Power and control in health work

Abstract

In most of the Western world the health care system as we know it today — with its biomedical focus, its hierarchy of trained health professionals and complex primary, secondary and tertiary facilities for cure and care — came fully into being only in the twentieth century. In Britain some health occupations, such as health visiting, only came into existence after 1900, and the idea of a national, co-ordinated service to treat illness was a product of the 1940s. The notion of a single medical ‘profession’, with a virtual monopoly over medical practice, dates from the later nineteenth century in Britain; in the USA monopoly status for doctors came much later. It was only in the 1880s that ‘germ theory’ began to be accepted, and it took another 30 years for it to become the orthodox way of thinking about disease among professional health workers in Europe. Finally, it was about two hundred years ago in the West that people began to think about bodies as collections of discrete cells and membranes rather than mainly undifferentiated ‘flesh’ and organs (Jewson, 1976).