Since 2013, local authorities have been responsible for public health services and improving the health of the population. Yet in the 19th and 20th centuries, councils also played a pivotal role in tackling unfit living and working conditions and curbing infectious disease. Using contemporary public health reports from Lancashire Archives, Emma Halliday from Lancaster University and Dr. Sakthi Karunanithi, Lancashire’s current Director of Public Health explore the role of the county council’s first Medical Officer of Health – Dr Edward Sergeant – and how his work compares to the present day.