Health Improvement in a Period of Austerity: a Public Health Perspective
| Date | 01 March 2017 |
| DOI | http://doi.org/10.1111/1758-5899.12216 |
| Published date | 01 March 2017 |
| Author | Walter W. Holland |
Health Improvement in a Period of Austerity: a
Public Health Perspective
Walter W. Holland
London School of Economics and Political Science
Abstract
This article reviews historical precedents, which might help to guide current practice. It discusses the role of explicit rationing,
distinguishes between need and demand and their respective determinants, and considers evidence as a means of prioritising
health services. It subsequently outlines some of the strategies to improve or maintain individual and population health. To
achieve these objectives, governments must analyse the provision of health services, including preventive care, and ensure
that adequate information is available on the utilisation and outcome of these services to determine where care provision is
deficient. Health improvements and maintenance must entail both considerations of the provision of health care services as
well as measures to improve health. In addition, it is important for any society that adequate information is available on both
the utilisation and outcome of any services provided both for evaluation and monitoring, in order that appropriate changes
can be made in a timely manner.
During times of economic recession, all health care providers
are enjoined to reduce their activities and to control costs.
Limiting consumption at the individual, industry or national
level, however, will not induce a growth in wealth. Health ser-
vices, whether they are curative, preventive or rehabilitative,
are not immune from these pressures. Thus, it is necessary to
consider how improvements in health that have occurred in
the past 30–50 years can continue to be maintained.
This article first reviews historical precedents, which might
help to guide current practice. It discusses the role of explicit
rationing, distinguishes between need and demand and their
respective determinants and considers evidence as a means
of prioritising health services. It subsequently outlines a
course of action for the future, in particular focusing on fund-
ing of effective and lifesaving treatments, education and pre-
vention and discusses policy options for optimizing health
expenditures in order to maintain and improve health status.
1. The role of rationing
Public health action should include interventions to improve
nutritional and dietary habits. As Burnett (1966) has pointed
out, there were two crucial periods in the improvement of
the national diet. These, ironically, coincided with times of
national crisis –the Great Depression of the 1880s and the
wartime and postwar difficulties of the 1940s. In both cases,
the basic reason for the improvement was a rising standard
of living as a result of an increase in purchasing power of
the population.
In the first time period, the increase in spending power
was due to external factors over which the government had
no control. In the second, the state played a direct part
through price fixing, rationing and pursuing nutritional and
social policy to raise standards. ‘This was probably the most
remarkable, though least publicised, achievement of war-
time control‘(Holland and Stewart, 1998).
At the outbreak of the Second World War, Britain was far
better prepared to cope with food supply disruptions than it
had been in the First World War. Britain had, because of its
land area and population size, become dependent on the
import of basic foodstuffs such as corn, sugar and meat.
During the First World War, because of the activities of U-
boats, the supply of basic foodstuffs became severely
restricted. It is said that Britain was, at one stage, only three
weeks away from starvation (Burnet, 1966).
After the First World War, British agriculture expanded
and the government planned to control food supply (Charl-
ton and Quaife, 1997). A Ministry of Food was established
(Holland and Stewart, 1998). There was exhaustive consulta-
tion with all those involved in manufacture and distribution
of foodstuffs. The science of nutrition had developed, which
enabled governments to plan a dietetically adequate
scheme of rationing. Professor J. C. Drummond, an eminent
nutritionist, was appointed as Chief Scientific Adviser to the
ministry. Because of his past research he was determined to
use food control to improve the nutritional value of the Brit-
ish diet (Drummond, Jaine and Wilbraham, 1992).
The British system of rationing was an immensely power-
ful public health tool. It was flexible and allowed freedom of
choice. Bread and potatoes were not rationed, but price
control mechanisms ensured that they were affordable to
the entire population. The major items that were rationed
were meat, bacon, cheese, fats, sugar and preserves in fixed
quantities per head. The amount of each of these items var-
ied at different times. The extraction rate of flour was raised
to 85 per cent, which increased the intake of iron, riboflavin
©2017 University of Durham and John Wiley & Sons, Ltd. Global Policy (2017) 8:Suppl.2 doi: 10.1111/1758-5899.12216
Global Policy Volume 8 . Supplement 2 . March 2017
30
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