Health Planning

Sanitary Reform Movement

In the late 1800s, American cities were growing rapidly, resulting in conditions that repeatedly led to epidemics. The sanitary reform movement responded based on the “filth theory”: the idea that miasmas or “bad airs” either directly gave rise to illness or were associated with contagion. Miasma could be traced to the cesspools and sinks used to store human waste. It was believed that by removing the waste, disease could be checked.

Three tools were created that facilitated health planning. First, epidemiological mapping of the environmental conditions of streets and building as they correlated to the incidence of disease set the foundation for the planning process. This technique was used most notably by the public health reformer Edwin Chadwick (1800–1890) in the England of the 1840s and by the Citizens' Association in the New York of the 1860s. The second resource was sanitary sewerage technology that allowed solid waste to be carried away through pipes and sewers. Finally, the Progressive Era political reform led to the belief that government should effectively serve the public interest by tackling issues such as public health problems.

With these tools in place, sanitary survey planning developed as a response to a yellow fever epidemic in the Lower Mississippi Valley in the late 1870s. Tennessee authorities requested that the newly created National Board of Health develop a plan for the future and conduct a complete sanitary survey. They made a comprehensive reconstruction plan based on a house-to-house survey. It suggested specific, local-area remediation; designed a sewage system; and proposed [Page 525]employing a sanitary officer. It also recommended the damming of bayous, the creation of public parks, repaving streets, and the enactment of a sanitary code raising buildings off the ground.

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