The Public Health Act of 1848

The Public Health Act of 1848, legislating on the sanitary conditions of England and Wales, is one of the great milestones in public health history, "the beginning of a commitment to proactive, rather than a reactive, public health" (1). For the first time, the state became the guarantor of standards of health and environmental quality and provided resources to local units of government in make the necessary changes to achieve those standards. The Public Health Act established a General Board of Health empowered to create local boards of health, either when petitioned in do so by at least one tenth of the taxpayer, in the district, or compulsorily when the average mortality rate in the area exceeded the national crude death rate of 23 per 1000 over a period of seven years. The local boards had authority to deal with water supplies, sewerage, control of offensive trades, quality of foods, paving of streets, removal of garbage, and other sanitary matters. A local board could appoint a medical officer of health, an inspector of nuisances, a surveyor, a treasurer and a clerk, National and local boards of health were accountable to and underwritten by the national Treasury, and they reported to the Privy Council. Loans for capital expenses were supplied by the central government and subsequently financed by local rates (2). The circumstances in which this ground-breaking public health legislation was conceived and enacted have long been studied and discussed by historians (3). The Act is generally viewed as a response in the social and health problems generated by the industrial revolution. Starting in the late 18th century with the expansion of the market economy, the introduction of stream power, the growth of transportation, and the increasing dominance of the factory system of production over home labour, the industrial revolution demanded a constant source of labourer, to feed the growth of machine production. Workers thus had to be brought into the factories, located in industrial towns and cities. Mobilizing this industrial labour force required abolition of the older system of poor relief. Landowners, rationalizing agricultural production, had enlarged and enclosed their holdings and thus began to drive rural labourers off the land. At first, provision was made for the landless and the unemployed in the parishes of their birth, following the Elizabethan Poor Law system. But as the ranks of the unemployed swelled and poor rates rose, the old Poor Law came to be viewed--at least by landowners, industrialists, and rate-payers--as a constraint on the mobility of labour and an impediment to progress (4). The organization and financing of poor relief was a central social policy problem of the early 19th century A Royal Commission was appointed in 1832 to examine the operation and administration of the Poor Laws, and its report, largely written by Edwin Chadwick, appeared in 1834. The Poor Law Amendment Act of 1834, incorporating the principles of the report, decreed that no able-bodied pauper could be given assistance except in a workhouse, The conditions of labour in the workhouses were to be made "less eligible", i.e. more miserable than those of the worst situated labourer outside the workhouse. The immediate intent and result of the Act was to reduce the burden of the poor rates, but it also served to drive the poor out of the rural areas and into the new industrial towns. Within 20 years, the proportion of the population living in industrial cities doubled and the mushrooming of towns and cities, speculative building practices, ramshackle housing and congestion led to an explosion of disease rates, Builders rarely troubled themselves to supply sewers, water closets or privies and little was done to supply fresh water, clean the streets or remove the garbage. The cholera epidemic of 1831 and 1832 had drawn attention to the deplorable lack of sanitation in the industrial cities. It was obvious that cholera was concentrated in the poorest districts, where sanitation was most neglected and the slum housing most befouled by excremental filth and other dirt. …