The introduction of the 1875 Public Health Act and its lasting legacy

This year marks 150 years since the enactment of the Public Health Act 1875. In this blog Jack Head, a Researcher at the Health Determinants Research Collaboration for Greater Essex, reflects on the impact of the 1875 Act, and draws parallels between the state of health in 19th century Britain and the growing health inequalities of today.

150 years ago Parliament enacted the Public Health Act of 1875. This important piece of legislation followed half a century of campaigning by public health and sanitary reformers, and marked the apotheosis of those important movements.

Following the publication in 1842 of Edwin Chadwick’s Sanitary Report – which as a result of his enterprising spirit sold over 100,000 copies – a series of major reforms were introduced aimed at improving the health of the public. These reforms brought historic changes, including the establishment for the first time of a General Board of Health (which would oversee the work of local bodies), compulsory vaccination of children against smallpox, and the construction of Bazalgette’s monumental sewerage system in London.

By the 1870s the public health movement was in full swing, with many reforms beginning to show their benefit. One consequence of this success was the need to take stock of the considerable body of legislation already introduced, and by the early 1870s discussions were already underway about the bill that would eventually become the Public Health Act 1875.

The 1875 Act has received less attention from historians than other pieces of 19th century public health legislation, but its importance should not be understated. With 11 Parts and five Schedules – around 180 pages – its length draws attention to the scale of the problem it attempted to address. It established existing local authorities as urban and rural sanitary authorities (giving them powers in relation to the disposal of sewerage and the enforcement of housing standards), ensured that Medical Officers of Health (forerunners to today’s Directors of Public Health) were registered doctors, and imposed health standards across the country in a uniform manner.

The 1875 Act also consolidated a number of earlier, disparate pieces of legislation, and its provisions remained largely in force for 60 years, when further consolidation and amendment was needed to account for the rapid change that had taken place in the first part of the 20th century.

In 2025 many of the issues these 19th century reforms attempted to deal with are, once again, at the fore. Next year the UK Health Security Agency will launch the latest iteration of its five-year action plan to tackle the growing threat of tuberculosis, estimated to have caused one third of all deaths from disease in Victorian Britain, and which the WHO now regards as a ‘disease of poverty’. And in a survey of its members earlier this year, the Royal College of Physicians found that 89% of respondents ‘were concerned about the impacts of health inequalities on their patients’, while 72% had seen patients in the last three months whose conditions were either caused or exacerbated by the wider determinants of health.

These wider determinants of health – the conditions in which we are born, grow, live, work, and age – were well known to certain Victorian reformers, even if our modern terminology wasn’t, as the provisions of the 1875 Act demonstrate: overcrowding, air pollution, food safety, and the fitness of homes for human habitation were all matters it attempted to deal with. In the 19th century, and in the 21st, it is environmental health practitioners who are largely responsible for tackling the threat to health posed by these wider determinants of health. The importance of these practitioners, who work in local authorities up and down the country, cannot be overstated.

The advice of Benjamin Disraeli, who ushered the Public Health Act 1875 through Parliament during his second premiership, is still relevant to those in central and local government responsible for allocating resource and setting priorities. Speaking in Manchester in 1872 as leader of the opposition, he declared that: ‘Pure air, pure water, the inspection of unhealthy habitations, the adulteration of food…it is impossible to overrate the importance of the subject. After all, the first consideration of a Minister should be the health of the people.’