of Scotland’s population priorities, the government’s prevention agenda, and the population health framework they are currently working to develop.  The framework is focused on four primary preventative drivers of health and well-being, including social and economic factors, healthy places and communities, health promotion, and equitable access. It was interesting for us to make comparisons between NHS Scotland and NHS England from our time in London.

Caitlin Frickleton, Senior Policy Officer for the Place and Well-being Program, shared the care and well-being portfolio of the country with us, in line with the government’s missions of equality, opportunity, and community. We learned that Scotland is prioritizing prevention as part of a wider healthcare strategy and is using the Health in All Policies approach. David Thompson, Head of Innovation Adoption, shared the use of technology and AI in healthcare. Some programs which have been piloted and currently taking place include the Dermatology Referral Program, Type 2-Diabetes Remission program, Pharmacogenetics program, and the lung cancer screening program. All of this information prompted us to ask many questions, which led to a great discussion about these programs and priorities of the Scottish Government as well as comparisons with those in England and Alabama. So much so, that we ran over our scheduled time and had to rush back to the hotel to get ready for our next tour. There was so much to learn, we could have stayed here all day!  Thank you to Kai, Caitlin, and David for a very rewarding morning!

After a quick change of outfits and shoes, we made our way to the Mary Kings Close! Not to mistake Mary King with Mary Queen of Scots, Mary King was declared a Burgess (a member of parliament for a borough) by her late husband, which means she could own a borough and have voting rights in the town. This was incredibly uncommon for her time, the 17th century, but she was granted these rights and built a borough that was suspected to support independent women of the time and was 80% occupied by women.

 Closes are very narrow streets which date back all the way to medieval Edinburgh, where residents would reside within these narrow paths deep that extended off the Royal Mile. This was highly convenient considering they were close to many of the royal buildings, markets, other residents, etc., but this caused tremendous problems. Since the residents were all packed together in these narrow paths, they were constantly near one another and had increased chances of spreading diseases and various illnesses. For instance, during Mary Kings’ time, they were faced with the bubonic plague, also known as the Black Death! This was caused by Yersinia pestis, a bacterium spread by fleas from the rats that ran rampantly throughout the city. Once infected, individuals will experience symptoms such as fever, headache, weakness, painful and swollen lymph nodes, and develop buboes in the neck, underarm or groin area. The window between onset of symptoms and death was approximately 48 hours (about 2 days) and only about 5% survived the illness.  The tips of fingers, toes and nose would turn black with gangrene, hence the term “Black Death”.

The plague epidemic throughout Edinburgh, Scotland was due to the crowded and unsanitary living conditions. There was not a sewage system during the 1600 and 1700’s, so residents would place their waste into buckets, then every morning and night the waste would be dumped out their windows or tossed down the steep incline that would drain into Nor Loch. This was usually the job of the youngest child in the household.  This practice would attract the rats which carried the fleas that spread the deadly plague. To put this into perspective, for every resident in Edinburgh there were approximately three rats (1:3 ratio of people to rats) within the city. So, we could imagine how fast this plague was spreading! Unfortunately, there were also not many physicians able to treat all these people, except one man…the plague doctor! The plague doctor would wear a leather and waxed fabric suit head to toe (the historic PPE) and would visit patient homes to try to treat them.  Treatment included lancing the buboes to release the infection. Then the doctor would cauterize the area. Some people died of septicemia due to infection being introduced to the blood stream, others dies of shock due to the cauterization.  So the options for treatment were very limited.  And all of this chaos was happening within these steep, narrow closes that we visited today and really stresses the importance of good environmental health and sanitation practices.  

After this we went on a walking tour of Old City Edinburgh and the Royal Mile, where we briefly discussed the theft of the Stone of Destiny in 1296. The Royal Mile is a stretch of streets running from Edinburgh Castle to the Palace of Holyroodhouse. It is called the Royal Mile because it is a 1.12 mile stretch between the two royal sites. On this tour we saw a few of the local closes as well as St. Giles Cathedral. St Giles is known as the Mother Church of Presbyterianism. We were able to view the Edinburgh High Court, where extremely important governmental decisions are made. We finished this tour by rounding the outside of the National Museum of Scotland where we finished our discussion on the Stone of Destiny. It turns out that the stone was returned to Scotland in the 1990s by some college students. Soon after its discovery, the Scottish government sent the stone back to England before its final return in the 2000s. This stone was used in the coronation of King Charles III in 2023.

We are so excited about the activities that we will be engaging in for the rest of the trip! Follow along for more from UAB School of Public Health!

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