Stadt und Gesundheit im Ruhrgebiet, 1850-1929: Verstadterung und kommunale Gesundheitspolitik dargestellt am Beispiel der jungen Industriestadt Gelsenkirchen (review)

Over the last thirty years, it has fallen largely to departments of history and the history of medicine to document the modern evolution of German social hygiene and health care. Numerous studies have documented morbidity and mortality among the urban working population, the stratification of the health professions, and the administrative structures developed to provide statistics and implement environmental, occupational, and personal health measures. The coercive and sociopolitical uses of these structures at the national level over the period 1880–1945 dominated the early stages of this research. This has now been augmented by work covering territorial and municipal developments accompanying the slow, uneven, but relentless growth of industrialization and urbanization since the beginning of the 1830s.

Martin Weyer-von Schoultz’s monograph on the emergence of the new city of Gelsenkirchen as a major manufacturing and industrial center in the pivotal northwest Rhineland falls into this category. Like most of its companion studies, it is an expanded version of a doctoral thesis and is relentlessly detailed and relentlessly documented with lengthy citations, numerous footnotes, and an extensive bibliography, the latter providing a useful overview of recent German work in the field.

Despite some difficulties of access, the study is recommended to those who are interested in how the generic processes and demands of urbanization and industrialization mesh with traditional patterns of providing and financing social and medical services. In Germany, this process was largely completed by the first decade of the twentieth century. As noted by Alfons Labisch, whose thinking has strongly influenced this and other recent German studies of public health, the relative advances in community hygiene, compared to the lag in medical breakthroughs, oriented administrative bodies toward living conditions and environmental measures. Despite the largely rural background of most industrial workers of the first and second generations, many responded quickly and positively to top-down demands that would improve housing and hygiene, promote urban integration, and ensure the continued ability to work.

Those interested in parallels to the travails of health-care reform in less structured societies will find them in the perennial invocations by nineteenth-century health departments and physicians to self-improvement—eat better and more, drink less, nurse your baby—that place the burden of guilt on the individual rather than on society. To an American public health establishment still at a loss as to whether and how to integrate the European experience, this book offers graphic and convincing examples of the fact that it takes a tradition of many and diverse health-care financing mechanisms to knit the web of universal coverage. In the German case, many of these were of long standing: they grew out of mutual aid associations originating in old professions such as mining (the Knappschaftskassen), were offered by new enterprises to assure a loyal work force, or (less importantly by the end of the nineteenth century) developed out of denominational charity schemes. All were an essential prerequisite for Bismarck’s famous reforms and the eventual coverage of a national population.

As noted, this and similar studies at the local and regional level have been nourished by departments of history that are only modestly oriented toward American social sciences concepts, let alone those of classical or neoclassical economics. There is an obvious need for the long-neglected consolidation of disciplines such as epidemiology, health economics, and information sciences in the new German schools of public health. But one hopes that greater disciplinary rigor will not lead to the decline of studies addressing historical issues of how to provide and finance health care and public health that are not just of historical interest.