Before the Health Transition : "Health" and Health Policy in Victorian England and after

The health transition has been introduced as a form of sustained change over time which accompanied the mortality transition. But measuring health trends remains deeply problematic. Since health history depends on how "health" is defïned, we should not be surprised that from the nineteenth century to the present competing definitions have produced divergent histories of "health", each of which had different implications for health policy. In this paper controversies over the meaning of "health" are explored as they developed in Victorian England. There the government's medical statisticians assumed that the individual's health status was a constant, while mortality actuaries, who were employed by insurance companies, assumed that it was highly variable over the course of the individual's lifetime. This led to radically different perspectives on to what extent mortality could be explained by environmental differences between places versus income differences between social classes. In both the past and present most of the disputes between professionals over the meaning of "health" were driven by concerns about their own professional welfare, not simply an abstract interest in human welfare.