Health, Civilization and the State: A History of Public Health from Ancient to Modern Times

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9780415200363: Health, Civilization and the State: A History of Public Health from Ancient to Modern Times

This book examines the social, economic and political issues of public health provision in historical perspective. It outlines the development of public health in Britain, Continental Europe and the United States from the ancient world through to the modern state. It includes discussion of:

* pestilence, public order and morality in pre-modern times
* the Enlightenment and its effects
* centralization in Victorian Britain
* localization of health care in the United States
* population issues and family welfare
* the rise of the classic welfare state
* attitudes towards public health into the twenty-first century.

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About the Author:

Dorothy Porter is Wellcome Senior Lecturer in the History of Medicine at Birkbeck College, University of London. She is co-author with Roy Porter of In Sickness and in Health (1988) and The Dialectics of Doctoring in 18th Century England (1989),

From The New England Journal of Medicine:

The 1990s have seen an outpouring of exceptional literature about the history of public health. Survey books have provided outstanding coverage of the broad scope of the growth of public health, and numerous scholars have published fascinating biographies of key figures in this field or stories detailing the successes and failures of public health. Regrettably, Porter's new book, intended as a standard textbook for students of public health, fails to match either the scholarship or the readability of these other works.

Porter, who has edited several works that examine primarily British medical history, focuses her current book on the concept of "population health," with strong sociological overtones of the theories of Max Weber and Norbert Elias and the philosophical views of Karl Marx and Michel Foucault. While stating that her book is limited to coverage of Europe and the United States, Porter periodically adds brief, extraneous sections on Latin America and the Far East. The entire book is a synopsis of a vast number of secondary sources, almost all of which are readily available to the interested reader. Paragraphs, and at times pages, are merely a review of what other authors have already said. Seldom does Porter share her own views on this material. Her writing often includes sociological jargon and can be challenging to understand; for example, her description of the British approach to social welfare in the early 20th century reads, "The notion of the independent social organism replaced the idea of society as a collection of freely competing atoms."

Despite the claim made in its subtitle, this survey skims over the pre-1700 period in a sketchy, brief section, much of which is based on essays from Kiple's Cambridge World History of Human Disease (New York: Cambridge University Press, 1993). Here and elsewhere in the book, Porter's selection and omission of secondary sources raise many questions: for instance, why exclude the standard works on classical medicine, such as those by Scarborough and Majno? In addition, factual errors appear here and in subsequent chapters: the life of the important Roman medical scholar, Galen of Pergamum, is misdated, and the publication date of the Flexner report, the landmark document of American medical educational reform, is incorrect.

The major part of this survey covers the period from the 18th century to the present. Its focus often jumps from Sweden to Germany and to France for brief coverage of the development of each nation's public health machinery and social-welfare legislation. At times, the reader feels buried under numerous names, dates, and facts, losing track of the main themes of public health. A pattern emerges after the first third of the book: superficial overviews of the above-mentioned nations alternate with in-depth examinations of Britain's public health history.

The strength of this book is Porter's coverage of the evolution of Britain's public health system from the 18th through the 20th centuries. She clearly explains the various factors that influenced the creation of the modern British welfare state and the obstacles that still confront it at the end of the 20th century. Major figures and important legislation are discussed in detail, and it is apparent that Porter is most comfortable describing the British scene.

Unfortunately, Porter's attempt to cover the United States in the same way is far from satisfactory. The discussion of American public health in the 19th century is superficial, failing to mention both the important problems created by the Constitution and the early public health efforts of the American Medical Association and such leading figures as Wilson Jewell. Besides ignoring several of the main reference sources for Civil War medicine and the National Board of Health, Porter fails to discuss two key factors in the limited approach to public health reform in the United States: the public's distrust of the medical community and opposition by business leaders to expensive changes. The author's minimal understanding of the history of public health in the United States continues to be apparent in her very weak discussion of 20th-century efforts at health insurance reform and her failure to appreciate Americans' ongoing distrust of involvement by the federal government in health care.

Porter harshly criticizes the failures of public health in contemporary Western societies to meet the health care needs of poor people. She concludes by stating that each nation, working within its own historical and cultural framework, will have to answer its own public health challenges.

I cannot recommend this book to students, but it has value as a bibliographic resource and is an excellent account of the history of British public health.

Reviewed by Jonathon Erlen, Ph.D.
Copyright © 1999 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

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