Alex Mold

Patient Groups and the Construction of the Patient-Consumer in Britain: An Historical Overview

This article presents an historical overview of the changing meaning of the patient-consumer, and specifically the role played by patient groups in constructing the patient as consumer. It is argued that patient groups were central to the formation of the patient-consumer, but as health consumerism was taken on by the state, they lost control of this figure. Competing understandings of what it meant to be a patient-consumer developed, a shift that raises further questions about the unity of claims made in the name of the patient-consumer.

Repositioning the Patient: Patient Organizations, Consumerism, and Autonomy in Britain during the 1960s and 1970s

This article explores how and why the patient came to be repositioned as a political actor within British health care during the 1960s and 1970s. Focusing on the role played by patient organizations, it is suggested that the repositioning of the patient needs to be seen in the light of growing demands for greater patient autonomy and the application of consumerist principles to health. Examining the activities of two patient groups—the National Association for the Welfare of Children in Hospital (NAWCH) and the Patients Association (PA)—indicates that while such groups undoubtedly placed more emphasis on individual autonomy, collective concerns did not entirely fall away. The voices of patients, as well as the patient, continued to matter within British health care.

'The rise of the user'? Voluntary organizations, the state and illegal drugs in England since the 1960s

This article examines the place of the drug user in drug policy and practice in England since the 1960s. It argues that though the drug user has ‘risen’ in the sense that users now play a key role in contemporary policy and practice, this was not a neat, linear process. Moreover, the current position of the drug user is constrained by a range of wider forces.

Illicit drugs and the rise of epidemiology during the 1960s

Epidemiology has been crucial to the understanding of both tobacco smoking and illicit drug taking as public health issues in Britain since the 1960s. There were, however, siginificant differences in the way in which epidemiology was used between the two psychoactive substances.

Framing drug and alcohol use as a public health problem in Britain: Past and present

Recent attempts to approach drug and alcohol problems as a public health issue in the UK and globally have begun to achieve some success. Yet, in historical terms, the idea that the use of psychoactive substances should be regarded as a public health problem is a relatively new one. In the UK, it was only in the latter half of the 20th century that what were termed “public health” approaches to alcohol and drugs began to gain purchase. Moreover, what was meant by a “public health” framing of psychoactive substance use changed over time and between substances. This article examines the development of public health approaches to drugs and alcohol in Britain since the 19th century. It suggests that a public health view of substance use existed alongside, and interacted with, other approaches to drug and alcohol use. To understand the meaning of a “public health” framing of drugs and alcohol we need to locate this in historical and geographical context.

‘Everybody Likes a Drink. Nobody Likes a Drunk’. Alcohol, Health Education and the Public in 1970s Britain

Summary This article examines the development of alcohol health education in Britain during the 1970s, using this as a way to explore the nature of public health and the place of the public within it. Focusing on a set of local health education campaigns, an expert committee report on alcohol prevention and a public consultation exercise on alcohol, the article highlights the presence of three different ‘publics’. Health education campaigns tended to focus on the individual drinker, but the drinking habits of the whole population were also of concern. So too were the rights and responsibilities of citizen-consumers. These three publics—drinkers, the population and citizen-consumers—were often in conflict with one another, and though it was drinkers that became the object of alcohol policy, the needs of the population, and of citizen-consumers, could not be ignored.

Addiction in Europe, 1860s-1960s: Concepts and Responses in Italy, Poland, Austria, and the United Kingdom

Concepts play a central part in the formulation of problems and proposed solutions to the use of substances. This article reports the initial results from a cross European historical study, carried out to a common methodology, of the language of addiction and policy responses in two key periods, 1860–1930 and the 1950s and 1960s. It concludes that the language of addiction was varied and nonstandard in the first period. The Anglo-American model of inebriety did not apply across Europe but there was a common focus on theories of heredity and national degeneration. After World War II, there was a more homogenous language but still distinct national differences in emphasis and national interests and policy responses to different substances. More research will be needed to deepen understanding of the conditions under which these changes took place and the social and policy appeal of disease theories.Concepts play a central part in the formulation of problems and proposed solutions to the use of substances. This article reports the initial results from a cross European historical study, carried out to a common methodology, of the language of addiction and policy responses in two key periods, 1860–1930 and the 1950s and 1960s. It concludes that the language of addiction was varied and nonstandard in the first period. The Anglo-American model of inebriety did not apply across Europe but there was a common focus on theories of heredity and national degeneration. After World War II, there was a more homogenous language but still distinct national differences in emphasis and national interests and policy responses to different substances. More research will be needed to deepen understanding of the conditions under which these changes took place and the social and policy appeal of disease theories.

Exhibiting Good Health: Public Health Exhibitions in London, 1948–71

This article examines the changing nature of public health services and their relationship with the public in post-war Britain by an analysis of the exhibitions mounted by Medical Officers of Health (MOsH) in London. Focusing on the period 1948–71, the article explores a time when public health practice, and the problems it faced, were in flux. A decline in infectious disease and an increase in chronic conditions linked to lifestyle required a new role for public health services. Exhibitions were one of several methods that MOsH used to inform the public about dangers to their health, but also to persuade them to change their behaviour. The exhibition, though, offers a unique insight into the relationship between public health authorities and the public, as exhibitions brought MOsH into direct contact with people. It is suggested that in the MOsH exhibitions we can find signs of a new relationship between public health practitioners and the public. Whilst elements of the pre-war, often moralistic ideology of public health services could still be detected, there is also evidence of a more nuanced, responsive dynamic between practitioners and the people. By the end of the 1960s, ‘the public’ was increasingly being thought of as a collection of ‘publics’, including individuals, target groups and vocal respondents.

‘“Grave Cause for Concern”? Private Practice, Professional Disputes and the Treatment of Heroin Addiction in Britain During the 1980s’

This article examines the debate surrounding the role played by private doctors in the treatment of heroin addiction in Britain during the 1980s. Whilst there were a number of problems connected with the treatment of addiction in private practice, this debate was something of a surface issue masking a deeper professional dispute. The involvement of general practitioners, whether in private or National Health Service practice, posed a threat to the recently established specialist status of psychiatrists working in the field. This came at a time when the specialist psychiatric approach to drug addition was increasingly being challenged by other non-medical agencies.

Using digitised medical journals in a cross European project on addiction history

This article draws on research conducted as part of a European project on the changing terminology used to conceptualise habitual drug, alcohol or tobacco use. We wanted to find out what language was utilised in Italy, Poland, Austria and the UK and how those concepts had changed since the mid-nineteenth century. We intended to make use of digitised journals for key word searches to enable comparisons to be made across countries and across time. Nothing, however, was straightforward. Few countries had digitised medical journals, so researchers had to use traditional search methods. Even in the UK, where journals were available digitally, there were problems with access and the searches that could be made. Digitisation did not provide a quicker way of researching cross nationally. Nonetheless our work did arrive at some valuable new conclusions. Our experiences also raise wider questions about using digitised journals for historical research.