In the early 19th century, many towns were governed by municipal corporations, usually 'closed' or self-selecting bodies in the hands of one political faction, with little sense of civic responsibility. Many residents were reluctant to pay taxes to these unaccountable bodies, which therefore had difficulties in investing. Not surprisingly, the response to urban growth was weak. Parliament reformed municipal government in 1835, but this did little to help. Rally around your vested interests.
Health is enormously expensive.
Be filthy and be fat. His satire was well directed, for many towns voted for cheap government, with low spending on drains or water supplies. Attempts by the central government to force laggards to act was soon denounced as a despotic interference in local liberties, an attack on 'constitutional government'. Thus the General Board of Health created by the Public Health Act of 1848 was soon abolished. Other means had to be found of encouraging local authorities and their electors to vote for spending on health and amenities, convincing them that being filthy did not make sense.