Source A


A picture by a modern artist of Roman toilets at Housesteads fort on Hadrian’s Wall. It is based on archaeological excavations.

1 (a) What does source A suggest about attitudes to public health in Roman times?
Explain your answer using Source A and your own knowledge. (4 marks)

Level 1 ‐ Answers that describe the source, e.g. ‘The source shows Roman people using
(1 mark) a public toilet and washing their hands.’

Level 2 ‐ Answers that draw a simple inference from the source, e.g. ‘The source suggests
(2‐3) that the Romans understood the importance of keeping clean because they are
washing their hands after using the toilet, and there is a sponge for wiping their
bottoms which one man is cleaning at the front.’

Level 3 ‐ Answers that draw a complex inference from the source, e.g. ‘The source suggests
(4 marks) that the Romans invested a lot of time and money into public health because the
source shows a public lavatory which the Roman government built for soldiers all
over the Empire. It also shows the importance of personal hygiene in Ancient Rome
as the men are washing their hands after using the toilet.’

Tips for question (a):

  • An inference is something that you can learn from the source which it does not directly tell you.
  • Looking for evidence of how much time and money governments put into public health is one way of doing this, but not the only way.

Source B


A modern drawing of a town in the Middle Ages

1 (b) What different attitudes towards public health are suggested by source B? (6 marks)
Explain your answer using Sources A and B and your own knowledge.

Level 1 ‐ Answers that describe source B, e.g. ‘Source B shows that people poured waste in
(1‐2) the streets and that animals roamed in the streets.’

Level 2 ‐ Answers based on a simple comparison between the sources, e.g. ‘Source A shows
(3‐4) good standards of public health because they are washing their hands, but source B
shows that they don’t keep the town clean because they allow animals on the streets
and throw waste there.’


Answers that may use both sources but draw an inference from one, e.g. ‘Source B
shows that standards of public health were not good in the Middle Ages. The people
do not seem to think it is important to keep the streets clean even though they are
also selling food from stalls in the same street. One man is even having some waste
poured onto his head from a house window which shows they did not respect the
importance of keeping themselves or each other clean.’

Level 3 ‐ Answers draws informed inferences from the details of BOTH sources, e.g.‘Sources
(5‐6) A and B suggest that standards of public health declined from Roman times to the
Middle Ages. In Ancient Rome, they clearly understood the need to get rid of human
waste safely by building public lavatories which emptied into a sewer, whereas in
source B, in the Middle Ages, they are making no attempt to keep the streets clean.
These will be full of animal and human waste. The Romans clearly had an
understanding of the importance of personal hygiene as they are washing their
hands whereas in the Middle Ages, in source B, they are selling food in the same
street as animals are roaming and doing droppings.’

Tips for question (b):

  • Make sure you refer to both sources A and B in your answer.
  • This may mean you repeat something from your answer to q. (a) which is fine.
  • You do not need to explain why the sources are different for this question.

Source C


A Ministry of Health poster from the Second World War

1 (c) Why were there different approaches to public health at these times? (8 marks)
Explain your answer using Sources A and B and your own knowledge.

Level 1 ‐ Answers that select details from the sources (1‐2)

Answers that say how the sources are different, e.g. ‘Source A is from Ancient
Rome and Source B is from the Middle Ages,’

Level 2 ‐ Answers that show simple reasoning based on differences between author, time
(3‐5) or place, e.g. ‘Source A is from Ancient Rome when they spent a lot of money
building things like aqueducts and bath‐houses. Source B, on the other hand, is from
the Middle Ages when a lot of the ancient buildings had fallen into ruins and the
government did not spend as much money on public health.’

Level 3 ‐ Answers that show developed reasoning based on differences between author,
time or place, e.g. ‘In Ancient Rome the government thought it was important to
spend a lot of time and money on public health because it would strengthen the
Empire. Good standards of public health would keep soldiers fit and healthy. It
would also ensure the health of workers so that Roman trade and business would
flourish. The Romans also wanted to show off that they were superior to the
Ancient Greeks and Egyptians by building things that were very impressive and
practical. Therefore, they built reservoirs, aqueducts and fountains to supply fresh
water to towns. They built bath‐houses, sewers and public lavatories, which you can
see in source A, to ensure the people and the towns were as clean as possible.
However, in the Middle Ages standards were not as good. In the Dark Ages, most of
the Roman buildings fell into ruin and were not used because the people did not
understand what they were for or how to use them. After the Dark Ages, the
government did realise that keeping things clean was important, but was not able to
enforce the law very effectively. Rulers in the Middle Ages were not as rich or
powerful as the Romans had been and therefore could not build as many facilities
for public health or enforce the laws about cleaning up very effectively, so people
kept on throwing waste into the streets because there was nowhere else to put it, as
can be seen in source B.’

Tips for question (c):

  • This question is about the provenance of the sources.
  • This means who wrote the sources, when and why.
  • This is what the markscheme means when it says ‘differences in author, time or place’.

1 (d) Study source C.

Public health has improved at different times for different reasons. Why was this? (8 marks)

Use sources A, B and C and your own knowledge to explain your answer.

Level 1 ‐ Answers that provide general statements, e.g. ‘Public health improves when the
(1‐2) government spends more money on it.’

Level 2 ‐ Answers that comment briefly on several factors, e.g. ‘Money is important because
(3‐4) you have to pay for things like public toilets like the Romans in source A. Knowledge of
diseases is important because then you know it is important to build sewers like they
did after the 1875 Public Health Act to stop cholera from spreading. Governments are
important because they can organise public health campaigns like the one in the poster
in source C. War is a factor because the government wants people to be as healthy as
possible to help the war effort, like in source C which is from the Second World War.’
Answers that explain in depth one factor, e.g. ‘Government action is a very important
factor because the government has the power and the money to affect the lives of
people across the whole country. In Roman times the government was very rich and
powerful and spent money on aqueducts, bath‐houses and public lavatories like the one
you can see in source A. When the government is not as rich or powerful then public
health is worse, as you can see in source B when people ignored the laws to keep streets
clean. In the twentieth century, the government has done a lot to improve public
health, e.g. the Liberal’s social reforms such as pensions and National Insurance or the
poster campaign in source C.’

Level 3 ‐ Answers that explain in depth several factors, e.g. as for second example from Level 2
(5‐6) above and then….. ‘War is also a factor for change. The Romans invested a lot of money
into public health to keep their soldiers fit and healthy so they would win wars to
defend and expand the Roman Empire. In the Dark Ages, there were a lot of wars
between tribes and may of the Roman buildings were destroyed or fell into ruin. After
the First World War, the government wanted to build ‘Homes Fit for Heroes’ and the
first council houses were built which was a big step forward. During the Second World
War the government wanted to ‘Keep the Nation Fighting Fit’ and organised public
health campaigns like the one in source C and the diphtheria immunisation campaign.’

Level 4 ‐ Answers that develop out of Level 3 and evaluate the relative importance of different
(7‐8) factors, e.g. as for Level 3 above and then …… ‘Overall, the most important factor for
different attitudes to public health is the government. The government is the only
group with enough power and money to make a difference to everyone in the country.
Governments are influenced by other factors such as war, technology and scientific
knowledge but in the end it is the government that has to decide to spend the money
and make the laws which improve public health, e.g. the 1875 Public Health Act or the
Liberal welfare reforms.’

Tips for question (d):

  • Explain each point that you can think of in as much detail as possible.
  • Use the sources and your own knowledge to explain your points fully.
  • Finish with a conclusion that provides some overall assessment, e.g. which factor is the most important.