Wealthy State = Healthy Populations? State Interventions, Health and Inequalities since the Nineteenth Century

Today, the health sector is both perceived as an opportunity for national economies, and as a burden for the states, becoming the target of neo-liberal discourses and policies about cost-efficiency. In this panel, we want to examine the historical transformation of the role of the state in investing in the health of its population, defined as a source of prosperity. By doing that we would like to improve the connection between the history of the welfare state and the history of public health.

Making a Connection between Health and Wealth

Since the 19th century, Western European states have problematized the health of the population as a wealth to preserve, to maintain, and to develop. In the context of growing competition between the emerging nation states, authorities invested in their populations’ health first in the field of public hygiene, often with prevention policies at a local level and in addition to private interventions. From the turn of the nineteenth century into the twentieth, within the development of the social states, national governments implemented the solidarity towards the (working) sick or the elderly. How has the link between the health of the population and the states` interventions been formalized and transformed over the last two centuries with the aim of boosting the nations` prosperity?

Measuring Health to Ground Public Policies

The new concern about wealth and health led to the emergence of knowledge (medical as well as social) about the population and its needs. For instance, surveys of hygienists demonstrated social inequalities of health in the population, i.e. the different vulnerability of individuals towards diseases or accidents in industrial societies. How have population health factors been studied and quantified - including by other actors than the State- and with what consequences for the orientation and implementation of public policies?

Controversies about the Costs of State Investment in Health

In the 20th century, in order to reduce social inequalities, authorities tried to manage populations’ health with the generalization of the access to healthcare and the development of national health systems. But since the 1960ies, state investment in the health sector has been under attack because of the ever-growing costs of healthcare systems caused by the preferences of curative technologies over preventive policies. How did healthcare systems answer to the problem of rising costs? How have some health risks been made visible and governable within certain policies of prevention while others have been ignored?

Contributions to this panel will investigate these different historical issues in specific national contexts.