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The history of post war UK public health : a neglected area?
| Public health history in and of the UK has undergone a renaissance in recent years. But much of this work has concentrated on the nineteenth century, on the sanitary period , the bacteriological revolution, or the turn of the century interest in motherhood and the ‘future of the race’. Likewise, the interest in inter war health and the international exchange of ideas and concepts has also brought renewed interest in public health and especially its operation at the local level as part of the patchwork of pre NHS health services. An incipient debate about the efficacy of local public health services in those years is related to current interest in the UK in the boundaries between health and social care and their operation.
This paper will move into the post 1945 period and will argue that post war public health deserves more sustained historical attention than it has so far received. It aims to open up discussion. The nature of public health itself is confused, with discussion veering between public health as a professional activity, as a series of institutional arrangements, or as a set of ideas and concepts. This paper will focus on the latter, which tend to be discussed only through the prism of particular topics like smoking, diet or alcohol. It will examine the reorientation of public health in the post war years. These saw the rise of two distinct tendencies : lifestyle public health with its epidemiologically focused whole population approach , and evidence based medicine, founded on the technology of the RCT. Public health in these years became a separate activity, rather distant from the formal public health profession, which moved out of contact with local communities and into the health service. Yet surprisingly, it is this professional activity of public health which continues to attract most historical attention.
The paper will end by surveying the contemporary history of public health ideology since the 1980s. It identifies complex tendencies in early 21st century public health : these include globalisation, the revival of communicable disease , but also mass medication and a concern with the regulation of public rather than family space and with ‘high risk’ populations rather than the population as a whole. The incipient focus on human rights of the AIDS era has been replaced by health protection and community safety as key concepts.
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