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1848–1906: the rise of public health

Significant progress was made towards improving the health of the population following the first Public Health Act in 1848. Throughout the 19th century there was a growing focus on the environment and sanitation, and their impact on public health. Following increasing concern about the unsanitary conditions facing the poor and fear over a cholera outbreak, the government passed the Public Health Act 1848, which consolidated other public health legislation and gave local boards powers to tackle ‘nuisances’. However, the act was criticised as being merely facilitating because it did not compel the local boards to tackle nuisances. Later Acts increased powers and responsibilities and introduced measures such as infectious disease control.

Against growing criticism of the conditions faced by the poor (and in particular those who were sick) in workhouses, the Metropolitan Poor Act 1867 was introduced. It provided for the establishment of asylums for the sick, insane and other classes of the poor in London. In 1871 the Local Government Board Act established the Local Government Board, which took over the administration of the poor law administration (from the Poor Law Board) and the public health work of the medical department of the Privy Council. Its public health responsibilities now included disease prevention, vaccinations, birth, death and marriage registrations, making public improvements and the provision of baths and wash houses.

Public health in the late 19th century was characterised by the bacteriological revolution. The impact of medicine on public health increased considerably with the scientific breakthroughs of the 1860s, when Louis Pasteur formulated the germ theory. With the bacteriological revolution vaccine development increased and investigations into food and water safety advanced, as did disease surveillance (Berridge et al., 2011). By the early 20th century, public health ‘was moving away from the collective management of the environment to interventions targeted at individuals in the home (Berridge et al., 2011).