Blog: The History of Improvement – Building Engagement


In the second blog in The History of Improvement series, Jess Roberts, Project Manager at Haelo, writes about the problem of the poor in the nineteenth-century urban slum, and the report that led to the first public health legislation.

Disease, criminality, and madness were rife among the Victorian poor in the industrial centres. For a long time, the middle classes and the government assumed that this was because the poor were inherently degenerate or prone to disease.

In response, lunatic asylums were built on the outskirts of large cities to contain people. Unfortunately these were not places that provided any treatment until towards the end of the century. They were essentially prisons for people suffering from mental illness or addiction issues. Medical professionals also debated what they saw as physical and mental degeneration among the poor, or, the idea that evolution was actually going in reverse.

Credit: British Library

However, in a ground-breaking sanitary report (1842), the social reformer Edwin Chadwick argued that the reason behind all these problems was the horrific slum conditions in which the poor were forced to live. Chadwick commissioned a prominent medical professional from each large town in England to produce a report of the circumstances of the poor. He was told about overcrowding and unsanitary conditions that spread disease, led to criminality, and to drunkenness and madness.

He was one of the first proponents of evidence-based improvement and preventative medicine, and he argued that it is impossible for people to behave well and be healthy when the conditions around them are bad. Although modern germ theory would not be developed until the end of the century, and Chadwick had no medical training, he argued that cleaning up the slums would clean up the people, both physically and morally. He was against the kind of one-off acts of financial charity that were bestowed by wealthy middle-class benefactors: this did not solve the underlying problem.

Chadwick used both quantitative and narrative methods to make his point: he grounded his report in both the data and in emotive stories. One table showed shocking figures for the average age at death for people in Bolton in 1839.

Chadwick also included testimonies that he wrote by “examining witnesses” for his report (Chadwick was a lawyer by training). For his descriptions of the squalor in which the urban poor were forced to live, he borrowed the emotive and literary style of Charles Dickens, whose novel The Old Curiosity Shop was published the year before Chadwick’s report. Dickens is well known for writing texts underpinned by his agenda for social change and Chadwick used this same style because it was proven to stir people’s emotions. Chadwick and Dickens both wrote heavily descriptive passages that captured, in detail, the claustrophobic, damp, and poorly ventilated housing, the stench of the air and the dirt on the streets, and the desperation and poverty of men, women, and children.

The sanitary report changed the way that the middle class thought about the urban poor, not by persuading people that there was a problem – they already knew that – but by emphasising that the real problem was the condition of the slums, and therefore the government could and should do something about it. The first public health legislation was passed as a consequence of this report.

The 1848 Public Health Act enforced:

  • improved drainage and provision of sewers
  • the removal of all refuse from houses, streets and roads
  • the provision of clean drinking water
  • the appointment of a medical officer for each town

As improvers, what can we learn from Chadwick when we think about building engagement from stakeholders?

Firstly, reframing the problem is often a useful first step: is the problem really what people think that it is? Or have we only been working on improving the symptoms rather than the cause?

To build engagement, Chadwick gathered data that could not be argued with. He combined this data with testimonies to create an emotional investment in the issue. While presenting data can make a powerful case for change, including patient stories as well strengthens your pitch even further. Chadwick used the tools at his disposal: the literary technique of a great author of the era, but we can use social media and film to engage a wide audience.

What do you think?

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