Speaking to the Society of Medical Officers of Health in February 1965, J. J. A. Reid – a well-known public health practitioner – addressed a familiar theme. ‘In this country’, Reid began, ‘the problems with which all branches of our profession are faced are very different from those of the past, when poverty, ignorance and infectious diseases were the main enemies of health.’ ‘Nowadays’, Reid continued, ‘it is towards cardiovascular disease, cancer, bronchitis, accidents, mental disorder, and such chronic conditions as diabetes mellitus and
Disrupting the welfare state’s ‘bonds
If the Children Act 1948 and
the publication in 1955 of the Underwood Report of the Committee on
Maladjusted Children were significant moments in the formation of
government policy towards children based on the Tavistock Model of
Human Relationships, then the MentalHealth Act 1959, the 1970 Local
physical, mental and spiritual health, in conjunction with health education advice to follow balanced diets, drink less and exercise more, were increasingly advocated – and purchased – as part of a healthy lifestyle: improving balance through movement and manipulation was thought to release energy, enhance resilience, promote endurance and productivity, combat obesity and increase a sense of ‘wellness’.
Balance also figured strongly in treatments of mental illness. From the 1920s
In 1968, a short Disney film, Understanding
Stresses and Strains , narrated by actor, writer and director Lawrence Dobkin, opened with the following statement:
A modern concept of well-balanced health may be visualised as an equilateral triangle composed of a physical side, a mental side and a social side, each of equal importance. This is a soundly based concept and those who live within it, keeping all sides in
Melissa Dickson, Emilie Taylor-Brown and Sally Shuttleworth
anxieties about mental and physical ailments arising from the general pressures of modern life were not unique to America, or to Britain, in the nineteenth century, but engendered concern across national boundaries and cultures. Central to this study is the question of how self-referential concepts of ‘the modern’ worked to structure perceptions of health, disease, and medical treatment in the long nineteenth century. Neurasthenia was not the only disease constituted in relation to problems of modernity or to national character. Similar claims were, as our volume
Despite the BDA submitting persuasive arguments for diabetes, the subsequent White Paper adopted fourteen quantified targets for five key areas: coronary heart disease and stroke, cancer, mental illness, HIV/AIDS and sexual health, and accidents. 94 The Major government suggested that these five areas met three key criteria, being areas of considerable premature death and avoidable ill-health, in possession of known effective interventions, and amenable to target-setting and monitoring. 95 Critics of the programme have suggested, by contrast, that alongside being
Dietary advice and agency in North America and Britain
University Press, 2010), p. 77. The adoption of various lifestyle practices to achieve better health, whether mental, spiritual or physical, could be seen in the philosophy and activities of Esalen, including massages, naked baths and organic free-range food, which promoted a religion of no religion – see J. J. Kripal, Esalen: America and the Religion of No Religion (Chicago: Chicago University Press, 2007), p. 8.
breakdown with imperial efforts to ‘civilise’ the South Pacific. Sympathetic to missionary proselytisation in the region, and desirous to bolster the standing of the Medical Department of the Navy, Messer suggested that tetanus was most likely to occur in victims possessing a ‘superstitious dread’ of poisonous arrows. The social, physical, and mentalhealth of the inhabitants of the Santa Cruz group, and of those who visited, were therefore said to be contingent upon the spread of Christian belief and modern medical understanding.
Only one year
Although the creation of the NHS had strengthened the role of hospitals in diabetes management, a minority of innovative practitioners began to experiment with more community-oriented care schemes in the 1950s. Clinics and local government health departments co-operated to extend the surveillance and educative reach of clinicians, with nursing and health visiting staff forming part of expanded care teams. With their growing mix of skills, the new teams sought to confront the myriad social and medical problems facing patients with a common
Health as moral economy in the long nineteenth century
deliverable, entitlements (or, more directly, ‘rights’), must be well defined. The ‘state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’, which the World Health Organization (WHO) obliges states to guarantee their citizens is indefinite.
The mandate offers no way to move from an expressed deficit of well-being to mediatory medicalisation, nor of prioritising harms to health. Nor does it acknowledge trade-offs in which delivering the right to some might require taking