4. The belief (sense of values) that the problem is important: This is an essential prerequisite to determination to do something about it. It is the most fascinating and challenging aspect of the essential features. It is the moral imperative that drives public health reforms. Geoffrey Vickers described the history of public health as a process of redefining the unacceptable – an endless process of identifying conditions, behaviours, circumstances, that individuals, communities, cultures, must no longer tolerate. Throwing the contents of the chamber pot into the street, clearing one’s nostrils on the tablecloth, coughing and spitting on the living-room floor, became unacceptable in the late 19th century. Many beyond the boundaries of medical science and public health practice played a role in this process. In the era of the great reforms of the 19th century, they included social reformers like Edwin Chadwick, journalists like Henry Mayhew and Charles Kingsley, novelists like Charles Dickens, cartoonists in Punch and other periodicals – all of them aided by the rise of literacy in those times. Collectively they inspired a mood of public outrage that became an irresistible force for reform.