Health and Society in Twentieth-Century Britain (review)

Helen Jones synthesizes primary and secondary sources to argue the determining influence of social class, gender, ethnicity, and race on the health status of the British people and on health policy in the twentieth century. She tells her story in an introduction, six chronological chapters, and an epilogue about the debate among academics concerning inequality in health status. Each of the chronological chapters examines the experience of particular socioeconomic groups and then summarizes political events that led to decisions about health policy. Jones makes judicious use of anecdotes and statistics and is an accurate reporter of most controversies among scholars.

The book has two subordinate theses. The first is that interwar (and even later) public health policy had a “flawed” ideology of “individual and personal responsibility” (p. 78). The second is that health policy since World War II has gradually displaced physicians from dominance in decisions about both policy and the provision of services.

Jones’s claims would be more persuasive if she did not define the “people” as mainly the working class and the poor. Yet her comparisons of the experience of people of different classes, genders, and ethnic groups are among the best passages in the book (e.g., pp. 39 and 50). It should be noted that the increase in morbidity and mortality from chronic disease over the past half century was not entirely a result of class, gender, and ethnicity. Much of the burden of chronic disease is a result of the achievements of biomedical science—the “failures of our successes,” in the title of a classic paper. Medical science, ironically, bears considerable responsibility for the declining authority of the medical profession.

Jones misses an opportunity to support her thesis about the dominance of health policy by physicians from the 1940s to the 1970s when she argues that conflict was more important than consensus in the origins and early history of the National Health Service. She agrees with the scholars who emphasize conflicts among political parties about such important issues as who should own hospitals, how physicians should be paid, and how general practice should be organized. Proponents of consensus do not ignore these intense conflicts. However, they emphasize the centrality for health politics of broad agreement about the purposes of health services and about how resources should be allocated to primary, specialist, inpatient, and community care. According to this agreement, acute general hospitals, led by teaching institutions, were the central institutions of health care, and specialized physicians the dominant decision makers. Jones somewhat illogically supports the conflict school even though she adduces new evidence (p. 111) from the Willink papers that demonstrates the extent to which nationalizing the hospitals was less a triumph of socialism than a logical step in implementing a consensus about the centrality of hospitals and the specialized physicians who dominated them.

This book ought to influence the understanding of both students and professional historians. A book of similar breadth and sophistication about events in the United States during the same years would be of great value.