. Wood, ‘Policy emergence and policy convergence: the case of “Scientific-Bureaucratic Medicine” in the United States and United Kingdom’, British Journal of Politics and InternationalRelations , 4:1 (2002), 1–21; S. Harrison and W. I. U. Ahmad, ‘Medical autonomy and the UK state 1975 to 2025’, Sociology , 34:1 (2000), 129–46; Flynn, ‘Clinical governance and governmentality’, pp. 155–6, 159–60; Kirkpatrick et al., The New Managerialism .
22 R. Klein, ‘The crises of the welfare states’, in R. Cooter and J. Pickstone (eds.), Medicine in the
In 1965, the Canadian-born psychoanalyst and social scientist Elliott Jaques introduced a term – the midlife crisis – that continues to structure Western experiences and expressions of love and loss in middle age. Jaques's early work, carried out at the Tavistock Institute of Human Relations during the 1940s and 1950s, had focused primarily on the ways in which social systems operated as forms of ‘defense against persecutory and depressive anxiety’ among their members, as well as a mechanism for protecting the
engaged with diabetes management as a clinically and financially important concern. In the political arena, diabetes management itself was simultaneously transformed into a clinical and public health act, one which provided a promising laboratory for practices of clinical governance, service management, and NHS reform. Finally, in telling the story of central government interest in retinopathy, this chapter also begins to trace the importance of international conditions and British neoliberal politics to diabetes management, concerns that are taken up in Chapters 5
fatigue: first, that crew fatigue be scientifically investigated; and, second, that the regulations controlling pilots’ hours of work and rest be reviewed.
Though it is an international industry, in the twentieth century civil aviation was governed almost entirely by national regulations.
It was not, therefore, within the remit of Singapore's inquiry commission to produce directives in relation to the working practices of flight deck crew employed by British airlines. The recommendations outlined by
that state–professional relations were not always smooth. It was here that the strength of the diabetes policy community became important. Through a vocal lay-professional organisation, interested civil servants, persuasive specialist advocates, and international pressure (especially from the WHO), diabetes was established as an important subject for novel managerial technologies. Diabetes thus provides a lens through which to view managerial policy, not only because of how it was conceived as a possible model for change, but also because of the ways in which it
National Diabetes Audit after 2005. However, in the following pages I want to set the developments in diabetes management explored over the preceding six chapters against changes in chronic disease care more generally, and to consider the story of British professional management in relation to international and present-day comparators. In so doing, this Epilogue returns to themes and questions laid out in the Introduction, reflecting on diabetes’ historic position as a model chronic condition and drawing out the relationship between chronic disease and professional
the perfect candidates for referral, and a significant proportion of GPs passed all diabetes care on to specialists. 10
Financial factors in referral were buttressed by intra-professional aversions and anxieties. On a local level, consultant staff and GPs could maintain good relations, but the existence of private medicine often helped to facilitate friendly co-operation. 11 In terms of diabetes, some GPs even served as ‘clinical assistants’ in specialist outpatient clinics, undertaking clinical assessments and consultation under direction of
one that expressed the need for stability and equilibrium within bodies, families, communities, societies, political systems and global relations.
The seemingly distinct domains of enquiry within which balance emerged as a concept were not disconnected: biological models of balance and homeostasis, for example, were employed to justify political arguments for the equitable distribution of resources and information; and political allegiances inflected physiological accounts of adaptation and health
Health as moral economy in the long nineteenth century
/adapt E. P. Thompson's concept of a ‘moral economy’, developed to explain features of social relations at the beginning of the long nineteenth century, to the domain of social medicine. Next, à la Raymond Williams, I begin to consider ‘keywords’, here verbs of existential unacceptability. These are probes for social practices, and good ways to chart change.
The first is the ‘complaint’ of my title. Sections three and four explore the nineteenth-century antecedents of general patho-physiological processes that served
according to predicted patterns. However, as complex individuals enrolled in various relations with competing demands, doctors and patients varied in their commitment to follow-up. For patients, clinics and their doctors could be remote, producing financial and temporal strains. 33 Decisions to attend were also based upon complex physical and psychological assessments. One interviewee with diabetes (diagnosed when aged seven in 1976) reflected on how she often had to wait for over an hour and a half for a consultation as a teenager, only to become ‘aggrieved’ with the