The twin problems of poverty and public health in 1830s and 1840s
At the beginning of the 19th century, Britain experienced the Industrial Revolution – a major economic and social transformation. There were far reaching developments in the fields of industry, technology, agriculture, transport, communication, population and urbanization. A major result of the Industrial Revolution in the UK was the phenomenon of congregation, in which the population explosion and urbanization along with the rapid development of the factory system resulted in excessive overcrowding of people for economic and social reasons (Hamlin 1998, p.65). The creation of large numbers of factories in the upland areas influenced by new technologies both created jobs and destroyed them. Employment was dependent on the unpredictable trade cycles. Uncertainty in employment and poor health were the major causes of poverty in the UK during the period.
While poverty was not new phenomenon in the UK, its increased concentration particularly in urban centers rendered it more visible and more shocking to those with wealth, influence and power (Gouda 1994, p.38). A combination of such factors as population explosion, rural-urban migration, insufficient sanitation and health care and inadequate housing translated that conditions were extremely poor and life expectancy was particularly low. The growing urban population mostly lived in squalor and poverty in addition to suffering from the general lack of adequate health provision. The twin problem of spiraling poverty and poor public health system in the 1830s and 1830s affected the entire English population, both the poor and rich, as evidenced by Royal Family’s discomfort from the smell of stench of the raw sewage on the banks of river Thames as well as the death of Queen Victoria’s husband, Prince Albert, from typhoid in 1861 (Craig 2003, p.82).
The severe problem of poverty in Britain at the time became known as the ‘condition of England Question’. Many Britons suffered from absolute poverty, where lacked income to afford the basic human need of food, water, clothing, shelter and warmth. Many more English people suffered from relative poverty, living below the normal standard of living of the time (Tulchinsky & Varavikova 2009, p.54). The privilege classes suffered from such “diseases of civilization” as gout, tuberculosis, respiratory diseases, hysteria and neuroses which were uncommon among the impoverished masses. It soon became obvious that reforms were needed urgently to contain the twin problem of poverty and public health in the UK. This saw the government become increasingly involved in provision of welfare to citizen, responsibilities previously not considered to be government’s (Williams 2007, p.46). As such, the 1830s and 1840s can be rightly termed to the formative years of the modern public health system in Britain.
A number of factors made the British government to establish a welfare state system and undertake reforms to tackle poverty and public health during the 1830s. The old Poor Laws had been subject to serious abuses as members of the vestry took advantage to make huge amounts of money from the system through awarding of contracts to themselves (Rees 2001, p.95). They also benefitted from the overly subsidized labor that significantly depressed wages. The old Poor Laws were criticized of creating a ‘dependency culture’, resulting into moral degeneracy. The political elite were worried that the series of social disturbances such as the Luddites and the Swing Rights would get out of hand in lead to a French-style social revolution. At the same time, a general climate of social and political reforms was in the air following the coming into power of a new Whig (early Liberal). For instance, the Great Reform Act of 1832 afforded the vote to the middle-classes (Byrne 2008, p.88).
In 1832, a Royal Commission to reform the Poor Law of 1601 was informed, including two most influential commissions Edwin Chadwick (Jeremy Bentham’s former secretary) and Nassau Senior (Professor of Political Economy at Oxford). The resulting report, known as Chadwick’s Report of 1834, formed the foundation of the Poor Law Amendment Act of 1834 that recommended the Poor Law to be influenced by efficiency and economy as opposed to the desire to give help to people in need (Morley 2007, p.71). It was observed that outdoor relief paid to the needy under the Old Poor Law system was a barrier that hindered individual from pursuing their Benthamite self-interest to its natural conclusion as it dictated wages and undermine the free play of the country’s labor market. It was further claimed that crime and disease considerably reduced an individual’s wealth creation ability and freedom in pursuing self-interested happiness. A figure was put on the cost of poverty, crime and disease – £7 million poverty rate; £5 million unsatisfactory health measures; and £2 million punishing crime. About 10% percent of the population, or about one and half million were estimated to be poor in Britain in 1832 (Mclean 2006, p.32).
The Chadwick report argued that the Elizabethan Poor Law resulted in a system in which the laborer was badly off than the pauper, something that encouraged able-bodied men from working and instead live in idleness and off the parish. This was despite the fact that the people who lived off the parish were mainly the elderly, the sick, orphans and a few able-bodied who could not find work (Kaufmann 2012, p.66). As a result, the British Parliament enacted a law establishing the Poor Law Commission mandated to regulate poor law administration. All parishes would be bundled together to share costs while workhouse would formed in each union of parishes to offer relief based on less eligibility and abolishing outdoor relief. The consequence of all these was that landowners persisted with their domination of politics and control of institutions such the Poor Law to the benefit of the new capitalist classes (Kaufmann 2012, p.87). However, the Poor Law Amendment Act of 1834 became the first major government effort at welfare reform during the nineteenth century although it was universally hated by the poor in Britain.
The 1830s and 1840s were also a time that Britain suffered from “disease of civilization” and the growth of “localities of pauperization” (poor slum quarters of deficient hygiene). There was deficiency of toilets and ventilation and heaps of decaying refuse and sewage that made ill health observably endemic (Fischer 2007, p.15) In 1831, the British Government enacted legislation to tackle the cholera epidemic. The health problem was, in addition to the unparalleled rapid urbanization and low wage economy, due to lack of government willingness to address urban health problems forthright due to its pervasive laissez-faire policy that discourage interventionist convictions (Craig 2003, p.92).
In 1840s, however, the government sought to undertake significant reforms in the public health provision. The initial public health measure dealt with the removal of miasmas or bad smells that caused disease by greatly focusing on cleanliness. Edwin Chadwick’s 1842 report on The Sanitary Conditions of the Labouring Poor in Great Britain brought to the fore the inequalities in health among the English population (Hamlin 1998, p.76). It concluded that societal advancement (due to industrial revolution in Britain) did not fairly measure to the universal improvement in urban health and that modern circumstances had established a major health schism between social groups. The Poor Law Amendment Act of 1834 regarded impoverishment and disease as the consequences of immoral habits in the presence of miasma. Disease was established as the main course of poverty and thus preventing disease was the way to reduce the poor rates in the country.
The Public Health Act of 1848 was a legislative effort to bestow health and social equity in Britain. It led to the establishment of a Board of Health and granted towns the right to appoint their own Medical Officer of Health (Williams 2007, p.63). By 1875, the Public Health Act had expanded to include laws on slum clearance, removal of nuisances, and provision of clean water and sewers to the population. The National Health Service Act of 1946 established the National Service in Britain. This integrated the voluntary hospitals, and the local government hospitals into a single hospital service. A newly formed welfare state, the NHS was established to provide British people with primary and free health care regardless of their financial situation, social class, profession, sex and age (Fisher 2007, p.2).
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