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 19^th 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 19^th-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.

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.

Fig. 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.

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.

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.

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.

Fig. 2 - Dr John Snow

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

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

Fig. 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.

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 20^th century to improve Public Health in Britain.

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.

The Public Health Act 1961

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.

Fig. 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.