Water, Sanitation and Health in the first industrial society: Britain 1780-1930

与城市发展有关的一些最大挑战是提供安全用水和处理大量粪便。英国是第一个实现工业化并达到现代城市化水平的社会（到1851年，超过一半的人口居住在城市中心），维多利亚城市的贫民窟成为快速和无管制城市增长的健康风险的象征。然而，英国在清洁水和污水处理方面的发展也很早熟，英国公共卫生改革的历史已经成为全球卫生改善的标尺。虽然早期的公共卫生史强调了埃德温·查德威克在19世纪40年代的城镇健康运动的重要性，但更近的和有影响力的记录将19世纪70年代确定为城镇最终被诱导提供清洁水和污水处理的时间点，并且水传播疾病的死亡率决定性地下降。然而，现有的证据（英格兰和威尔士）表明情况要复杂得多。“粪口病”死亡率的福尔斯下降并不是同步的，而是因疾病而异，最致命和依赖水的疾病（霍乱、伤寒和痢疾）在婴儿腹泻死亡率下降前半个世纪就已经下降了。粪口病的下降也具有复杂的地理特征，在最大的城镇下降最快，但在其他城镇和农村地区下降的时间和速度相似。苏格兰的模式仍然在很大程度上unexplored.This项目旨在重新概念化的现代历史的城市卫生和健康在英国的背景下，通过解开不同的创新和政策的影响，供水和粪便处理方法的死亡率从特定的粪便-口腔疾病。粪口病的传播依赖于水、食物、苍蝇和家庭卫生习惯，其致命性也明显不同。在理解英国和全球“卫生革命”的不平衡进展方面，很大程度上的困难是由于人们倾向于将不同类型的卫生改善和死亡原因混为一谈。我们的研究将在比传统方法更长的时间内分析特定疾病的结果（1780 - 1930年），这将使我们有可能检验工业化是否与粪口病的增加有关，以及早期供应清洁但未经过滤的饮用水的努力是否足以推动霍乱和痢疾的大幅福尔斯下降（主要依靠水传播），而婴儿腹泻的改善不得不等待采用全面的污水处理和室内供水。我们的研究是新颖的，因为它需要一个非常长的历史，粪便-口腔疾病和水，卫生和个人卫生（WaSH）干预措施;因为它采取针对疾病和政策的方法;因为它使用跨学科和混合方法。这也是第一个对英格兰、苏格兰和威尔士的发展采取综合和比较方法的研究。我们将使用新创建的特定措施（供水，污水处理和处理）的公共投资指标和特定粪便-口腔疾病的死亡率指标来研究地方政府如何应对感知到的问题，以及在什么情况下他们的努力是有效的。我们的方法结合了统计建模与详细的案例研究和档案研究，以了解发生了什么，为什么。该项目将挑战传统的叙述'卫生革命'在英国，取而代之的是一个更细致入微的帐户的斗争英国城镇面临的，将提供一个更现实和翔实的比较WASH方案在贫困人口今天。该项目将制作一系列经济和人口数据集，供学术使用，并提供学校教材和公开的死亡率。

Some of the greatest challenges associated with the growth of cities are the provision of safe water and the disposal of large quantities of faeces. Britain was the first society to industrialise and to achieve modern levels of urbanisation (with over half the population living in urban centres by 1851), and the slums of Victorian cities became emblematic of the health risks of rapid and unregulated urban growth. However Britain was also precocious in the development of clean water and sewerage, and the history of British reforms in public health has become a yardstick for sanitary improvements globally. While early histories of public health emphasised the importance of Edwin Chadwick's Health of Towns movement in the 1840s, more recent and influential accounts identify the 1870s as the point when towns were finally induced to provide clean water and sewage disposal, and when mortality rates from waterborne diseases fell decisively. However the available evidence (for England and Wales) suggests a much more complex picture. Falls in mortality from 'faecal-oral' diseases were not synchronised but varied markedly by disease, with the most lethal and water-dependent diseases (cholera, typhoid and dysentery) declining half a century before infant diarrhoeal mortality. Faecal-oral diseases also declined with a complex geography, falling first and fastest in the largest towns, but with similar timing and speed in other towns and in rural areas. The pattern in Scotland remains largely unexplored.This project seeks to reconceptualise the modern history of urban sanitation and health in the British context by disentangling the effects of different innovations and policies regarding water supplies and faecal disposal methods on mortality from specific faecal-oral diseases. Faecal-oral diseases differ markedly in their dependence on water, food, flies and domestic hygiene practices for transmission, and in their lethality. Much of the difficulty in understanding the uneven progress of the 'sanitary revolution' in Britain and globally has been due to a tendency to lump together different types of sanitary improvements and causes of death. Our study will analyse specific disease outcomes over a much longer period than is conventional (from 1780 to 1930) and this will make it possible to test whether industrialisation was associated with a rise in faecal-oral diseases, and whether early efforts to supply clean but unfiltered drinking water were sufficient to drive major falls in cholera and dysentery (which rely mainly on water-borne transmission), whereas improvements in infant diarrhoea had to wait for the adoption of comprehensive sewerage and in-house water supplies.Our study is novel because it takes a very long view of the history of faecal-oral diseases and water, sanitation and hygiene (WaSH) interventions; because it takes disease- and policy-specific approaches; and because it uses interdisciplinary and mixed methods. It is also the first study to take an integrated and comparative approach to developments across England, Scotland and Wales. We will use newly-created measures of public investment in specific measures (water supplies, sewage disposal and treatment) and of mortality from specific faecal-oral diseases to study how local governments responded to perceived problems, and under what circumstances their efforts were effective. Our approach combines statistical modelling with detailed case studies and archival research to understand both what happened, and why.The project will challenge the conventional narrative of the 'sanitary revolution' in Britain and replace it with a much more nuanced account of the struggles British towns faced that will provide a more realistic and informative comparator for WaSH programmes in poor populations today. The project will produce a range of economic and demographic datasets for academic use as well as school teaching materials and publicly available death rates.