Abstract
It is a truism that most health is gained and lost outside the scope of health services; yet, the real engine rooms of public health often struggle for recognition against the spotlight directed elsewhere. As we enter a profound economic recession against the backcloth of war in Europe and the breakdown of social consensus as to what makes up the good life, it is timely to remind ourselves that it doesn’t have to be like this.
The lives and work of two pioneers from the recession and war years provide a glimpse of alternative paths.
One of the features of the interwar period was the explosion of car ownership and the development of ‘car culture’. 1 The number of private vehicles on the road increased from 187,000 in 1920 to 1,523,000 by the outbreak of World War II. The rapid increase in the number of privately owned cars was facilitated by the reduction in the price of cars and a general rise in living and income standards of lower middle-class families. As the number of vehicles increased, so did the number of fatal accidents, from 2386 in England and Wales in 1920 to 5690 in 1935.
Against this background, the single-minded impact of Leslie Hore-Belisha as Minister for Transport from 1934 to 1937 stands out. Coming from an established Jewish family whose longstanding affiliations were to the progressive West London Synagogue, he was a member of the Liberal Party and lawyer before entering parliament in 1923. 2 A supporter of Ramsay MacDonald and the National Government in 1931, he had become chairman of the National Liberal Party and Financial Secretary of the Treasury, but it was as Minister of Transport that he first made his mark.
Belisha’s 1934 Road Traffic Act introduced not only the Highway Code and driving tests for new drivers but also set a speed limit of 30 mph and put in place safe pedestrian road crossings marked by the distinctive ‘Belisha Beacons’. In a 12-month period, road traffic injuries were reduced by 12,805 and deaths by 822. 3
With war on the horizon, on 25 May 1937, Belisha was appointed the Secretary of State for War where he would overlap with a second significant figure in the battle for public health in extreme adversity, Lord Woolton, nee Frederick James Marquis.
Born in Salford in 1883, Woolton was the only surviving child of a saddler and had gone via grammar school to Manchester University. An active member of the Unitarian Church, he spent many years as a volunteer doing social work in a poverty-stricken area of Liverpool. Judged unfit for military service in World War I, he had worked as a civil servant in the War Office at the Leather Control Board, an experience that led on to his joining Lewis’s Department Store, where he progressed to director in 1928 and chairman in 1936. In 1938, he responded to Hitler’s annexation of Austria by announcing that his stores would boycott Nazi German goods, a move that antagonised Chamberlain’s National Government but coincidentally resonated with Hore-Belisha’s increasingly vocal criticism of German ambition and underscored a convergence of these two men’s trajectories.
On appointment as the Secretary of State for War, Belisha had called in Sir Isadore Salmon, head of Lyons Corner House Cafes, to advise on catering. With the British Army under strength and in a state of crisis, Belisha embarked on an energetic set of reforms; barracks were to be centrally heated and provided with spring beds, showers, recreation rooms and radios; married men could sleep with their wives out of barracks; soldiers under 21 could sleep at their parents’ homes; generous pensions were to be provided; men with dentures were to be accepted; soldiers leaving the services were to be trained on full pay for civilian occupation; tunics were replaced with practical battle dress; and promotion was to be on merit, a measure that antagonised an officer class used to preferential treatment. Recruitment to the territorial army subsequently doubled but Belisha had made powerful enemies who would not rest until they had their revenge. 2
While Belisha was doing his best to prepare the country to face up to the threat posed by Nazi Germany, Lord Woolton was moving up a gear, drawing heavily both on his logistical expertise from managing a major department store and on his passion for statistics that he had carried with him from his early years as a teacher in Burnley.
Having been knighted in 1935, when war broke out in 1939, Chamberlain invited Woolton to use his background in mass procurement to clothe the British Army. In setting about the task, using whatever data he could find on the anthropometric measurements of the troops, he pointed out that ‘The War Office had no statistical evidence to assist me … I had the greatest difficulty at arriving at any figures that would show how many suits of uniform and how many boots were involved’.
Ennobled in 1939, and having taken the title of Woolton from his home in Liverpool, he was moved by Chamberlain to be Minister of Food with the task of keeping the nation from starving.
4
Once again he was met with the problem of a dearth of relevant data on which to base policy, turning to Major Greenwood from the London School of Hygiene and Tropical Medicine and friends and colleagues at the Royal Statistical Society for advice and support. According to Woolton, Here indeed was a field for the statistician. Our needs had to be interpreted in terms of calories and vitamins … different classes of people had widely different needs if their health and vigour were to be maintained; our armies had to be fed according to the needs conditioned by fighting in widely differing climates; our children and nursing mothers had to have food appropriate to their particular needs; and all these variations had to be expressed in terms which would enable us to determine the nature of home production and the precise tonnage of our imports …
This evidence base provided the foundations for a system of scientifically based rationing that endured until well after the war and represented a major social realignment of equitable access to good nutrition. One of Woolton’s most celebrated initiatives was ‘Woolton Pie’, a vegetarian recipe created by Francois Latry, the French born chef of the Savoy hotel and consisting of diced potatoes, cauliflower, swedes and carrots, spring onions, vegetable extract and whatever pastry could be found as a crust. It is often claimed that for the duration of food rationing, pregnant working-class women were able to experience a level of nutritional wellbeing previously unknown. 5
While Woolton’s career and reputation continued throughout the war, and subsequently when he became President of the Royal Statistical Society, Chairman of the Conservative Party and Minister for post-war Reconstruction, as ships passing in the night, for Hore-Belisha it was to be a much more mixed ride. His warnings about the rise of fascism in Germany led to an anti-Semitic backlash led by the Conservative MP Archibald Ramsay, who in a speech in 1938 warned that Hore-Belisha ‘will lead us to war with our blood-brothers of the Nordic race in order to make way for a Bolshevism Europe’. In 1939, Archibald Ramsay founded a secret right-wing society with the explicit purpose being ‘to clear the Conservative Party of Jewish influence’. The pressure built on Chamberlain, and in January 1940 Hore-Belisha was sacked as Secretary of State for War despite all he had achieved in getting the armed forces up to speed to face down the Nazi threat. Brought back briefly by Churchill as Minister of National Insurance in the post-war caretaker government of 1945, he lost his parliamentary seat later that year.
Lord Woolton died in Arundel in 1964, aged 81, while Hore-Belisha died suddenly from a stroke on a visit to France in 1957, aged 63.
These two remarkable men who rose to the challenge of public health when it was most needed and had a global impact of population's health through environmental and behavioural policies.