workers in post-warBritain were encouraged to stay on the job beyond their contracted working hours. Overwork, and the fatigue that this often entailed, were generally accepted where financial recompense was offered. There were, however, some instances where overwork was formally restricted. In the United Kingdon, regulations governing hours of work and rest stretch back to the nineteenth century. Many state regulations – including the 1844 and 1850 Factory Acts – had a social and moral imperative. They were intended to protect vulnerable groups from exploitation and
Through a study of diabetes care in post-war Britain, this book is the first historical monograph to explore the emergence of managed medicine within the National Health Service. Much of the extant literature has cast the development of systems for structuring and reviewing clinical care as either a political imposition in pursuit of cost control or a professional reaction to state pressure. By contrast, Managing Diabetes, Managing Medicine argues that managerial medicine was a co-constructed venture between profession and state. Despite possessing diverse motives – and though clearly influenced by post-war Britain’s rapid political, technological, economic, and cultural changes – general practitioners (GPs), hospital specialists, national professional and patient bodies, a range of British government agencies, and influential international organisations were all integral to the creation of managerial systems in Britain. By focusing on changes within the management of a single disease at the forefront of broader developments, this book ties together innovations across varied sites at different scales of change, from the very local programmes of single towns to the debates of specialists and professional leaders in international fora. Drawing on a broad range of archival materials, published journals, and medical textbooks, as well as newspapers and oral histories, Managing Diabetes, Managing Medicine not only develops fresh insights into the history of managed healthcare, but also contributes to histories of the NHS, medical professionalism, and post-war government more broadly.
Concepts of ‘balance’ have been central to modern politics, medicine and society.
Yet, while many health, environmental and social challenges are discussed
globally in terms of imbalances in biological, social and ecological systems,
strategies for addressing modern excesses and deficiencies have focused almost
exclusively on the agency of the individual. Balancing the Self explores the
diverse ways in which balanced and unbalanced selfhoods have been subject to
construction, intervention and challenge across the long twentieth century.
Through original chapters on subjects as varied as obesity control, fatigue and
the regulation of work, and the physiology of exploration in extreme conditions,
the volume analyses how concepts of balance and rhetorics of empowerment and
responsibility have historically been used for a variety of purposes, by a
diversity of political and social agencies. Historicising present-day concerns,
as well as uncovering the previously hidden interests of the past, this volume’s
wide-ranging discussions of health governance, subjectivity and balance will be
of interest to historians of medicine, sociologists, social policy analysts, and
social and political historians alike.
This chapter explores the complex relationship between ‘the public’ and the
‘self’ in post-war British public health by tracing the development of
alcohol health education during the 1970s and 1980s. Health education was
put forward during these decades as a way to encourage individuals to
moderate their alcohol consumption – to behave responsibly by becoming
‘sensible drinkers’. Yet, at the same time, considerable scepticism was
expressed (even by those involved in the campaigns) about the ability of
health education to change behaviour. Other approaches, such as increasing
the price of alcohol, were suggested as ways of reducing alcohol consumption
at the population level. At issue, however, was not simply the capacity for
individuals to achieve healthy balance. Policy-makers weighed numerous
social, economic and political concerns alongside health outcomes. A growing
focus on moderation may have expanded public health’s target population, but
a reliance on health education and nebulous concepts like the ‘sensible
drinker’ also reflected the ways that disciplinary power could be
counterbalanced by broader policy concerns.
interrelated political, economic, cultural, intellectual, and technical transformations in post-warBritain has also rendered medical professionals subject to previously unthinkable managerial technologies, created in the name of quality. 20 Through its history of diabetes management in post-warBritain, this book explores these transfigurations and asks how British medicine was so extensively subjected to management over the second half of the twentieth century. Who promoted managerial mechanisms, and why? And what connected new forms of clinical management with the rise
indirect connections, especially in light of the role that health management organisations play in the care of chronic disease and their emphasis on guidelines and audit. 46 As with managerial medicine more broadly, further comparative histories are needed to throw the relationships between chronic disease and professional management into greater relief. 47
Professionals, professionalism, and the state
What, then, does the emergence of professional management in post-warBritain say about the changing nature of
with medical advice during the first half of the twentieth century. Following the work of David Armstrong among others, it suggests that the self-caring ‘diabetic’ was not a given entity. Instead, through medical innovation, training and collective action, the ‘good diabetic’ was a figure who had to be made in relation to the shifting institutional and political structures of interwar and early post-warBritain.
As the Richardson article suggests, concepts of balance were
disease’ in the general population. Within discussions of chronic disease, diabetes assumed something of a symbolic position, providing a medium through which to discuss pathology and disease management. It was a position diabetes would retain, in various ways, for the rest of the century.
The transformations of the health service, diabetes management, and concepts of chronicity over the first decades of the post-war period, therefore, had ramifications lasting into the new millennium. Within the fluid political contexts of post-warBritain, the
This is not to say that the political situation in Britain was unchanged after 1979. Under the Conservatives many areas of policy – from industry and union regulation to social security, finance, and local government – experienced considerable transformation. 79 Nonetheless, some policy modifications had a longer trajectory than a change of government, and many interventions were adjusted considerably in implementation. 80 Equally, the profound social and economic transformations of post-warBritain – as well as the development
Visualising obesity as a public health concern in 1970s and 1980s
preservation long pre-dated these post-war health education initiatives and had been evident since at least the early modern period in England, where dietetic culture was central to medical understandings of the self.
But personal body management techniques including the control of diet and exercise endured as an essential part of personal identity and social worth in post-warBritain, where the consumerist society contributed to the creation of new disease-focused diet cultures. The centrality of the self to risk factor