Health, welfare, and the state—the dangers of forgetting history

Abstract

The art of medicine Health, welfare, and the state-the dangers of forgetting history Recent public policy in the UK has been dominated by a discourse which asserts that public expenditure on universal health coverage and welfare is a burden on the productive economy and unaffordable in what has been deemed a time of austerity. There is a widely held assumption that universal welfare provision, as offered by most modern, welfare states is a luxury, only afforded since the World War 2 by wealthier economies. According to this view, if the productive efficiency of the economy falters, then this luxury should be trimmed back aggressively. Reduction in universal welfare will relieve enterprise, capital, and socalled hard-working families from the burdens of taxation required to fund these unproductive public services and (by implication) those unproductive families-the poor. We argue from history that there should be an end to setting the goal of economic growth against that of welfare provision. A healthy and prospering society needs both. We suggest that they feed each other.A long-term historical perspective shows how universal benefits funded by progressive taxation can both assure health and welfare and support social cohesion, with concomitant processes and behaviours likely to be important stimulants for a productive economy. Investing in universal health coverage and welfare makes for national prosperity every bit as much as the increasing wealth of an economy provides the funding for enhanced health and social security. We begin with England's 200-year rise to global economic pre-eminence during the course of the 17 th and 18th centuries. This was intimately associated with the innovation, under Elizabeth I's rule, of the Poor Laws. Elizabeth acceded to the throne at a difficult time.The country was at war with France, and was near bankrupt, there were poor harvests, and the dissolution of the monasteries by her father, King Henry VIII, had removed the associated welfare system provided by the Catholic Church. The Elizabethan Poor Laws of 1598 and 1601 were an extraordinary response; pragmatic in origin, but drawing nonetheless on principles of the common good. The laws were based on social relations and mutual rights and responsibilities of local communities caring for all kith and kin. They provided, for the first time, access to support in times of need for all people settled in the parish. They enshrined an absolute "right of relief" for every subject of the Crown. They created a nationwide system of social security through a progressive community tax to fund provision at local level. This was predicated on the assumption that poverty is an unavoidable and common risk, which can be shared and mitigated.Relief was provided by the Anglican parish (averaging 500 persons each in 1600) as the designated unit of Tudor local government. Each parish was mandated to establish a fund to offer a comprehensive safety net against destitution as required and throughout the year for vulnerable groups, including orphans,...

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