Prevention is better than cure

The NHS has been celebrating its 70th birthday, but the anniversary of an equally important event is not being marked in quite the same way. The Public Health Act 1848 is now 170 years old but, unlike the NHS, its anniversary has passed largely unnoticed.

The Act was a key piece of legislation that saw improvements in sanitation, housing and water quality to help tackle the causes of multiple infectious diseases. It resulted in significant improvements to people’s health.

Its purpose was to promote the public’s health and to ensure “more effective provision… for improving sanitary conditions of towns and populous places in England and Wales”. Such clarity of purpose is impressive.

“The argument was economic… if the health of the poor were improved, it would result in fewer people seeking poor relief

The catalyst for reform was the anxiety caused by a new cholera epidemic sweeping Europe. The background to the Act was a remarkable piece of work on mortality and morbidity rates across the country. Its provisions were based on the findings and recommendations of social reformer Edwin Chadwick in his ‘Report on the sanitary conditions of the labouring population of Great Britain’.

Chadwick’s argument was economic, as he was convinced that if the health of the poor were improved, it would result in fewer people seeking poor relief; much poor relief was given to the families of men who had died from infectious diseases. Money spent on improving public health was therefore cost-effective, as it would save money in the long term.

Local boards of health became responsible for removing ‘nuisances’, such as refuse or bad paving, from the streets, and for drainage and water supply, as well as other sanitary actions. They were also empowered to appoint officers of health and inspectors of nuisances – forerunners to modern-day environmental health officers.

The legacy of the 1848 Act was one of enabling and encouraging partnership between national and local government in legislating, regulating, and creating the conditions necessary for longer, healthier lives.

The need for partnerships has never been greater – between communities, individuals, businesses and public agencies. These partnerships will flourish only with ongoing investment and through a commitment at all levels to developing a ‘health in all policies’ approach to policy making.

Both the Prime Minister and Health and Social Care Secretary Matt Hancock have publicly prioritised prevention in the NHS Long Term Plan, describing it as “mission critical”.

These priorities are very encouraging and will strike a positive chord with members who have long argued that the current social care and health system is unsustainable.

They say it will buckle under the weight of demand unless we re-engineer our planning and service provision to promote healthy choices, protect health, prevent sickness and intervene early to minimise the need for costly hospital treatment and social care.

Local government has been unanimous in our support for taking leadership of public health and working with our local partners to achieve shared priorities. We really do think we can make a difference to the lives of our local population by helping them live longer, healthier and more fulfilling lives, but only if we do things differently and are resourced appropriately.

Although our health has improved immeasurably since 1848, some problems remain, such as poor air quality, inadequate housing, bad diet, and substance misuse; the Act’s approach remains just as relevant today.

For LGA information and resources on public health, please visit


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