John Eyles - Geography of the National Health (RLE Social and Cultural Geography): An Essay in Welfare Geography

ROUTLEDGE LIBRARY EDITIONS:
SOCIAL AND CULTURAL GEOGRAPHY

Volume 4

THE GEOGRAPHY OF THE NATIONAL HEALTH

THE GEOGRAPHY OF THE
NATIONAL HEALTH

An Essay in Welfare Geography

JOHN EYLES

First published in 1987

This edition first published in 2014
by Routledge
2 Park Square, Milton Park, Abingdon, Oxon OX 14 4RN

and by Routledge
711 Third Avenue, New York, NY 10017

1987 John Eyles

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British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library

ISBN: 978-0-415-83447-6 (Set)
eISBN: 978-1-315-84860-0 (Set)
ISBN: 978-0-415-73156-0 (Volume 4)
eISBN: 978-1-315-84856-3 (Volume 4)

Publishers Note
The publisher has gone to great lengths to ensure the quality of this reprint but points out that some imperfections in the original copies may be apparent.

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The publisher has made every effort to trace copyright holders and would welcome correspondence from those they have been unable to trace.

AN ESSAY IN WELFARE GEOGRAPHY

JOHN EYLES

CROOM HELM
London Sydney Wolfeboro, New Hampshire

1987 John Eyles
Croom Helm Ltd, Provident House, Burrell Row,
Beckenham, Kent, BR3 1AT

Croom Helm Australia, 4450 Waterloo Road,
North Ryde, 2113, New South Wales

British Library Cataloguing in Publication Data

Eyles, John
The geography of the national health: an essay in welfare geography.
1. Medical geography Great Britain
2. Medical caro Great Britain
I. Title
362.10941 RA847

ISBN 0-7099-0928-4

Croom Helm, 27 South Main Street,
Wolfeboro, New Hampshire 03894-2069, USA

Library of Congress Cataloging-in-Publication Data

Eyles, John
The geography of the national health.

Bibliography: p.
Includes index.
1. Medical care Great Britain Utilization.
2. Medically underserved areas Great Britain.
3. Resource allocation. 4. Public welfare Great Britain. I. Title [DNLM: 1. Delivery of Health Care Great Britain. 2. Medically Underserved Area Great Britain. 3. Public Policy Great Britain. 4. Social Welfare Great Britain. W 84 FA1 E9g]
RA410.9.G7E95 1987 362.10425 86-29120
ISBN 0-7099-0928-4

Printed and bound in Great Britain by
Biddies Ltd, Guildford and Kings Lynn

This book about the geography of the national health, as viewed as outcome of resource allocations themselves based on power relations and conceptions of need and justice, has been a long time in the making. It began as a joint project between John Eyles and Kevin hoods and has ended as a solo effort by the former as the latter left Queen foary College to take up an appointment in the NHS. Delays were caused by trying to retain the book as a joint venture but because of Kevin Woods new commitments this became increasingly to mean that it would perhaps never see the light of day. Generously, Kevin Woods has allowed his work to be used and moaified. I gratefully acknowledge the use of that material. The necessary take-over of the volume by John Eyles has perhaps meant that emphases have changed. Thinking about and drafting the conceptual chapters and then trying to relate them to empirical and policy matters has led to the conclusion that this book is a start to reconstruct, in a particular way, the geography of welfare: hence its sub-title. This may lead health care geographers to view the volume unfavourably, although in its defence it may be suggested that health and welfare themes from the new Poor Law to the 1960s are used to illustrate the broader themes, which of necessity go beyond geography of the national health. And to be meaningful, a geography of welfare must treat not only the where question but also the who, the what and crucially the how. It is hoped ttiat these themes may be further tied together in a third (and final) volume on comparing health and welfare systems.

Some acknowledgements are in order: Carol Gray yet again produced high quality camera-ready copy, Leslie Mine excellent maps and diagrams and Kevin Woods, especially early on, shared his insights. Peter Sowden at Croom Helm must be thanked for letting many final deadlines pass. My family put up with yet another absence, this being particularly hard on a three-year old. And it is to him that 1 dedicate this book.

The purpose of this book is to describe and analyse the geography of the national health with special reference to Britain. It is in many ways a study in welfare geography as its central themes are covered by the question who gets what where and how. The various parts of this question structure the book and form the foci of different chapters. The what is taken up in , six, summarises the main arguments of the book, comments on the nature of welfare geography, assesses the impact of integrated approaches on the policy process and points the way forward to geographies rather than a geography of the national health.

The purpose of this book is to examine the shape and texture of the geography of the national health. We intend, however, to take a specific view of geography and national health. By geography, we mean not only the patterning of social and epidemiological conditions across territories. We also regard the spatial basis of policy initiatives to tackle problems emanating from these conditions as geography. A geographical perspective is, therefore, a necessary frame of reference for any analysis of health and health care. It is not of course a perspective sufficient to itself. Any geography must be part and parcel of a broad-based examination of health. A fuller discussion of this view may be found in Eyles and Woods (1983). The term national health is derived from the British experience and may be regarded as an implicit reference to the national health service (NHS). We do not, however, intend to present a discussion of the changing nature of the NHS. There are several recent expositions of such developments (Allsop, 1984; Klein, 1983). Rather, we are concerned with the nature of health. Indeed, this chapter will deal with the conceptual problems of health and illness the what question and we shall see that the national health in essence means the national illnesses and that the NHS would be better called the NIS (the national illness service) or the NSS (the national symptom service). As may be surmised national is simply taken to mean health and health care in one country, specifically, in our case for the purposes of this book, Britain. We recognise that illness and disease can be exported as in the occupational hazards of branch plants and factories in the Third World and the iatrogenic illnesses associated with drug exporting policies in the same regions of the world. We must also note that styles of health care delivery in one part of the world will influence, affect and shape those in other areas as has happened with the US private system of provision influencing British policy and practice and the Australian system of funding health care being based on the Canadian. These interrelations are, however, beyond the scope of this book.