Water, Sanitation and Health in the first industrial society: Britain 1780-1930

Some of the greatest challenges associated with the growth of cities are the provision of safe water and the disposal of large quantities of faeces. Britain was the first society to industrialise and to achieve modern levels of urbanisation (with over half the population living in urban centres by 1851), and the slums of Victorian cities became emblematic of the health risks of rapid and unregulated urban growth. However Britain was also precocious in the development of clean water and sewerage, and the history of British reforms in public health has become a yardstick for sanitary improvements globally. While early histories of public health emphasised the importance of Edwin Chadwick's Health of Towns movement in the 1840s, more recent and influential accounts identify the 1870s as the point when towns were finally induced to provide clean water and sewage disposal, and when mortality rates from waterborne diseases fell decisively. However the available evidence (for England and Wales) suggests a much more complex picture. Falls in mortality from 'faecal-oral' diseases were not synchronised but varied markedly by disease, with the most lethal and water-dependent diseases (cholera, typhoid and dysentery) declining half a century before infant diarrhoeal mortality. Faecal-oral diseases also declined with a complex geography, falling first and fastest in the largest towns, but with similar timing and speed in other towns and in rural areas. The pattern in Scotland remains largely unexplored.

This project seeks to reconceptualise the modern history of urban sanitation and health in the British context by disentangling the effects of different innovations and policies regarding water supplies and faecal disposal methods on mortality from specific faecal-oral diseases. Faecal-oral diseases differ markedly in their dependence on water, food, flies and domestic hygiene practices for transmission, and in their lethality. Much of the difficulty in understanding the uneven progress of the 'sanitary revolution' in Britain and globally has been due to a tendency to lump together different types of sanitary improvements and causes of death. Our study will analyse specific disease outcomes over a much longer period than is conventional (from 1780 to 1930) and this will make it possible to test whether industrialisation was associated with a rise in faecal-oral diseases, and whether early efforts to supply clean but unfiltered drinking water were sufficient to drive major falls in cholera and dysentery (which rely mainly on water-borne transmission), whereas improvements in infant diarrhoea had to wait for the adoption of comprehensive sewerage and in-house water supplies.

Our study is novel because it takes a very long view of the history of faecal-oral diseases and water, sanitation and hygiene (WaSH) interventions; because it takes disease- and policy-specific approaches; and because it uses interdisciplinary and mixed methods. It is also the first study to take an integrated and comparative approach to developments across England, Scotland and Wales. We will use newly-created measures of public investment in specific measures (water supplies, sewage disposal and treatment) and of mortality from specific faecal-oral diseases to study how local governments responded to perceived problems, and under what circumstances their efforts were effective. Our approach combines statistical modelling with detailed case studies and archival research to understand both what happened, and why.

The project will challenge the conventional narrative of the 'sanitary revolution' in Britain and replace it with a much more nuanced account of the struggles British towns faced that will provide a more realistic and informative comparator for WaSH programmes in poor populations today. The project will produce a range of economic and demographic datasets for academic use as well as school teaching materials and publicly available death rates.