From Cradle to Grave (HI278) Lecture 1: Introduction Dr Katherine Rawling, Office H315

Lectures: Mondays, 3-4pm in R1.04 Seminar Group 1: Mondays, 4-5pm in H2.03 Seminar Group 2: Mondays, 5-6pm in H2.03 Office hour: Mondays, 1-2pm (Also in on Thursdays but make an appointment) I expect you all to do the required reading on a weekly basis and also to lead some of the seminar discussions

Objective of module To 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

Today’s Lecture Topics 1.Demographic change and shifts in medical anxieties over past 200 years 2.Problems of an aging population 3.Themes a)Medicalization of society b)Age, time and bodies – ‘temporality’ c)State medicine and the role of institutions d)Access, entitlement, expectations and consumption e)Ideas of health 4.Media Watching - linking the past with present

1. Demographic increase

Population9 million58 million Wealth per capita£1,500£21,000 Life expectancy4079 The UK in 1800 and 2000: some comparisons

Cause of Death Smallpox221 (1.0%)13 (0.07%) Scarlet Fever876 (3.9%)158 (0.9%) Fevers908 (4.1%)182 (1.0%) Tuberculosis2,679 (12.1%)1,391 (7.6%) Cancer317 (1.4%)758 (4.2%) Circulatory Diseases1,247 (5.6%)1,657 (9.1%) All causes22,16518,194 Average mortality per year per million England and Wales

Demographic Changes and Concerns C19th – concern for everyone dying Epidemic diseases Poor public health provision Dire working and living conditions Late C19th – concern for infants and young 1900 – per 1000 live births, 154 died before 1 st birthday 1950 – 30 deaths 1985 – 9 deaths Mid-Late C20th – concern for chronic diseases in middle life E.g. Heart disease, Type II diabetes, cancer End C20th – concern that everyone’s living too long Associated conditions/diseases of old age– e.g. Dementia, Alzheimer’s

Letter 97. Childless “I have had four children, and all were born one year and a half after each other. My two eldest died in one week from whooping cough, age five and three. Two of my children were still-born. I was very young at the time...I have a good husband, but we are childless I’m sorry to say.” Wages 18s. to 27s.; two children, two still-births, one miscarriage. ‘ Letter 97. Childless’, in Margaret Llewelyn Davies (Ed.) Maternity: Letters from Working Women (Virago, 1989, first pub.1915), p.123.

2. Problems of aging population ‘Population aging 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’ (WHO)

Potential relationship between historical and current issues: Dementia February 2013 – Health Secretary Jeremy Hunt announced new cap of £75,000 – the amount individuals would be expected to pay for their care in old age.

3. Recurring Themes Region Education/Ignorance Poverty Intervention Responsibility Economics Class Gender Surveillance Control Knowledge

a) Medicalization/psychologization of society

b) Temporality A key concept for the course Key text: David Armstrong, ‘The temporal body’ in Roger Cooter and John Pickstone (eds), Medicine in the Twentieth Century (2000), pp Refers to changing markers of birth and death 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 “the C20th is remarkable for the extent to which this temporal line has been remapped, its space sub- divided, scrutinized, and reconstituted as a web of temporal movements, its outer boundaries increasingly blurred”. (Armstrong p.248).

Examples of temporal change The subdivision of infancy c.1850s-1950s Death Development of medical specialisms relating to different stages in lifecycle Illness – shifts from ‘event’ to a ‘process’ (discussed in seminar) Risk - medicine and the future (discussed in seminar)

The division of infancy In 1838 – death registration introduced 1857 the Registrar-General reported the number of deaths of children under the age of one – giving formal recognition to the infant mortality 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).

“This segmentation of the early part of life not only established a detailed temporal trajectory, but also transformed the traditional beginning of life. Birth was no longer the beginning but just another step in temporal space”. (Armstrong, The Temporal Body (2000), p.249)

Death and temporality When does death occur? – Writing of the death certificate? – On examination of body by a doctor to determine death? Types of death (1960s onwards) – Somatic? – Organ? E.g. Heart or brain – Molecular? – Flatline of the EEG? (Electroencephalogram) or ECG?(Electrocardiogram)

Medical Specialism C19th – medicine geared towards search for pathological lesions Age of the body – not important But diseases specific to age began to be recognized. A symptom in an adult may be pathological but in a growing child might be normal. A subtle but important change – from diseases in children to diseases of children By mid C20th – separate departments of each specialism for children and adults – paediatric experts in various fields of medicine

c) State medicine and responsibility

d) The NHS and access to care Beveridge Report 1942 Universal health care was necessary to eliminate the ‘Five Giants’ – want, disease, squalor, ignorance, idleness Social security should be provided from the ‘cradle to the grave’ The ‘right’ to care? Was the NHS new?

d) From spectacles and dentures to the perfect smile

d)Consumption and innovation

e) Ideas of health WHO 1948, ‘Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’

4. Media Watching Keep an eye on TV news Radio (e.g Radio 4) Documentaries Newspaper reports Current NHS campaigns Social Media

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 (2011), p.13)

Anti-vaccination

Current debates in health service

To sum up... Context Demographic changes Medicalization of society Temporality Please read Armstrong! Themes Linking past with present Keep an eye on the media this week