6 Governments and populations
Another of the key features of modernisation in twentieth-century Europe was the changing relationship between ordinary people and the state. In the nineteenth century, the state would have impinged very little on the lives of peasant farmers or industrial workers; in the early twentieth century, local and central governments increasingly regulated their behaviour and supported them through periods of crisis. State support for the sick, the old and the young began in the 1880s in Germany, when the first old-age pensions and sickness and unemployment insurance were established. Other countries followed suit. For example, Britain introduced state pensions in 1908 and a range of benefits under the 1911 National Insurance Act, and Sweden introduced pensions in 1913. In addition, governments began to offer a range of health and welfare services.
Historians have traditionally seen the state provision of health services as a rational response to disease, initiated and shaped by medical experts and bureaucrats. However, more recently, many historians of public policy and medicine have argued that health services were fundamentally shaped by broader social, political and moral ideas. Policy was driven not only by central government but also by charities, political groups, dedicated campaigning associations and local government, many of whom were active in providing services. Putting policy into practice involved a range of experts – doctors, nurses and health visitors. As a result, welfare policies varied from country to country, reflecting particular social and political contexts.
Behind the drive to introduce new forms of welfare and of health provision in the early twentieth century was a concern about the strength of populations. As you have seen, the growth rate of populations was slowing before the First World War and remained low after 1918. In the 1930s, statisticians produced alarming projections of the size of national populations: the population of Britain would be just 28 million by 1976 and 17 million by the year 2000 (Glass, 1967, p. 84). The population of France was predicted to fall from 41 million in 1931 to 29 million in 1980. Towns would be deserted, and factories would lie idle for lack of workers. As well as worrying about the size of the populations, commentators were also concerned about the health and strength of individuals. Wartime recruitment had shown that many of the poorer classes were small or weak, or had defective teeth or eyesight. The size of population and the fitness of its men mattered: at a time of intense national rivalries, ‘population was power’ (Davin, 1978, p. 10). A small, weak population could not provide workers to support industries or manpower to supply the armed forces. As one British MP remarked: ‘The empire cannot be built on rickety or flat-chested citizens’ (Davin, 1978, p. 17). All over Europe, governments made unfavourable comparisons between their own populations and those of their competitor states. Medicine offered possible solutions: encouraging healthy parents to have more children, ensuring that infants received a good start in life and controlling diseases that weakened the adult population.