Why did it take until 1875 for the Government to introduce Compulsory and effective Public Health legislation

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In 1875 a ground breaking act came into effect, The 1875 Public Health Act. This act was primarily a consolidation of 30 previous laws. It established that the country was compelled to have a public health authority in every county, and that a medical officer and sanitary inspector were to ensure the laws and standards on issues such as water supplies were to me met, furthermore these authorities had the power to lay sewerage and drains as well as facilities such as Public Baths.

But despite crisis of health such the cholera epidemics and “the great stink”, why did it take so long for this kind of legislation to come about? This is the question I shall attempt to answer. At this time in history the government had no idea where to begin with public health. The sheer scale of the problem was so daunting many in power had no idea where to start with trying to solve the problem.

Public health or more so the level of health was at such a low and was inextricable linked in with poor housing and employment making the problem seem even more daunting. The scale of disease was always highest among the poorer areas of the country, in these highly cramped housing and living conditions lack of suitable sewerage and clean water were the biggest cause of the rapid spread of disease.

If the government were to introduce an effective public health legislation it would mean it would have to overcome a lot of factors, including cost, one such cost was the massive expense of having to build effective sewerage and means of getting fresh water, and this basically every large city such as London, Liverpool or Manchester had dire sewerage systems it would mean shelling out a lot of money to pay this, something the government was unwilling to do.

Moreover it would mean taxing the rich even more to obtain the money, yet again something the government didn’t want to do, seeing as the rich were powerful within society the government didn’t want to upset them. At the time the prevailing philosophy on public health among all classes in society not to mention within the government was the sentiment of laissez-faire. Many believed that the problems around health could not be solved, and that only way the problems would subside were if the problem sorted itself out on its own.

But in contradiction to that, the government did prove that if epidemics such as cholera in 1831, the government were willing to investigate and learn some knowledge of how to improve public health, the acted by advising local governments to set its own boards of health. But from this many problems arose, for one this action was largely piecemeal and it was not compulsory for local governments to set up boards, and secondly these was an issue of legality-what rights did the boards have to insist people co-operate.

A theory at the time was the “Miasma” theory, a theory that many believed in, and a theory which hindered the governments willingness to investigate disease and public health further. The miasma theory suggested that diseases were spread by “smells” in the air, and until John Snow came up with his own theory which stated that cholera was spread through physical contact, yet this theory was formulated in 1831 but it wasn’t until 1870 that it didn’t get fully accepted and this was due to the miasma theory having such a overruling acceptance within society.

Both the prevailing philosophy and the miasma theory are in my historians views such as Rosemary Rees important factors that prevented the government from introducing an effective Public Health legislation act sooner. It is the view amongst many historians that these were important factors although there are some who disagree. Without doubt one of the more profound factors that affected the government taking public health action was the existing administration at the time. The government were generally unwilling to take the problem by the reigns.

The most amount of action the government would take was to set up commissions and reports into public health, but although this may show some effort it was the fact that they didn’t act upon these reports and results from commissions. The government also at the time had insufficient personnel to implement legislation at the time, and any legislation depended upon a good infrastructure to make it effective and without this clearly there were going to many legal loopholes for people to escape from.

An important factor regarding the government and the administration to being able to bring in effective legislation was the level of acceptance by the general public in believing that legislation is desirable and wanted. Government couldn’t introduce legislation if there was going to be too much opposition to it. This therefore then links into the factor of the prevailing philosophy of the time that the public held which in turn effected by the scale of poverty and theories such as the miasma theory.

This to me then shows how the philosophy of the time was a very important factor as it was the base for importance of other factors such as the lack of effective administration which I have just talked about. This said, as a standalone factor, the lack of effective administration to introduce legislation was still a very important factor for the government not bringing in legislation. Even today the importance of this factor is still debated amongst historians, although most agree that this is an important factor.

Linking from the factors of prevailing philosophy and lack of effective administration comes another important reason as to why legislation wasn’t introduced sooner, – the cost of making and effectively introducing legislation. As I have discussed earlier the government knew that it had to spend a lot of money to make and introduce good sewerage systems and clean water supplies and better quality housing. The amount of money they could spend depending not only on the wealthy classes belief in wanting better sewerage but also the entire publics beliefs.

The government didn’t want to tax the rich more and spend more of its own money if it knew it wasn’t going to be accepted and if they were going to lose public support in their party. By now it is clear that many factors are not independent, but are heavily interlinked with other factors. This reason on its own though was a primary reason why the government was unwilling to introduce effective public health legislation. My final point on why the government didn’t introduce public health legislation until 1875 ties in with the opposition to the government and the rich.

Up until 1875 only some cities such as Liverpool ran its own boards that controlled sewerage. Its important to remember that still many cities didn’t have effective waste disposal and sanitation, many still used privies which were rather foully handled and cleaned by the “night-soil” men, which was very unhygienic to say the least. More often than not when it rain human waste from privies and wells would spill over into the street and attract disease ridden rodents which in turn would spread disease even more.

The government at the time did not control the state of affairs. Private companies and not the government were responsible for removal of waste and sewerage and general sanitary conditions within cities and allotted homes. These companies became know as “vested interests”, and opposed the government becoming anyway involved in public health and taking over, because it would mean they lost there business and would become poorer.

Because it was generally the rich that ran these vested interests they were in a sense very sensitive and prone to being ham-fisted if the government appeared to be acted and getting involved too much. As you can see that factor links In with many of the above factors like the prevailing philosophy adopted at the time and existing administration, this in turn is an important factor as it effected and was a substantial reason why it took the government so long to act on public health.

Overall it is hard to find a single factor that was the most important in explaining why it took the government so long to incorporate into society and effective piece of Public Health legislation. It is very clear however that all these points link together and fuelled and supported each other making it very hard for the government to find a solid footing from which to act on. Saying that in my opinion the scale of poverty and disease was the most important factor, because it was the basis from which many other factors arose from.

So far I have talked about factors that explained why it took the government so long introduce the 1875 Public Health Act legislation. But it wasn’t all just opposition, there factors, such as people and advances within society that galvanised the government into taking action, but more importantly it made the government start to think about what to do and how to act even if they didn’t necessarily act upon these thoughts.

It can be said that the cholera epidemics of 1831, 1848, 1853 (more predominant) and of 1866 were the building blocks which started the government into taking steps towards public health legislation. The shocking amount of deaths from cholera during these times such as the 62,000 deaths In the 1848 epidemic made the government stand up and acknowledge the issue of how dire public health was, in most cases in was the loss in the labour workforce which then aptly affected the economy and business’s, which caught the governments eye.

The first step they took was to introduce Local Boards of health in cities, but this was not compulsory and only those who could fight off vested interests and get enough public support set up the local boards of health. Despite these boards having many problems and being largely ineffective they did show how the government was willing to get involved. Many of the boards were only set up in times of cholera epidemics and as a result were shut down shortly afterwards. But from cholera came one of the most influential figures at the time in public health history – John Snow, I mentioned his work earlier.

John Snow came to change public and government theory with his at the time critically acclaimed theory on the cause and spread of diseases such as cholera. As a founding block which galvanised the government into action, this factor was very important in making the government act. For the first time the government was taking an active interest in public health. The cholera epidemics then led onto another important factor which moved the government toward taking action and that was medical advances.

Although most of these advances came after the final outbreak of cholera there are still major factors that show the government was acting and was doing so at an increasing rate. In 1865 Louis Pasteur proved conclusively that germs caused disease and were not caused by it. In 1869 a Royal Commission set up on the back of Pasteur’s work was set up. It revealed that the conditions in towns were little better then when Chadwick had investigated it some 30 years previous.

Another factor which stemmed from the cholera epidemics was the recognition of work done by individuals, such as John Snow who I mentioned earlier and quite importantly Joseph Bazalgette. He was the chief engineer of the Metropolitan Board of Works whose design of a complete system of intercepting sewers kept the boards of health and its bosses locked in fruitful argument until 1858. Therefore the new system despite being revolutionary hygienic and efficient did not come into full use to save London from the last cholera epidemic.

Another critical individual was Edwin Chadwick the Poor Law commission Secretary work tirelessly throughout the 19th century to promote the government into taking action, one his most resounding achievements was “Report on the sanitary conditions of the labouring population of Great Britain, 1842” – in this report he showed the connection between the environment and disease which was his biggest impact, Chadwick was also very clear about what actions had to be taken to cure the public health problems, from which the government took very seriously.

The work of medical and civil workers alike was very much a contributing factor which influenced the government to take action. The factors of medical and civil advances though is heavily tied in with cholera, and it can be fair to say that without the cholera outbreaks these advances in society and public health may not have occurred until a much later date making the cholera outbreaks vitally important when considering the reasons why the government did eventually introduce Public Health legislation.

My final point revolves around reports made during the 19th century and the way the strongly galvanised the government into action. The first major report was the “moral and physical conditions of the working classes employed in the cotton trade in Manchester,1832. ” This was the first detailed work on a specific group of people and was done by Dr. James Kay. More importantly the his results showed for nearly the first time the connection between dirt and disease.

This report was very important because it effectively set the scene for future reports. Other major reports such as “connections between the Poor law and public health”, “Report on the sanitary conditions of the labouring population of Great Britain, 1842”, and probably most importantly the “Report of the Royal Commission into the sanitary conditions of large towns and populous districts, 1844. very highly influential on the action and direction the government pursued Public Health. Many of these reports were the reasons why many influential smaller local legislations came about and, such as the Liverpool Sanitary Act, 1846 which empowered health authorities too appoint medical officers, which was the first time this had been done ever. There were quite a few crucially important pieces of legislation that helped the government form the 1875 Public Health Act.

Firstly the 1848 Public Health act, then the 1858 local government act and finally probably the most influential act the 1866 Sanitary act, this act in particular was led by John Snow and as a result was quite influential on Government thinking and public thinking, this act gave local authorities more powers to punish “nuisances” and more sanitary powers. But most importantly for the first time, compulsion was a significant element of an act of parliament dealing with public health, the state no longer advised local authorities but compelled them.

From this point onwards, the state was effectively directing public health reform. After looking at all the factors that helped push the government, I find that the reports and work of individuals such as Edwin Chadwick that had the most profound effect. Saying that we can not disregard the other factors since they were inextricable interlinked with the other factors, supporting and strengthening one another.

The 1875 Public Health Act broke new ground, it was when looking at it a consolidation of basically 30 other laws. The act now meant that every county in the country had to have a local Public Health Authority, and that every public health authority had to have at least one medical officer and one inspector to insure water supplies and sanitary conditions. Also now local authorities had substantial power to lay sewers and drains as well as public works. This act was so ground breaking it remained until 1936.

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