The problem of social medicine: radical reform or authoritarian interventionism?

The aftermath of the First World War saw a transition from the control of epidemic, infectious diseases to international endeavours promoting social medicine. It was hoped that international peace could be underpinned by alleviation of social deprivation and injustice: effective health and welfare services were intended to stabilise the existence of new states and modernise administrative structures. State administrations adopted ambitious plans to extend social welfare provisions; and a private sector that had been heavily engaged in war relief work attempted to shift the basis of voluntary care away from philanthropic aid, and towards tackling the scientific roots of poverty and disease. The new priority given to maternal and child health, and to the prevention of chronic degenerative diseases (notably tuberculosis and certain sexually transmitted diseases) was linked to a range of demographic and social issues. Visionary schemes promoted innovative concepts of positive health and diverse concepts of ‘social hygiene’, ‘social medicine’ and of a healthy ‘human economy’. Clinical medicine was to be ‘reconstructed through social science’, and the organisation of medical care was to be collectivised by state and municipal public health physicians superintending polyclinics and public hospitals.

Whatever the prevailing political system, there was an international consensus among public health experts that the collectivisation of health care should look to advances in biological and social sciences.