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Chronic Disease in the Twentieth Century

A History

George Weisz

Publication Year: 2014

Long and recurring illnesses have burdened sick people and their doctors since ancient times, but until recently the concept of “chronic disease” had limited significance. Even lingering diseases like tuberculosis, a leading cause of mortality, did not inspire dedicated public health activities until the later decades of the nineteenth century, when it became understood as a treatable infectious disease. Historian of medicine George Weisz analyzes why the idea of chronic disease assumed critical importance in the twentieth century and how it acquired new meaning as one of most serious problems facing national healthcare systems. Chronic Disease in the Twentieth Century challenges the conventional wisdom that the concept of chronic disease emerged because medicine’s ability to cure infectious disease led to changing patterns of disease. Instead, it suggests, the concept was constructed and has evolved to serve a variety of political and social purposes. How and why the concept developed differently in the United States, the United Kingdom, and France are central concerns of this work. In the United States, anxiety about chronic disease spread early in the twentieth century and was transformed in the 1950s and 1960s into a national crisis that helped shape healthcare reform. In the United Kingdom, the concept emerged only after World War II, was associated almost exclusively with proper medical care for the elderly population, and became closely linked to the development of geriatrics as a specialty. In France, the problems of elderly and infirm people were handled as technical and administrative matters until the 1950s and 1960s, when medical treatment of elderly people emerged as a subset of their wider social marginality. While an international consensus now exists regarding a chronic disease crisis that demands better forms of disease management, the different paths taken by these countries during the twentieth century continue to exert profound influence. This book seeks to explain why, among the innumerable problems faced by societies, some problems in some places become viewed as critical public issues that shape health policy.

Published by: The Johns Hopkins University Press

Title Page, Copyright Page

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pp. i-iv


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pp. v-vi

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pp. vii-xiv

The structure of this book reflects my conviction that chronic disease—though a traditional medical term—was primarily an American policy construct during the first half of the twentieth century. In part I, I devote seven chapters to the United States and offer what I hope is a somewhat different perspective on...

List of Abbreviations

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pp. xv-xviii

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pp. 1-14

This work has its origins in confusion. In December 2005 I had the good fortune to be invited to a workshop in London devoted to “chronic disease,” a term I thought I understood. I left the meeting without the faintest idea what it meant (my own paper was on premenstrual syndrome [PMS], which gives some...

Part I: Chronic Disease in the United States

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1. “National Vitality” and Physical Examination

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pp. 17-36

In the early twentieth century, Americans approached their health, both individual and collective, with a mixture of confidence and anxiety. Confidence was based on the sharp decline of infant mortality; increasing control over infectious diseases; and the promise that science and rational management, backed by...

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2. Expanding Public Health

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pp. 37-55

In 1920 C.-E.A. Winslow, professor of public health at Yale University, presented a long address to the American Association for the Advancement of Science in which he made the case for a “New Public Health” with a vastly enlarged role. Such expansion was already underway, he argued. Public health had...

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3. Almshouses, Hospitals, and the Sick Poor

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pp. 56-76

Hospitals in the nineteenth century were charitable institutions for the poor and closely associated with other welfare agencies. By the twentieth century, they were becoming highly medicalized and serving the entire population; but they nonetheless frequently remained administratively and practically connected...

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4. New Deal Politics and the National Health Survey

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pp. 77-100

During the 1930s, chronic disease became widely recognized as a critical social problem in the United States. One reason was the growing influence of the cancer movement, then attracting considerable financial support and public attention. Cancer had a life of its own, however, and the intense fears, hopes, and...

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5. Mobilizing against Chronic Illness at Midcentury

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pp. 101-127

The National Health Survey on Chronic Illness (NHS) catapulted the problem of chronic disease onto the national American political stage. In the decade that followed World War II, the issue became central to a variety of American institutions: public and private, local and national, healthcare and welfare. Literature...

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6. Long-Term Care

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pp. 128-147

The Commission on Chronic Illness (CCI) set out an expansive, multifaceted strategy to cope with chronic disease that can be faulted on many levels. Foreign commentators noted the generality of its proposals. From our own twenty-first- century perspective, there was perhaps too much emphasis on secondary...

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7. Public Health and Prevention

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pp. 148-168

When Lester Breslow first applied for a job with the California Health Department in 1946 in order to work on chronic disease, he was initially turned down because the head of the department had no interest in this issue. The situation, however, turned quickly around. Breslow was eventually hired for...

Part II: Chronic Disease in the United Kingdom and France

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8. Health, Wealth, and the State

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pp. 171-175

For much of the twentieth century, the American preoccupation with chronic disease was exceptional. Most of the issues associated with such illness were not specific to the United States but they were perceived, understood, and classified in different ways in other countries. I illustrate this point in the following...

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9. Alternative Paths in the United Kingdom

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pp. 176-203

Many of the same conditions that promoted concern with chronic illness in the United States also existed in the United Kingdom. During the interwar period, there was considerable talk about disease prevention by major figures like Sir George Newman, longtime chief medical officer in the Health Ministry, and...

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10. Maladies chroniques in France

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pp. 204-232

When I first began researching chronic disease in France, I encountered two difficulties. First, French historians and sociologists had no idea what I was talking about. It was not that they did not understand the literal meaning of the words; these simply had little relevance to healthcare, as they understood...

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pp. 233-246

For much of the twentieth century, France and the United Kingdom faced somewhat different health issues than did the United States. Their populations were older, although by the 1970s the age gap had narrowed and Medicare had made the health of older people a significant part of the American chronic...


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pp. 247-294


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pp. 295-307

E-ISBN-13: 9781421413044
E-ISBN-10: 1421413043
Print-ISBN-13: 9781421413037
Print-ISBN-10: 1421413035

Page Count: 328
Publication Year: 2014