Papers by Christopher Sirrs
American Journal of Public Health, 2018
The UN Sustainable Development Goals of 2015 have restored universal health coverage (UHC) to pro... more The UN Sustainable Development Goals of 2015 have restored universal health coverage (UHC) to prominence in the international health agenda. Can understanding the past illuminate the prospects for UHC in the present? This article traces an earlier history of UHC as an objective of international health politics. Its focus is the efforts of the International Labor Organization (ILO), whose Philadelphia Declaration (1944) announced the goal of universal social security, including medical coverage and care. After World War II, the ILO attempted to enshrine this in an international convention, which nation states would ratify. However, by 1952 these efforts had failed, and the final convention was so diluted that universalism was unobtainable. Our analysis first explains the consolidation of ideas about social security and health care, tracing transnational policy linkages among experts whose world view transcended narrow loyalties. We then show how UHC goals became marginalized, through the opposition of employers and organized medicine, and of certain nation states, both rich and poor. We conclude with reflections on how these f
Journal of Global History, 2017
This article examines the development of health system metrics by international organizations, ex... more This article examines the development of health system metrics by international organizations, exploring their relationship to the politics of world health. Current historiography treats measurement either as progressive illumination or adopts a critical stance, viewing indicators as instruments of global governance by powerful nations. We draw on diverse statistical publications to provide an empirical overview of change and continuity, beginning with the League of Nations Health Organization, which initiated health system statistics, and concluding with the World health report 2000, with its controversial comparative rankings. We then develop analysis and explanation of these trends. Population indicators appeared consistently owing to their protective function and compatibility with development thinking. Others, related to provision, financing, and coverage, appeared more sporadically, owing to changing trends and assumptions in international health. While partly affirming the critical literature, metrics were also used by peripheral or resistant actors to challenge or influence policy at the centre.
Dynamis, 2019
This article discusses the early postwar history of international engagement
with the ... more This article discusses the early postwar history of international engagement
with the strengthening of health services by the World Health Organisation (WHO). Standard
narratives emphasise that the WHO prioritised vertical programmes against specific diseases
rather than local capacity-building, at least until the Alma Ata Declaration of 1978 launched
a policy focus on primary health care. There was, however, a longer lineage of advisory work
with member states, and our aim is to examine this intellectual and policy history of health
services planning and administration. We begin by surveying the relevant secondary literatu
-
re, noting that this theme appears only briefly in the institution’s first official histories, with
minimal contextualisation and analysis. We then proceed chronologically, identifying an early
phase in the 1950s when, despite its marginalisation at the WHO, the interwar European social
medicine tradition kept alive its ideals in work on health planning. However, the sensitivities of
the USA and of the colonial powers meant that consideration of social security, health rights
and universal coverage was absent from this discussion. Instead it was initially concerned
with propounding Western models of organisation and administration, before switching to a
focus on planning techniques as an aspect of statecraft. In the 1960s such practices became
incorporated into economic development plans, aligning health needs with infrastructure and
labour force requirements. However, these efforts were entangled with Western soft power,
and proved unsuccessful in the field because they neglected issues of financing and capacity.
In the 1970s the earlier planning efforts gave rise to a systems analysis approach. Though in
some respects novel, this too provided a neutral, apolitical terrain in which health policy could
be discussed, void of issues of rights and redistribution. Yet it too foundered in real-world
settings for which its technocratic models could not account.
Governing Risksin Modern Britain: Danger, Safety and Accidents, c 1800–2000, 2016
Over the last twenty years, three short words have come to dominate many discussions about the co... more Over the last twenty years, three short words have come to dominate many discussions about the control of risks: ‘health and safety’. In colloquial use, the term embodies a multitude of concerns about the impact of everyday actions on the bodies and minds of individuals; it also commonly conflates what are often separate areas of statutory regulation, particularly road safety, food safety and environmental regulations. Together with two other words often uttered in the same sentence, ‘gone mad’, ‘health and safety’ is often used as a kind of shorthand for bureaucracy, and the whole gamut of rules and regulations that have evolved in response to the risks of everyday life.
Social History of Medicine, 2015
The 1972 Robens Report is widely regarded to have provided the underlying rationale for the 'mode... more The 1972 Robens Report is widely regarded to have provided the underlying rationale for the 'modern' system of occupational health and safety regulation in Britain, embodied in the Health and Safety at Work Act (HSW Act) 1974. The HSW Act advanced a new, more flexible system of regulation, premised on the ideal of self-regulation by industry. This article advances a more nuanced historical understanding of the Report and its ethos-the 'Robens philosophy'-than hitherto developed, situating its assumptions about accidents, regulation and the role of the state in the social, economic and political context of Britain in the 1960s and early 1970s. Highlighting the interaction between these trends and long-established regulatory practices, the article argues that the turn to 'self-regulation' heralded by the Robens Report was highly convincing from a political and regulatory perspective at the time it was promulgated.
The International History Review`, 2020
In recent years, universal health coverage (UHC) has returned with a vengeance to the internation... more In recent years, universal health coverage (UHC) has returned with a vengeance to the international agenda, raising complex and highly political questions about how health systems should be organised and financed. Drawing upon an extensive analysis of archival material, this article examines the International Labour Organisation's (ILO) approach towards health systems financing in the second half of the twentieth century, exploring its evolving strategy towards social health protection in the context of international development, and its relationship with other international agencies, notably the World Health Organisation and World Bank. It argues that while the ILO's role in international development has come into question in recent decades, its officials have nevertheless made a meaningful contribution to the promotion of health protection worldwide. Despite the wider marginalisation of universalism in postwar international discourse, ILO officials continually shifted their strategy to ensure that mechanisms of health protection such as social health insurance were prioritised in health systems development. ILO support contributed to some notable successes, such as the achievement of UHC in Thailand in 2002.
Thesis Chapters by Christopher Sirrs
This thesis engages with recent historical scholarship on occupational health and safety by analy... more This thesis engages with recent historical scholarship on occupational health and safety by analysing the conditions that shaped the development of British health and safety regulation between 1961 and 2001. Drawing upon a rich vein of archival material as well as oral history interviews, the thesis focuses on the role played by two regulatory bodies, the Health and Safety Commission (HSC) and Health and Safety Executive (HSE), in generating and enforcing this framework of laws and standards. The thesis illuminates two major historical trends. Firstly, it explores the gradual transformation of the British state in its role as health and safety regulator. Since 1974, the focus of British regulation has been to promote ‘self-regulation’ by employers and employees, and the thesis analyses the ways in which HSC/E has attempted to foster a ‘safety culture’ in British industry, in the context of social, political and economic pressures. Secondly, the thesis analyses the evolution of risk in health and safety regulation, from implicit assumptions and practices in policymaking and enforcement, to the formal demand for all employers to conduct written risk assessments. In so doing, the thesis reconciles various paradoxes. One such paradox is that while the role of the British state in regulating health and safety has ostensibly ‘rolled back’ (e.g. via deregulation), health and safety has in another sense ‘crept forward’, extending beyond the workplace to intervene in public safety and environmental issues. Another paradox is that while British health and safety legislation has been ostensibly ‘successful’ in reducing fatal workplace accidents, it has come under unprecedented public and political scrutiny in recent years. Examining the evolution of health and safety against an extensive theoretical background (e.g. the ‘risk society’), the thesis explains how health and safety has become increasingly central to our work and public lives.
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Papers by Christopher Sirrs
with the strengthening of health services by the World Health Organisation (WHO). Standard
narratives emphasise that the WHO prioritised vertical programmes against specific diseases
rather than local capacity-building, at least until the Alma Ata Declaration of 1978 launched
a policy focus on primary health care. There was, however, a longer lineage of advisory work
with member states, and our aim is to examine this intellectual and policy history of health
services planning and administration. We begin by surveying the relevant secondary literatu
-
re, noting that this theme appears only briefly in the institution’s first official histories, with
minimal contextualisation and analysis. We then proceed chronologically, identifying an early
phase in the 1950s when, despite its marginalisation at the WHO, the interwar European social
medicine tradition kept alive its ideals in work on health planning. However, the sensitivities of
the USA and of the colonial powers meant that consideration of social security, health rights
and universal coverage was absent from this discussion. Instead it was initially concerned
with propounding Western models of organisation and administration, before switching to a
focus on planning techniques as an aspect of statecraft. In the 1960s such practices became
incorporated into economic development plans, aligning health needs with infrastructure and
labour force requirements. However, these efforts were entangled with Western soft power,
and proved unsuccessful in the field because they neglected issues of financing and capacity.
In the 1970s the earlier planning efforts gave rise to a systems analysis approach. Though in
some respects novel, this too provided a neutral, apolitical terrain in which health policy could
be discussed, void of issues of rights and redistribution. Yet it too foundered in real-world
settings for which its technocratic models could not account.
Thesis Chapters by Christopher Sirrs
with the strengthening of health services by the World Health Organisation (WHO). Standard
narratives emphasise that the WHO prioritised vertical programmes against specific diseases
rather than local capacity-building, at least until the Alma Ata Declaration of 1978 launched
a policy focus on primary health care. There was, however, a longer lineage of advisory work
with member states, and our aim is to examine this intellectual and policy history of health
services planning and administration. We begin by surveying the relevant secondary literatu
-
re, noting that this theme appears only briefly in the institution’s first official histories, with
minimal contextualisation and analysis. We then proceed chronologically, identifying an early
phase in the 1950s when, despite its marginalisation at the WHO, the interwar European social
medicine tradition kept alive its ideals in work on health planning. However, the sensitivities of
the USA and of the colonial powers meant that consideration of social security, health rights
and universal coverage was absent from this discussion. Instead it was initially concerned
with propounding Western models of organisation and administration, before switching to a
focus on planning techniques as an aspect of statecraft. In the 1960s such practices became
incorporated into economic development plans, aligning health needs with infrastructure and
labour force requirements. However, these efforts were entangled with Western soft power,
and proved unsuccessful in the field because they neglected issues of financing and capacity.
In the 1970s the earlier planning efforts gave rise to a systems analysis approach. Though in
some respects novel, this too provided a neutral, apolitical terrain in which health policy could
be discussed, void of issues of rights and redistribution. Yet it too foundered in real-world
settings for which its technocratic models could not account.