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Chronic Disease in the Twentieth Century: A History by George Weisz (review)
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Reviewed by
George Weisz. Chronic Disease in the Twentieth Century: A History. Baltimore: Johns Hopkins University Press, 2014. xvi + 307 pp. $29.95 (978-1-4214-1303-7).

Weisz’s latest book has strengths and flaws as a result of his having read widely but selectively in pertinent primary and secondary sources. His overarching thesis is that recognition of the increasing problem of chronic disease and the formulation of policy to address it occurred sooner and more thoroughly in the United States than in either France or the United Kingdom.

Weisz presents his evidence and argues his thesis in an introduction, ten chapters, and an epilogue. His most original contributions are descriptions, grounded in archival and published primary sources, of policy in the 1920s and 1930s for chronic disease in Massachusetts (pp. 47–54) and New York City (pp. 69–75) and a history of the National Health Survey conducted in 1935–36 and its influence on policy (pp. 77–110).

Weisz’s repeated assertions that policy and clinical practice for responding to chronic disease have long been more effective in the United States than in France or the United Kingdom are not persuasive. With a few exceptions late in the book (notably p. 231), he fails to grasp the significant relationship between the politics of achieving and implementing universal coverage and the organization and financing of services for persons with chronic disease. Because the United States has moved more slowly and incrementally toward universal coverage than other industrial countries, American policy for reimbursing physicians and hospitals has, until quite recently, incentivized physicians and hospitals to prioritize intervening in acute manifestations of chronic disease over managing the consequences of these diseases for patients’ health and functional status.

Weisz also claims that older Americans have had, for decades, better access to home- and community-based long-term care services than their counterparts in France and the United Kingdom (and perhaps also in Canada, where he lives, but which he mentions only briefly). Many persons who make and study health policy have, however, demonstrated that the United States, unlike the United Kingdom and numerous other countries, has only recently begun to address comprehensively the progressive but intermittent frailty of seniors, especially those who suffer from multiple chronic diseases. Weisz’s claim (p. 172) that the absence of universal [End Page 357] coverage made it easier for leaders in the health sector in the United States to prioritize chronic disease is likely to astonish many knowledgeable readers.

Moreover, Weisz repeatedly criticizes this reviewer for overemphasizing the failures of American policy to address chronic disease (pp. 8, 129, 132, 166). I am grateful to him for recognizing that I have written about how and why policy for chronic disease in the United States has failed to maximize patients’ access to care that could maintain and improve the quality of their lives. But he neither identifies nor evaluates the causes to which I attribute this failure: (1) the comparatively slow achievement of universal coverage in this country; (2) the relative absence until recently (compared to numerous other countries) of strong financial incentives to providers of health services to integrate the types and levels of care; and (3) public and private sector financing policy that has incentivized the commercialization of health care since the late nineteenth century.

The book also has omissions and misstatements that may, in part, result from inadequate prepublication peer review. An important omission is the contribution of both research and clinical policy in the United Kingdom to influential guidance for policy published initially by the World Health Organization in 1976 as The International Classification of Impairments, Disabilities and Handicaps. (Weisz recognizes but does not name this publication on page 202 and cites a significant article by its principal author, Philip Woods, on page 286.) Errors include confusing the authority of decision makers and staff of the committee appointed by President Franklin D. Roosevelt to write the Social Security Act (p. 82); misstating the history of the U.S. National Science Foundation (p. 151); misunderstanding the history and scope of clinical epidemiology (p. 153); oversimplifying by omission the history of the U.K. National Health Service (pp. 179–88); and...