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Some Christmas Books: Social policy and the NHS

In the nineteenth century concern about the health of the people and an interest in social conditions were both inseparable and virtually synonymous. It was largely alarm about conditions in the urban slums, where poverty fuelled disease, which inspired a series of major social reforms. The foundations of the Welfare State-from municipal housing to free school meals-were policies designed to eradicate epidemics and improve the nation's health. For the past 50 years or so, however, there has been an estrangement-almost a divorce-between health and other social policies. To the extent that a transformed medical technology could cure disease and save lives, so an interest in the social environment appeared redundant. Now there are signs of a reconciliation. It is becoming apparent that the National Health Service is as much a machine for manufacturing social problems as for dealing with physical disease, and that the biggest scope for improving health may lie in measures which change social behaviour rather than increasing the supply of medical care. This is why, of course, the literature on social policy is of more than peripheral interest to those working in the NHS, and why it is worth analysing current intellectual fashions-despite the fact that the renewed love affair between health and social policies is somewhat one-sided. Although there is widespread concern within the medical profession to see the problems of the NHS in a wider social framework, this interest is barely reciprocated among those who write about social policy (elastic and ambiguous though that phrase may be). It is not that the affairs of the NHS are totally ignored, but that they tend to be left to specialists rather than incorporated into the major themes of concern. Professor Townsend's book,' a collection of articles published over the past decade, is instructive in this respect. Only a few of the papers reprinted deal specifically with the NHS and then exclusively with services for the mentally ill and handicapped. And it is not for these that the book deserves attention: it is, rather, because Townsend is now among the most influential figures shaping the attitudes of Labour Party supporters on issues of social policy. He is the nagging conscience of the party, with his generous and inexhaustible capacity for indignation on behalf of the underdog. To understand the pressures on a Labour Goverment from their own ranks, it is also necessary to understandthe viewsrepresented and articulated by Townsend. His writings are the mirror of ideology, in which political rhetoric comes face to face with political reality.