Health and Society in Twentieth Century Britain

Helen Jones

• Publisher: Routledge
• Year: 2014
• Print ISBN: 9781138836150
• eBook ISBN: 9781317902119
• Topic: Storia
• Subtopic: Storia britannica

Few things tell us more of a nation's general well-being than the development of the life-expectancy of its citizens; the rising standards of health that they come to demand; and how evenly that improvement is shared throughout society. Helen Jones examines the record of twentieth-century Britain in these respects. She has much heartening progress to record - yet stark inequalities remain. Her book is thus both a review of, and contribution to, the current debates over gender, class and ethnic inequalities in standards of health in Britain today.

1 INTRODUCTION: A PICTURE OF HEALTH

DOI: 10.4324/9781315846859-1

‘Health’ is difficult to define and measure. Individuals know when they feel well or ill, but perceptions of health change over a lifetime; they also vary between generations as well as between individuals or groups at any one time. Even within the relatively short compass of the last hundred years, ideas about health have changed. Notions of basic minimum standards of housing and working conditions are significantly higher, and we all expect more of health services. Disease and an early grave affect fewer of us, and our ideas about what it means to be healthy are couched in far more positive terms than at the beginning of the century. ‘Health’ is relative to one's age and expectations. In 1948 the World Health Organisation offered a comprehensive definition of health as ‘Not merely the absence of disease and infirmity but complete physical, mental and social well-being.’ This definition suggests that an individual's health is multi-dimensional, and intimately linked with the social and economic environment. When people talk about tension headaches and nervous stomachs they are acknowledging that their health is affected by social situations and relationships.¹ ‘Health’ cannot be siphoned off and analysed in isolation from other aspects of our daily lives.

Social relationships – those relationships between men and women, between classes, between ethnic groups and between the medical profession and the rest of the population – all mesh together to create changing patterns of health experiences and standards of health.² Material factors, such as income, housing and the environment, along with cultural influences, which shape our attitudes and beliefs, all affect the ways in which those relationships are negotiated and fractured. Power relations in the home are gendered, and economic relationships are affected by an individual's or a group's position in the labour market. Relationships between ethnic groups are affected by power coupled with prejudice (racism).

Both material and cultural influences have been brought to bear on the strategies which different groups have developed to promote their health and well-being. Throughout the twentieth century women have played a crucial role as formal and informal health promoters and carers. In turn, it is impossible to understand women's experiences without exploring the ways in which ideas about the family and motherhood impacted on gender relationships.

The way in which social relationships affect our health is the subject of this book. Such an approach is in contrast to those studies which treat the health of women, or a particular class, or an ethnic group, in isolation; none of these categories are ‘optional extras’ to be tagged on to a discussion of the health of society.

The approach of this book means that many of the conventional ‘history of medicine’ subjects, such as the history of the medical and nursing professions, medical institutions, health policies, diseases and how medical knowledge has been applied to them, are only dealt with in passing, if at all.³ Instead, the book discusses the ways in which the social history of twentieth-century Britain has affected the health of differing groups in society. It focuses on the ways in which relationships between social groups have affected inequalities in standards of health. Such an approach is not politically uncontroversial.

In the 1970s and 1980s arguments over the causes of health inequalities led to major political rows between health researchers and politicians. The Black Report, commissioned by a Labour government and presented to a Conservative one in 1980, received a hostile reception from the Secretary of State, Patrick Jenkin. He refused to endorse the report, and warned in its foreword ‘I must make it clear that additional expenditure on the scale which could result from the report's recommendations … is quite unrealistic in present or any foreseeable economic circumstances.’ The report was not published in the usual fashion; only 260 duplicated copies of typescript were made available. No press release or press conference was called when copies were sent to a few journalists, on the Friday before the August bank holiday. This apparent attempt to bury the report provoked a backlash: an alternative press conference was called; the press reviewed the report enthusiastically; it was taken up in health circles around the country, and a Penguin edition of the report was produced, so ensuring a wide readership.

In 1986 the Health Education Council (HEC) commissioned an update of theBlack Report. Its findings, published as The Health Divide, found increasing class inequalities in standards of health. In its preface, Dr David Player, Director General of the HEC, drew out the political implications of the report, and commented, ‘Such inequality is inexcusable in a democratic society which prides itself on being humane.’ The launch of The Health Divide in 1987 followed a similar pattern to that of The Black Report. An hour before the press brief was due to start it was cancelled by the chair of the HEC, Sir Brian Bailey. An alternative press briefing was quickly arranged and intense media interest was aroused, both in the contents of the report and the means of its launch. In contrast to its frosty reception from the Government, health researchers and those involved in health issues at grassroots level took up the report's findings. Most accepted the report's conclusions, and in many parts of the country they led to plans for action.⁴ The attitude of governments in the 1980s is not untypical of those in earlier decades. In the 1930s research findings which were embarrassing to governments were ignored or belittled.⁵ Even when governments have recognised the relevance of social and economic circumstances and relationships for people's health, they have done little to change them.

A Note on Sources

This book relies heavily on published secondary work; a range of primary sources, many of them published, have also been used. No one source is entirely reliable; and it is best to regard each source as part of a jigsaw, with some pieces chipped or tarnished and with other pieces missing altogether.

Contemporary publications by social reformers and investigators usually rely on personal predilections and insight. They are more haphazard for the early part of the century, but all depend on what the investigators’ subjects ‘allow’ them to see; and they paint their subjects as saints or sinners, depending on the purpose of their project. For instance, between 1909 and 1913 the Fabian Women's Group compiled a dossier on the daily lives of working-class families in Lambeth, London. Round about a Pound a Week (1913) aimed to show how well working-class families coped in overcrowded homes with too little money. In 1989 it was criticised by Mary Chamberlain for offering a sanitised version of working-class life. In an attempt to portray the working class as skilful and careful household managers, Chamberlain argues that they were thereby rendered merely a dim reflection of the middle class. In reaction, she wroteGrowing up in Lambeth to provide an insight into the richness of working-class life – warts and all.⁶

Annual Reports of Medical Officers of Health and other governmental publications are useful as a guide to what was important to governments at a particular point, but they must be seen as political documents expressing the views of officials and politicians, rather than as reliable guides to the attitudes and experiences of differing groups of the population. Charles Webster has revealed that in the 1930s the Chief Medical Officer of Health wrote politically inspired reports with considerable economy of truth.⁷ Other non-governmental organisations, such as the Women's Co-operative Guild (WCG), also wrote with a specific audience and goal in mind. All these sources may shed as much light on the investigator as those under the microscope.

Autobiographies and diaries tend to be patchy, and even when unpublished they may have been written with an audience in mind. Oral histories can provide information and colour not available from other sources, but they are not necessarily any more reliable – memories fade or are influenced by subsequent events; interviewees tell the interviewer only what they want the world to know. Jocelyn Cornwell interviewed twenty-four people in the East End of London. She found that some of them gave substantially different accounts of events when they were reinterviewed. Cornwell did not believe that the discrepancies were tricks of memory; rather, they occurred because of a changing relationship between her and the interviewees. What people say will vary according to whom they are saying it, the circumstances in which they are being interviewed and the interview techniques employed.⁸

Archival sources, such as the Imperial War Museum, the Bradford Heritage Recording Unit or the National Sound Archive all contain material which throws light on people's health and well-being. However, the material was not normally collected with the express purpose of finding out about people's health. Such information has emerged as a by-product, which means that people may have written or spoken comments without the same forethought that they gave to other subjects. People caught off their guard may utter revealing comments, or misleading and simplistic ones. At the very least these sources provide ‘human interest’, but this is again problematical, as a balance has to be achieved between failing to make explicit the horrors of domestic violence, racist attacks and poverty on the one hand, and avoiding a prurient voyeurism on the other hand.

Official statistics of morbidity and mortality offer us a picture of broad trends. Morbidity statistics are only partial as much illness goes unreported. Mortality figures are more comprehensive but there are various methodological problems in their use; for instance, during the course of the twentieth century there have been changes in the way in which information is collated and categorised.

Changes have also occurred during the twentieth century in the main causes of death and the age at which death normally takes place (see Table 1 p. 195). More and more people now die in old age; cancers and circulatory diseases pose a greater threat than in the past, but rarely are people struck down in the prime of life by the old infectious diseases, such as smallpox, chicken-pox, croup, tuberculosis, scarlet fever, diphtheria, whooping cough, polio and measles. In the first decade of the century the death-rate per million of the population at ages under fifteen years was 271 for scarlet fever, 571 for diphtheria, 815 for whooping cough and 915 for measles. Now, as the century draws to a close, only whooping cough and measles appear in the figures; the former is down to one per million and the latter to two per million (see Table 2, p. 196). During the course of the century life expectancy for the young has increased by over twenty years. The most impressive improvements have occurred in the infant mortality rate. For every 1,000 live births, 154 babies died in 1900, thirty died in 1950 and nine died in 1985 (See Table 3, p. 196). Unfortunately, TB has again raised its ugly head in various parts of the country. The death of babies has plummeted as a result of an entire raft of changes which include rising incomes, improved nutrition, better housing, a decline in family size, the growth of state welfare, and medical improvements which are now more widely available than at the beginning of the century.⁹ Stark inequalities in standards of health and health experiences nevertheless remain: broad trends conceal enormous variations within a class, a region and even a family (See Table 4, p. 197).

Notes

• 1 For a full examination of definitions of health see Blaxter M. 1990 Health and lifestyles. Routledge, pp. 2–4, 16, 30, 35–6, 42 and passim.
• 2 See Chapter 8 for use of the terms class and ethnicity.
• 3 Some useful histories are: Dingwall R., Raffety A. M., Webster C. 1988 An introduction to the social history of nursing. Routledge; Bryder L. 1988 Below the magic mountain: A social history of tuberculosis in twentieth-century Britain. Clarendon; Webster C. 1988 The health services since the war. Volume I. Problems of health care: The National Health Service before 1957. HMSO. For a list of recently commissioned institutional histories see Cantor D. 1992 Contracting cancer? The politics of commissioned histories Social History of Medicine5: 131. This article is a warning beacon against the ethical problems which the author argues are inherent in commissioned histories.
• 4 Inequalities in health 1988 The Black report: The Health divide. Penguin, pp. 3–4, 8, 13.
• 5 See Chapter 4.
• 6 Chamberlain M. 1989 Growing up in Lambeth. Virago, pp. 9–11.
• 7 See Chapter 4.
• 8 Cornwell J. 1984 Hard-earned lives: Accounts of health and illness from East London. Tavistock, pp. 1, 11–12.
• 9 McPherson K., Coleman D. 1988 Health. In Halsey A. H.British social trends since 1900: A guide to the changing social structure of Britain. Macmillan, pp. 39, 408.

2 THE RACE FOR HEALTH: EDWARDIAN BRITAIN

DOI: 10.4324/9781315846859-2

Introduction

In this chapter we discuss the ways in which social and economic conditions influenced standards of health. Health experience was usually far removed from the influence and control of the medical profession. For example, women of all classes developed their own health strategies, independently of the medical profession. Similarly, the Jewish community developed health services (some of which led the field) to meet its cultural requirements. All levels of society perceived health issues as intimately linked with power, either between groups within the country or, in the cas...

Table of contents

• Cover
• Half Title Page
• Title Page
• Copyright Page
• Table of Contents
• Acknowledgements
• List of Abbreviations
• Dedication
• 1. Introduction: a picture of health
• 2. The race for health: Edwardian Britain
• 3. Fighting fit? 1914–18
• 4. Poverty and the public’s health: the inter-war years
• 5. The people’s health: 1939–45
• 6. Hidden from view: 1945–68
• 7. Open sores: the late 1960s to early 1990s
• 8. Inequalities in health experience: the debate
• Bibliographical note
• Tables
• Index