How is planning rooted in public health?

In the nineteenth century industrial cities grew rapidly and chaotically, and housing for the poorest was squalid. It was often poorly constructed, overcrowded, damp, lacking water supply or sanitation. Overall, mortality rates were high and life expectancy low.

The 1848 Public Health Act

Edwin Chadwick, a social reformer, published a “Report on the sanitation conditions of the labouring population of Great Britain” in 1842 that investigated the link between poor living standards, sanitation and the spread of disease. This played a key role in the creation of the 1848 Public Health Act. Whilst this Act was an important step forward and resulted in the creation of a Central Board of Health, it did not force local authorities to act on the Board’s recommendations ((1),(2).

Influence of environmental factors on health

During the 1800s, little was known about how diseases were transmitted from one person to another. In Europe, the ‘miasma theory’ was established. This was the idea that disease was spread through the foul-smelling dank air, that hung around the narrow passages and cramped courtyards of cities. Miasma was held responsible for many fatal diseases and conditions during this time, including cholera.

During a cholera outbreak in 1854, Dr John Snow investigated cholera cases in the Soho area of London, recording and mapping cases in addition to information about the water supply to the affected houses. His research showed that the disease was associated with contaminated water supply from a pump in Broad Street.

Through his investigation, Dr Snow disproved the miasma theory and also influenced changes in public health, showing the importance of environmental factors in health.

The 1875 Public Health Act

Public health campaigners wanted to improve housing and sanitary conditions. However, it was not until the 1875 Public Health Act that the first effective legislation was introduced, including minimum standards for housing. Under the Act, previous legislation on sanitation and public health were brought together, and local councils were required to introduce byelaws for new housing to ensure structural stability, effective drainage, air circulation and sanitation (3).

The 1875 Public Health Act was, in effect, the first urban planning act. The Act significantly contributed to improvements in the health and life expectancy of working-class people, however, an unintended consequence was that the resulting terrace housing often lacked adequate green space and other local amenities.