Eugenics, Social Medicine and the Career of Richard Titmuss in Britain 1935-50

Abstract

The pursuit of health by a society or social group requires a position to be adopted on two central issues. One issue concerns the relative importance of nature and nurture, while the second, related question has to do with whether it is the individual or the environment that is seen as the appropriate focus of health-promoting activities. While the philosophy of eugenics expresses one extreme of this continuum nature and the importance of the individual that of social medicine as articulated in the postwar period in Britain marks the other, in stressing the importance to health of social and environmental factors. For most of the first half of the twentieth century, the terminology of eugenics, the first 'scientific'2 understanding of individual conduct and development, dominated the public discourse about health in Britain and other countries. During the years leading up to and out of the Second World War, the public debate about health in Britain focussed on the spectre of a fading population. The debate highlighted population quality as well as quantity, shaping the problem into the ideological format of 'differential fertility', defined by D. V. Glass, leading investigator of population issues, as one of the primary aims of the new discipline of demography.3 The concept of differential fertility drew attention to the fact that socially advantaged groups tended to have fewer children than disadvantaged ones. But, somewhat paradoxically, out of this concern with differential fertility and mortality emerged the new phenomenon of social medicine. Whilst the public health movement had earlier focussed attention on people's living conditions as a source of important health constraints, social medicine, by providing 'a medicine of the social',4 added to this by directing attention to facets of individuals' 'lifestyles' as affecting health and use of health services. In tracing the birth of social medicine from a parentage dominated

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