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Public Health Acts

Public Health Acts

For government interventions in public health to be effective, they need to meet five characteristics:

  1. Defence against health risks,
  2. Prevention using the population,
  3. Fostering a working relationship between the government and the people,
  4. Creation of a public health system,
  5. Recognition of the role of individuals and businesses.1

The government has not always played such a prominent role in public health, but this changed during the 19th century with overwhelming evidence that something had to be done. Let's examine some key public health acts, the reasons for them, and their effects.

Purpose of the Public Health Act passed in 1848

The Industrial Revolution in 19th-century Victorian Britain brought immense wealth and the spoils of the British Empire. Still, it came at the price of worsening conditions within cities. The first public health legislation in 1848 was primarily due to the social reformer Edwin Chadwick.

The Poor Law 1834

Involved in public health for many years before the 1848 Act, Chadwick's basic philosophy was that poor living conditions bred poor health. In 1834, he was instrumental in introducing a Poor Law which gave people in workhouses basic provisions such as food, clothing, and a place to sleep.

One aspect of this law was that should a person die due to poor conditions or disease, a "poor relief" would be paid to their families. In many ways, this was a forerunner of the benefits people receive from the government today. With many cholera outbreaks, this proved expensive.

Cholera in the 19th century

The backdrop for deaths among workers coincided with the onset of a deadly disease. Cholera first arrived in Britain in 1831. It ran rampant as citizens did not know about germs until the 1860s. The most up-to-date theory was still the 'bad air' notion, referred to as 'miasma'. During the 1832 outbreak, there were 21,000 deaths alone. Spread through bacteria in dirty water, the effects of cholera were often severe and swift, causing fatalities within hours of symptoms.

Cholera

A serious disease usually caused by infected water supplies that attacks the small intestine and can often prove fatal.

Miasma

A theory that disease originated from bad air or decomposed material from the ground. This would become obsolete after the discovery of germs.

Cholera was a chief antagonist for the government and the reason for much of the 'poor relief' they needed to pay. The epidemic that recurred in 1848 was one of the direct triggers for the 1848 Public Health Act.

Chadwick knew that to make economic sense something else had to be changed: better Public Health. This was the purpose of the 1848 Public Health Act.

The Sanitary Report 1842

Chadwick knew that if the health of the poorest sections of society improved, so would the economy. Therefore, a Public Health Act made sense. In his 1842 Sanitary Report, he discovered that workers in towns steeped in the industrial revolution had a far lower average life expectancy than in the countryside. Labourers in rural Rutland had an average life expectancy of 38, whereas, in industrial Liverpool, it was as low as 151. This was a shocking statistic and showed that drastic action was required. We must now consider why the Industrial Revolution had such an impact.

The Industrial Revolution (1740 - 1860)

The Industrial Revolution brought profound changes to Britain. By 1851, more people lived in cities than rural areas for the first time in history. It was their manpower that became integral to Britain's increased wealth. However, it came at a cost. We have already seen the devastating effects of cholera from polluted water, but this was not the only disease that thrived.

Public Health Acts Industrial scene in Monmouthshire Wales StudySmarterFig. 1 - Depiction of an industrial scene in Monmouthshire, Wales during the Industrial Revolution

Why was the Revolution to blame for this? Not only were there high levels of toxicity that increased mortality rates from the coal-burning factories, the shift in demographics meant that living conditions were horrendous. A typical house in London's East End could have nine rooms, with a family of around seven in each, meaning that 63 people would be using the same toilet.3 Tuberculosis, spread through the air, was responsible for a third of deaths in London between 1800 and 1850. Packed together, this was a breeding ground for germs to survive.

Tuberculosis

A deadly disease that attacked the lungs and spread through the droplets of coughs and sneezes of the infected.

In fact, even the workhouses provided by the Poor Law often provided better conditions than ordinary housing. In the city many were malnourished, making them more vulnerable to disease, and the food they did eat had a greater chance of being contaminated during its transportation from rural areas. The poor migrants from the countryside in search of more profitable work bore the brunt of these issues.

Lastly, persistent belief in the 'miasma' theory meant that waste would be redirected from sewage into the River Thames, which provided the water for the city. Thus cholera and other water-borne diseases such as typhoid thrived.

Public Health Act 1848

The Public Health Act commissioned a Central Board of Health, which would help towns set up localised boards of health too. Chadwick chaired this and pledged to tackle public health using three key pillars:

  • Improving sewage systems to ensure clean drinking water.
  • Removal of waste from housing and streets.
  • A medical officer who was responsible for the public health of every town.

These reforms should have heralded a departure from the hands-off or laissez-faire approach of the government to public health. Unfortunately, a key element was missing in the legislation. As the creation of local boards or health authorities was optional and at a grassroots level, the old laissez-faire attitudes prevailed.

Grassroots

At the most basic or local level.

Laissez-Faire governance

Derived from the French for 'let it be', this refers to a hands-off governmental approach to public health, where it was not considered a priority.

Furthermore, the boards set up were reluctant to spend money without a basic level of knowledge on why standards of hygiene were so important. Despite this, with increased understanding, there would soon be a seed change and real progress for British public health.

Period of the First Public Health Act

The first Public Health Act was passed in 1848, and the second came nearly 30 years later, in 1875. In the years between the two major public health acts of the nineteenth century, a series of important events started to change attitudes and forge an understanding of how public health could be improved.

Public Health Acts Dr John Snow StudySmarterFig. 2 - Dr John Snow

We will highlight the important events in this timeline and see how the proof was finally in the pudding.

YearEvent
1855John Snow linked cholera to bad water in his report "On the Mode of Communication of Cholera". He connected cholera infection to a contaminated water pump on Broad Street.
1858The Great Stink in London caused by a hot summer made the sewage in the River Thames ferment and created a disgusting smell throughout the city. Joseph Bazalgette created embankments and a more sophisticated sewage network in response to this.
1861Louis Pasteur's Germ Theory marked a departure from the idea of 'bad air'. Now there was a concrete idea that explained how diseases spread.
1866Despite some distrust in the Germ Theory, the Cattle Plague became a nationwide problem when farmers didn't kill infected cows. Lionel Beale subsequently found the microbe causing the infection. Eminent lecturer John Tyndall was influential in spreading this knowledge and supporting the Germ Theory.
1867The Second Reform Act gave 1 million men, most of whom were working class, the right to vote.
1870The Education Act made schooling mandatory for all children. Education improved understanding of the necessity for environments to be sanitised.

The legislation would need to develop to move with the changing winds of this period and, by 1875, the government finally took action.

Public Health Acts Bust of Louis Pasteur StudySmarterFig. 3 - Bust of Louis Pasteur

It was the start of the government's departure from laissez-faire thinking on public health to playing a prominent role in ensuring the well-being of its citizens.

Second Public Health Act

The Second Public Health Act of 1875 addressed many of the concerns put forward by the 1848 legislation. The primary focuses were also the maintenance of sewage, the cleanliness of streets, and the introduction of health inspectors. Crucially, the establishment of localised health authorities was now compulsory and forced councils to improve hygiene standards in towns and cities. Further legislation quickly backed this up.

In 1875, Prime Minister Benjamin Disraeli introduced the Artisan's Dwelling Act which aimed to repurpose filthy slums into council housing that had to meet certain standards of cleanliness. A year later, in response to the Great Stink, the 1876 River Pollution Protection Act stopped the dumping of sewage in rivers.

The Great Stink (1858)

Even the laissez-faire government could not ignore the Great Stink. During the summer of 1858, a potent cocktail of human waste and industrial by-products combined with humid conditions to fill the capital with a putrid stench. With such an unbearable smell, visible to the senses, unlike germs, it forced the government to take action.

Infectious disease was a deadly scourge, but it was the 'great stink' of 1858 that helped secure the funds needed to sort out London's sewage.4

- Ian Roberts, 'The Economics of Tackling Climate Change', 2008

In response, Joseph Bazalgette's sophisticated network of drains solved the issue of the smell and hid the waste. In addition, embankments allowed sewage to funnel away from the capital. By its completion in 1875, it could carry 2 million litres of waste a day, vital for the ever-increasing population.

Finally, the safety of food was examined and standardised with the Sales of Food and Drugs Act (1876) to stop the use of harmful ingredients.

Legacy of the Second Public Health Act

It seemed as though finally the government had decided to play a meaningful role in public health, but there was still plenty of work to be done. At the start of the twentieth century, war was a factor in accelerating public health reforms. Despite the successes in the Boer War and World War I, the health examinations put a microscope on the poor condition of British soldiers. This led to many reforms, including the creation of a Ministry of Health in 1919. Let's look at the further legislation made throughout the 20th century to improve Public Health in Britain.

For more information about the role of war and British public health, read our Impact of War on British Public Health article.

The Public Health Act 1936

More simplified legislation on public health was passed in 1936. It sought to unify the previous acts and amend some aspects of them. This act had over 600 sections and updated many of the measures before it. It demonstrated that public health continued to be a key government concern.

After World War II, the Emergency Medical Service and the Beveridge Report's success led to the National Health Service in 1948 with the aim of providing health and social care to all, regardless of background. This has allowed for effective coordination on a national scale since its establishment.

The Public Health Act 1961

This Public Health Act developed previous legislation. Now, local authorities carried out any remedial tasks to improve hygiene standards if it was deemed necessary. If remedial work was required, the council now had the power to recover the cost incurred from the property owners.

The Public Health (Infectious Diseases) Regulations 1988

This act allowed specific measures of control to be applied to infectious diseases. We have seen its effects through government mandates during Covid-19.

Food Safety Act 1990

The Food Safety Act remains vital in ensuring that the standard of the food we consume is fit and proper for human consumption.

Smoking Ban 2007

The prohibition of smoking in enclosed public spaces in 2007 marked a strong stance from the UK government to tackle a specific cause of ill public health.

Public Health Acts No Smoking sign StudySmarterFig. 4 - No smoking sign from the UK

Public Health Acts Summary

The challenges brought about by the Industrial Revolution meant that the government had to depart from their hands-off approach towards public health in the nineteenth century. The Public Health Act of 1875 and other legislation were a fantastic start but by 1900 life expectancy was still below 50 and 165 out of 1000 children still lost their lives before their first birthday. Most crucial, however, was the shift in mentality to a government that took responsibility for the health of its citizens. This provided the groundwork for future action in the twentieth century when, by 1950, only 32 children would die from 1000.

Public Health Acts - Key takeaways

  • With rapid industrialisation and poor living conditions in cities, Edwin Chadwick's 1842 Sanitary Report was vital in showing that government action for public health was necessary.
  • In 1848, the first Public Health Act pledged to improve sewage systems to allow for clean drinking water, remove waste from houses and streets, and introduce health inspectors for every town.
  • Unfortunately, the establishment of localised health boards was optional, and the local council's laissez-faire attitudes continued.
  • Between the public health acts, scientific knowledge and understanding dramatically advanced. The Germ Theory in 1861 was of particular importance in changing entrenched mindsets.
  • The Public Health Act of 1875 made the formation of localised health boards compulsory. It marked the growing government role in public health, which was accelerated by war at the start of the twentieth century.
  • Subsequent public health acts have been more all-encompassing and have used the NHS to coordinate campaigns.

References

  1. L.O Gostin, 'Public Health Law in the New Century: Part 1: Law as a tool to advance the community's health', JAMA, (Jun 2000), pp. 2837 - 41.
  2. Edwin Chadwick, 'Report on the Sanitary Condition of the Labouring Population of Great Britain', National Archives. (1842)
  3. Drew P. Gray, London's Shadows: The Dark Side of the Victorian City (2010), pp. 124.
  4. Ian Roberts, 'The Economics of Tackling Climate Change', BMJ: British Medical Journal, Vol. 336, No. 7637 (Jan. 26, 2008), pp. 165-166.

Frequently Asked Questions about Public Health Acts

Improvement of sewage systems to ensure clean drinking water, removal of waste from housing and streets and the optional appointment of local councils with a medical officer for every town.

The new scientific evidence for germs and disease meant that previous legislation was not drastic enough. Meaningful action had to be taken to improve public health.

Food safety regulations, disease control and smoking bans are all examples of public health laws.

  1. Defence against health risks.
  2. Prevention using the population
  3. Fostering a working relationship with the government and people.
  4. Creation of a public health system.
  5. Recognition of the role of individuals and businesses.

The first Public Health Act in 1848 was ineffective because it was not compulsory for local health boards to be set up and local councils still had a laissez-faire attitude towards public health.

Final Public Health Acts Quiz

Question

Poor relief was a forerunner of                  .

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Answer

benefits.

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Question

What did Chadwick's 1842 Sanitary Report highlight?

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Answer

The disparity in life expectancy between rural (higher) and industrial communities (lower).

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Question

Cholera spread through sneezing and coughing.

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Answer

False.

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Question

Which of these rules was not part of the 1848 Public Health Act?

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Answer

Mandatory establishment of local health authorities.

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Question

What does laissez-faire mean?

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Answer

Laissez-faire means 'let it be' and is a term used to describe a hands-off government approach.

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Question

                       during the Great Stink.

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Answer

Sewage in the Thames fermented.

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Question

What did Joseph Bazalgette do?

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Answer

In response to the Great Stink, Bazalgette built embankments and a more sophisticated sewage network.

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Question

What was Louis Pasteur responsible for in 1861?

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Answer

The Germ Theory.

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Question

Which lecturer helped spread ideas about Pasteur's Germ Theory?

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Answer

John Tyndall.

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Question

The Second Reform Act of 1867 gave around                     working-class men a chance to vote.

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Answer

1 million.

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Question

Education allowed understanding of the necessity of a sanitised environment to avoid               .

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Answer

germs.

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Question

What was the vital difference between the 1848 and 1875 Public Health Acts?

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Answer

The 1875 Public Health Act made the establishment of local health authorities compulsory.

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Question

What did the Artisan's Dwelling Act do?

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Answer

It aimed to repurpose filthy slums into council housing that met hygiene standards.

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Question

                          has been vital for modern public health in the UK.

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Answer

The creation of the NHS.

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Question

Which public health act has come into effect during the Covid-19 pandemic?

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Answer

The Public Health Regulations (1988).

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