Summary of the impact

The impact on public discourse and public services of this case study derives from research in the history of medicine and public health in modern Wales and is felt by members of the public, disabled individuals and disability groups, health and medical professionals, and civil servants and politicians. Individuals in these various groups have gained a better understanding of the history of their contemporary situations that has allowed them to think, act and behave in different ways, and enabled them to negotiate the contemporary health challenges posed by the rapidly changing economic environment in Wales over the last two centuries.

Underpinning research

The case study is underpinned by extensive research into the history of public health and medicine in modern Wales that has been carried out at Aberystwyth University since 2002 by Dr Steven Thompson (lecturer, senior lecturer since 2012). This work has focused on a variety of aspects of the history of medicine, health-care and welfare in modern Wales and, in all the work completed, an effort has been made to link developments in the particular area to broader social, cultural, economic and political contexts. It is this contextualisation that enables the work to have an impact beyond the academic historical community.

The research work was initiated by Thompson's doctoral thesis, which appeared as a monograph entitled Unemployment, Poverty and Health in Interwar South Wales in 2006 (3.3), and which focused on standards of health in interwar south Wales and found that health and mortality patterns were the product of a complex interplay of a variety of factors such as economic depression, cultural practices, and environmental conditions. Initial work after the doctorate was focused on hospital provision in south Wales during the nineteenth and twentieth centuries and found that, in different contexts at different times, provision of services was both a cause and a consequence of community cohesion and fragmentation (3.2). Further work by Thompson focused more closely on the labour movement to assess the ways in which working-class organisations were involved in the provision of medical care and welfare services; the focus here fell on medical aid societies that arranged GP services for working-class people and trade unions that offered, or facilitated access to, a range of medical and welfare services to members (3.1; 3.5; 3.7). This work emphasised the mutualist aspects of voluntary medical and welfare provision, and the considerable agency exercised by lay people in the past. Subsequent research has focused on particular groups within the population, particularly women and children, to assess the extent to which they gained access to services and the factors that promoted or limited access, and found that such groups were too often marginalised in the provision of services (3.4; 3.6).

Involvement in a major five-year research project on disability in the British coal industry (October 2011 to October 2016), funded by the Wellcome Trust, is the latest research activity that contributes to this case study (3.8). The project is intended to enrich contemporary disability policy and practice by challenging individualized understandings of disability, explaining the importance of social factors, and demonstrating that, since attitudes and policies towards disability are culturally constructed, they are open to change. This is being done through engagement with the Welsh Assembly Government, agencies such as Public Health Wales, disability groups, disabled people, healthcare practitioners, coalfield residents, and the general public. Public engagement activities such as the roadshow have led disabled and non-disabled visitors alike to reflect on the nature of disability in contemporary society. Thompson was the main organiser of the Roadshow and delivered a talk on the Miners' Federation as a disability organisation as part of the day's activities.

Certain themes run through the various research insights gained and have particular relevance to the impact agenda. Such themes include: the distinctiveness of approaches to medicine, health-care and welfare in Wales; the impact of medical and welfare provision on users; the involvement of lay persons in the provision and administration of services; interactions between patients and medical and health-care professionals; and the demographic and health outcomes of provision. These have all been key themes in the research that underpins the case study and serve to increase the impact of that research outside the academic community.

References to the research

Grants Awarded:

3.8 `Disability and Industrial Society: A Comparative Cultural History of British Coalfields, c.1780-1948', five-year collaborative research project funded by the Wellcome Trust, worth £907,220, and involving colleagues at Swansea, Glasgow Caledonian and Strathclyde universities from 2011 until 2016.

Evidence for quality of the research:

• Peer-reviewed journal articles and book chapters

• Wellcome Trust award

• Invited lectures and conference papers in the UK

Details of the impact

The first area of impact, on public discourse, came as a result of the dissemination of research in various public engagement activities. A `Disability History Roadshow' held in Swansea in March 2013 and, organised by Thompson, was one of the public engagement activities of the five-year Wellcome Trust-funded collaborative research project `Disability and Industrial Society: A Comparative Cultural History of British Coalfields, c.1780-1948'. The Roadshow attracted a large and enthusiastic audience, made up of former miners and their families, disabled individuals and members of the public; the average attendance at the Museum on the previous five Saturdays was 973 while the attendance on the day of the Roadshow was 1,213. Questionnaire responses indicated considerable engagement with the various themes in disability history that were pursued through the various activities. Attendees were stimulated by the various talks by historians, enjoyed the historic documentary films, literary readings and ballad performances, and found the discussion of disability in the industry with former trade union leaders to be moving and thought-provoking. As one attendee commented, `'It would be nice if the Welsh Assembly guided by appropriate people and organizations develop a type of educational roadshow to visit schools in Wales and show the children the hardships suffered by people in the coal industry' (5.1). Another attendee stated 'I did not realise how many people died, were disabled until I saw the statistics' (5.1). Writing in a blog on the impact of the Roadshow, the Head of the National Waterfront Museum described the event as a `resounding success' (5.2).

In addition, the dissemination of the research in a variety of media contributions served to extend the impact to a much broader public audience. Feature-length articles on two aspects of the research, workers' medical schemes as inspiration for the NHS and artificial limbs in modern Welsh history, have appeared in the Western Mail, the largest daily newspaper in Wales with an average daily circulation of about 30,000 and a readership of over 100,000; the newspaper's website reaches 1.4 million unique visitors each month. The article `Carving out the story of a false limb's true worth' caused one of its readers to connect the information provided by the article to his pre-existing knowledge about a particular type of artificial limb (5.3). Furthermore, numerous appearances on radio and television programmes and documentaries have served to further disseminate the research to a wider audience and give historical perspective to contemporary issues and discussions. These include an appearance by Thompson on the Post Prynhawn programme on Radio Cymru in 2008 on the history of voluntary hospitals; this was intended to offer historical insights in a longer item on the state of hospitals in contemporary Wales and the threatened closures to local hospitals that were under discussion at that time. Thompson has also appeared on a documentary programme on health services in Britain before the NHS (5.7) and his contributions on a variety of issues were included in the programme, most notably in relation to the Tredegar Workmen's Medical Aid Society, an aspect of his research. The programme was presented by Professor Robert Winston and broadcast on BBC4 in September 2012. In a review published in The Guardian, Sam Wollaston contrasted the inequalities in health care before the creation of the NHS made apparent by the programme: `People with money lived longer of course. They could buy medical treatment. They could take out health insurance. Perhaps their company provided them with schemes; they could go to nice hospitals when they got sick. But if you didn't have a job, or a policy, or you'd let it lapse, you were screwed. On the scrapheap.' (5.4). Other comments on the programme focused on the material on the Tredegar Workmen's Medical Aid Society as of particular interest (5.6).

Thompson also appeared on an edition of Darn Bach o Hanes (A Little Bit of History) that considered the medical provision of the Ivorites friendly society (produced by Cwmni Da and broadcast on S4C in April 2013), and two episodes of Corff Cymru (The Welsh Body) (produced by Boom Pictures Company and broadcast in April 2013) to discuss diet, health and childbirth in recent Welsh history. He has also contributed to features on living standards, health and illness in interwar south Wales for various programmes being produced by Green Bay Media, in English and Welsh, some of which are intended for broadcast while others are being made into teaching resources for school-children. Thompson also appeared live on the live magazine programme Prynhawn Da in March 2013 to discuss disability in the coal industry in south Wales.

A second area of impact, in relation to public services, came with the publication of Public Health in Wales c.1800-2012: A Short History, co-authored with Pamela Michael. This publication places the fruits of academic research at the heart of public health practice and policy-making in Wales. This publication, written in a more accessible style, was commissioned by the Chief Medical Officer of Wales in 2011 as a means to provide historical context to politicians, civil servants, and health and medical professionals in the course of their everyday work and to enable them to make decisions and policy that is informed by historical perspectives. As he stated in the preface, the publications helps to explain `the distinctive Welsh tradition in public health and build the confidence in these roots to secure our healthy future' (5.8). As a result of its location on the NHS Wales website and its distribution at a series of public events, the publication has reached policy-makers, civil servants, politicians and public health practitioners throughout Wales. Hard copies of the book were also sent to all Assembly Members, including the First Minister and the Health Minister, all MPs representing Welsh constituencies, Welsh members of the House of Lords and other academic and medical personnel. Another example of the impact of Public Health in Wales can be seen in a comparison of the mental health services for elderly people in Wales and France written by a French Director of Health and Social Services Trainee from the French Public Health School (EHESP, Ecole des Hautes Etudes en Santé Publique) who was due to take on an appointment as a Director of a nursing home in France (5.9).

These various research outputs and public engagement activities allow individuals working in the sphere of medicine and public health, either as practitioners or as policy-makers, to better appreciate the contexts in which their work has been continued in the relatively recent past. It also enables patients, disabled people, and members of the general public to contextualise and arrive at a deeper understanding of their contemporary experiences within the health system and to manage their interactions with health providers and services.

Sources to corroborate the impact

5.1 Questionnaires completed by visitors to The Price of Coal: A Disability History Roadshow, held at the National Waterfront Museum, Swansea, 23 March 2013.

5.2 Blog by Steph Mastoris, Head of the National Waterfront Museum, Swansea: http://www.dis-ind-soc.org.uk/en/blog.htm?id=4

5.3 Western Mail (Wales Online)
Reader's Comment on `Carving out the story of a false limb's true worth':
http://www.walesonline.co.uk/lifestyle/nostalgia/welsh-history-month-carving-out-3863319

Responses to the BBC4 documentary `Health Before the NHS':

5.4 Sam Wollaston, `TV review: Monroe; Health Before the NHS', The Guardian, 1 October 2012. http://www.guardian.co.uk/tv-and-radio/2012/oct/01/tv-review-monroe-healt-before-the-nhs

5.5 Peter Davies, `Back to the future: healthcare before the NHS', British Medical Journal, 29 September 2012.

5.6 http://liberalconspiracy.org/2011/10/11/watch-how-life-was-before-the-nhs/

5.7 DVD: BBC4 Documentary `Health Before the NHS'

5.8 http://wales.gov.uk/topics/health/cmo/publications/annual/historyph/?lang=en

5.9 Pierre Gavara, How can the mental health needs of the elderly be managed in a context of ageing population and financial constraint? A comparison between Wales and France (2012).
http://www2.nphs.wales.nhs.uk:8080/VulnerableAdultsDocs.nsf/($All)/B28A42F2BA972D0B80257AD7004322CD/$File/GAVARA-Pays%20de%20galles-DESSMS-12-13_rapport-anglais.pdf?OpenElement