Public health reform: lessons from history

This is an historical review of the drivers behind the slow development of safe water and sanitation services that took place in Britain during the nineteenth century. Widespread social concern about the living conditions of the poor was combined with more powerful economic incentives to maintain an efficient workforce, and so public health reform was brought about through the joint forces of political reform and specific legislation. Today, the Millennium Development Goals aim to halve by 2015 the one sixth of the world's population that does not have safe water, and the one fifth that has no basic sanitation facilities. An understanding of the historical drivers for change, rather then simply 'good will', will help to ensure that these efforts are based on experience, rather than experiment.