The history of public health crises: governance and trust

In order to understand the impact of recent public health crises it is important to take a longer view of the role of public health in Britain and how it has evolved. In this report we consider the twin issues of governance and trust and explore how these were impacted by different public health crises in the late twentieth and early twenty-first centuries. We analyse a series of case-studies, drawing out the challenges, opportunities and long-term implications presented by each. Collectively, these examples demonstrate that whilst public health crises undoubtedly present significant difficulties for government, the wider public, and the relationship between these, these are also moments which offer potential for beneficial change.

The report begins with a brief overview of the historical context to the development of the governance of public health in Britain, and the changing nature of public trust in relation to public health. The main body of the report is divided into two main sections. First, we present an analysis of governance in relation to public health crises. We consider two key examples: HIV/AIDS in the 1980s, and Swine Flu in 2009-10. In the second section we turn our attention to trust and public health crises. We look at three broad areas – health surveys, vaccination, and health education – and we examine two different examples for each. We conclude the report with some reflections on the broader implications of these specific examples