Intended for healthcare professionals

Education And Debate

Millennium report to Sir Edwin Chadwick

BMJ 1998; 317 doi: (Published 29 August 1998) Cite this as: BMJ 1998;317:592
  1. Iqbal Sram, locum consultant in public health,
  2. John Ashton, regional director of public health
  1. NHS Executive North West, Warrington WA3 7QN
  • Accepted 12 August 1998

Editorials by Alderslade, Palmer Recent advances p 584 Education and debate pp 587, 596

To mark the 150th anniversary of the 1848 Public Health Act, Iqbal Sram and John Ashton write a memo to Edwin Chadwick, the architect of the 1848 act, on the state of the public health at the end of the millennium

I will not cease from mental strife,

Nor shall my sword sleep in my hand

Till we have built Jerusalem

In England's green and pleasant land

William Blake William Blake

Dear Sir Edwin,

We live in a world which you would have envied. You played a dominant role in laying the foundations of this world. A clean and secure water supply for the population at large, coupled with the separate disposal of their sewage and waste, were the central planks of your crusade to protect public health in your day. However, Sir Edwin, we enter a caution here. The harmonious world referred to is, in essence, the “first world.” The insanitary conditions which you were determined to eradicate still persist over large parts of the globe.

It will not have escaped your notice that it is 150 years since the enactment of the 1848 Public Health Act (An Act for promoting the Public Health), for you were its chief architect.1You subscribed to the contemporary laissez faire doctrines in the management of economic affairs, having worked closely with the economist Nassau Senior in the reform of the poor laws, which dated back to Elizabethan times.2 In the social policy arena you battled hard and successfully against those who wished to extend and entrench that approach to a wide range of public policy areas. Your energy and determination secured support for state intervention for public health protection from the major perceived health hazards of the day,3 …

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