Chapter 9 ‘Suspect’ screening

Like their peers across western Europe, Australia and the Americas, large segments of the British public and a significant proportion of Britain’s medical establishment have enthusiastically promoted medical screening (and de facto medical selection) of would-be migrants since World War II. Moreover, from 1962, British law explicitly empowered medical inspection and the exclusion of migrants on health grounds at all three of Britain’s idiosyncratic ‘medical borders’: during entry clearance procedures in their countries of origin; at Britain’s ports and airports; and via public health surveillance in the British towns and cities that were the migrants’ destinations. However, Britain’s geographical and internal borders were largely unmedicalised in the twentieth century and remain comparatively free from specifically medical controls even today. I explore the role of the National Health Service – both as a national symbol and as a physical institution – in shaping and responding to this paradox. Given the intensity of popular suspicions of migrants’ bodies and their hygienic and reproductive practices, and the frequency with which medical claims mediated and bolstered anti-migrant rhetoric, why has medical ‘control’ itself proven politically elusive and persistently suspect

Picturing race in the British National Health Service, 1948-1988

In 1970, Harold Evans, the respected editor of Britain’s best-selling Sunday broadsheet the Sunday Times from 1967 to 1981, roundly reproached his fellow journalists for their reporting of ‘race’. Writing for the resolutely middle-brow The Listener magazine (published from 1929 to 1991 by the British Broadcasting Corporation [BBC] since 1929 to accompany and amplify the national broadcaster’s educational and cultural mission), Evans asserted that ‘the way race is reported can uniquely affect the reality of the subject itself’. In the matter of race, he observed, the newspapers did far more than fulfil their ‘traditional’ role as a ‘mirror of society’. Instead, ‘stealthily in Britain, the malformed seeds of prejudice have been watered by a rain of false statistics and stories’.1 Evans, famously a supporter of US-style campaigning investigative journalism, applied similar techniques to excoriate his fellow journalists. Focusing closely on the language in which stories about non-white migrants and racialized ethnic minorities were reported, he condemned rhetoric portraying migrants as ‘pouring in’ and Britain as being ‘overrun’

Weighting for health : management, measurement and self-surveillance in the modern household

Histories of late nineteenth- and early twentieth-century medicine emphasise the rise of professional and scientific authority, and suggest a decline in domestic health initiatives. Exploring the example of weight management in Britain, we argue that domestic agency persisted and that new regimes of measurement and weighing were adapted to personal and familial preferences as they entered the household. Drawing on print sources and objects ranging from prescriptive literature to postcards and ‘personal weighing machines’, the article examines changing practices of self-management as cultural norms initially dictated by ideals of body shape and function gradually incorporated quantified targets. In the twentieth century, the domestic management of health—like the medical management of illness—was increasingly technologised and re-focused on quantitative indicators of ‘normal’ or ‘pathological’ embodiment. We ask: in relation to weight, how did quantification permeate the household, and what did this domestication of bodily surveillance mean to lay users

Histories of medicine in the household : recovering practice and ‘reception’

Introducing the essays in this special issue on medicine in the household, Bivins, Marland and Tomes briefly sketch the existing historiography and argue for the enduring importance of the household as a site of medical decision making and practice. The household as explored by this collection also offers a valuable space within which to test new methodologies addressing the challenges that face historians and other scholars seeking to trace the reception, adoption and adaptation of new knowledge, practices and products

Compassionate care : not easy, not free, not only nurses

Compassion has historically been defined as an underpinning principle of work conducted by health professionals, especially nurses.1 Numerous definitions of compassionate care exist, incorporating a range of elements. Most include a cognitive element: understanding what is important to the other by exploring their perspective; a volitional element: choosing to act to try and alleviate the other’s disquiet; an affective element: actively imagining what the other is going through; an altruistic element: reacting to the other’s needs selflessly; and a moral element: to not show compassion may compound any pain or distress already being experienced by the other

‘Suspect’ screening : the limits of Britain’s medicalised borders, 1962–1981

Like their peers across western Europe, Australia and the Americas, large segments of the British public and a significant proportion of Britain’s medical establishment have enthusiastically promoted medical screening (and de facto medical selection) of would-be migrants since World War II. Moreover, from 1962, British law explicitly empowered medical inspection and the exclusion of migrants on health grounds at all three of Britain’s idiosyncratic ‘medical borders’: during entry clearance procedures in their countries of origin; at Britain’s ports and airports; and via public health surveillance in the British towns and cities that were the migrants’ destinations. However, Britain’s geographical and internal borders were largely unmedicalised in the twentieth century and remain comparatively free from specifically medical controls even today. I explore the role of the National Health Service – both as a national symbol and as a physical institution – in shaping and responding to this paradox. Given the intensity of popular suspicions of migrants’ bodies and their hygienic and reproductive practices, and the frequency with which medical claims mediated and bolstered anti-migrant rhetoric, why has medical ‘control’ itself proven politically elusive and persistently suspect

Commentary : serving the nation, serving the people : echoes of war in the early NHS

It is something of a cliché to speak of Britain as having been transformed by the traumas of World War II and by its aftermath. From the advent of the ‘cradle to grave’ Welfare State to the end of (formal) empire, the effects of total war were enduring. Typically, they have been explored in relation to demographic, socioeconomic, technological and geopolitical trends and events. Yet as the articles in this volume observe across a variety of examples, World War II affected individuals, groups and communities in ways both intimate and immediate. For them, its effects were directly embodied. That is, they were experienced physically and emotionally—in physical and mental wounds, in ruptured domesticities and new opportunities and in the wholesale disruption and re-formation of communities displaced by bombing and reconstruction. So it is, perhaps, unsurprising that Britain’s post-war National Health Service, as the state institution charged with managing the bodies and behaviour of the British people, was itself permeated by a ‘wartime spirit’ long after the cessation of international hostilities

Using neighborhood-level census data to predict diabetes progression in patients with laboratory-defined prediabetes

Context Research on predictors of clinical outcomes usually focuses on the impact of individual patient factors, despite known relationships between neighborhood environment and health. Objective To determine whether US census information on where a patient resides is associated with diabetes development among patients with prediabetes. Design Retrospective cohort study of all 157,752 patients aged 18 years or older from Kaiser Permanente Northern California with laboratory-defined prediabetes (fasting plasma glucose, 100 mg/dL-125 mg/dL, and/or glycated hemoglobin, 5.7%-6.4%). We assessed whether census data on education, income, and percentage of households receiving benefits through the US Department of Agriculture’s Supplemental Nutrition Assistance Program (SNAP) was associated with diabetes development using logistic regression controlling for age, sex, race/ethnicity, blood glucose levels, and body mass index. Main Outcome Measure: Progression to diabetes within 36 months. Results Patients were more likely to progress to diabetes if they lived in an area where less than 16% of adults had obtained a bachelor’s degree or higher (odds ratio [OR] =1.22, 95% confidence interval [CI] = 1.09-1.36), where median annual income was below $79,999 (OR = 1.16 95% CI = 1.03-1.31), or where SNAP benefits were received by 10% or more of households (OR = 1.24, 95% CI = 1.1-1.4). Conclusion Area-level socioeconomic and food assistance data predict the development of diabetes, even after adjusting for traditional individual demographic and clinical factors. Clinical interventions should take these factors into account, and health care systems should consider addressing social needs and community resources as a path to improving health outcomes

Ideology and disease identity : the politics of rickets, 1929-1982

How can we assess the reciprocal impacts of politics and medicine in the contemporary period? Using the example of rickets in twentieth century Britain, I will explore the ways in which a preventable, curable non-infectious disease came to have enormous political significance, first as a symbol of socioeconomic inequality, then as evidence of racial and ethnic health disparities. Between the 1920s and 1980s, clinicians, researchers, health workers, members of Parliament and later Britain's growing South Asian ethnic communities repeatedly confronted the British state with evidence of persistent nutritional deficiency among the British poor and British Asians. Drawing on bitter memories of the ‘Hungry Thirties’, postwar rickets—so often described as a ‘Victorian’ disease—became a high-profile sign of what was variously constructed as a failure of the Welfare State; or of the political parties charged with its protection; or of ethnically Asian migrants and their descendants to adapt to British life and norms. Here I will argue that rickets prompted such consternation not because of its severity, the cost of its treatment, or even its prevalence; but because of the ease with which it was politicised. I will explore the ways in which this condition was envisioned, defined and addressed as Britain moved from the postwar consensus to Thatcherism, and as Britain's diverse South Asian communities developed from migrant enclaves to settled multigenerational ethnic communities