28 February 2018, University of Auckland

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The era of economic reform in the 1980s was also a pivotal moment in the history of New Zealand’s health system. There was a growing sense of the need for change, rethinking and policy innovation.  By 1980, 50 per cent of New Zealanders had some form of private health insurance – what did this mean for the universal health care system implemented in 1938? The new Labour Government coming to office in 1984 inherited the Area Health Boards Act from the outgoing National Government, with implications for organising health services. As well as the gradual establishment of area health boards from 1983, focal points of debate were the 1986 Health Benefits Review and the 1988 Gibbs Report (‘Unshackling the Hospitals’). Out of this ferment came the more radical health reforms of the early 1990s as well as the establishment of PHARMAC.  The 1980s was also a time when Māori were continuing to exert their right to tino rangtiratanga (sovereignty) and there was growing acknowledgement by politicians that this needed to be reflected in policy.

The aim of this seminar was to capture and record the experience of participants, including politicians, civil servants, the voluntary sector, health providers and activists, to illuminate key aspects of New Zealand’s health politics of the time. Given the ongoing salience of many of the issues debated at the time, we were concerned to identify factors that accelerated or inhibited major change. This seminar forms part of a wider project on the New Zealand health system and the UK’s NHS and the connections between the reforms proposed and implemented in both systems as well as the exchange of ideas.

The meeting was jointly convened by Prof Martin Gorsky and Dr Hayley Brown (LSHTM) and Prof Linda Bryder (University of Auckland) and supported by a Wellcome Trust grant 106720/Z/15/Z.

As part of the Prisoners, Medical Care, and Entitlement to Health project, we organised a witness seminar in May 2017 as an opportunity for key individuals to discuss their experiences and memories of the development of prison policy around HIV/AIDS.

We invited 12 people to participate, including Sir Richard Tilt, former Governor and Director General of the Prison Service of England & Wales, Dame Ruth Runciman, former chair of the AIDS working group of the Advisory Council on the Misuse of Drugs and co-founder of the Prison Reform Trust, and Mike Trace, former Director of the Cranstoun Parole Release Scheme and Chief Executive of the Rehabilitation for Addicted Prisoners Trust. They were joined in conversation by former governors, drugs workers, public health advisers, and representatives of the National AIDS Trust and Department of Health.

The experiences of our speakers began in the early 1980s, just as AIDS was emerging as a new and unclear threat. Speakers recalled the lack of information and enormous fear surrounding HIV/AIDS, and the initial impulse to provide special segregated facilities for prisoners with HIV/AIDS. Reflections and experiences encompassed the 1990s as well, with worries about bad headlines, disagreements between Ministers and prison administrators over controversial issues such as providing condoms or needle exchanges in prisons, and a lack of funding for prison healthcare in general making their mark. However, the witness seminar also drew out some of the good work that was done by committed individuals and committees and the changes that were introduced, often as a result of practice informing policy. Ultimately, as many speakers pointed out, prisons could be ‘doggedly resistant’ to change, but they also reflected the attitudes of the wider community and its concerns and priorities.

Thanks to all who helped or participated in the seminar, and for any questions or comments please contact Janet Weston.

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Symposium organised by the Centre for History in Public Health, LSHTM, and the Institute of Public Policy Research, with support from the Wellcome Trust on the 9th May 2017.

This symposium brought together historians and policy makers to ask what we could learn from 20th century British history about the decentralisation of health powers and the local reform agenda. Greater devolution has been common ground in public policy in recent years, both across the four nations of the UK, and subsequently to regions and local authorities – with devo-Manc and STPs at the forefront of peoples’ minds. Yet there is a much longer history of debate and dillemmas in the British health system about striking the proper balance between the central and the local, that goes right back to before the NHS. Our aim was to explore that history, and see what light it may shed on today’s policy puzzles. Read transcript

For more information click here. 

November 21st, 2013 Somerset House, London

The focus of this Witness Seminar was the work of the Resource Allocation Working Party (RAWP).  Appointed by the Labour government in 1975, the RAWP’s work led in 1976 to the introduction of a new formula for distributing funding in the British National Health Service (NHS).  Henceforth it would be allocated according to measures of need, and not by the historical precedent which had hitherto favoured some regions more than others. Prior to the RAWP, the track record of Britain and of other Western nations in improving equality of access had not been impressive, despite decades of state intervention in health services.  Aneurin Bevan’s initial vision had been that the NHS would ‘universalise the best’, but thus far the goal had remained elusive.

Behind RAWP’s dry title and acronym then, lies a story which speaks to some central issues in the history of the NHS.  These range from the high idealism that has inspired the service, to the pragmatic and contentious political questions that attend reform efforts, to the technical but intellectually absorbing debates about how to achieve the fairest formula for redistribution.  The RAWP also deserves historical attention because it stands as an example of successful policy-making in the NHS.  Different views will be taken on how successful it was, and of course the postcode lottery debate is as live as ever.  Yet the RAWP episode instilled in the NHS the enduring policy goal of ‘equality of access to health care for people in equal need’.

Historical understanding of the RAWP is therefore important both to our understanding of the NHS and to the broader study of health systems.  The aim of the Witness Seminar was to examine this key episode, through the recollections of some of those involved at the time.

The meeting was jointly convened by the Dr Martin Gorsky (LSHTM) and Dr Virginia Preston (King’s College London).  It was initiated and organised by CHiPH, supported by the Wellcome Trust grant ‘Witness Seminars in NHS History’.

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Martin Gorsky and Virginia Preston ed. (London School of Hygiene and Tropical Medicine and Institute of Contemporary British History: 2013).

Overy C, Reynolds L A, Tansey E M. (eds) (2011) History of the National Survey of Sexual Attitudes and Lifestyles.Wellcome Witnesses to Twentieth Century Medicine, volume 41. London: School of History, Queen Mary, University of London.

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Crowther, SM, Reynolds, LA and Tansey, EM (eds) The Medicalization of Cannabis. Wellcome Witnesses to Twentieth Century Medicine, Vol. 40 (Wellcome Trust Centre for the History of Medicine at UCL, 2010).

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Martin Gorsky, The Griffiths NHS Management Inquiry, its origins, nature and impact. The transcript is now available online to read only. Please contact Ingrid James for a printed version.

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V Berridge, DA Christie and EM Tansey, Public health in the 1980s and 1990s: Decline and Rise? Wellcome Witnesses to Twentieth Century Medicine, Vol. 26 (Welcome Trust Centre for the History of Medicine at UCL, 2006)

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A conference co-organised by Dr Tony Fletcher (Public and Environmental Health Research Unit) and Professor Virginia Berridge (Centre for History in Public Health) of LSTHM to commemorate the 1952 London Smog. It was held at the Brunei Gallery SOAS, on the 9-10 December 2002.
This major international Conference which attracted over 200 participants from various countries, reviewed the events that led up the the 1952 smog and reflected on the current state of air pollution.

The History Group organised the Witness Seminar held on the second morning of the Conference. Speakers at the Witness Seminar included Professor Roy Parker, Sir Donald Acheson and Professor Richard Scorer. Funding was provided by the Wellcome Trust. The full transcript of the seminar is now available on-line or to purchase as a hard copy.

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Review of the Conference

Almost fifty years to the day, LSHTM held a conference to commemorate the lethal London Smog of 1952. It is an auspicious time for such a meeting and the conference attracted over 200 participants. It aimed to reassess the historical context and the health impacts of the episode, to summarise current health impacts of pollution in large cities and to present future trends and policies on urban air pollution for London, in particular, and Europe, generally. The conference was organised jointly by DR Tony Fletcher (Environmental Epidemiology Unit) and Professor Virginia Berridge (History Group) of LSTHM, with the help of a planning committee.

After a welcome by Professor Andy Haines (Dean of LSHTM), the first morning session provided the historical background, and considered the health impacts. Professor Peter Brimblecombe (University of East Anglia) analysed why London suffered from so much lethal smog. Catherine Wills (University of Essex) examined the impact of the ‘Clean Air Crusaders’ including the National Smoke Abatement Society. Dr Stephen Mosley (University of Birmingham) showed that whilst domestic smoke came to be considered more harmful than industrial smoke, Victorian governments feared the public’s response to any interference with freedom within the home. Activists tried to impress that a good citizen would reduce smoke outputs from the home, but householders failed to respond effectively. Professor Ross Anderson (St George’s Medical Hospital School) explained that the main health problems lay with the respiratory and cardiovascular systems; elderly people with bronchitis being especially affected. Intriguingly, it appeared that children with asthma were not unduly troubled. A screening, to a packed audience, of the film Killer Fog, was introduced by Dr Michael Clark (Wellcome Trust).

The afternoon session focused on new agendas for air pollution after the 1950’s. Dr Mark Jackson (Exeter University) contrasted two quotes, one from 1955 that stressed the links between pollution and bronchitis and one from 2000, which attributed the deaths to asthma. He explored the reasons for this contrast, arguing that the Smog set in motion a series of events which served to change approaches to respiratory disease and to fashion new classificatory methods and a new appreciation of the links between pollution and health. Professor Berridge presented on ‘lifestyle versus environment’ arguing that the air pollution issue was symbolic of a wider change within the focus of public health. Pollution by individual smokers came to the forefront and this was emblematic of the move to individually oriented public health. Day One’s final session focused on air pollution in London and across the world. Professor Frank Kelly, (King’s College, London) highlighted the changing nature of air pollution, from the decrease in traditional pollutants like sulphur dioxide, to increases in nitrogen dioxide, ozone, and PM10’s, namely due to the growth in motor vehicle traffic. Dr Michael Krzyzanowski (WHO) spoke of the global health burden of air pollution. He summarised the World Health Report’s section on air pollution which indicated that the burden fell predominately on developing countries. David Hutchinson (GLA) expanded upon London’s present air quality strategy. After concluding remarks by Dr Fletcher, guests adjourned to continue their discussions at a reception held at LSHTM.

Day Two began with a witness seminar chaired by Professor Brimlecombe. Professor Roy Parker, Sir Donald Acheson and Professor Richard Scorer constituted the panel. Each spoke about their unique experiences during the Smog, triggering contributions from the audience, members of which commented that they found the testimony of witnesses invaluable. A poster exhibition opened for participants to view a range of posters and to talk to their authors.

The afternoon sessions were more specialised and focused on the lessons of air pollution incidences and future prospects. Speakers included Professor Devra Davis (Carnegie Mellon University, USA) and Professor Michael Brauer (University of British Columbia.) Brauer read a paper on air pollution caused by vegetation fires, focusing on the 1997-8 Southeast Asian fires which were associated with decreased lung function and mortality. After the presentations, guests had the opportunity to attend the opening of an art exhibition at LSHTM, at which contemporary artists marked the anniversary of the London Smog. This exhibition will continue until the 14th February 2003.

This successful conference commemorated the 1952 Smog but also highlighted the necessity in continuing to combat air pollution and it brought together perspectives from historians, epidemiologists, doctors and the general public. Its importance and present day relevance was highlighted by its truly international flavour, attracting participants from Canada, Germany, Greece, the Netherlands, and the USA, as well as, generating press interest, particularly, in the USA and Germany. It attracted a great deal of media interest at home, with the conference organisers appearing in various locations and articles appearing in The Guardian, History Today, The Independent and elsewhere.

This conference was organised by the History Group and the Health Promotion Research Unit to celebrate the 90th birthday of Professor Jerry Morris. It was held on 21 July 2000 at LSHTM.

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This witness seminar, on the 1980 Report of the Working Group on Inequalities in Health (known as the Black Report after its chairman) was held at the London School of Hygiene & Tropical Medicine on 19th April 1999. It was part of a one-day conference on ‘inequalities and history’ which preceded a conference on inequalities at the School. The seminar was chaired by Professor Virginia Berridge, and amongst the witnesses were Sir Douglas Black, the Committee Chair, Professor Jerry Morris and Professor Peter Townsend, both Committee Members.

The Black Report and the Health Divide (These three articles were originally published in October 2002 in the journal Contemporary British History as part of a special issue on ‘Poor Health: Social Inequality Before and After the Black Report’. They are made available here with permission of the editors of Contemporary British History)

Dispelling the myths of the Black Report (An accompanying memoir by Patrick Jenkin, Secretary of State at the Department of Health and Social Security at the time of the Report)

The Origin of the Black report R Wikinson  (A summary of an interview conducted by Berridge with Richard Wilkinson, then an academic researcher examining health inequalities and social class, on the origins of the Black Report).

Andy Williams (Cardiff University), March 20 2014

Science news is not formed in a social, economic, or cultural vacuum. It is written by people at news organisations which are cutting staff and investing fewer resources into news production than previously. Full discussions of science news in the UK must be situated in the context of the economic and political conditions under which that news is made. Drawing on the findings of an internet survey of UK science news journalists and 52 semi-structured interviews with specialist journalists and editors this talk will investigate elements of the political economy of UK specialist science, health and environment news journalism by assessing changes in the strength of this news beat over time and evaluating changes in working practices and working conditions among this group of news workers.

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