Smoking and the new health education in Britain 1950s-1970s

You and Your Baby (home, husband, and doctor): maternal responsibility in the British Medical Association booklet (1957-1987)

You and Your Baby was a pregnancy advice booklet, produced by the British Medical Association (BMA) from 1957-1987. This booklet was provided to expectant mothers in the UK, free of charge, and offered authoritative information on pregnancy, childbirth and caring for infants. Reprinted each year, You and Your Baby captured contemporary maternity policy and advice. But, in addition to the typical information that you might expect about mother and baby health, You and Your Baby advised readers on matters such as maintaining their appearance, marital relations and domestic duties. In this way, it advocated a specific vision of motherhood, with responsibilities to the home and husband. Further to these duties, this article will focus on the balance of responsibilities between pregnant women and their doctors, and how attitudes to trust and authority developed over time. The BMA publication repeatedly warned readers against listening to 'old wives' tales', instead emphasising the importance of accepting (and not questioning) professional medical guidance. Following the thalidomide scandal, however, women were made partially responsible for doctors' professional integrity; women were advised to avoid asking their doctors to prescribe medication that may later prove to be harmful, shifting the responsibility from the healthcare practitioner to the mother. This created an uncomfortable dissonance between the publication's attempts to establish and reinforce medical authority, and yet shift professional responsibility. The booklet series, therefore, posed women as responsible for their doctors, as well as their babies. In summary, this article presents a case study of the You and Your Baby BMA booklet, examining developing healthcare messaging around maternal behaviour and responsibility. It draws attention to supposed responsibilities to the home, husband and doctor and how those responsibilities changed over 30 years.

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.

Just say know: Drug education and its publics in 1980s Britain

Until the 1980s, anti-drug education campaigns in the UK were rare. This article examines the reasons behind a policy shift that led to the introduction of mass media drug education in the mid 1980s. It focuses on two campaigns. 'Heroin Screws You Up' ran in England, and 'Choose Life Not Drugs' ran in Scotland. The campaigns were different in tone, with 'Heroin Screws You Up' making use of fear and 'shock horror' tactics, whereas 'Choose Life Not Drugs' attempted to deliver a more positive health message. 'Heroin Screws You Up' was criticised by many experts for its stigmatising approach. 'Choose Life Not Drugs' was more favourably received, but both campaigns ran into difficulties with the wider public. The messages of these campaigns were appropriated and deliberately subverted by some audiences. This historical policy analysis points towards a complex and nuanced relationship between drug education campaigns and their audiences, which raises wider questions about health education and its 'publics'.

Historicising "containment and delay": COVID-19, the NHS and high-risk patients

Despite the first case of the novel coronavirus only being reported to the WHO at the end of December 2019, humanities and social science scholars have been quick to subject local, national and international responses to COVID-19 to critique. Through television and radio, blogs, social media and other outlets, historians in particular have situated the ongoing outbreak in relation to previous epidemics and historicised cultural and political responses. This paper furthers these historical considerations of the current pandemic by examining the way the National Health Service (NHS) and discourses of risk have figured in public and policy responses. It suggests that appeals to protect the NHS are based on longer-term anxieties about the service's capacity to care and endure in the face of growing demand, as well as building on the attachment that has developed as a result of this persistence in the face of existential threats. Similarly, the position of elderly, vulnerable and "at risk" patients relates to complex histories in which their place in social and medical hierarchies have been ambiguous. It thus argues that the ways in which time appears as both a threat and a possibility of management in the current crisis form part of a longer trajectory of political and cultural thinking.

Superman vs. Nick O'Teen: anti-smoking campaigns and children in 1980s Britain

In December 1980, the Health Education Council launched a campaign designed to discourage children from taking up smoking. Advertisements on TV and in comics and magazines featured a battle between Superman and the evil Nick O'Teen as he attempted to recruit children to his army of smokers. Children were also encouraged to join Superman in his fight by signing a pledge not to smoke, in return for which they received a poster and badges featuring the superhero. This article examines the design, production, delivery and reception of the Superman vs. Nick O'Teen campaign in order to probe the multi-faceted nature of the making of healthy publics in 1980s Britain. Children constituted a particularly problematic public. On the one hand, they were thought to be vulnerable and easily led towards unhealthy lifestyle choices. But on the other, children were also recognised as agents who might convince adults, as well as their peers not to smoke. This ambivalent conceptualisation of the child as a potential victim of malign influences, or potential rational agent and force for good, is typical of the 1980s, a time when the meanings of the child as consumer, agent, and citizen were undergoing increased ideological debate. This campaign also took place as ideas about health education, its place within public health policy and practice, and its relationship with the public, were in flux. The battle between Superman and Nick O'Teen was thus not just about smoking, but about particular ways of seeing and interacting with healthy (and unhealthy) publics.

Exhibiting Good Health: Public Health Exhibitions in London, 1948-71

This article examines the changing nature of public health services and their relationship with the public in post-war Britain by an analysis of the exhibitions mounted by Medical Officers of Health (MOsH) in London. Focusing on the period 1948-71, the article explores a time when public health practice, and the problems it faced, were in flux. A decline in infectious disease and an increase in chronic conditions linked to lifestyle required a new role for public health services. Exhibitions were one of several methods that MOsH used to inform the public about dangers to their health, but also to persuade them to change their behaviour. The exhibition, though, offers a unique insight into the relationship between public health authorities and the public, as exhibitions brought MOsH into direct contact with people. It is suggested that in the MOsH exhibitions we can find signs of a new relationship between public health practitioners and the public. Whilst elements of the pre-war, often moralistic ideology of public health services could still be detected, there is also evidence of a more nuanced, responsive dynamic between practitioners and the people. By the end of the 1960s, 'the public' was increasingly being thought of as a collection of 'publics', including individuals, target groups and vocal respondents.

Thin blue lines: product placement and the drama of pregnancy testing in British cinema and television

This article uses the case of pregnancy testing in Britain to investigate the process whereby new and often controversial reproductive technologies are made visible and normalized in mainstream entertainment media. It shows how in the 1980s and 1990s the then nascent product placement industry was instrumental in embedding pregnancy testing in British cinema and television's dramatic productions. In this period, the pregnancy-test close-up became a conventional trope and the thin blue lines associated with Unilever's Clearblue rose to prominence in mainstream consumer culture. This article investigates the aestheticization of pregnancy testing and shows how increasingly visible public concerns about 'schoolgirl mums', abortion and the biological clock, dramatized on the big and small screen, propelled the commercial rise of Clearblue. It argues that the Clearblue close-up ambiguously concealed as much as it revealed; abstraction, ambiguity and flexibility were its keys to success.

Marketing health education: advertising margarine and visualising health in Britain from 1964-c.2000

During the post-war period, margarine was re-conceptualised as a value-added product with distinct health benefits. This article contextualises the advertising of margarine as a healthy food, focusing on Unilever's Flora brand as an important case study in legitimising the emergent role of disease prevention as a marketing tool. It uses the methodology of visual culture to examine how advertising employed chronic disease prevention as a selling tool. This article assesses how the post-war environment gave rise to new ways of visually advertising food, and how these promoted innovative visualisations of food, the body and their interactions with health.

"Health for All" in England and Brazil?

This article discusses the achievements and challenges that England and Brazil face in relation to their capacity to address inequalities in health through health promotion and public health policies. Using secondary data (policy texts and related documents), this article contextualizes, explains, and critically appraises health promotion and public health efforts for the reduction of inequalities in health in the 2 countries. A historic documentary analysis was undertaken, with hermeneutics as the methodological framework. The global economic crisis has prompted the so-called developed economies of Europe to reconsider their economic and social priorities. England represents a state facing this kind of challenge. Equally, Brazil is assuming new positions not only on the world stage but also in terms of the relationship it has with its citizens and the priorities it has for state welfare. The United Kingdom continues to finance a health care system allowing universal access in the form of the National Health Service, and state concern about the public health task of reducing inequalities has recently been underlined in policy. For Brazil, although there have been recent achievements related to population access to healthcare, challenges continue, especially with regard to the quality of care.

Inhaling Democracy: Cigarette Advertising and Health Education in Post-war West Germany, 1950s-1975

In the late 1960s and early 1970s, the West German government was faced with the challenge of addressing a damaging health behaviour, smoking, in the context of an emerging late modern democracy, when the precedent for addressing that behaviour was set in the Nazi past. This paper details the two-pronged approach which the government took: seeking restrictions on cigarette advertising, whilst educating young people to adopt positive health behaviours in the face of pressure to smoke. This approach can be understood in the social and economic context of the time: an economic commitment to the social market economy worked against restrictions on the sale of cigarettes; whilst concerns about past authoritarian structures prompted the health authorities to seek novel ways of addressing smoking, emphasising choice. In a nuanced way, post-war anti-smoking strategies were a response to West Germany's National Socialist past, but more importantly, a signal of an increasingly international outlook.

The meanings of smoking to women and their implications for cessation

Smoking cigarettes is a gendered activity with sex- and gender-specific uptake trends and cessation patterns. While global male smoking rates have peaked, female rates are set to escalate in the 21st century, especially in low and middle income countries. Hence, smoking cessation for women will be an ongoing issue and requires refreshed attention. Public health and health promotion messages are being challenged to be increasingly tailored, taking gender into account. Women-centred approaches that include harm-reduction, motivational interviewing and trauma-informed elements are the new frontiers in interventions to encourage smoking cessation for women. Such approaches are linked to the meanings of smoking to women, the adaptive function of, and the overall role of smoking cigarettes in the context of women’s lives. These approaches respect gender and sex-related factors that affect smoking and smoking cessation and respond to these issues, not by reinforcing destructive or negative gender norms, but with insight. This article discusses a women-centred approach to smoking cessation that could underpin initiatives in clinical, community or public health settings and could inform campaigns and messaging.

The Machinery of Authoritarian Care: Dramatising Breast Cancer Treatment in 1970s Britain

This article examines the professional and public response to the television play Through the Night, which aired on BBC1 in December 1975. One of the first British mass media portrayals of a woman's experience being treated for breast cancer, this play attracted a large audience and considerable attention from both critics and everyday viewers. My analysis of the play draws on sources documenting expert responses to the play in its production stages, as well as critics' and viewers' responses to what the play said about breast cancer treatment in particular, and about Britons' experiences of medical institutions more broadly. Together, I argue, these sources help us see how Through the Night's critique of what one expert called 'the machinery of authoritarian care' reverberated with and supported the efforts of professionals anxious to improve patient experience, and how it crystallised the concerns of activists and everyday viewers.

Failing to professionalise, struggling to specialise: the rise and fall of health promotion as a putative specialism in England, 1980-2000

Significant attention has been paid to the history of public health in England during the final part of the twentieth century. Within this, however, the field that came to be known as specialist health promotion (SHP) has been relatively neglected. Between 1980 and 2000 those working in this field, generally known as health promotion specialists (HPSs), enjoyed a relative rise in policy and practice prominence before SHP was effectively abandoned by government and others charged with developing and sustaining public-health structures. This paper seeks to explain why the fall of SHP is important; to move towards explaining its rise and decline; and to argue for greater historical attention to be paid to an important but neglected field within health and health care. Essentially, SHP emerged from a set of loose and contingent practices known as health education. A range of important social, economic, organisational and political influences contributed to the slow construction of a putative specialism in health promotion, accompanied by the desire on the part of some (but not all) HPSs to ‘professionalise’ their role. Finally the projects of both specialisation and professionalisation failed, again as a result of then prevailing organisational and political influences. The importance of such a failure in a so-called era of public health is discussed. In the light of this, the paper concludes by briefly setting out an agenda for further research related to the history of SHP.

Anti-alcohol posters in Poland, 1945-1989: diverse meanings, uncertain effects

We provide a historical study of the anti-alcohol public health poster in Poland between 1948 and 1990. Our case study illuminates public health policies under communism, with the state as the dominant force in health communication. Poland has a distinctive history of poster art, moving from a Stalinist phase of socialist realism to the diverse styles of the later Polish School. Quantitative and qualitative analysis of 213 posters establishes the major themes and differentiates community approaches, which depict the drinker as a social or political deviant, from those emphasizing individual risk. Medical issues were a minor theme, reflecting public policies geared more toward confinement than treatment. However, Polish School artists used metaphor and ambiguity, and references to the contested cultural symbolism of drink, to complicate and subvert the narrow propaganda intent. Thus, although apparently unsuccessful in restraining overall consumption, these posters offer valuable lessons for policymakers on the use of visual media in health campaigns.

The British National Health Service 1948–2008: A Review of the Historiography

This article surveys historical writing on the British National Health Service since its inception in 1948. Its main focus is on policy-making and organisation and its principal concerns are primary care and the hospital sector, although public health, and psychiatric and geriatric care are briefly discussed. The over-arching narrative is one of transition from paternalism and technocratic planning to market disciplines and a discourse of choice, and of the ceding of professional autonomy by clinicians to managers and to the state. These issues are discussed in a chronological survey of policy-making from Bevan's ‘creation’ to the Blair era. Later sections consider evaluations of the service, starting with Webster's thesis that the NHS has been subject to prolonged under-funding, particularly under Conservative stewardship, then moving to assessments of the Thatcher, Major and Blair reforms. Much of the historical literature on the NHS is contentious and opinions are sharply divided on the reform era since the 1970s and the trajectories this has set for the future.

Intelligence in girls and their subsequent smoking behaviour as mothers: the 1958 National Child Development Study and the 1970 British Cohort Study

BACKGROUND

Exposure to tobacco smoke either in utero or postnatally can have substantial adverse effects on child health, yet many women continue to smoke during pregnancy and after the birth. How women's intelligence in childhood affects their smoking behaviour as mothers is unclear.

METHODS

The participants were from two British national birth cohorts: 3325 women aged 33 years from the 1958 National Child Development Study and 1971 women aged 34 years from the 1970 British Cohort Study. We used structural equation modelling to examine the direct and indirect effects of intelligence measured at age 10-11 years, parental and current social class, educational attainment and age at first birth on smoking during pregnancy and current smoking status.

RESULTS

Forty per cent of women in the 1958 cohort smoked during pregnancy, compared with 28% of those from the 1970 cohort. In both cohorts, women with lower IQ in childhood were more likely as adults to smoke during pregnancy and to be a smoker currently. Structural equation modelling showed that the effects of childhood IQ on smoking behaviour were indirect, as they were statistically mediated by educational attainment and age at first birth. There was some effect of educational attainment and age at first birth on smoking behaviour over and above the effect of intelligence.

CONCLUSION

Childhood intelligence influenced women's smoking behaviour as mothers primarily through its contributions to educational attainment and age at first birth.

Multidisciplinary public health: What sort of victory?

Multidisciplinary public health (MDPH) has been a phenomenon in the UK of the 1990s and the early 21st century. Its achievement has been seen as a victory for non medical interests. While acknowledging this, the paper questions what sort of victory this represents. Public health in its sanitary phase in the mid-19th century was, after all, what passed for multidisciplinary with its mix of engineers, doctors and statisticians. Is the present simply a return to the sanitary phase? The paper argues that it is not, and that contemporary public health badly needs clearer definition. It identifies three dimensions of recent public health. Public health can be an occupation; a discourse or movement, and also an institutional location of which public health research is part. Looked at in this frame, public health has been multidisciplinary in the post war period. The development of public health research out of social medicine in the 1950s was multidisciplinary. Public health campaigning, separate from public health professionals, has also been multidisciplinary since the 1970s. Public health as an occupation has been preoccupied with its professional positioning. Will the wider multidisciplinary impetus of public health now be lost in a preoccupation with status?

"Cancer as the general population knows it": knowledge, fear, and lay education in 1950s Britain

This article examines British medical debates about cancer education in the 1950s, debates that reveal how those responsible for cancer control thought about the public and their relationship to it, and what they thought the new political economy of medicine introduced by the National Health Service would mean for that relationship. Opponents of education campaigns argued that such programs would add to the economic and organizational pressures on the NHS, by setting in motion an ill-informed, uncontrollable demand that would overwhelm the service. But an influential educational "experiment" devised by the Manchester Committee on Cancer challenged these doubts, arguing that the public's fear was based in their experience with family and friends dying of the disease. The challenge for cancer control, then, was to improve that experience and thus change experiential knowledge.

As depressing as it was predictable? Lung cancer, clinical trials, and the Medical Research Council in postwar Britain

In recent years lung cancer specialists have complained that due to stigma resulting from the association of the disease with smoking, theirs is a neglected field. This paper demonstrates that in the 1950s and 1960s, when the British Medical Research Council (MRC) started to organize clinical trials for various forms of cancer, this was not the case. Rather, the organizers of these trials saw lung cancer as a particularly promising object of research, for much was known about the disease. The cancer trials were part of a strategy to use the Randomized Controlled Trial (RCT) technology to cement the role of the MRC as the dominant body overseeing medical research in Britain. The organization of the trials, however, turned out to be very difficult, due to ethical problems and the dominance of one form of therapy, surgery. The trial results were deeply disappointing. I argue that these frustrating results contributed to the notion of hopelessness that has come to surround lung cancer, and to the shift of focus from cure to prevention that was triggered by epidemiologic studies identifying tobacco smoke as the main cause of the disease. The paper deals with an important episode in the history of clinical cancer research in postwar Britain, illustrating the ethical and practical problems faced by the organizers.

Medicine and the public: the 1962 report of the Royal College of Physicians and the new public health

The 1962 report of the Royal College of Physicians on smoking was a significant event in the history of smoking. Its significance was, however, more than smoking-specific: the RCP committee's appointment, its membership, its work, and the manner of its publication signified the changes within social medicine, and within the medical profession more generally, in postwar Britain. Doctors assumed the right to speak to the public and to government on matters of individual health, and a new risk-based public health was in the process of formation. A public health "policy community" formed, and governments began to assume responsibility for advising the public on health matters. The use of research in the report, and of social research in response to it, was important in the emergence of evidence-based medicine within public health. The paper argues for greater attention to the change in public health epitomized by the report in current debates on the concept of the 1960s "permissive society." It was the harbinger of a new style of "coercive permissiveness" in health.

THE POLICY RESPONSE TO THE SMOKING AND LUNG CANCER CONNECTION IN THE 1950s AND 1960s

A key current concern is how scientific knowledge may inform policy in relation to major environmental and health concerns. There are distinct schools of analysis about this relationship between science and policy. They stress rational relationships; denial and delay; or the role of networks. History is important in modifying such perspectives: smoking policy in the 1950s and 1960s is the case study here. The initial response in the 1950s to the link between smoking and lung cancer was in part conditioned by the role of the tobacco industry and the financial importance of tobacco: the British tobacco industry had closer relationships with government than the American one, and did not rely on public relations. Public health interests worked with the industry. But politicians were concerned also about the fluidity of the epidemiological evidence; the dangers of stirring up further pressure over air pollution; the financial and ideological implications of health education and its location; and the electoral dangers of intervening in a popular mass habit. In the 1960s the British and American medical reports stimulated the growth of a public health 'policy community'. The initial political considerations began to weaken and these years marked the beginning of a new style of public health.