Virginia Berridge

Public health is a term much used in the media, by health professionals, and by activists. At the national or the local level there are ministries or departments of public health, whilst international agencies such as the World Health Organisation promote public health policies, and regional organisations such as the European Union have public health funding and policies. But what do we mean when we speak about 'public health'? In this Very Short Introduction Virginia Berridge explores the areas which fall under the remit of public health, and explains how the individual histories of different countries have come to cause great differences in the perception of the role and responsibilities of public health organisations. Thus, in the United States litigation on public health issues is common, but state involvement is less, while some Scandinavian countries have a tradition of state involvement or even state ownership of industries such as alcohol in connection with public health. In its narrowest sense, public health can refer to the health of a population, the longevity of individual members, and their freedom from disease, but it can also be anticipatory, geared to the prevention of illness, rather than simply the provision of care and treatment. In the way public health deals with healthy as well as sick people it is therefore a separate concept from health services, which deal with the sick population. Drawing on a wide range of international examples, Berridge demonstrates the central role of history to understanding the amorphous nature of public health today. ABOUT THE SERIES: The Very Short Introductions series from Oxford University Press contains hundreds of titles in almost every subject area. These pocket-sized books are the perfect way to get ahead in a new subject quickly. Our expert authors combine facts, analysis, perspective, new ideas, and enthusiasm to make interesting and challenging topics highly readable.

Tabloid headlines attack the binge drinking of young women. Debates about the classification of cannabis continue, while major public health campaigns seek to reduce and ultimately eliminate smoking through health warnings and legislation. But the history of public health is not a simple one of changing attitudes resulting from increased medical knowledge, though that has played a key role, for instance since the identification of the link between smoking and lung cancer. As Virginia Berridge shows in this fascinating exploration, attitudes to public health, and efforts to change it, have historically been driven by social, cultural, political, and economic and industrial factors, as well as advances in science. They have resulted in different responses to drugs, alcohol, and tobacco at different times, in different parts of the world. Opium dens in London, temperance and prohibition movements, the appearance of new recreational drugs in the 20th century, the changing attitudes to smoking: by taking us through such examples, moulded by socio-economic and political forces, including the growing power of pharmaceutical companies, Berridge illuminates current debates. While our medical knowledge has advanced, other factors help shape our responses, as they have done in the past.

"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.

The post war history of public health and the role of smoking within that history epitomises the tensions which surround taking health to the public. Public health history has largely concentrated on the nineteenth century sanitary period or on the years before the Second World War, often focussing on the environmental advances, or on the professional and occupational history of public health as an activity. This book has a different focus: it deals with the change in the outlook of public health post war. From a focus on services, vaccination, and dealing with health issues at the local level, public health had developed new discourse. Centring on chronic disease, it became concerned with the concept of 'risk' and targeted individual behaviour. The mass media and centralised campaigning directed at the whole population replaced local campaigns, and politicians changed their mind about speaking directly to the public on health matters. Their early worries about the 'nanny state' gave place to a desire to inculcate new norms of behaviour, and it was debated how change was to be achieved. Identifying debates between those believing in 'systematic gradualism' and those who advocated a more coercive approach, Virginia Berridge uses smoking as a model. Such debates brought into play tensions over the relationships between public health and industrial interests. Health campaigning by new style pressure groups like ASH, which were part state funded, was an important motive force behind the change. In the 1980s and 1990s, public health changed again. Passive smoking and HIV/AIDS brought environmental concerns back into public health, which had disappeared after the 1950s. The 'rise of addiction' for smoking demonstrated the power of pharmaceutical interests to define a new 'pharmaceutical public health' in which treatment and 'magic bullets' were also tactics for prevention. In the early 21st century, public health was play to complex tensions and conflicting impetuses. This book shows that those tensions were nothing new and outlines their development over the last half century.

British health policy has undergone enormous change in the post-war era. The NHS established in the post-war period has been constantly reorganised, and the role of doctors and associated medical professions has radically changed. This book considers the changes in health policy and in the service provided by the NHS, and examines in detail the ‘mixed economy’ of health care and the role of different providers of health care, as well as their relationships both with recipients of care and the state. In doing so, Professor Berridge sheds light on the increasingly important part that lay people, especially women, have played in the provision of health care and looks at community care and the shifting balance of power within the medical profession. The book provides a guide to changes in health and health policy during and since World War II, giving an authoritative analysis of the most recent research.

British health policy has undergone enormous change in the post-war era. The NHS established in the post-war period has been constantly reorganised, and the role of doctors and associated medical professions has radically changed. This book considers the changes in health policy and in the service provided by the NHS, and examines in detail the ‘mixed economy’ of health care and the role of different providers of health care, as well as their relationships both with recipients of care and the state. In doing so, Professor Berridge sheds light on the increasingly important part that lay people, especially women, have played in the provision of health care and looks at community care and the shifting balance of power within the medical profession. The book provides a guide to changes in health and health policy during and since World War II, giving an authoritative analysis of the most recent research.

Fifteen years ago the AIDS `epidemic' did not exist on the public agenda. In just over a decade the public and official response to the disease has resulted in the development of a whole network of organizations devoted to the study, containment, and practical treatment of AIDS. In this important and original analysis of AIDS policy, Virginia Berridge examines the speed and nature of the official (and unofficial) response to this new and critical historical event. The policy reaction in Britain passed through three stages. From 1981-1986 the outbreak of a new contagious disease led to public alarm and social stigmatization, with a lack of scientific certainty about the nature of the disorder. AIDS was a new and open policy area - there were no established departmental, local, or health authority mechanisms for dealing with the problem. This was a period of policy development from below, with relatively little official action and many voluntary initiatives behind the scenes. This phase was succeeded in 1986-1987 by a brief stage of quasi-wartime emergency, in which national politicians and senior civil servants intervened, and a high-level political response emerged. The response was a liberal one of `safe sex' and harm minimization rather than draconian notification or isolation of carriers. The author demonstrates that despite the `Thatcher revolution'in government in the 1980s, crisis could still stimulate a consensual response. The current period of `normalization' of the disease sees panic levels subsiding as the rate of growth slows and the fear of the unknown recedes. Official institutions have been established and formal procedures adopted and reviewed; paid professionals have replaced the earlier volunteers. The 1990s have seen change in the liberal consensus towards a harsher response and the partial repoliticization of AIDS. In this fascinating and scholarly account, Virginia Berridge analyses a remarkable period in contemporary British history, and exposes the reaction of the British political and medical elites, and of the British public to one of the most challenging issues of this century.

Fifteen years ago the AIDS `epidemic' did not exist on the public agenda. In just over a decade the public and official response to the disease has resulted in the development of a whole network of organizations devoted to the study, containment, and practical treatment of AIDS. In this important and original analysis of AIDS policy, Virginia Berridge examines the speed and nature of the official (and unofficial) response to this new and critical historical event. The policy reaction in Britain passed through three stages. From 1981-1986 the outbreak of a new contagious disease led to public alarm and social stigmatization, with a lack of scientific certainty about the nature of the disorder. AIDS was a new and open policy area - there were no established departmental, local, or health authority mechanisms for dealing with the problem. This was a period of policy development from below, with relatively little official action and many voluntary initiatives behind the scenes. This phase was succeeded in 1986-1987 by a brief stage of quasi-wartime emergency, in which national politicians and senior civil servants intervened, and a high-level political response emerged. That response was a liberal one of `safe sex' and harm minimization rather than draconian notification or isolation of carriers. The author demonstrates that despite the `Thatcher revolution' in government in the 1980s, crisis could still stimulate a consensual response. The current period of `normalization' of the disease sees panic levels subsiding as the rate of growth slows and the fear of the unknown recedes. Official institutions have been established and formal procedures adopted and reviewed; paid professionals have replaced the earlier volunteers. The 1990s have seen change in the liberal consensus towards a harsher response and the partial repoliticization of AIDS. In this fascinating and scholarly account, Virginia Berridge analyses a remarkable period in contemporary British history, and exposes the reaction of the British British political and medical elites, and of the British public, to one of the most challenging issues of this century.