Public Health Act 1875 150 years on – reflections from members

Over the summer we marked the 150th anniversary of a landmark piece of legislation – the 1875 Public Health Act.

We were thankful to a number of members and prominent EHPs who spoke to us about the history and significance of the act, how it resonated with them and their careers and what they saw as the most pressing public health challenges now and on the horizon.

In this blog post, we bring together those conversations which we hope you find an informative and interesting read.

Rachel Flowers, Chartered EHP, CIEH Public Health Advisory Panel member and former Director of Public Health

Firstly, Rachel spoke about the importance of the Act and why she feels it is the ‘one of the most significant public health acts we've had in the United Kingdom’.

She said: “Although the 1848 Act was the first Public Health legislation, and we are right to celebrate it, most areas didn’t apply this legislation and there were still a lot of challenging public health issues in many areas.

“The 1875 Public Health Act required all councils to provide clean water, with proper drainage and sewage and a medical officer of health but more importantly, particularly when discussing environmental health, a sanitary inspector to ensure the laws on food, housing, water and hygiene were carried out.

“The 1875 Act really shoved our country into much more of a public health focused setting. It made it compulsory for local powers to purchase, repair and create sewers, control water supplies, regulate cellars and lodging houses and established bylaws for controlling new streets and buildings.

“Disraeli ensured the passing of the 1875 Act and when mocked by his opponents for what they saw as neglecting more important political reforms, he retorted ‘Sanitas Sanitatum! Omnia Sanità’s’, loosely translated meaning ‘health above everything’, which is a quote I really like.

“Disraeli was the first Prime Minister who actually chose to put public health at the top of the agenda and the 1875 Act is a fundamental building block of public health. It embedded the principles of environmental health as we now know them.”

Rachel’s is proud of her environmental health roots, however for nearly 20 years she has also been a registered public health specialist, and she said the 1875 Act still resonates with her today.

She said: “The 1875 act legislated for all local authorities to consider the health of the population, it looked at not just the environment, but safer housing, safer sanitation, safer food and actually explicitly talked about sanitary inspectors and the roles they played.

“For me, because I played those roles, it has been fundamental, but obviously as we are now 150 years on, there have been other things that have built on from that.

“However, it’s always useful to look back and consider where it all started and actually recognise the value of advocacy from politicians who realise that public health made a real difference, improving health, particularly of the most vulnerable.”

Bringing the conversation up to the present day and looking ahead to the future challenges in public health, we firstly asked Rachel if she had the ability to take a public health risk out of action, the way John Snow removed the water pump handle on Broad Street 150 years ago, what risk would she remove.

“If only it was always that simple,” she said. “If I had a magic wand, I would use it to reduce poverty as most of the challenges we have link back to that – the poverty of income, the poverty of education, the poverty of housing etc.

“But I don’t think it’s easy to say if you did this one thing it would improve, as in public health and environmental health it’s never that simple.

“In terms of the history of sanitary inspectors, there’s a reason why a lot of EHPs became Directors of Public Health, because of the training where we were actually taught a wide range of things, practical applications in different ways to try and solve complex problems.

“Inevitably with the work being done at a local level, it’s rarely one thing, it’s a combination.”
Looking ahead to what challenges Rachel sees on the horizon in terms of public health, there were two main issues that came to mind.

“It has to be climate change”, she said. “Many people reading this will remember the United Nation’s Agenda 21, 35 years ago now, where I was working around climate change, so this has been a conversation for a while.

“Now we are starting to see more extremis, and of course with EHPs, we now getting the risk of more mosquitos, we’re seeing more flooding etc.

“However, equally I would say inequality, as we are now seeing the risk in the four countries of the United Kingdom, where the children are likely to die before their parents.

“We are seeing the impacts of poverty in a range of things and a growing inequality which means that people living in the poorest parts of the country, somebody in their 40s has the same ill health as someone in their 70s in a more affluent place.

“They spend nearly half of their life in ill health – and that is just not right.”

Mike Studden, Retired Chartered EHP, Honorary CIEH fellow and CIEH Public Health Advisory Panel member

Mike Studden enjoyed a long and distinguished career working in public health and risk management roles in local authority, civil service and the private sector.

He firstly spoke about the relevance of the act to him and his work and why he feels it was such a ‘significant’ piece of legislation.

He said: “This was the first encompassing legislation which brought everything together and empowered local councils to take a firm grasp of the situation in many ways, to start to build local authority housing, to appoint a medical officer, to do all of those things to address problems.

“The councils could take responsibility for its own area and for improving the health of its local population. So that was significant.”

When Mike began in the profession in his native Scotland before his career took him to England, his principal Public Health Act was the 1897 Public Health Scotland Act, and he believes the acts were ‘timeless’

He said: “We're talking now sort of mid-sixties, early seventies and a lot of it was still as relevant then as it had been in 1897. I've no doubt that the English Public Health Act was a parallel. They were timeless.

“For some reason they always had the answer to modern day problems until they were superseded by modern legislation, but they were all-encompassing pieces of legislation, they brought together all the powers, requirements and responsibilities and were always the first point of call if you had a problem, as that’s environmental health - we solve problems.

“I'm amazed at how relevant some of it still is - the act's way outdated now because of the modern stressors, although I’m on record saying that the stressors are still the same, they just present in a different way.

“For example, air quality is still a major problem. Back when I started, air quality was industrial pollution, now it’s more to do with vehicles. Communicable diseases were a different kettle fish altogether, but it was still a problem. Food borne infections - there are different food borne infections now, but it still addressed those.

“I think each of the public health acts was strong enough to be able to cope with change for a very long time. I wasn't around 150 years ago but it's still provided the basis for trying to provide a healthy community for people to live in and thrive and by the time I started to practice in 1970, I could still turn to the public health acts in their later stages.”

As with everyone we spoke to, we asked Mike if he had the ability to take a public health risk out of action, as John Snow removed the water pump handle on Broad Street 150 years ago, what risk would he remove.

He said: “The one thing that has always struck me as strange, was that local authorities had busy roads with huge amounts of traffic on them and would segregate a path next to them for cyclists.

“They had the best intentions in the world to make people more mobile and less vehicle dependant, but these cycle paths are right alongside the most polluting vehicles and in the highway, so you know, there seemed a bit of a strange mix.

“For me I would say to local authorities that is not going to solve your problem, all you are doing is exposing a bigger part of the population, on the basis that they are supposed to be getting healthier and cycle on these paths, to the worst pollution in your area.

“Some things are going to be distasteful when your managing risk and the solutions are harder than the risk appetite of some local authorities as they are very close to the people and will find it difficult to take decisions sometimes, so the professional advisors find themselves in that fork.

“Cycle paths are a good example – I feel sorry for these poor cyclists who think they are doing their health immeasurable good but are opening themselves up to a health risk.”

Looking into the future at what challenges Mike sees as the biggest public health threat, it was the ongoing issue of air pollution which was at the forefront of his mind.

He said: “We’ve seen huge technological advancements, but we still haven’t come to terms with providing clean air as a right to every citizen.

“London is a classic example. I stopped going to London, which has been helped with now having Zoom and video calls, as I would come home feeling ill inevitably with the amount of pollution I was soaking up.

“So, I think air pollution is still a major problem – outdoor but also, we shouldn’t forget indoor. Things like carbon monoxide poisoning, and we’ve been exposed over the years to many other substances such as the chemicals they build into carpets to stop them taking stains.

“For me air quality is the biggest public health threat we are facing still.”

Carol Archibald and David Dovey, Essex EHPs and CIEH members

Carol and David have seen most things during their time in the profession and had some really interesting insights on the 1875 act and its legacy.

We asked them whether the Act resonated with them in their careers and what similarities they think have remained from what sanitary inspectors faced in 1875.

David said: “Of course, standards have improved. Those days they were bad because they didn't have anything to fight pest activity. We've now got second and third generation poisons, but obviously we are still dealing with pests. We're using the Prevention of Damage by Pest Act now predominantly.

“So, do we still deal with filthy and verminous conditions? Yes. Have I had the need to de-lice somebody? No!

“With the public health acts, when they first came out you had an awful lot of power. You could literally take someone off the street.

“We used to be able to take people off the streets and cleanse them and enforce quarantines. All that has gone.”

When Carol started her career in Ipswich, the remnants of some of those practices covered in the 1875 Act remained.

She said: “In the building that we were in, they actually had the baths where they used to bring in our people to de-lice them and the building had been built with those facilities still in it, but I don’t think you’d find that there today.

“So that’s kind of a societal change. But is there still a need to do it – probably there still is.

“Although things have evolved, the fundamental basics are still the same.

“We don’t do very much drainage stuff now, because there was an Act that split it between us and the water companies, but when we did, you were still opening up the drains and you had all the Victorian sanitation and its complications down there and you had to work out what they’d done and how they’d done it.

“It was quite amazing and complex how they had done it. That’s why it has stood the test of time and why we are still servicing what was put in place back then.”

As with Rachel and Mike, we asked Carol and David if they had the ability to take a public health risk out of action as John Snow did 150 years ago, what risk would they remove.

David said: “Where John Snow moved the water pump, I would stop water companies from discharging into the sea and rivers. If we had the power to do that, I would do it - that would solve a lot of problems.”

From a food point of view, Carol said: “I would take away the registration that we have now and put in place licensing, because it's far more powerful, we could have better controls and make sure everything's all set up right before people start out in business.

“It's just so frustrating that anybody can just start a food business. We need to have more powers to be able to stop poor food businesses operating.”

David agreed this would be a benefit to public health in tackling unfit food.

He said: “The amount of food poisoning outbreaks we are having, you see it in the news with salmonella cases increasing substantially this year.

“That all comes back to public health acts because they were supposed to clean up the streets, clean up the food supply, drinking water etc.”

So, 150 years on from the Public Health Act, we asked what they see as the next big public health threat on the horizon.

“I think it’s going to be the next pandemic,” David said. “My fear is that this time people won’t listen, after what our leaders did last time.

“We are going to try and shut premises down for their safety and they are not going to listen. The police will try to quarantine people, and they are not going to listen.”

Carol shares David’s concerns and that the country and the profession need to be better prepared for what could be coming.

She added: “During Covid we dealt with an awful lot of people who just wanted advice on how they could reopen; not how could they not get Covid or avoid spreading to loved ones or the elderly and vulnerable. It was just down to money.

“So, I would agree with David, and I would still ask, what did we learn from Covid? There has been nothing from the profession, for the profession that has come out of that period, no discussion about what we could do differently which concerns me. We should be doing that and looking to make changes to ensure we are better prepared.”

Thank you to all the members who have shared their views and reflections on the 1875 act.

More content about the anniversary including case studies, blogs and videos can be viewed on our website here: https://www.cieh.org/about-us/history-of-cieh/150-years-of-public-health-act/