the core themes of this volume, it asks how and why new selves were constructed and regulated in the post-war period at the expense of structural adjustments to working environments, sets out a new timeline for twentieth-century subjectivity and historicises present-day concerns with work-life balance and the costs of overwork.
Acute fatigue and the regulation of working hours, 1954–72
In the twentieth century overwork was under-regulated. In fact, many
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-war Britain, where the consumerist society contributed to the creation of new disease-focused diet cultures. The centrality of the self to risk factor
Balance, malleability and anthropology: historical contexts
as a yardstick of progress, and ‘Boasian culturalism’ (to use the sometimes pejorative shorthand) inverts the whole idea of this hierarchy. It does not invert the hierarchy itself (reversing the positions on the scale) but inverts the idea: from a vertical conception of difference to a horizontal one. This horizontal conception of culture, this cultural relativism is the ‘deep structural content’ of twentieth-century anthropology and post-structuralist history. Human nature here is malleable and the differences are non-hierarchical. Thus far I have only gestured
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
and conformity; individualism and incorporation; static and dynamic; and, as Hobsbawm pointed out, losers and winners.
Hobsbawm recognised that extreme social conditions or political positions were not necessarily unbalanced or labile. Opposing forces – such as capitalism and communism during the Cold War – could be inherently stabilising, serving to preserve a precarious balance of power.
According to some post-war Western
, 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
Tavistock Clinic in London.
The notion of crisis carried wider resonance as a tool for articulating the anguish of ageing. Jaques's depiction of the ‘defensive fantasies’, embraced by middle-aged men in particular, to forestall the effects of growing old, figured strongly in post-war literary and cinematic treatments of love and loss around midlife.
In the novels of John Updike, Sloan Wilson, Simone de Beauvoir and Joseph Heller, or in Ingmar Bergman's film Scenes