Introduction

Modern local government in the United Kingdom (UK) was born out of a growing concern about the links between social conditions and the state of public health. Yet while ‘social determinants of health’ has become a global discipline, local government has ceded its role over the last decade as its capacity has withered during the time of austerity. The COVID-19 crisis of 2020 has shown the capacity of local government to mobilise anew around public health issues, but its fundamental fiscal and constitutional weaknesses show that a new settlement is needed more than ever.

The story of local government and public health

One way of interpreting the last 150 years of English local government is through the lens of inequality and wellbeing – or what we are now calling the social determinants of health. As the Industrial Revolution developed and England grew wealthier, the health and welfare of its workers deteriorated. Between 1801 and 1841, the population of London doubled and that of Leeds nearly tripled. But such growth in urbanisation was deadly. Between 1831 and 1844, the death rate per 1,000 increased in Birmingham from 14.6 to 27.2, in Bristol from 16.9 to 31 and in Liverpool from 21 to 34.8 (Bryant and Rhodes, 2019). This crisis was the result of a terrible mismatch between the increase in the urban population and available housing. Overcrowding and poor living conditions led to widespread disease and poor health.

The shock of these negative effects on public health led to significant sanitary reforms in the 19th century and subsequently to the establishment of public health institutions.

During the 19th century, the new and growing cities and towns gained powers from Parliament to create municipal corporations (citybased all-purpose councils) with significant powers of taxation. By 1900, ‘most public provision was in the hands of these councils or special-purpose authorities.