Social factors are central to this discussion. The changing social trends of Victorian Britain brought the concept of philanthropy to a much higher status than it had been previously. Trends of philanthropy emerged increasingly, from the building of academic institutions by people like Newnham, to the benevolence of people like Dr Barnardo. From the academic sphere of development to concern about the poor, there was a transformation towards ideas of concern. Yet, around 1850, these trends were seldom seen. The reason for this is simply because the permeation of those people in a position to be benevolent was not great. Indeed, the society of the time was characterised by suspiciousness, as country folk who were used to a close community suddenly found themselves in an anonymous community. This had obvious connotations for health: a doctor who knew his patients by sight and socially in a rural community had a bond of trust, poor health could be monitored and remedied, yet in to a person used to this sort of health care, to receive health care from people who quite often no contact was made with would have lost that bond of trust. People were simply not naturalised into the urban community. Although these trends did continue into the 20th century, a certain amount being felt even today, a social culture rather than community developed to assist this with the prominence of sport, especially football, and workers co-operatives coming to the fore. Yet social reform was needed, and although there was a reform of the Poor Law (with the poor areas of society needing to go through far more stringent controls than previously) reform could only be brought by an independent interested body such as a wealthy industrialist or the government. In addition, the working class were not willing to provoke the government into action they desired a community like that of their forebears not a maternal system, the trends of suspiciousness and anonymity were too strong. But a system was needed, and something needed to bring the philanthropists. The answer lies in economics.
Before economic factors are addressed, and important issue made up of purely socio-economic factors should be discussed. Migration is an important topic that deserves to stand-alone. Trends for migration in early to mid 19th century explain much about the initial state of affairs in the rural communities. Migration had the important consequence of taking away people from the country communities and relocating them as urban workers. The economic decline of the agricultural sector was due in no small part to the loss of a new generation of fit male labourers to the towns, which wouldn’t have been recognised particularly between 1850 and c.1870. Moreover, the immigration of workers into urban areas meant that not only was demand for jobs absorbed, but the sheer volume meant that demand for jobs in a different sense was created, from a demand for employees to a demand for employers. This has an important consequence when discussing health because it is this that fills the need for philanthropists to provide a system of health-care. Where there is a demand for jobs, there is a possibility of business. In effect, the migration of workers created (or at least expanded) a new industrial class, paving the way for caring hierarchical system. In another sense also, the way in which one judges the health of an area is important. It is not by the fortunes of a single class of people but by the average fortunes of the whole, or the more wealthy (Cambridge, for example, has many impoverished people, but it is still considered a fairly affluent area) that one makes this judgement. By encouraging a new class of wealth, migration meant that the health standards of the towns were increased automatically, especially by the creation of Disraeli’s ‘shopocracy’. In this sense the disadvantages of the smoky, smoggy heavily populated city, were slowly overcome by the change in the class make-up of the cities, bringing doctors and calls for sanitation.
Economic factors are very important. The philanthropic middle classes were brought not directly by migration, but as a result of the profit made out of an increase in demand for work. Moreover, as agriculture failed after 1850, many landed families spent most of their time within the cities and towns. The benevolence which general society benefited from was not always the result of a social feeling of ‘do good’. The increasing urban working population meant that factory and shop owners would invest in sanitation out of a generally held conception that a healthier work force was more productive. In this sense the motives for the change towards a healthier Britain were economic. The reasons for the town becoming healthier than the countryside in the sixty years after 1850 can also be attributed to economic factors. Before the 1870s, most urban areas relied heavily on the agriculture of neighbouring rural areas, explaining why there were such huge discrepancies in the standards of living between rural areas next to a town or city and rural areas away from any urban activity. By the 1870s, the towns and cities had become sufficiently self-sufficient that they could rely on themselves for food, thus slowing the growth of the rural areas, the removal of protectionism with the 1849 Corn Law repeal enhanced this factor greatly, but only over a period of 20 years. Measures such as the Public Health Act of 1872 and the later sanitation acts allowed for increased development in urban areas, with new inventions such as the electric street lamp and new indoor toilets connected to sewer networks were only made available after the Poor Law reforms in the late 1850s and 1860s. In addition to these factors, one must not forget the general boom in the British industrial sector in the late 19th century, which precipitated the reforms.
Although one must be very careful of labelling the late 19th early 20th century urban areas ‘healthy’, one may say that they were considerably healthier than half a century beforehand. The reasons that sanitation and more general health took a while to improve, and its rural counterpart stagnated, are many. Socially there was a change in culture; Victorian values were central to the formation of a system concerned with health in the towns and cities. The increased prominence of working class sports such as soccer overcame the previous anxieties felt by rural people in an anonymous urban setting, a community was beginning to be formed. This had the consequence of changing many urban areas into various communities often centred round the local place of work (workplace sports teams are representative of this). At the same time concerns about self-education, were also rising to the fore. Yet along with this came the actual political change in sanitation regulations. This was precipitated by economic factors that brought industrialists and aristocrats into city culture. In this sense, migration improved the country as a whole, after all, by 1914, only 20% of the country was rural (population). Many factors such as the Corn Law repeal of 1849 showed their effects much later. In effect, much of the change from an unsanitary urban demographic to a sanitary one is not due to changes of that point in time, but to earlier changes which precipitated both migratory action and delayed economic consequences. In summary one must conclude that the reasons for the towns and cities becoming so much more sanitary than the countryside are primarily economic, but inextricably linked with a social trend. Migration brought the need, philanthropy provided the solution, and industry reconciled the two.
