all workers and persons living under forms of audit-related precarity, such as those being constantly reassessed for disability benefit: T. Schrecker and C. Bambra, How Politics Makes us Sick: Neoliberal Epidemics (Basingstoke: Palgrave Macmillan, 2015).
88 See the mix of prevention and monitoring in the NSF. On the decline of structural solutions in post-war public health: D. Porter, Health Citizenship: Essays in Social Medicine and Biomedical Politics (Berkeley: University of California Press, 2011), pp. 154
diabetes were as numerous as those from all infectious diseases put together’ during the 1930s, and estimates of the condition's prevalence rose steadily over the post-war period. 3 Likewise, medical professionals regularly referred to increases in workload and escalating consultations for the disease during the 1970s and 1980s; new technologies and understandings of risk management had extended the boundaries of treatment, whilst greater life expectancy and disease detection buttressed changes of demography, employment, leisure, and diet that probably underpinned
rationally planned and integrated care raised during post-war reconstruction were not realised in the ways envisaged by policy-makers.
Taking the gap between vision and practice as its starting point, this chapter analyses the ways in which diabetes management intersected with changing healthcare structures and emergent notions of chronicity during the two decades after 1945. Beginning with an overview of disease management strategies in the 1940s, it traces how the creation of the NHS confirmed diabetes as a hospital condition, one closely connected
, the Thatcher and Major governments were also motivated by a long-held desire of the British state to control NHS costs, and later initiatives built upon developments that took place before the 1980s.
Parliament and the Treasury had placed constant pressure on NHS budgets since 1948. Initial hopes that expenditure would decline as national health improved were dashed very quickly. Governments tried numerous strategies over the post-war period to control costs, ranging from the introduction of charges (most notably for prescriptions in the 1950s
Practitioners (RCGP) incorporated diabetes care into projects of quality assurance and public health practice. Diabetes, in other words, became a disease more feasibly managed in general practice because of changes in the institutional environment, but it was also a disease around which general practice could be remade in ways consonant with broader professional projects.
Such endeavours cannot be divorced from post-war political and economic developments. The spectre of cost-control – and related calls for greater service integration and efficiency
quality as measurable, assessed in relation to defined outcome measures, and best secured by following agreed protocol standards and undertaking regular review. Pre-war clinical medicine had been subject to external constraints and peer discussion, but in issuing guidance post-war specialists and their organisations began to add layers to existing, informal regimes of clinical government. During the late 1980s and the 1990s, that is, elite medical professionals produced national standards to directly inform local protocols (previously devised through experience and
eighty per cent coverage by December 1990, 27 in line with the UNICEF goal of Universal Child
Immunization. In Nigeria, this goal was only achieved for
Bacille-Calmette-Guérin vaccine (BCG) coverage. 28
The year 1990 was considered to be the high-point in national
immunisation coverage. However, on 30 June, responsibility for primary
health-care services was transferred to the local governments as part of a
Colonialism and Native Health nursing in New Zealand, 1900–40
wanted the best: with the
‘very best qualifications, both general and midwifery’.24 When she
advertised a position in the Māori district of Te Araroa in 1912 she
explained that the posting was ‘a most responsible one, the nearest
doctor being fifty miles away, at Waipiro. When he is connected by
telephone, it will be a great relief to the nurse. Even then, she must act
on her own initiative a great deal.’25
Nurses in post underscored that sense of responsibility. Akeheni
Hei sent letters to Kai Tiaki describing her experiences, starting in
1909 when she was stationed