Disease Prevention as Social Change: The State, Society, and Public Health in the United States, France, Great Britain, and Canada

Notes

Notes Chapter 1 1. McKeown’s thesis was adopted enthusiastically by some social scientists, primarily for its scathing critique of Big Medicine’s claims to responsibility for declining death rates (McKinlay and McKinlay 1977; McKinlay, McKinlay, and Beaglehole 1989). Although these authors make no bones about the political implications of their position, the lesson drawn in the publications cited is somewhat inconsistent with McKeown’s essential rejection of human agency. In the view of McKinlay and colleagues, to refute the claims of Big Medicine was to make the case for social reform. In more recent work, McKinlay has joined the advocates of public health (McKinlay and Marceau 2000). 2. In work that harks back to McKeown, Link and Phelan have identified socioeconomic status as a fundamental cause of disease and death (Phelan et al. 2004, 265; see also Link and Phelan 1995). I would argue that public policies are critical in potentiating or mitigating the impact of socioeconomic status on public (as well as individual) health. 3. Comparative work on the environment includes Mary Douglas and Aaron Wildavsky (1982), David Vogel (1986), and Howard Kunreuther and Joanne Linerooth (1983). On HIV-AIDS, it includes David Kirp and Ronald Bayer (1992), Eric Feldman and Bayer (1999), and Peter Baldwin (2005a). On tobacco, it includes Donley Studlar (2002), Feldman and Bayer (2004), and Roddy Reid (2005). 4. In the words of its inventor, Max Weber, the function of the ideal type “is the comparison with empirical reality in order to establish its divergence or similarities , to describe them with the most unambiguously intelligible concepts, and explain them causally” (1949, 43, emphasis in original). The strong and weak state constructs are just such ideal types. (As should be self-evident from this explanation, “ideal” as used by Weber is not intended to be evaluative: one may construct ideal types of dictators or saints.) Chapter 2 1. Greater knowledge of causes and cures has not, of course, eliminated the politicization of disease, as the subsequent narratives will amply illustrate. 259 2. Public health historians of both countries are in agreement on this point (see La Berge 1992; Pickstone 1982; Cooter 1983). Anthony Brundage describes how in 1840 a House of Commons Select Committee on the Health of Towns was deflected away from an inquiry into “the discontents of the working classes in populous districts” into the safer topic of working class public health (1988, 81). 3. To trace the origins of the highly pragmatic evangelism that characterized British public health reformers in the nineteenth century is beyond the scope of this project. It is important to note, however, that even before the 1860s and later, when this movement spread to the mayors and city councils of industrial towns, it had inspired the closely allied network of men whose writings and public appeals laid the groundwork for later events. Anthony Wohl writes, [the] opening phase of sanitary reform [in the 1840s] was . . . infused with the enthusiasm and moral fervour of a small group of men, well-known to one another, and approaching the work ahead of them with optimism and proselytizing zeal. Typical was the Metropolitan Health of Towns Association, which was formed in 1844. Inspired by Dr. Southwood Smith, a Benthamite and close associate of [Edwin] Chadwick’s, it brought together political leaders and aspiring politicians . . . and [prominent] doctors. . . . The purpose of the Association was principally propaganda [for public health]. (1983, 144–45) 4. The story of how this happened—from Edwin Chadwick’s landmark report The Sanitary Condition of the Labouring Population of Great Britain published in 1842 to the resignation of John Simon in 1876 as medical officer to the Privy Council—has been often and well told (see, for example, Flinn 1965; Lewis 1952; Wohl 1983; Brundage 1988). My purpose is limited to establishing the historical setting for the narratives that follow and highlighting the contrast between public health in Britain and France. 5. The Local Government [Board] Act of 1871 merged the activities of several existing bodies (the Poor Law Board, the Local Government Act Office, the Registrar-General’s Office, and the Medical Office of the Privy Council) to create a centralized authority for public health in Britain. Subsequent acts, in 1872 and 1875, further refined and clarified the Board’s responsibilities. The Local Government Board’s (LGB) effectiveness in practice, however, was substantially limited by the act’s placement of medical civil servants under lay authority (Brand 1965, 22). Local of...