Making Health Policy: Networks in Research and Policy after 1945. Vol. 75 of Clio Medica (review)

The history of health policymaking in the United Kingdom since World War II and the role of scientists in this history, as well as the evidence they produced and employed, have been a focus of much interest in recent years, thanks not least to work by Virginia Berridge and the members of a group of historians and sociologists working under her direction at the London School of Hygiene and Tropical Medicine in a program entitled "Science Speaks to Politics." This book is a product of that collaboration, a coherent collection of essays that in places reads more like a coauthored volume. Its chapters deal with the networks of doctors, public health experts, politicians, activists, and publicists that shaped health policy in Britain in the second half of the twentieth century, and with the interactions among these groups, some formal and others informal, which turned them into networks.

Berridge's introduction provides us with a welcome overview of the groups and institutions involved, the changing interactions between social scientists and medical experts, and the nature of the evidence employed in policymaking. The construction of this evidence is the subject of Luc Berlivet's chapter on the history of risk-factor epidemiology and the epistemology behind it, which turned statistical association into cause and was central to new, postwar approaches in public health. Betsy Thom's chapter on alcohol policy deals with the use of such evidence and the different models employed in making sense of alcohol problems, from a "moral" via a "disease" and a "public health" model to one that merged aspects of health and criminal justice. Berridge's chapter on the antismoking campaign group ASH (Action on Smoking and Health) and the industry-funded Tobacco Products Research Trust reveals the mutual dependencies between these organizations and the government. Mark Bufton guides us through a succession of expert committees on dietary questions, from the austerity of the postwar years when the necessary protein intake was a central issue, to a time of affluence when such advice was informed more by epidemiological concepts that linked diet with heart disease. Sarah Mars analyzes the networks and discusses the concepts that informed modern drug policies, especially the 1984 Guidelines of Good Clinical Practice in the Treatment of Drug Misuse. Interesting chapters by Stuart Anderson and Jennifer Stanton deal with complex issues of reorganization, rationing, and best practice in hospital pharmacy services, renal dialysis, and intensive-care provision. Kelly Loughlin, finally, contributes chapters on the ways in which the British Medical Association managed its press and public relations, and on the reporting on health and medicine in the British media in the 1950s and 1960s.

Some of the issues covered here have received little scholarly attention so far; others benefit from being discussed from a different perspective. Berridge classifies the ways in which science-policy relationships have been written about as informed by, one, the "evidence-based medicine/health policy approach" (p. 16); two, the "journalist school" of thought (p. 17); three, the sociology of scientific knowledge; and four, the science policy approach. The papers in this volume fit mostly into categories three and four, but readers used to one and two will also read them with benefit. The volume confirms the central role of evidence generated by chronic-disease epidemiology in providing crystallization points for policy networks, especially where behaviors such as smoking, eating, or taking drugs were concerned. This is a useful book, and some chapters will be essential reading for anyone interested in the use of evidence in the shaping of health policy since World War II, not only in the United Kingdom.