Battle for safe milk

Buying milk used to be a life-or-death gamble, especially for the poor. But laws ensuring public safety were resisted for more than a century. In an age of novel pathogens and growing scientific obscurantism, it’s a warning.

How safe is the milk you buy from local shop? We’re talking about cow’s milk here – not the kind made from oats, peas or soy beans. Pretty safe, right? If you aren’t allergic to it, you can be almost 100% certain that legally-compliant milk consumed before its expiration date isn’t going to make you ill.

Having said that, recent exchanges between environmental health professionals on RHE's 'Communities' platform indicate that milk being sold via vending machines, now popping-up in a myriad of locations across the UK, may present significant risks to the health of the public, unless careful and diligent management is exercised by those owning and operating them.

The sale of unpasteurized or ‘raw’ cows’ milk is prohibited in England except from farm premises, where microbial controls can be more confidently guaranteed, thanks to visits from EHOs. Legislation and effective food safety enforcement normally protect us.

But that wasn't always the case. Bovine TB was identified as health risk to humans who drank milk from infected animals in the 1890s. Yet milk pasteurisation did not become compulsory in England, Wales and Northern Ireland until 1985. It is estimated is that a million deaths were caused in Great Britain by bovine TB contracted from infected milk from 1850 to 1950.

As we saw with BSE and, more recently, Covid-19, new zoonotic pathogens can emerge at any time. Political delay while science is uncertain is understandable – even advisable. But, in the case of milk, proven aetiologies between animal and human disease went unheeded by policy makers for a century. It’s a shocking example from history and a warning – especially as the links between science and policy are now loosening, in era when social media channels amplify ignorance.

The first laws allowing EHOs to crack down on filthy dairies and cowsheds, that were known incubators for animal and human disease were passed in 1879. Buying milk was a life-or-death gamble, especially for the poor, who needed it most for its fat, carbohydrates, vitamins and minerals.

Milk could be watered down and adulterated with chalk, flour or arrowroot. It could also be contaminated with bacteria causing typhoid, enteritis, diphtheria, scarlet fever and TB. In 1907, a Royal Commission stated definitively, following a debate that had raged since the 1880s, that bovine TB could transfer, in a lethal form, to humans.

Despite this significant announcement, legislation protecting the public was successfully resisted by vested interests for decades. In rural districts, adoptive laws imposing hygienic standards on dairy farmers were rarely and unevenly enforced. 

Milk was poisoning the poor

That was less the case in large cities. But their medical officers of health knew that, each day, trainloads of TB-infected milk were arriving from the countryside to serve fast-growing populations. It was an issue of grave concern – a public health scandal – especially for infants who relied on milk, ‘nature’s perfect food’, to avoid rickets and malnutrition.

From the 1890s, the Liverpool and Manchester Corporations and the London Council used private acts of Parliament to assume powers allowing them to prevent the sale of milk from tubercular cows. Uniform national legislation was urgently needed to tackle what was now a well-known and preventable threat to public health, but the implementation of Herbert Samuel's 1914 Milk and Dairies Bill of 1914, designed for that purpose, was postponed by the onset of the First World War and it took many more years for uniform protection of the public from infected milk to be assured.

Clean milk’s most persuasive champion of the new century appears in The Sanitary Journal in February 1916, in which a talk he gave to EHOs is recorded. Wilfred Buckley was born in Birmingham in 1873 and amassed a fortune from his family's exporting business. Returning from the US in 1906, he purchased a 1,000-acre estate in Moundsmere, Hampshire, and set himself up as a sheep, poultry and dairy farmer.

Buckley had a personal interest in hygienic dairy farming. His daughter contracted bovine TB in 1902. With a fellow dairy farmer, the wealthy newspaper proprietor, Waldorf Astor MP, owner of the Cliveden Estate and vice president of the Pure Food and Health Society of Great Britain, he had set up the National Clean Milk Society (NCMS) in 1915.

The society advocated the mandatory refrigerated transportation of 'certified' milk of guaranteed cleanliness and hygiene score cards for dairy farmers. These had been successfully adopted in the US but not in Britain, whose farming practices remained firmly rooted in the nineteenth century. 

Buckley was a persuasive campaigner. He used multimedia techniques – pamphlets, posters, articles, films and lectures illustrated with magic lantern slides – to put across his shocking and compelling message – an average sample of milk contained the same number of bacteria per cubic centimetre as a municipal sewage farm.

As a result, he was gaining powerful allies, including the king's surgeon, Sir Frederick Treves. A 'milk drought' was also impelling government intervention in the milk supply, as had taken place in munitions and housing. In October 1916, milk reached the shocking price of 6d a quart in some London districts, resulting in a demonstration by mothers and infants in Hyde Park.

Wars tighten standards

In December 1916, a Ministry of Food Control was created. Its second minister, Lord Rhondda, adopted unprecedented national powers. In October, Buckley was appointed director of milk supplies, a position in which he was able to exert considerable influence on Lord Astor's official inquiry into milk production.

Milk prices were now fixed and the Local Government Board was given powers to regulate distribution and sale, including reduced prices for mothers and children. Most significantly, from Buckley's point of view, milk grading was initiated, on a small scale.

From September 1918, dairies with high hygiene scores could be licensed to produce grade A milk, which was awarded a 3d a pint premium. Grade B milk was slightly less clean, but still of a high standard. The scheme was inherited from the Local Government Board in 1919 by the new Ministry of Health but, to the frustration of the UK's first health minister, Liberal MP, Christopher Addison, it was not mandatory and was patchily adopted.

After the war, Buckley continued to give lectures for the NCMS and helped to set up the National Milk Publicity Council. He died aged 60, in 1933, un-knighted despite his years of valiant campaigning.

Through the 1920s and 1930s, the opposition of the farming lobby to dairy reform prevailed. It would take another war and further technological developments for effective mandatory national standards to be introduced. The Milk (Special Designations) Bill of l949 ushered in certified TB-free herds and the widespread use of pasteurisation, the efficacy of which had been known in the nineteenth century. One of the strongest advocates of the bill had been the Labour MP, Edith Summerskill, who was Parliamentary secretary to the food ministry and a campaigner for women's rights. As a doctor she had seen, seen first-hand, the effects of poor nutrition on mothers and young children in the 1930s.

Will Hatchett has been a journalist since 1986 He was editor of Environmental Health News from 1998 until 2018. The views expressed here are purely his own.

 

How the poor eat

The UK’s obesity crisis is getting worse. And the government is doing less and less.  Meanwhile, just as they were in Edwardian Britain, the poor are blamed by the well-fed for their irresponsible behaviour.

In 1901, social reformer and chocolate magnate, Joseph Rowntree, calculated, from a comprehensive survey, how much money a family in York would need a week in order to sustain “physical efficiency”. It was 21s and 8d (£1.08 in today’s money). By his calculation, a little more than half of that would be spent on food. But such an income, he asserted, would only provide a meagre diet, less varied than that enjoyed by able-bodied paupers in workhouses.

Rowntree concluded that around half of York’s population were living in poverty and 28% In extreme poverty, unable to acquire even basic necessities, such as food, fuel and clothing. Echoing the conclusions of a similar survey, conducted by a wealthy shipping line owner, Charles Booth in the East End of London between 1886 and 1903 this assertion caused shock and, in many cases, frank disbelief, among the affluent.

How could this be possible? These people must be improvident or feckless, the wealthy opined, in their favourite newspapers, wasting their money on alcohol, tobacco and trips to the music hall. In any case, if they were educated in healthy diets, they would not need to go hungry. 

In reality, the poor lived on white bread, tea, sugar, stewed greens and cheap cuts of meat. The thrifty and eagle-eyed would shop at antisocial times, such as Saturday nights when spoiled food was disposed of. They would buy food in tiny quantities. Groceries were generally bought by the ounce, meat and fish by the halfpennyworth. Popular purchases included cheese crumbs from the grocer and cods' heads for fish cakes, 'pairings' from the tripe shop and bones from the butcher that could be boiled into a watery soup. No KFC or McDonald's then.

Life on a pound a week

For the poorest, bread could account for an eighth of family income. Some food was, frankly, weird. In Birmingham, a dish called 'slosh' or 'slop' consisted of the leavings of a tea pot, poured over a slice of bread and drained off, with the addition of a knob of margarine. Universally, a stale loaf would be toasted and mashed with tea and sugar (milk was too expensive) to provide an alternative to rusks for babies. 'Cag-mag' was butchers' trimming, often of dubious quality, parcelled together. A shilling's worth of cag-mag could be made into a stew on a Saturday night and served up for breakfast on a Sunday morning. Yum.

For comparison, Edward VII, Britain’s monarch from 1901 to 1910, known by his subjects as ‘Bertie’ and ‘tum tum’, enjoyed four meals a day and dinners of 12 or 14 courses – pheasant stuffed with truffles, quails filled with foie gras, sole poached in Chablis garnished with oysters and prawns and boned snipe with Madeira sauce were favourites. He would have a cold chicken placed at his bedside, in case he became hungry in the middle of the night.

An Australian-born journalist and feminist, Magdalene Reeves, researched typical expenditure and diet in south London in 1911. It was the year after King Edward, died, aged 68, his demise hastened by his heavy smoking and gluttony.

Her pamphlet for the Fabian's Women's Group, ‘Family Life on a Pound a Week’,  breaks down the 50p that were spent by a city warehouse worker, Mr W, and his wife every week on food. At 15p, meat made up the largest part of the budget. In descending order, came bread, butter, flour, milk, tea, sugar, dripping, potatoes and greens. She writes: "Cold meat, with bread and butter and tea, would be provided for the evening meal. The "eternal bread, butter and tea” would be breakfast.

Life wasn’t that different for the hard up when author George Orwell travelled to industrial Lancashire and Yorkshire in 1936 to research, ‘The Road to Wigan Pier’. Publisher Victor Gollancz had commissioned an account of unemployment and social conditions in the north of England. It was. But he took violent exception to Orwell’s description of how ordinary people perceived socialists – as bearded sandal-wearers, vegetarians and nudists.

Orwell’s description of the psychology of the poor and their attitude to food is acute. Like Booth, Rowntree and Reeves, he carefully itemises the weekly budget of an unemployed Yorkshire miner and his wife. It totals £1.60 with almost a third allocated to rent. He observes: “The miner's family spends only tenpence a week on green vegetables and tenpence halfpenny on milk and nothing on fruit; they spend one and nine on sugar and a shilling on tea. The basis of their diet is white bread and margarine, corned beef, sugared tea and potatoes.”

He adds: “Would it not be better if they spent more money wholesome things like oranges and wholemeal bread, saved on fuel and ate their carrots raw? it would, but the point is that no ordinary human being is ever going to do such a thing. The ordinary human being would sooner starve than live on brown bread and raw carrots. When you are underfed, harassed, bored and miserable, you don’t want to eat dull wholesome food. You want something little bit ‘tasty’.” Like “three pennorth of chips” he suggests – in today’s terms, a Deliveroo Big Mac or a pizza.

Obesogenic environment

Our food choices are not rational. They are governed by emotions and volitions that we do not understand and by simple proximity and convenience. The same arguments that were deployed against Booth and Mayhew are still used today – that the poor could eat healthily, if they wanted or chose to. But the odds are stacked against them more than ever.

Unhappy humans are still governed by perverse instincts of immediate gratification from energy-rich sugar and carbs, as identified Orwell, but they face additional problems that he did not anticipate. We live in a world which encourages us to eat unhealthily from every supermarket aisle and billboard and in which sugar and salt-laden, ultra-processed and additive-filled foods are relatively cheap and ubiquitous. It has been called an obesogenic environment.

A hundred years after Orwell’s journey to Wigan, the food landscape has changed radically. Today, just eight companies control 90% of UK food supply. A quarter of places to buy food on the high street are fast-food outlets and food advertising is dominated by confectionery, snacks, desserts and soft drinks.

According to The Food Foundation, the most deprived fifth of the UK population would need to spend 50% of their disposable income on food to meet the cost of the government recommended healthy diet – a metric that is worsening year by year. This compares to just 11% for the least deprived fifth. The default UK diet – low in vitamins and minerals, high in starchy carbohydrates, fat and sugar, has produced an epidemic of obesity. And it’s getting worse.

A Defra select committee reported this July that rising food prices caused by the Covid pandemic, Brexit, climate change and the Ukraine mean that a fifth of UK households are resorting to unhealthy, high-calorie diets, due to trouble in accessing good quality food at reasonable prices. The report says: “The promotion of cheap, calorie-dense foods lacking essential nutrients has resulted in 30% of the population becoming obese. This figure is expected to rise to 40% by 2035, with NHS spending on Type 2 diabetes treatments outweighing current expenditure on treating all cancers.

Government retreat

The government has retreated in the face of this unravelling catastrophe. Attempts to modify our obesogenic environment appeared, in a modest form, in 2011 in the form of a ‘voluntary public health responsibility deal’ for the food industry. In 2016, a sugary drinks tax was introduced. But in June 2022, Henry Dimbleby’s 300-page Defra commissioned food strategy, proposing taxes on salt and sugar, free fruit and veg for those on low incomes, advertising restrictions and expanded free school meals was kicked into touch, causing Dimbleby to resign.

Introducing, in his Conservative party conference speech, a modest progressive restriction on the sale of cigarettes, Rishi Sunak said that the smoking is the UK’s biggest entirely preventable cause of ill-health, disability, and death. However, as campaigners pointed out, obesity costs £27billion a year through its knock-on effects – £10bn more than tobacco.

Why act on one public health issue and not another and fail to save the NHS billions? Put on the back foot in an interview with the BBC, Sunak said that here is “no safe level of smoking” and it “isn't the same as eating crisps or a piece of cake”. These statements are misleading and disingenuous. The argument that we are “free” to choose junk food, or not to, is a fig leaf – especially for the poor. 

The tobacco industry is also in retreat and has shifted its gigantic marketing budgets in wealthy countries from smoking to vaping, especially among the young, with flavoursome addictive options. The UK food industry, led by the Food and Drink Federation has lobbied hard, and successfully, against measures that would risk reducing its profits, so that nearly all healthy food options are more expensive than the alternatives. Where is the freedom in that?

Will Hatchett has been a journalist since 1986 He was editor of Environmental Health News from 1998 until 2018. The views expressed here are purely his own.

This blog was posted on the RHE Global website