Intended for healthcare professionals


Congestion charging and the walking classes

BMJ 2003; 326 doi: (Published 15 February 2003) Cite this as: BMJ 2003;326:345

New charge tackles road danger at its source

  1. Ian Roberts (, professor of epidemiology and public health
  1. Public Health Intervention Research Unit, London School of Hygiene and Tropical Medicine, London WC1B 3DP

    Two hundred years ago London was a cesspit. Its streets were awash with sewage and infectious disease was a deadly scourge of the urban poor. The man credited for cleaning up the mess was a tenacious London politician called Edwin Chadwick.1 His 1842 report Survey into the Sanitary Conditions of the Labouring Classes was a landmark in public health with its graphic descriptions of how filthy living conditions were a key factor in the spread of infectious disease.2 Chadwick battled hard for sanitary reform, waging political war against those opposed to central government intervention in public health matters. His opponents argued that people were clever enough to manage their own affairs, claiming there was “insanity in sanity.”1 But Chadwick won through and is now acclaimed as the instigator of the most important public health reform of the 19th century.

    The sewage has long gone, but now the streets of London are in gridlock and traffic …

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