Healthy or hungry thirties?

Infant mortality and social causality: Lessons from the history of Britain's public health movement, c. 1834-1914

What are the historical conditions under which a sociologically informed understanding of health inequality can emerge in the public sphere? We seek to address this question through the lens of a strategically chosen historical puzzle-the stubborn persistence of and salient variation in high infant mortality rates across British industrial towns at the dawn of the previous century-as analysed by Arthur Newsholme, the Medical Officer of the Local Government Board. In doing so, we retrace the historical processes through which the evolving public health movement gradually helped crystallise a scientific understanding of the social causes of excess mortality. We map the dominant ideology of the public sphere at the time, chart the shifting roles of the state, and retrace the historical origins and emergence of 'public health' as a distinctive category of state policy and public discourse. We situate the public health movement in this historical configuration and identify the cracks in the existing ideological and administrative edifice through which this movement was able to articulate a novel approach to population health-one that spotlights the political economy of social inequality. We relate this historical sequence to the rise of industrial capitalism, the social fractures that it spawned, and the organised counter-movements that it necessitated.

Food hygiene, public health education and citizenship in Britain, 1948-1967

This article examines food hygiene campaigns in Britain between 1948 and 1967, using these as a way to explore the making of health citizenship and the relationship between state and citizen. The projection of hygienic citizenship amalgamated old concerns around morality, modernity and cleanliness, as well as new issues surrounding the changing position of women, the home and the rise of consumerism. Other ways of thinking about citizenship, such as social citizenship and consumer citizenship, were incorporated within food hygiene campaigns. The success or otherwise of such efforts points to a complex re-working of the connections between public health and its publics.

Health inequalities in the Great Depression: a case study of Stockton on Tees, North-East England in the 1930s

BACKGROUND

Parallels have been drawn between the 'Great Depression' of the 1930s and the more recent 'Great Recession' that followed the 2007/8 financial crisis. Austerity was the common policy response by UK governments in both time periods. This article examines health inequalities at a local level in the 1930s, through a historical case study.

METHODS

Local and national historical archives, Medical Officer for Health reports, and secondary sources were examined from 1930 to 1939 to obtain data on inequalities in health (infant mortality rates, stillbirths and neonatal mortality rates, 1935 and crude overall mortality rates, 1936) and ward-level deprivation (over-crowding rates, 1935) in Stockton-on-Tees, North-East England.

RESULTS

There were high geographical inequalities in overcrowding and health in Stockton-on-Tees in the 1930s. Rates of overall mortality, in particular, were higher in those wards with higher levels of overcrowding.

CONCLUSIONS

There were geographical inequalities in health in the 1930s and the most deprived areas had the worst overall mortality rates. The areas with the worst housing conditions and health outcomes in the 1930s remain so today - health inequality is extant over time across different periods of austerity.

Getting it right? Lessons from the interwar years on pulmonary tuberculosis control in England and Wales

This paper examines morbidity and mortality patterns in interwar England and Wales, using previously under-explored primary archival source materials. These materials help us understand not only what local authorities could and did do, but also the reasons for the marked variations in the ability of different authorities to manage the problem. We identify where and why there were problems and also how and why some authorities were more successful than others in dealing with the disease. Wealth was not an issue. We find a combination of pro-active preventative measures was significant.

Ideology and disease identity: the politics of rickets, 1929-1982

How can we assess the reciprocal impacts of politics and medicine in the contemporary period? Using the example of rickets in twentieth century Britain, I will explore the ways in which a preventable, curable non-infectious disease came to have enormous political significance, first as a symbol of socioeconomic inequality, then as evidence of racial and ethnic health disparities. Between the 1920s and 1980s, clinicians, researchers, health workers, members of Parliament and later Britain's growing South Asian ethnic communities repeatedly confronted the British state with evidence of persistent nutritional deficiency among the British poor and British Asians. Drawing on bitter memories of the 'Hungry Thirties', postwar rickets-so often described as a 'Victorian' disease-became a high-profile sign of what was variously constructed as a failure of the Welfare State; or of the political parties charged with its protection; or of ethnically Asian migrants and their descendants to adapt to British life and norms. Here I will argue that rickets prompted such consternation not because of its severity, the cost of its treatment, or even its prevalence; but because of the ease with which it was politicised. I will explore the ways in which this condition was envisioned, defined and addressed as Britain moved from the postwar consensus to Thatcherism, and as Britain's diverse South Asian communities developed from migrant enclaves to settled multigenerational ethnic communities.

The end of destitution: evidence from urban British working households 1904-37

We estimate the reduction, almost to elimination, of absolute poverty among working households in urban Britain between 1904 and 1937. We exploit two recently-digitized data sets. The paper presents a statistical generalization, to working families in the whole of urban Britain, of the poverty decline found in the town studies by, amongst other, Bowley and Rowntree. We offer corroborative evidence and perform a simulated decomposition of the poverty reduction into its proximate causes. The two most important causes were the rise, 1904–37, of about 30% in real wages on the one hand and the reduction of one-third in the number of people in the average household over the same period. Between them, these two changes imply a near doubling of the income per capita of an average household supported by a worker on the average wage. We conclude with a discussion of deeper causes.

Stillbirth registration and perceptions of infant death, 1900-60: the Scottish case in national context

The history of vital registration has attracted substantial attention from both social historians and historical demographers. While much of that research has touched upon issues of fertility and mortality, the contentious issue of the stillborn child-which falls somewhere between the two-has been largely neglected. Although civil birth and death registration was introduced to Scotland in 1855, stillbirth registration did not begin until 1939. Using a range of legal, medical, and statistical evidence, this article explores the history of stillbirth registration in Scotland from a social history perspective. It outlines the problems associated with lack of stillbirth registration, the processes that eventually led to registration of the stillborn child, and the wider significance of that registration.

Local leadership in public health: the role of the medical officer of health in Britain, 1872-1974

The recent policy focus in British public health on the importance of local action invites consideration of historical precedent. The role and achievements of the medical officer of health (MOH), the local government official charged with public health responsibilities, is discussed. The gradual accretion of duties is traced in the first section: the mid-Victorian concern with urban sanitation; the preventive strategies adopted after the bacteriological revolution; the extension of personal health services in the early 20th century; and the more diminished role under the National Health Service (NHS), when infectious diseases retreated. The historical verdicts passed on the MOsH are reviewed in the second section. The leading role of the MOsH in the late 19th-century mortality decline has been reasserted, and although there is some justification in the argument that in the 20th century public health lost its focus, it is important to recall that the extension of personal health services under MOH direction signified a major extension of access to care. Similarly, the charge that MOsH did not redefine their role in the period before their final demise in 1974 is not entirely justified. The emphasis of the NHS on curative rather than preventive medicine, and the economic constraints on local authority health service expansion limited their room for manoeuvre. The history of local leadership in public health may offer some enduring lessons. These include the importance of monitoring local population health, acting as a public interface between medicine and the community, facilitating joined-up working and confronting vested interests.

Saving children during the Depression: Britain's silent emergency, 1919-1939

The health of a large section of the British population was more adversely affected by the interwar Depression than was acknowledged by official sources. Particular concern was aroused by the condition of women and children. Many new charitable bodies were formed in response to this problem, and these included Save the Children Fund. This paper gives an indication of the scale of the health problem, which was particularly severe in the areas of heavy industry and high unemployment. It then considers the role of charitable organisations in drawing attention to the severity of deprivation and campaigning for appropriate responses on the part of government. Although these pressure groups were energetic and professional in their campaigning, it is conceded that in the short term they exercised only limited influence. However, it is argued that they won the intellectual contest. Finally, it is pointed out that their policies came to be accepted during World War II; thereby organisations like Save the Children Fund contributed to laying the foundations of the modern welfare state.

"Please never let it happen again": lessons on unemployment from the 1930s

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