The Rise Of The "Nanny State"

27.4.06

• Increasing state responsibility for health.
-Vaccination.
-Health of infants.
-Health "protection" and "promotion."
• Risk and responsibility in health.

Why introduce state medicine?
• Threat theory.
-Provoked by epidemic diseases - cholera.
-"Urban penalty" of high mortality rates.

Contagious Diseases Acts
• Passed in 1864, 1866, 1869.
• Women with disease could be detained and forcibly treated.
• Acts suspended in 1883, repealed in 1886.

Compulsory Disease Notification
• 1889 Act.
• Permissive, not compulsory.
• Limited to certain infectious diseases.
-Smallpox, diphtheria, scarlet fever, typhoid.
-Later, tuberculosis.

• Improvement theory.
-Fear of national deterioration.
-Increasing competition with German and USA.
-Poor health of Boer War recruits.
-1904 - Report on Physical Deterioration.

19th Century medical care
• Piecemeal, un-integrated network.
• Three types of hospitals.
-Voluntary (including cottage).
-Poor Law.
-Municipal (isolation).

• Primary care.
-Private physicians for wealthy.
-Dispensaries for working classes.
-Increased use of friendly societies, clubs.

Health visiting
• Voluntary middle class movement.
• Salford - 1870s.
• Targeting mothers.

Political pressure
• Enfranchisement of working classes (and women!)
• Rise of Labour Party.

Liberal Welfare Reforms
• 1905-1911 - "a welfare state in embryo."
• School medical service.
• Free school meals and milk.
• Infant and maternal welfare clinics.
• Health visiting.
• 1911 - National Health Insurance Act.
• Established panel doctors (state paid).
• Only covered working men.
• Limited medical treatment.

Enough to eat?
• 1930s.
• Evidence of malnutrition in working class communities.
• Government attitude.
• Politicisation of health research.

1948 - new expectations
• 5 July 1948 - formation of NHS.
• Further shift in responsibility from individual to state.

Role of medicine
• Central to new NHS.
• Aneurin Bevan's attitude to engaging doctors: "If necessary, I will stuff their mouths with gold."

Smoking and lung cancer
• 1950s.
• Richard Doll and Austin Bradford Hill.
• Study of doctors' smoking habits.
• Government response.

Duty to inform?
• 1962 - Royal College of Physicians report on smoking and health.

Duty to promote?
• Exercise and healthy eating.
• Family planning.

Duty to protect?
• Public expectations.
• 1970s whooping cough vaccine problems.
• AIDS.
• BSE.
• Passive smoking.