From Cradle to Grave: Introduction

1. From Cradle to Grave: Introduction • Hilary Marland, Office H315 • Office Hours Mon 2-3 and Weds 11-12 • Email hilary.marland@warwick.ac.uk

2. Objective of module • ‘Explore medicine in modern Britain through the lens of the life cycle, examining how health care and medical interventions impinge on individuals and families from birth, through adolescence, maturity and aging, and death’ • Lectures 3-4pm S0.19 • Seminars 4-5pm H102 • I expect you all to do the required reading on a weekly basis and also to lead some of the seminar discussions

3. Lecture topics • General introduction • Demographic change and shifts in medical anxieties over 200 years e.g. problem of aging • Literature/themes and medicalisationof society • Linking past with present • Age, time and bodies - temporality • State medicine/role of institutions • Access, entitlement, expectations and consumption • Media watching – seminar

4. Current debates in health service!

5. Demographic increase

6. The UK in 1800 and 2000: some comparisons

7. Average mortality per year per million England and Wales • Cause of death 1851-60 1891-1900 • Smallpox 221 (1.0%) 13 (0.07%) • Scarlet fever 876 (3.9%) 158 (0.9%) • Fevers 908 (4.1%) 182 (1.0%) • Tuberculosis 2,679 (12.1%) 1,391 (7.6%) • Cancer 317 (1.4%) 758 (4.2%) • Circulatory diseases1,247(5.6%)1,657(9.1%) • All causes 22,165 18,194

8. Demographic changes and concerns • Roughly speaking the modern period (1800-2000) has been marked by: • 19thC concern about everybody dying, but notably those dying too young or of working age/childbearing age – most deaths resulted from a wide range of usually epidemic disease, made worse by poor public health provision, dire working and living conditions • by late 19thC deaths from most major diseases were in decline – attention shifted to concerns about infants and young children, given the extremely high rates of infant mortality – for every 1,000 live births, 154 babies died in 1900 before their first birthday, 30 in 1950 and 9 in 1985 • moving into mid to late 20thC preoccupation with chronic diseases often of middle life, notably heart disease and cancer, which began to impact significantly on death rates • towards end of 20thC great concern not about people dying too young but living too long. Living longer does not necessarily equate with living healthier. Anxieties about the aging population and how to support them into an ever longer old age.

10. Problems of aging population • In words of WHO • ‘population ageing can be seen as a success story for public health policies and for socioeconomic development, but it also challenges society to adapt, in order to maximize the health and functional capacity of older people as well as their social participation and security’

11. Dementia and society • Relationship between historical work and current issues This week, Health Secretary Jeremy Hunt announced a new cap - £75,000 - on the amount that individuals will be expected to pay towards their own social care.. This, he claims, is designed to readjust the balance of responsibility between the individual and the state, and prevent the 'scandal' of older people having to sell their homes to pay for their care. In an interview given to Andrew Marr this weekend, he particularly mentioned the plight of those suffering from dementia, a condition which has become a prominent cultural repository of our darkest fears about the challenges, losses and burdens of old age. Hunt alluded to the figures at the heart of the Prime Minister’s ‘Challenge on Dementia’, launched last year, which suggested that the number of people living with this condition will double in the next 40 years, to reach 1.7 million by 2050. http://www2.warwick.ac.uk/knowledge/culture/oldage/ 12 Feb. 2013

12. Medicalisation/psychologisation of society

13. Linking past and present? • ‘Although the historical method is concerned primarily with the past, that is with opening up new ways of understanding how health and disease have been experienced and managed in past times, the scope and meanings of medical history are also overtly shaped by, and contribute to, present debates.’ (Mark Jackson, Oxford Handbook, p.13)

14. Anti-vaccination

15. Temporality • Changing markers of birth and death • See David Armstrong, ‘The temporal body’ in Roger Cooter and John Pickstone (eds), Medicine in the Twentieth Century (2000). 247-59. • Relationship between time, age and bodies has changed significantly in the modern period. • Birth and death are the traditional outer markers of the temporal space of the life span. But this temporal space has been remapped, and sub-divided in the 19th and 20th centuries.

16. The division of infancy • 1857 that the Registrar-General reported the number of deaths of children under the age of one (deaths first registered in 1838) – giving formal recognition to the infant morality statistic and highlight high number of infant deaths. • In 1926 stillbirths (after 28 weeks of pregnancy) began to be recorded in (Births and Deaths Registration Act), giving a new starting point to infancy after 28 weeks. • In 1938 neonatal mortality was recorded separately, the first four weeks of an infant’s life. • In the 1950s perinatal mortality – deaths in the first week of life – came into general use (now deaths after 24 weeks of gestation according to WHO).

17. State medicine and responsibility

18. NHS and access to care • The creation of the NHS in the reconstruction years following World War II was based on William Beveridge’s 1942 report, which argued that universal access to health care was necessary in order to fight the ‘five giants’ (want, disease, squalor, ignorance and idleness). • Beveridgebelieved that the government should provide its citizens with social security ‘from the cradle to the grave’.

19. From spectacles and dentures to the perfect smile

20. Consumption and innovation

21. Ideas of health • WHO 1948, Health ‘Not merely the absence of disease and infirmity but complete physical, mental and social wellbeing’