Preliminary Programme

Public health history in and of the UK has undergone a renaissance in recent years. But much of this work has concentrated on the nineteenth century, on the sanitary period , the bacteriological revolution, or the turn of the century interest in motherhood and the ‘future of the race’. Likewise, the interest in inter war health and the international exchange of ideas and concepts has also brought renewed interest in public health and especially its operation at the local level as part of the patchwork of pre NHS health services. An incipient debate about the efficacy of local public health services in those years is related to current interest in the UK in the boundaries between health and social care and their operation.

This paper will move into the post 1945 period and will argue that post war public health deserves more sustained historical attention than it has so far received. It aims to open up discussion. The nature of public health itself is confused, with discussion veering between public health as a professional activity, as a series of institutional arrangements, or as a set of ideas and concepts. This paper will focus on the latter, which tend to be discussed only through the prism of particular topics like smoking, diet or alcohol. It will examine the reorientation of public health in the post war years. These saw the rise of two distinct tendencies : lifestyle public health with its epidemiologically focused whole population approach , and evidence based medicine, founded on the technology of the RCT. Public health in these years became a separate activity, rather distant from the formal public health profession, which moved out of contact with local communities and into the health service. Yet surprisingly, it is this professional activity of public health which continues to attract most historical attention.

The paper will end by surveying the contemporary history of public health ideology since the 1980s. It identifies complex tendencies in early 21st century public health : these include globalisation, the revival of communicable disease , but also mass medication and a concern with the regulation of public rather than family space and with ‘high risk’ populations rather than the population as a whole. The incipient focus on human rights of the AIDS era has been replaced by health protection and community safety as key concepts. (Show less)

Health education for forest labourers and career women: Anti-smoking campaigns and the modernization of Finland c.1950-1975


Finland was the world leader in the per capita tobacco consumption in the 1920s and, though losing its `world leadership', still ranked high among European countries in the 1940s and 1950s. As research on the health effects of smoking accumulated in the course of the 1950s and early 1960s, the Finnish medical community, together with some social scientists, began campaigns to reduce the degree of smoking by educating people on the health risks linked with tobacco use. The government bodies, which first remained rather passive spectators in the movement, assumed a more active role in the late 1960s and early 1970s. Smoking and smoking-related illnesses assumed the dimensions of public, political problem, and the Tobacco Act, which included several strict control measures, was passed in 1976.


This paper analyses the Finnish anti-smoking campaigns before the enactment of the 1976 Tobacco Act, examining not only the ways in which the campaigns promoted smoke-free lifestyles but also the wider political and social aims these campaigns were deployed to advance. The launching of the anti-smoking campaigns in the 1950s and 1960s coincided with the process of rapid urbanization and modernization of the country. Thousands and thousands of Finns left their traditional farmhouses and agricultural jobs for the modern suburbs and booming industrial economies of the cities. The aim of this paper is to analyse how the anti-smoking campaigns reflected the political and social concerns caused by the rapid modernization and how these campaigns were used - both wittingly and unwittingly - not only to promote public health but also to control and regulate the changes in society.


The political and social objectives behind the anti-smoking campaigns are revealed, for example, by looking at the groups on which the campaigns focused. The campaigns targeted, firstly, the groups who struggled to keep up with the modernization process. Many studies showed that the prevalence of smoking was highest among working-class men in both urban and rural areas, but the campaign targeted especially those men who lived in remote rural areas in Eastern and Northern Finland and worked as forest or farm labourers. Secondly, the anti-smoking campaigns targeted the groups who had `too eagerly' seized the opportunities opened up by modernization and especially educated working women living in the biggest cities. This case reveals very clearly health authorities' tendency to accept unquestioningly those aspects of research findings that supported their own preconceptions of the problem and selectively ignore the research findings that challenged their understanding. For example, several studies showed that children and adolescents whose father or mother smoked were more likely to start smoking than children and adolescents whose parents were non-smokers. Health authorities used this research finding to blame mothers (and especially educated mothers) but not fathers for giving a bad example to their children. (Show less)

The structure of the German health system, which has remained largely unchanged since the time of Otto von Bismarck (Chancellor of the German Empire 1871 – 1890), continues to remain a topic of debate.
During World War II in exile health policy debates experts were developing alternatives to the existing health care system - mainly because many German doctors and health institutions had become part of the system of registration, mutilation and extermination of hundred thousands, who had been forced to sterilization, who had been killed in the different “euthanasia”-programs for handicapped, and the medical experiments within the concentration camps.
The developed alternatives indeed played a significant role in the debates immediately following the war. Moreover, these models echoed ideas that had played a role in debates regarding the proper organization of the health system before (!) and within the Weimar Republic.
In East Germany, the ideas of the working class political movement served as inspiration for the reconstructed health system. In West Germany, the health system was reconstructed along the lines of a structural foundation that had been established before and during the Weimar Republic and consolidated under National Socialism and along the lines of the medical profession’s position of authority, which emphasized diagnostics and the treatment of the individual patient and not prophylaxis.
In sum, the Western system made health care an individual responsibility, while in the East the state assumed responsibility for health care.
Although the terms “Americanization” and “Sovietization” were employed to characterize these health systems during the Cold War and in later scholarly accounts, more recent scholarship demonstrates that these terms do not adequately describe the course of events at the time. (Show less)

One of the characteristics of the Scandinavian welfare states is their universalism, many of the services and benefits were given to all citizens irrespective of needs and resources. Gradually from the 1970s a change took place in two aspects. 1) Interventions were increasingly targeted those considered to be in need either by medical or social standards. The needs assessment implied a categorisation of the recipients of the services. A number of risk groups were defined. 2) Interventions increased in numbers and scope. These two processes were probably interrelated since the urge to target increased when more resources were invested. This paper focus on health checks for pregnant women and children which were introduced in the 1930s and 1940s.

While most attention in the beginning was given the physical conditions of the children the focus expanded from the 1970s to include the social and mental well being of not only the children but the whole family, hereunder efforts to improve social networks of the parents and their ability to handle their relationship.

The categorisations and thus risk group creation both concerned medical and increasingly social conditions and necessitated definitions of normality in a number of areas and more information to be gathered. More surveillance and registration was needed, in order to assess which women and children did live up to the criteria of normality. An example is that in the 1970 Danish obstetricians defined 25 conditions which required extra interventions or attention. The definitions of risk groups or categorisations both shape the field of intervention and most likely the self perceptions of those categorised.

The needs assessment has not had the effect that those considered well functioning or healthy get less, only that part of the increase in interventions have been targeted those considered to be in need. Universalism is thus combined with an increased needs assessment and categorisations. (Show less)