Author:  George Weisz
Publisher: Johns Hopkins University Press – 307 pages
Book Review by: Sonu Chandiram

This book – a history of chronic disease (which meant different things to different people, as you will find out) – is a comparison and contrast by George Weisz of how it was dealt with by governments, medical communities, and other entities in the United States, the United Kingdom, and France in the 1900s.

Like the origins of most books, Weisz found that no such history existed, and that he would write one. He also found that “chronic disease” to some people meant those diseases that linger and are also degenerative, such as cancer, diabetes, and heart disease that weaken people over time and lead to death.

To others, “chronic disease” has meant acute diseases, like infectious diseases – such as cholera, malaria and tuberculosis – that have come and gone, but killed large numbers of people, despite mass vaccination.

He covers a lot of ground, as shown in the contents page:

  1. Chronic Disease in the United States
    1. “National Vitality” and Physical Examination
    2. Expanding Public Health
    3. Almshouses, Hospitals, and the Sick Poor
    4. New Deal Politics and the National Health Survey
    5. Mobilizing Against Chronic Illness at Midcentury
    6. Long-Term Care
    7. Public Health and Prevention
  2. Chronic Disease in the United Kingdom and France
    1. Health, Wealth, and the State
    2. Alternative Parts in the United Kingdom
    3. Maladies chroniques in France
    4. Epilogue

Weisz shows that for a large part of the twentieth century, the U.S. had different health issues than did France and the United Kingdom. The latter had populations that were of an average older age, and “chronic disease” did not play a significant policy role in those two European nations as it did in the U.S. But since 2000, that has changed, and today, new initiatives deal with the problem in France and the United Kingdom.

Beginning in the latter part of the twentieth century, chronic disease has been dealt with through disease-management strategies, the author points out. These were what spurred this approach:

  • Rising healthcare costs
  • The need to improve quality of care
  • Coordination across healthcare services
  • Standardized outcome measures
  • Use of evidence-based guidelines to direct long-term management of conditions
  • Reduction of acute episodes

Commercial disease-management companies either developed the services with and / or sold them to local health agencies. The disease-management industry grow from $78 million in 1997 to $1.2 billion in 2005, Weisz points out.

The healthcare industry in the United States today is estimated to generate about $2.9 trillion, or one sixth of the country’s gross domestic product of $17.6 trillion.

This important book makes a unique and valuable contribution to the history of disease in general and chronic disease in particular by making comparisons among the United States, the United Kingdom and France. It is well researched and provides unusual and rare insights.

 

George Weisz is a professor of social studies and medicine and Cotton-Hannah Chair for the History of Medicine at McGill University in Quebec. He is the author and editor of several books, including Divide and Conquer: A Comparative History of Medical Specialization, and co-editor of Greater than the Parts: Holism in Biomedicine, 1920-1950 and Body Counts: Medical Quantification in Historical and Sociological Perspectives.