Western Medicine: An Illustrated History

JANE LEWIS

DURING the twentieth century, the domestic issues that we might loosely categorize as 'welfare' issues--matters concerning employment and unemployment, health, housing, and education--have become the stuff of 'high politics'. This has happened gradually. In the UK, the government spent more time discussing the problems of ruling India in the 1930s than it did mass unemployment. But post-war elections have been won and lost on social policies. Health care has become both big business and a major political issue. The National Health Service (NHS), set up in the UK in 1948, is one of Europe's largest employers, and while it was no secret that, while Prime Minister during the 1980s, Margaret Thatcher wished radically to change its form, the political threat any such action would have posed to the Conservative Party allowed the NHS to survive as a universal, tax-based service, free to all at the point of delivery. In the USA of the 1990s, it was widely accepted that health-care reform could make or break the Democratic Presidency. The spectacular growth in size and complexity of Western health-care systems has been underpinned by the fundamental assumption that personal health care delivered by a doctor to a patient, especially in the hospital, is a worthy endeavour that should be widely available. In Europe, one of the hallmarks of the post-war welfare regimes was the way in which the relationship between economic growth and social provision was seen as positive. Early growth theorists stressed that the accumulation of physical capital was basic to growth, and human capital theorists extended discussion to individual human capital. The period of the 'classic welfare state' (from 1945 to 1976) was characterized by a commitment to full employment, social security that redistributes (although the extent to which this actually happened is debatable) and enhances social consumption, and social services (education, health, housing) that may be regarded as social investments. These kinds of beliefs ensured an overwhelmingly large role for the State in the provision of health care in all European countries. In many, the State had in any case been an active provider of health care throughout the early part of the century via health insurance schemes and Poor Law systems. Even where the State did not become a significant actor early on, as in the USA,

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