Expertise, bureaucracy and the body: dilemmas of empowerment in post-war British governance

Speakers: Gayle Davis, Gareth Millward, Glen O’Hara

Chair: Tom Crook

This panel will explore the tensions that emerged in the second half of the twentieth century between the empowerment of ‘the people’ (including increased democracy, democratization, local government, and patients’ rights) and the empowerment of state officials and experts (e.g. local government officers, hospital boards, civil servants, doctors and dentists). These tensions were long-established and were a crucial feature of the ‘liberal’ governance of the Victorian period, when Britons first started debating the relative merits of ‘central’ and ‘local government’ and railing against excessive ‘bureaucracy’. But they also flourished in what post-Second World War Britons thought of as a ‘social democracy’, which was supposed to involve a deepened sense of democratic participation (including mass parties, the full franchise for all adults, and more inclusive decision-making processes). Now, all kinds of expertise for planning and administering ‘the social’ became controversial subjects of bitter public debate, both inside and outside the traditional political parties, including the subject of this panel: the regulation of the very life and health of the human body. Crudely, the question was: where should the ‘empowerment’ of the individual end, and the enormous influence of what was good or better for those individuals – as evidenced by science, expertise and evidence – begin? This panel will look at three instances of the management of these difficult borderlines in post-war Britain: firstly, the difficult relations between doctors, the state and individual morality in debates about contraception and abortion; secondly, the anti-vaccination campaigns of the 1970s; and thirdly, the controversy over adding fluoride to drinking water to help preserve children’s teeth in the 1950s and 1970s. By so doing, the panel participants will reflect on the varying powers, images and clashes of experts and citizens, and concepts of ‘the public’ in the making and remaking of British public life during the second half of the twentieth century.

Paper 1 Abstract: ‘Sex on the National Health’: the medicalisation of fertility control in ‘swinging’ Scotland

Gayle Davis, Senior Lecturer in the History of Medicine, University of Edinburgh

The increasing availability of safe and effective means of fertility control – abortion and contraception – arguably constitutes one of the most significant social developments of the twentieth century. Many social historians have located this trend within the general programme of so-called ‘permissive’ measures introduced to Britain during the ‘Swinging Sixties’, measures that reconfigured the role of the state in issues relating to sexual morality and gave significant power to individuals over their own bodies. Despite the centrality of the medical profession to both the formation of reproductive health policy and the delivery of services, scholarship has therefore tended to neglect, caricature or denigrate their role. This paper stems from ongoing research into the interface between reproduction, sexuality, health and medicine in post-World War Two Scotland. It will explore the social, medical and political factors that influenced fertility control provision in Scotland, charting the complex relationship between state, church, medicine and the public. In particular, it will provide a more nuanced examination of the state’s devolvement of responsibility to a reluctant medical profession, and the resulting impact on women’s bodies and patient rights.

Paper 2 Abstract: Who decides how ‘safe’ is ‘safe’? The pertussis vaccine scare and the Vaccination Damage Payments Act 1979

Gareth Millward, Research Fellow, Centre for History in Public Health, London School of Hygiene and Tropical Medicine

Weeks before the 1979 General Election was called, the Labour government passed an Act to provide payments to parents whose children had been damaged by vaccinations given under the state’s public health programmes. This followed the ‘pertussis vaccine scare’, in which the whooping cough vaccine had been linked to brain injuries in children. By the early 1980s, the medical community was again broadly united in declaring the vaccination ‘safe’ – but in the meantime, enough doubt had been sowed in the general public to cause vaccination rates to plummet. For historians, this poses interesting questions about public trust in the medical authorities and their understandings about how medical treatments ‘work’ or might ‘go wrong’. Following the high-profile thalidomide scandal, Parliament, the press and pressure groups were open to the idea that the medical community may have allowed a dangerous drug to be administered to millions of British children. This paper addresses these conflicts between the public, the medical profession and the government over what constituted a ‘safe’ vaccine. What role did the state have for informing parents of the potential risks without causing undue panic? How was medical ‘truth’ contested both within Britain and in the international arena, as similar debates were being conducted in Japan and the US? And how did campaign groups such as the Association of Parents of Vaccine Damaged Children and their allies in parliament seek to secure compensation from the government for injuries they were convinced were caused by state-administered vaccinations? Through these questions, historians can show that ideas such as ‘risk’ and ‘expertise’ were not static, and the way these were debated in public gives us a vital insight into 1970s’ British approaches to both medicine and public policy.

Paper 3 Abstract: Something in the water: the fluoridation debate in post-Second World War Britain

Glen O’Hara, Professor of Modern and Contemporary History, Oxford Brookes University

Fluoride was supposed to provide a cheap, quick, clean, easy and ‘modern’ answer to tooth decay. As rationing came to an end in the 1950s, and tooth decay from sugary drinks and sweets became a topic of great concern for doctors and dentists who saw themselves as having ‘solved’ many other health crises, UK policymakers looked to US experiments with fluoridising the water supply for a glimpse of a scientific future that would help them escape from dilemmas of diet and lifestyle. But they came up against a well-organised, determined and ideologically-committed group of anti-fluoridisers, gathered under the banner of the National Pure Water Association, who perceived ‘compulsory medication’ to amount to tyranny, and enforced intervention in individual Britons’ bodies akin to Nazi medical experimentation. The anti-fluoridation campaign cut across political parties and traditional conceptions of ‘left’ and ‘right’, finding adherents across the UK, and all in all main ideological groupings. What such groups opposed was what they perceived to be the unacceptable risk with their children, imposed on them by the same ‘experts’ who caused the thalidomide tragedy in the late 1950s. Once the Conservatives had declined to legislate in the early 1960s, finding the whole issue too controversial for central direction, anti-fluoridation campaigners kept up the pressure in the courts, and on local authorities, until they managed to thwart the idea of near-universal fluoridation itself. Only about a fifth of the UK’s water was to be fluoridated by the end of the century – a controversy that continues in the early twenty-first century, at the borders of acceptable state intervention in the health choices of each individual.

 

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