International Journal of Epidemiology 2002;31:268
© International Epidemiological Association 2002
Book Review |
‘The Battle for Health'. A Political History of the Socialist Medical Association, 1930–51.
J Stewart. Aldershot UK/ Brookfield USA: Ashgate, 1999, pp.259, £55.00. ISBN: 1 85928 218 0.
John Stewart has worked hard to provide, so far as I know for the first time, an independent retrospective assessment of the impact of the Socialist Medical Association (SMA now Socialist Health Association) on Labour Party policies during the long gestation and early infancy of the British National Health Service (NHS). Until now, anyone interested in this subject has had to rely on David Stark Murray's internal account of this in his Why a National Health Service?1 This certainly overstated SMA influence on power-holders in the Labour Party, though probably not on either the Party membership and activists, or on the wider Labour and Trade Union Movement.
From the first paragraph he recognises an important theme running throughout this history, that SMA pioneers ‘held that medical practice, when allowed to work cooperatively and without economic barriers to the care of all patients, in itself provided a model for socialism'. If its author fully recognized the power of this idea, as much today as in 1930 (now that all thought of socialism has been virtually eliminated not only from New Labour practice but even from its rhetoric), his book could have had greater impact and wider appeal. Society could be fundamentally different than it is, and large political choices still possible, even if no political party anywhere close to power now offers them.
Though part of a series called History of Medicine in Context, the social and political contexts of this book are retrospectively conceived, and for me, having experienced and participated in much of this history, almost unrecognizable. This mainly concerns the historic conflict between fascism on the one hand, and the eventual alliance between liberal democracies and the USSR and its Communist Parties on the other. Stewart refers often to the embarrassments caused to the SMA by Communists within its ranks (many of whom he seems unaware), suggesting that its life might have been easier and its work more effective, had it avoided contamination in the first place. In his biography of Bevan, Michael Foot, no friend to Communism, admits that ‘demonstrations of protest with which liberal England tries retrospectively to salve its conscience were organized by the Communists. It is not true, unhappily, that the Labour Party and the TUC, inspired by their anger at the MacDonald betrayal, turned with revived energy to lead and guide the passion of revolt'.2 Revolt against mass unemployment, against destitution in the South Wales valleys, and against the appeasement of fascism in Spain, were initiated and led by Communists. In each case they were initially resisted by leaders of the Labour Party and the Trades Union Congress (TUC), though later selectively adopted as their own history. If the SMA had not accepted Communists for membership, or had it succumbed to the many demands from the Labour Party executive before and after the war to expel them, it would never have been an effective campaigning organization. As it was, largely because of the wise, humane, tolerant and imaginative leadership of Somerville Hastings, the SMA stood almost alone in the labour movement first in building a united socialist front in the 1930s, and then in maintaining it even to the present day, when Communism and the Communist Party have virtually disappeared as effective political or intellectual forces, at least in the UK.
Contemporary views of history in the making are always incompletely informed and to a large extent illusory, but they have two outstanding virtues. Day to day experience of how things felt to some people sets limits to how things actually were for everyone else. And contemporary illusions, contemporary choices between the various real forces actually available, were prospective, and therefore falsifiable by subsequent experience. Without some respect for the contemporary views of participants, and some sense of the transient fashions moulding their own opinions, the judgments of historians are likely to seem even sillier to their successors, than the illusions of contemporaries.
In 1926 Christopher Lord Addison, the first Liberal Minister for Munitions, then a Labour Minister of Health, published his influential book Practical Socialism.3 Apart from six interesting pages on the early years of the Medical Research Council, in a wide review of the whole UK economy and society, he never mentions health care even as a social or economic force, let alone as an embryo for future socialist society. By 1948, Bevan's speeches both in and out of the House of Commons4 make it clear that the NHS was, for him and for virtually everyone else active in the broad Labour movement, their first and greatest opportunity to build the origins and foundations for a future society serving human needs rather than personal greed. The experiment came closer to socialist ideas than any of the other nationalizations, and proved far more durable. This transformation in outlook was in large part achieved by the SMA, ironically confirmed today by an equally vigorous campaign from ‘left-leaning' top civil servants and academics to eliminate it, inviting the rich to help the NHS by paying for their own care, rather than by returning to former rates of income tax. Whether the SMA's successor, the Socialist Health Association, will be able to remobilize the labour movement around principles of solidarity remains to be seen. Read critically and with imagination, this book could help them.
References
1 Murray DS. Why a National Health Service? London: Pemberton Books, 1971.
2 Foot M. Aneurin Bevan: a biography. Vol. 1. London: McGibbon & Kee, 1962, p.158.
3 Addison C. Practical Socialism (2 Vols). London: The Labour Publishing Company, 1926.
4 Webster C (ed.). Aneurin Bevan on the National Health Service. Oxford: Wellcome Unit for the History of Medicine, 1991.
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