Health and Society in Britain since 1939 (review)

Virginia Berridge. Health and Society in Britain since 1939. New Studies in Economic and Social History. Cambridge: Cambridge University Press, 1999. viii + 133 pp. $39.95 (cloth), $13.95 (paperbound).

Virginia Berridge synthesizes a vast amount of data and assesses competing interpretations about health policy and its implementation in Britain since 1939, in 102 pages of text and 31 of supporting material. This book deserves to be read with care by historians of medicine and social policy--and particularly by colleagues who formed their opinions about health policy since the Second World War some years ago. If a book of this quality could be written about health policy in every industrial country, the writing of history and political science, and even some policy, would be considerably improved.

Berridge divides the book into five chapters. Three of these are chronological, addressing, respectively, the Second World War, the years from the inception of the National Health Service (NHS) in 1948 to its first major reorganization in 1974, and the subsequent quarter century. The other chapters are an introduction and conclusion in which Berridge acknowledges the contradiction between the title of the book and the subjects that most scholars of health policy have addressed. She knows that health services, however important they are to population health status, are not the only determinant of it. Yet most scholarship that purports to address health is about the politics and performance of services, not about their results (or "outcomes," in current jargon).

Berridge also uses the introduction and conclusion to emphasize her major finding about the history of health policy in the twentieth century: no industrial country--not Britain, or even the United States--has been an outlier. Policies among countries are more similar than they are different. Berridge uses the international literature on health policy to expose recent debates among historians of British health policy about consensus and conflict as sectarian wrangling driven by ideology. She notes that policymakers in every industrial country accepted similar assumptions about the epidemiologic situation and remedies for it. These assumptions justified overinvestment in hospital and specialty services. She explains that the flawed organizing principle for health policy--that health flowed out and down from the research laboratories of medical schools and teaching hospitals--drove policy under quite different policy regimes and economic conditions. Moreover, she generalizes to good effect from her own pioneering research on the policy response to HIV/AIDS in Britain. This research taught her the importance of international opinion about pathology, intervention, and policy, and how this opinion is refracted through the political institutions and personalities of each country.

The flaws of the book are minor. Much more could have been said about research on determinants of health other than medical care. Berridge's brief comment on the Oregon Health Plan (p. 60) is wrong on the dates, process, data, and decisions. She is in excellent company, however, since the Oregon initiative has been a projective test rather than a source of research information for many scholars of health policy.

In sum, this book announces the arrival at full maturity of a major scholar of health and society in twentieth-century welfare states.

Daniel M. Fox
Milbank Memorial Fund

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