International health accounting in historical perspective, 1925–2011
resources and containing costs is a top priority, while in others, especially in the global South, improving access to health care, fairness in financing, and tackling health inequalities are also important considerations. By relating health spending to key outcome indicators, such as healthy life expectancy (HALE), national health accounting allows the assessment of health systems performance, a task which in recent decades has fallen to internationalorganisations including the World Health Organisation (WHO) and World Bank.
extensions of health systems as well.’ 128 Whilst developing countries
had focused on infant mortality and basic diseases of childhood
until the early 2000s, the growing focus on autism as a global
health crisis has encouraged internationalorganisations to shift
their attention to child mental health too, an initiative supported
by the WHO.
Whilst some researchers have drawn attention
diabetes and service guidance. Reflecting their historic concerns with service organisation, and engaging with mounting critiques of medicine made from within and without the profession, various professional bodies, internationalorganisations, and the BDA became increasingly concerned about standards of diabetes care over the last quarter of the twentieth century. The Royal Colleges and BDA, for instance, collaborated in drawing up guidance on service organisation in 1977, and audited the staffing and facilities available for NHS diabetes management in 1984. Into the
The evolving relationship between infection and length of stay in antibiotic-era hospitals
, and internal debates and doubt about what they were measuring, meant that there was an ambiguity about the evidence base. This did not help the nascent hospital infection control experts demonstrate the authority necessary to convince policymakers, or individual clinicians, to take action.
Literature searches, for example in the journal Hospital Infection Control and Prevention , demonstrate that these concerns about the relationship between infection, length of stay and costs have often been cyclical. The creation of national and internationalorganisations
the MRC invented a new ‘MRC scale’ instead of using the HRSD or Hamilton scale in its study of depression between 1964 and 1965, which supports the claim that the organisation places a high value on standardised scales. See Worboys , M. , ‘ The Hamilton Rating Scale for Depression: The Making of a “Gold Standard” and the Unmaking of a Chronic Illness, 1960–1980 ’, Chronic Illness , 9 : 3 ( 2012 ), 202 – 219 , p. 210.
90 Cayet , T. , Rosental , P. A. , and Thebaud-Sorger , M. , ‘ How InternationalOrganisations Compete: Occupational Safety and Health at
different arenas of discussion and governance, helped these figures to align recommendations of local and regional NHS authorities, elite professional bodies, internationalorganisations, and lay-professional and state-sponsored agencies. They thus provided sufficient agreement for managerial recommendations and infrastructures to emerge, and mediated potentially conflicting agendas. 106 Using government funding and activity, certain elite specialists and professional bodies helped set national standards and, through their production of tools for management, sat at the
Through a study of diabetes care in post-war Britain, this book is the first historical monograph to explore the emergence of managed medicine within the National Health Service. Much of the extant literature has cast the development of systems for structuring and reviewing clinical care as either a political imposition in pursuit of cost control or a professional reaction to state pressure. By contrast, Managing Diabetes, Managing Medicine argues that managerial medicine was a co-constructed venture between profession and state. Despite possessing diverse motives – and though clearly influenced by post-war Britain’s rapid political, technological, economic, and cultural changes – general practitioners (GPs), hospital specialists, national professional and patient bodies, a range of British government agencies, and influential international organisations were all integral to the creation of managerial systems in Britain. By focusing on changes within the management of a single disease at the forefront of broader developments, this book ties together innovations across varied sites at different scales of change, from the very local programmes of single towns to the debates of specialists and professional leaders in international fora. Drawing on a broad range of archival materials, published journals, and medical textbooks, as well as newspapers and oral histories, Managing Diabetes, Managing Medicine not only develops fresh insights into the history of managed healthcare, but also contributes to histories of the NHS, medical professionalism, and post-war government more broadly.
This chapter examines the development of new forms of general-practice-based diabetes management over the last quarter of the twentieth century. Although GPs had retained responsibility for ongoing patient care after 1948, the creation of the NHS consolidated the dominant role of the specialist clinic in post-war diabetes management. During the 1970s and 1980s, however, hospital clinicians and GPs began to devise more formal systems of structured and integrated diabetes care, with GPs assuming greater roles in disease management. For clinicians, deputing responsibilities to GPs offered a way to manage patient loads and increasing demands for surveillance in a context of constrained resources, and enabled consultants to refocus on challenging work. For GPs, new forms of care dovetailed with emerging professional projects connected with distinguishing GPs from hospital practitioners and moving GPs into team-based, proactive preventive health work. By the early 1990s, the Royal Colleges, the British Diabetic Association, the Department of Health, and international organisations all supported the increasing role of primary care practitioners in diabetes care. Medical politics, resource distribution, and epistemic change had once again combined to reshape approaches to diabetes management and reposition it as a form of long-term risk prevention.
The cultural construction of opposition to immunisation in India
health that was able to
devise strategies particularly suited to the demographic, social and cultural
characteristics of Indian society. These strategies excluded the wholesale
acceptance of immunisation programmes designed by rich, western countries and
their adherents in internationalorganisations. While Banerji's aggressive
rhetoric might have had a limited impact on the actual public health policy in
India, it does illustrate the
lobbied ministers, and policy networks produced quantified measures of the costs of the disease and its complications. 64 With the government interested in new forms of professional management, chronic diseases like diabetes provided promising subjects for piloting new programmes. Healthcare teams were already using many of the tools required for implementation, whilst elite professional bodies and internationalorganisations were creating standards documents, clinical guidelines, and model audit systems. There were alternative routes to promoting managed medicine