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Principle of Prevention in United Kingdom

The Principle of Prevention and the Majority Report of the Royal Commission of 1905-1909

In this issue about the principle of prevention, the book “English Poor Law Policy” [1] reads as follows: From the Minority Report proposals, thus succinctly put, we have so far omitted what is really the kernel of the whole matter. These ordinary functions of municipal and county administration-the hospitals and schools and asylums and the domiciliary treatment of one kind or another-are costly; and they are apparently especially costly the more consciously and the more systematically we administer them on the Principles of Curative Treatment, Compulsion, and Universal Provision. If we hand over to the Local Education Authorities those children for whom the Boards of Guardians still provide; to the Local Health Authorities those infants, sick and infirm, who are still under the Poor Law; to the Local Lunacy Authorities the feeble-minded still retained in the workhouse; to the Local Pension Authorities the aged who have not yet got national pensions; and to the Unemployment Authorities, local or national, the vagrants and other able-bodied persons who are still among the paupers, will not this involve, in comparison with the cost under the Board of Guardians, a great increase of public expenditure, and can any such increase be justified?

We need not, at this point, stay to argue that, owing to the practical abandonment of the “Principles of 1834,” the administration of the Board of Guardians has itself become very costly; that children in Poor Law Schools and patients in Poor Law Infirmaries often cost more per head than children in the boarding schools of the Local Education Authority and patients in the hospitals of the Local Health Authority; and that seeing that the very existence of overlapping Public Authorities and duplication of work is, in itself, a wasteful extravagance, there is no reason to expect any increase in net cost from the mere fact of the transfer.

In the view of the Minority Commissioners what is more important is that the whole development of Municipal and County administration, of which we may take the Public Health Acts as the leading example, is justified to the rate-payer and to the economist, by the still greater expense that it prevents. The Minority Report embodies a whole series of proposals, which would amount, as has been expressly said, to setting on foot a systematic crusade against the very occurrence of destitution in any of its forms: against the destitution caused by Unemployment, the destitution caused by Old Age, the destitution caused by Feeble-mindedness and Lunacy, the destitution caused by Ill-health and Disease, and the destitution cause by Neglected Infancy and Neglected Childhood.

The deliberate and systematic adoption of this Principle of Prevention is the very basis of the Minority Report proposals. It is, in fact, this principle which underlies all the three “Principles of 1907,” that we traced in a previous chapter as the outcome of all the practical experience of the last seventy-five years. The Local Authorities do not apply the Principle of Curative Treatment wholly, or even mainly, for the pleasure or the advantage of the individual sufferer; what they have in view is the prevention of future evils to the community from the spread or recurrence of the disease, or the continuance of the disability. When they apply the Principle of Compulsion, they do so, not for its own sake, and not even for the immediate advantage that it brings, but in order to prevent greater evils to the community in the future, such as the existence of illiterate and wholly uneducated persons, or the outbreaks of violent lunatics, or the more subtle degradation of the Standard of Life by the procreation of the feeble-minded and the undermining competition of degenerates. If, in one service or another, the Principle of Universal Provision is adopted, it is because we have become convinced, with regard to that service, that Universal Provision, either gratuitously or at a charge, is actually less expensive than any alternative; or that it is of such great importance to the community to “maximise the consumption” that it may be looked upon as really preventing some more costly evil. Throughout the whole field we find this Principle of Prevention at once limiting the real cost to the community, and justifying the outlay. In some cases, indeed, the application of the Principle of Prevention is so successful as to bring to an end the very outlay which it has inspired. To put up a smallpox hospital is costly; but it may end in freeing the community from smallpox, with the result that the building stands empty. By starting special treatment for ring-worm and favus, the most enterprising Local Education Authorities now see their way to the total elimination of these diseases from their schools.

Now, the inherent vice of the vast expenditure at present incurred by our Poor Law Authorities is, to the economist, not its amount, nor its indiscriminateness, but the absence of this Principle of Prevention. Except with regard to the small minority of “indoor” or “boarded-out” children, and a small proportion of the sick, it cannot be said that the Poor Law Authorities make any attempt to prevent the occurrence of destitution. It is, indeed, not their business to do so. Unlike the Local Health Authority, the Destitution Authorities can do nothing to alter the social environment which is continually producing new destitution. They can do nothing for the man who is just beginning to suffer from phthisis, but who still earns wages and is not yet destitute; though they know that, in a year or two, for lack of proper provision at the incipient stage, the man will become gradually worse, and will eventually enter the workhouse, long after the curable stage has passed, merely to die. Unlike the Local Education Authorities, the Destitution Authorities cannot reach out to prevent the neglect of children which will, in time, produce “unemployables.” The whole of the action and the whole of the expenditure of the existing Boards of Guardians, and equally that of the new Public Assistance Authorities proposed in the Majority Report, must, in law, be confined to the relief of a destitution which has already occurred.

If we wish to prevent the very occurrence of destitution, and effectively cure it when it occurs, we must look to its causes. Now, deferring for the moment any question of human fallibility, or the “double dose of original sin,” which most of us are apt to ascribe to those who succumb in the struggle, the investigations of this Royal Commission reveal three broad roads along one or other of which practically all paupers come to destitution, namely: (a) sickness and feeble-mindedness, howsoever caused; (b) neglected infancy and childhood, whosoever may be in fault; and (c) unemployment (including “under-employment”), by whatsoever occasioned. If we could prevent sickness and feeble-mindedness, howsoever caused, or effectually treat it when it occurs; if we could ensure that no child, whatever its parentage, went without what we may call the National Minimum of nurture and training; and if we could provide that no able-bodied person was left to suffer from long-continued or chronic unemployment, we should prevent at least nine-tenths of the destitution that now costs the Poor Law Authorities of the United Kingdom nearly twenty millions per annum. The proposal of the Minority Report to break up the Poor Law, and to transfer its several services to the Local Education, Health, Lunacy, and Pension Authorities, and to a National Authority for the able-bodied, is to hand over the task of treating curatively the several sections of the destitute to Authorities charged with the prevention of the several causes of destitution from which those sections are suffering. This means a systematic attempt to arrest each of the principal causes of eventual destitution at the very outset, in the most incipient stage of its attack, which is always an attack of an individual human being, not of the family as a whole. It is one person, at the outset, who has the cough of incipient phthisis, not a whole family; though if no preventive force is brought to bear, destitution will eventually set in and the whole family will be on our hands. There may be in the family neglected infants, neglected children, or feeble-minded persons lacking proper care or control, who may not be technically destitute, who may even be dependents of able-bodied men in work, but who, if left uncared for, will inevitably become the destitute of subsequent years. Hence it is vital that the Local Health Authority should be empowered and required to search out and ensure proper treatment for the incipient stages of all diseases. It is vital that the Lunacy Authority should be empowered and required to search out and ensure proper care and control for all persons certifiable as mentally defective, long before the family to which they belong is reduced to destitution. It is vital that the Local Education Authority should be empowered and required to search out and ensure, quite irrespective of the family’s destitution, whatever Parliament may prescribe as the National Minimum of nurture and training for all children, the neglect of which will otherwise bring these children, when they grow up, themselves to a state of destitution. It is becoming no less clear that some Authority-the Minority Commissioners say a National Authority-must register and deal with the man who is unemployed, long before extended unemployment has demoralised him and reduced his family to destitution. It is important to put the issue quite clearly before the public. The systematic campaign for the prevention of the occurrence of destitution, that the Minority Commissioners propose that the community should undertake by grappling with its principal causes at the incipient stages, when they are just beginning to affect one or other members of a family only, long before the family as a whole has sunk into the morass of destitution, involves treating the individual member who is affected, in respect of the cause of his complaint, even before he is “disabled” or in pecuniary distress. It means a systematic searching out of incipient cases, just as the Medical Officer of Health searches out infectious disease, or the School Attendance Officer searches out children who are not on the school roll, even before application is made.

At present the Local Education Authorities, the Local Health Authorities, and the Local Lunacy Authorities only feebly and imperfectly grapple with their task of arresting the causes of destitution in the child, the sick person, or the person of unsound mind, partly because they have only lately begun this part of their work, but principally because they have not been legally empowered and legally required to do it. Moreover, they do not yet have forced on their attention, as they would if they had to maintain those who needed to be cured, the extent to which they fail to prevent. If the Health Committee knew that it would have eventually to maintain the sick men whom it allowed to sink gradually into phthisis, as it has now practically to maintain persons who contract smallpox, it would look with a different eye upon the Medical Officer of Health’s desire to “search out” every case of incipient phthisis whilst it is yet curable, to press upon the ignorant sufferer the best hygienic advice, and to do what is necessary in order to enable the insidious progress of the disease to be arrested. This does not entail that all diseases shall be treated free, any more than the Public Health supervision of sanitation entails that bad landlords shall have their house drainage provided at the public cost. All the increased activity of the Public Health Authorities in searching out and treating sickness may coincide with a systematic enforcement of personal responsibility in respect to personal hygiene, and with regard to the maintenance in health of dependents, which we, in fact, recommend. The break-up of the Poor Law implies, in short, not only the adoption of a systematic crusade against the several preventable causes of destitution, but also a far more effective enforcement of parental responsibility than is at present practicable.

Viewed in this light, the fear of an increased charge upon public funds fades away. Prevention is not only better, but also much cheaper, than cure. What the Minority Report asserts-and the assertion cannot fairly be judged except by reading the elaborate survey of the facts and the whole careful argument, that it has now become possible, with the application of this Principle of Prevention by the various Public Authorities already at work, for destitution, as we now know it, to be abolished and extirpated from our midst, to the extent, at least, that plague and cholera and typhus and illiteracy and the labour of little children in cotton factories have already been abolished. If this confident assertion is only partially borne out by experience, it is clear that, far from involving any increase of aggregate cost to the community, the abolition of the Poor Law and of the Poor Law Authority will have been a most economical measure.

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Notes and References

  1. Sidney Webb and Beatrice Webb, “English Poor Law Policy” (1913), Longmans, Green and Co., London, New York, Bombay and Calcuta.

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  • Article Name: Principle of Prevention
  • Author: Glanville L. Williams
  • Description: The Principle of Prevention and the Majority Report of the Royal Commission of 1905-1909 In this issue about the principle [...]

This entry was last updated: March 13, 2017

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