The campaign for better public health was a major social issue in England during the second half of the nineteenth century. As in the case of Poor Law and factory reform, Edwin Chadwick stands as the person who directed public interest toward the need for sanitary reform. He did this through his association with the Poor Law Commission in the late 1830s, then through his seminal and widely read 1842 Report on the Sanitary Condition of the Labouring Population. Chadwick's report captured the minds of many in the British upper middle class. The Health of Towns Association, founded in 1844, helped to diffuse information on the “physical and moral evils that result from the present defective sewerage, drainage, supply of water, air, and light. …” Although the sanitary reformers had made some minor gains by 1847, they had failed to produce a satisfactory bill that would allow government some role in coordinating sanitary improvement. At this point, neither Chadwick, nor any other leading proponent of sanitary legislation wanted to put full authority in the hands of the central government, but they did desire a more efficient combination of local and national control.
The sanitary reformers, and particularly Chadwick, achieved a measure of success in 1848 when the Public Health Bill received parliamentary approval. It was hoped the Act would bring about a useful consolidation of responsibility for drainage, sewerage, water supply, and road maintenance. Instead, the legislation spurred a furious debate over how much national government interference was acceptable. It did little to improve public health because the argument over government interference for a time took attention away from critical issues of sanitation reform. Although never completely overcome, the argument over principles faded in the 1850s in the face of an urgent need for reform.