Academic journal article Health Sociology Review

Silent Witnesses: Child Health and Well-Being in England and Australia and the Health Transition 1870-1940

Academic journal article Health Sociology Review

Silent Witnesses: Child Health and Well-Being in England and Australia and the Health Transition 1870-1940

Article excerpt


Historians of childhood - of children's health and well-being - struggle with the muteness of their subjects (Stearns 2008). Even more than the poor and powerless, children are rarely heard in their own voices in the historical record: perhaps a scrap of conversation, a request, a cry may survive, but little else. The few extended testimonies are those of exceptional children in exceptional circumstances. We have to make do with the observations of their elders, both loving and indifferent; or with childhoods recollected via the vested interests of adulthood; or with records created by those entrusted with their supervision or surveillance. More often than not, these are missives from the past that tell us more about their creators than their subjects.

The child is father of the man

Even the demographic and epidemiological history of child health and well-being is largely studied obliquely, as the sequelae of the mother and baby story of infant mortality or as a foundational chapter in the life-course of adult survival (Cooter 1992). In those countries where longitudinal data exists, children between the ages of one and 15 were the first age-group to show an improvement in mortality rates, and in Australia this has been explained as a decline in death from infectious diseases of childhood (Taylor et al 1998a; 1998b). Debate continues about the relative significance of infectious compared to chronic disease in the English mortality decline (Condrau and Worboys 2007; Mooney 2007). However, what is more significant is the distinct cohort pattern to allage mortality decline, first perceived by Kermack and his colleagues (1934) in the early 1930s. They found that is was not the year of death that revealed changes in mortality risk, but the year of birth, and that the health transition advanced in Great Britain in distinct cohorts. The first cohorts to show improved mortality were in the mid-nineteenth century and successive cohorts thereafter demonstrated a steady improvement in survival, as each was progressively less affected by infectious disease, malnutrition, over-crowding and economic exploitation. Thus, advances in the health and well-being of children could be established by inference, without much direct evidence of morbidity or of its specific causes.

Kermack noted, however, that infant mortality failed to fall in concert with this cohort effect, unless it was understood to be linked to the health of mothers, and then it could be seen to have fallen with the first generation of healthier mothers, in particular those whose had benefited from the introduction of compulsory schooling from the early 1870s (Davey Smith and Kuh 2001). It was inferred that healthier mothers were more likely to rear babies who survived the hazards of infancy. While this interpretation has withstood the test of time, recent research points also to technological improvements in artificial feeding and the administration of legislation to protect infants placed with paid carers as making key differences to babies' survival (McCalman et al 2008; Garrett et al 2006). And the fall in infant mortality was also contemporaneous with the fertility decline - the fall in one affecting the other, where birth rates fell as fewer infants died, and smaller families managed better within their limited physical and emotional resources. The long-run changes in infant and child mortality in England have been reconstructed by Garrett et al (Figure 1).

This history is best understood in the United Kingdom, where it has occupied a central place in scholarly and ideological debates over the ills and benefits of industrialisation, the extension of state powers in the growth of public health and state welfare, and the effectiveness of medical intervention (Davey Smith and Lynch 2004; Szreter and Woolcock 2004). George Davey Smith, Diana Kuh and John Lynch have revisited Kermack's work as perhaps the historical foundation of life course health studies, and as an attenuated influence on the early origins of adult chronic disease research programmes inspired by David Barker (Davey Smith and Kuh 2001; Davey Smith and Lynch 2004). …

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