When the French National Assembly declared health, along with work, a right of man in 1792, it laid the political foundations that would form the basis of a social contract of responsibility for population health between the democratic state and its citizens. By the middle of the nineteenth century, the British state translated the idea of health citizenship into a universal equal right under the law to protect the population from epidemic disease. In 1848, a French and a German revolutionary—Jules Guérin in the Gazzette médicale de Paris and Rudolf Virchow in his reports on typhus in Upper Silesia—interpreted health citizenship as constituted through democratic freedom, universal education, and amelioration of social and economic inequality.

Throughout the nineteenth century, central European states adopted increasingly interventionist legislation to protect populations against the threat of infectious disease. In the United States and Canada, “sanitary revolutions” took place at local and regional levels, but federal interventions were less comprehensive. By the last quarter of the century, the effects of local, regional, and central state actions began to be effective in reducing mortality from infectious diseases in industrial societies. The most significant changes were registered in lower infant mortality, as the result of the increasingly comprehensive supply of clean, noncontaminated water in urban environments.

As infectious diseases declined in industrialized urban societies at the turn of the twentieth century, the attention of public health authorities and medical academics turned toward the control of chronic diseases.