Concepts and interests in twentieth-century health policy

Abstract

Chronic disease has a long history as a general category in medical knowledge, defined broadly in contrast to acute disease. Its usefulness diminished in the nineteenth century as the emphasis in explanations of disease shifted from constitutional factors to specific disease entities and diminished further with the advance of medical specialisation in the early twentieth century and the requirement for more detailed death certificates. As chronic disease has lost its utility in explanations of disease, however, it has gained prominence as a health problem of great social significance. In this context, the category chronic disease encompasses medical conditions ranging from ‘a cancer that may kill you within months, diabetes that requires lifelong management and senility in old age’, a multiplicity of health and welfare services and medical and paramedical forms of knowledge. What holds such a commodious concept together? One explanation emphasises the alterations in patterns of disease and causes of death following the conquest of infectious disease around the turn of the twentieth century. Another, more critical account, emphasises the medicalisation of aspects of social life previously managed by social welfare institutions, and the identification of an expanding range of conditions through pervasive forms of screening. George Weisz excavates more deeply into the history underlying these generalisations to make a case for finding an answer to this question in the national health policy environment of the USA from the 1920s onwards, and in the influence of American medicine in the international health policy arena in the second half of the twentieth century. The book is divided into two parts. Part one is concerned with health policy in the USA since World War I to the end of the twentieth century. Part two offers a comparative perspective through an examination of health policy in England and France over the same period. A short epilogue carries the story briefly into the