The year 1848 witnessed the arrival of the first dedicated official home for health policy
in Whitehall, the General Board of Health. It marked the advent of a new era of central
supervision and accountability in the making and implementation of British health policy.
Between 1871 and 1919 the key central office was the Local Government Board.
Throughout this period, health policy was always a plural formation, composed of a number
of overlapping strands: sanitary reform and environmental health; industrial health and the
health of children; state medicine and the control of infectious diseases; and welfare and
health insurance.
This made for problems of institutional coordination and administrative clarity, however.
The consolidated leadership of health policy proved elusive. No particular central authority
enjoyed a bird’s eye view of health policy across Britain as a whole.
The implementation of health policies was highly variable across time and space. This
can be explained by a number of factors: the highly localized culture of administration;
a pervasive commitment to economy; and active resistance from multiple groups,
among them MPs, owners of capital, councillors, and members of the public.
These administrative problems should not obscure the considerable gains secured to the
health outcomes for the British population. This, too, can be explained by a number of
factors: the growing professionalization of health policy and its day-to-day implementation;
the gradual accretion and refinement of permanent infrastructural and bureaucratic
systems that set new standards of healthcare; and the scope for innovation and
experimentation afforded by the relatively localized culture of administration
