Placing the Public in Public Health in Post-War Britain, 19482012 (Medicine and Biomedical Sciences in Modern History)

This open access book explores the question of who or what ‘the public’ is within ‘public health’ in post-war Britain. Drawing on historical research on the place of the public in public health in Britain from the establishment of the National Health Service in 1948, the book presents a new perspective on the relationship between state and citizen. Focusing on health education, health surveys, heart disease and the development of vaccination policy and practice, the book establishes that ‘the public’ was not one thing but many. It considers how public health policy makers and practitioners imagined the public or publics. These publics were not mere constructions; they had agency and the ability to ‘speak back’ to public health. The nature of publicness changed during the latter half of the twentieth century, and this book argues that the relationship between the public and public health offers a powerful lens through which to examine such shifts. Acknowledgements 6 Contents 8 1 Introduction 10 1 Outline of the Book 13 Bibliography 15 2 The Public and Public Health 16 1 The Public 17 1.1 Public = Population, Citizens 18 1.2 Public = Space for Action 20 1.3 Public = Values 22 2 Public Health 23 2.1 Challenges 25 2.2 Systems 27 2.3 Outlook 29 3 The Changing Relationship Between Public Health and the Public 30 3.1 The Nineteenth Century 31 3.2 1900–1945 32 3.3 Post 1945 33 4 Conclusion 35 Bibliography 35 3 Imagining Publics 42 1 Public = Population 44 1.1 Epidemiological Surveys 44 1.2 Mass Vaccination and Herd Immunity 46 1.3 Universalising Individual Behaviour: Exercise 47 2 The Public = Groups 49 2.1 Class 50 2.2 Gender 54 2.3 Ethnicity 57 3 Public = Individual Behaviours 60 3.1 Risk 61 3.2 Targeting: Health Education 64 4 Conclusion 67 Archival Material 68 4 Speaking Back 75 1 Resistance 76 1.1 Active Resistance 77 1.2 Passive Resistance 82 2 Complaints 85 2.1 Complaints and the Survey 86 2.2 Complaints to Medical Officers of Health 89 3 Reinterpretation and Appropriation 90 3.1 Letters to Whitehall 91 3.2 Health Education 93 3.3 Lay Epidemiology 96 4 Conclusion 99 Archival Material 100 5 Changing Publicness 106 1 Private 107 1.1 Personal Responsibility and Individual Choice 108 1.2 Individual Risk 110 1.3 Private Companies and Public Health 112 2 Public 113 2.1 Representation 114 2.2 Population 117 3 Beyond Public and Private 122 3.1 Social Structure 122 3.2 The Environment 125 3.3 New Spaces 126 4 Conclusion 128 Archival Material 129 6 Conclusion 137 1 The Place of the Public 138 2 The Nature of Public Health 139 3 The Relationship Between the Public and Public Health 140 Bibliography 142 : Index 144