July 17, 2007

Changing attitudes to Public Health

Virginia Berridge, the Director of the Centre for History in Public Health at the London School of Hygiene and Tropical Medicine in the University of London, has written a very interesting article about the history of medical and governmental attitudes to smoking in the UK. She has produced some very interesting useful facts about medicine and the state in the UK- but they are worth rethinking because in my view she hasn't placed them in the most appropriate analytical framework. The problem is that the history of public health is in reality the history of two things- coercion and information- those things are related and their histories are interesting.

In the 1950s and before coercion was widely used- people were coerced into vaccination to remove the great diseases of the era- but government's worried about extending that coercion into other parts of people's lives- particularly into smoking. In the 1940s pensioners were even given smoking coupons along with their pensions in order to purchase ciggarettes or cigars. All this of course has changed- government still coerces people rightly to take vaccines- but it also coerces people to stop smoking in public places.

One of the key distinctions that is implicit in Berridge's analysis but not drawn out by her- is that government since the 1960s and public health bodies like the Royal College of Physicians have become deeply involved within discussions about lifestyle. Doctors are now much more frequently heard on television and radio telling people how to live. In the 1950s the Head of the Royal College of Physicians informed a doctor who wanted to publicise anti-smoking information that so long as doctors in general knew then the College had met its objectives- by the late 1950s and into the 1960s and right up until today Doctors have changed their attitude- no longer a mystical caste disseminating magical vaccines, they now give advice on what to eat, what to smoke or to drink.

And of course they have been opposed- nobody has much interest in opposing vaccination- but many people have an interest in opposing doctors telling you it is unhealthy to take a cigar and smoke it. So doctors have become involved in a public debate- ceaselessly tackling corporate executives and representatives- in the way mocked by the film Thank you for Smoking- Doctors have become participants in a public debate about public health to a much greater extent than they were in the past and their craft has been demystified. Ultimately those two things must be good- fewer people now in the UK will die through smoking because fewer smoke.

The change in attitude has extended the role of government- now with a knowledge for example about the health consequences of passive smoking, a ban on smoking in public places has been adopted in the UK and other things will no doubt follow. In a way laws to make sure that the public health utility of private acts have always been carried out- but with more information lifestyles as well as vaccines have become subject to the force of law. Medicine has become a science instead of magic and the consequence is greater understanding and hence a greater role for the law within people's lifestyles- and drug prohibitions and smoking bans are a consequence of that move.


edmund said...

actually there was and has been massive oppostion to compulsory vacination (the much more jusifed equivlant of passive smoking bans in pubs) - resuling after 50 years or so of battles in its elimination-a rare case of the state being rolled back rather than forwards since around a century or so.

i think a new morality of empowermnt and therapy repalicn a preiovus one of responsability has a lot to do with these changes.

smoking is still elgal in many public places eg the street and banned in many private ones eg private offices and bars- it's an inadquate way of describing the ban