Healthcare: Public and Private

We all love getting post – but bills and letters from the Student Loans Company don’t quite compare to receiving a copy of a book, part of which you wrote …or, I should say, co-wrote.

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As the 2015 general election approaches, the National Health Service is right at the top of the political agenda. Alongside talk of Labour attempting to “weaponise” the NHS, Lord Ashcroft says the debate on the NHS “has already become an exchange of insults, doubtful assertions and unreliable statistics of the kind that voters find so edifying. But despite the noise, both parties are avoiding real discussion of the subject.”

Well, if historical perspective is to be part of that discussion, perhaps Lord Ashcroft like to might purchase a copy of the newly-published Healthcare in Private and Public from the Early Modern Period to 2000. This really brings together the varied work on common themes from many of the historians who are or recently were at Oxford Brookes University’s Centre for Health, Medicine and Society: Past and Present (recently renamed the Centre for Medical Humanities, and there’s a whole other blog post in what, if anything, that name change means). This is where I did my PhD, and I think the influence of this wider intellectual community can really be seen in my own work. The rest of the contributors were the staff around me when I was studying, so I was chuffed to be asked to co-author the chapter on the NHS and its place in this bigger story of the public-private mix of healthcare provision.

If Lord Ashcroft did get a copy, he’d find an analysis that provides deep context for the British voter preference he finds for using more private companies whilst also maintaining a service free at the point of use. “We take a thematic approach”, writes editor Paul Weindling, “rather than one restricted to any short period or one location”. He continues:

Professor Paul Weindling“Our common concern is the crucial polarity of public and private. Our studies explore the time- and region-specific character of the mixed economy of healthcare, and the nature of patient and professional experiences of such systems. Of particular interest is how these issues reflected a complex interplay between public (the state, national and local), private (from the professional entrepreneur to family and self-help), and philanthropic bodies, which range from corporate to mass public donor medical charities. Our diverse investigations have focused on the financing of health services, the character and meaning of institutional provision, differential patient access to treatment, professional careers, and the geographical reach of the medical market. It has become ever clearer that there was an indistinct, porous and fluctuating frontier between the different sectors.”

Did poor patients have more influence in the past than now, ask Elizabeth Hurren and Steve King? What of growing state intervention in the health and welfare of children, which Alysa Levene calls “the most private aspect of the private sphere”? How, asks Katherine Watson, did forensic science in the form of the medical expert enhanced the authority of the state? Has the reform of public and private space, which Tom Crook notes often promises greater health and hygiene, changed the way we live our everyday lives?  Despite politicians’ protestations that their various reforms remain true to the ‘founding principles’ of the NHS, how can we make sense of both the enduring popularity of and the continual changes to the British National Health Service, a unique health system alongside a world full of alternatives, Glen O’Hara and I ask? How did the balance of public and private play out in Eastern Europe, where Marius Turda identifies public health as a key dimension of nation-building in the wake of fallen empires? How did the balance and choice between not only different healthcare providers, but also different systems of medicine, look from the perspective of the South African patient, asks Anne Digby? How have the state and the market interacted, asks Viviane Quirke, in pharmaceutical innovation, manufacturing, marketing and consumption? What role did the Holocaust play, asks Paul Weindling, in the widespread growth of sickness insurance and the emergence of socialised medicine internationally across the twentieth century? Did the adoption of public health agendas by transnational organisations amount to an abandoned of the liberal state for new forms of sanitary surveillance?

To find out our answers you’ll have to buy the book.

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