Alex Mold

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.

Over the last fifty years, British patients have been transformed into consumers. This book considers how and why the figure of the patient-consumer was brought into being, paying particular attention to the role played by patient organisations. Making the patient-consumer explores the development of patient-consumerism from the 1960s to 2010 in relation to seven key areas. Patient autonomy, representation, complaint, rights, information, voice and choice were all central to the making of the patient-consumer. These concepts were used initially by patient organisations, but by the 1990s the government had taken over as the main actor shaping ideas about patient-consumerism. This volume is the first empirical, historical account of a fundamental shift in modern British health policy and practice. The book will be of use to historians, public policy analysts and all those attempting to better understand the nature of contemporary healthcare.

"This clear and informative volume, packed with rich sources and illustrations, will be a must for students and scholars embarking on a study of public health. Covering a range of geographical areas and a wide array of topics, it also succeeds in being challenging and thought-provoking, urging its readers to engage with the ways in which historical research can shape our understanding of current health issues." Professor Hilary Marland, Centre for the History of Medicine, University of Warwick, UK "The great strength of Public Health in History is that its authors show how … history is always a dialogue between the present and the past, and present policy is always informed by understandings of the past. The book is comprehensive in the range of areas covered, yet uses case-studies to explore issues in depth. It will be essential reading for anyone who works or has an interest in public health then and now." Professor Michael Worboys, Centre for the History of Science, Technology and Medicine, University of Manchester, UKThis fascinating book offers a wide ranging exploration of the history of public health and the development of health services over the past two centuries. The book surveys the rise and redefinition of public health since the sanitary revolution of the mid-nineteenth century, assessing the reforms in the post World War II years and the coming of welfare states. Importantly, the book also includes:A comparative examination of why healthcare has taken such different trajectories in different countries Case studies on malaria, sexual health, alcohol and substance abuseExercises enabling readers to easily interact with and critically assess historical source materialVisual materials and illustrations ranging from a fifteenth century syphilis sufferer to the 1980s HIV/AIDS mass media campaignsWritten by a team of historians from the London School of Hygiene and Tropical Medicine, this is the definitive guide for teaching the history of public health and health services. Public Health in History will engage health students, practitioners, policy makers and anyone who would like know more about these crucial areas of public health in countries across the global north and global south. Series Editors: Rosalind Plowman and Nicki Thorogood. Contributors: Maureen Malowany, John Manton and Suzanne Taylor.

Heroin, often viewed as the "hardest drug," looms large in the popular consciousness. Heroin addiction in Britain first began to cause concern during the 1920s, yet while one group of doctors regarded the addiction as a disease which required treatment, other physicians viewed it as a vice which demanded strict control. The medical community and the government have debated both the definition of addiction—medical condition, moral failing or social problem—and the method of dealing with addiction—medical treatment vs. legal controls. In Heroin, Alex Mold examines the interaction of the different approaches to heroin addiction and argues that the treatment of the addiction as a disease and the control of heroin as a social problem could, in practice, rarely be separated. Treatment became a way of controlling the addiction and the addicts themselves, but debates about the nature of addiction treatment and the methods used resulted in politicisation of the topic. During the late 1960s Drug Dependence Units (DDUs) were established as a means to combine both medical treatment and social control. The "British System" essentially treated addiction as a disease and offered maintenance—the administering of heroin or an opioid substitute on a long-term basis—as treatment. Maintenance proved to be a source of tension between psychiatrists specialising in addiction treatment and private and general practitioners who operated outside the DDUs. This conflict manifested itself in heated disputes on the pages of medical journals, in government committees and in disciplinary hearings before the General Medical Council. The same debates, conflicts and tensions which have beset drug addiction treatment since the beginning of the twentieth century persist today. Despite international laws and codes concerning addiction and treatment, there is much that is peculiar and significant about the British case. Drawing on government papers, private archival collections, medical journals, oral history sources and official reports, Mold presents the first detailed historical analysis on the subject. Historians, sociologists, addiction specialists and contemporary policy-makers can look to this groundbreaking study to learn from the past and shape the future response to heroin addiction.