Sub-project 6: Negotiating health and illness: The United States as a reference model for Dutch health care, 1890-1990

postdoc: dr. Hieke Huistra

This project examines the referential role of the United States with respect to ideas and values associated with individual and collective responsibilities in the pursuit of good health. The focus will be on Dutch appreciation of health risks vis-à-vis considerations of public and private health care arrangements during the twentieth century.

According to anthropologists and historians such as Hofstede, Kleinman and Rosenberg, medical theories and practices are tightly interwoven with cultural traditions. This means that even in countries with similar cultural backgrounds, discourses about health and illness are distinctly articulated. In the United States, for example, low blood pressure is regarded as a sign of good health, in general. In the Netherlands it is treated as a disorder and discussed accordingly.

The on-going Framingham Heart Study (1948) was a driving force behind the redefinition of cardiovascular diseases as a major health problem in the United States, and subsequently in the Netherlands and other European countries from the 1950s. However, Framingham is the result of an earlier development: the rise of the biomedical paradigm in medicine and the use of statistics as a powerful social technology in the nineteenth century. Both developments changed the perception and definition of health and health risks. In the course of the twentieth century, illness was perceived and articulated as a calculable and patterned risk. As a result, new concepts of illness and health were introduced and individual lives were linked to larger economic, scientific and cultural realities in public discourse. This project aims to examine how the United States gradually emerged as a leading reference culture for the Netherlands in this specific subject area, triangulating economy, science and technology, and culture. In order to analyze the ways in which medicine and health care in the United States were perceived and projected in the main research corpus, we will use advanced text-mining tools on Dutch newspapers from 1890 to 1990.

Developments in both countries have both diverged and converged during the twentieth century. The United States adopted an individualistic approach in which health was primarily seen as an individual’s responsibility. The insurance of health risks was consequently placed in the personal sphere. In the Netherlands, the promotion of health was mainly seen as a collective responsibility. The insurance of health risks was, therefore, largely placed on the collective level. Yet, there are similarities as well. Dutch citizens might prefer a collective approach, but medicine is—much like the United States—the realm of private enterprise. Recent evidence even suggests that the Dutch are becoming more like the United States in their coping strategies.

The way in which the United States was used as a reference model in Dutch public debates about the provision and governance of health care seems to mirror a general European ambivalent perspective. Yet we know surprisingly little about the ways the Dutch oscillated between the support of and resistance to developments in the United States. By focusing on this ambivalence, we gain insight in the cultural interference between the United States and the Netherlands. We will also increase our knowledge about the historical mechanisms and patterns of change in Dutch appreciation of health risks and considerations of changing public and private health care arrangements during the twentieth century.

How did ideas and perceptions of health risks and the management of these risks circulate and evolve, and what role did the United States play as a reference culture? How was Dutch appreciation of the mixture of public and private in the provision and governance of health care influenced by developments in the United States? And how did the various historical actors use and frame the differences and similarities between both countries in public discourse?

To answer these questions, this project will compare the results of the newspaper analysis with a study of Dutch insurance journals (Het Verzekeringsblad, De Verzekeringsbode, VVP, etc.) and research in the archives of branch-organizations of health insurers (Verbond van Verzekeraars, ZN), the Royal Dutch Medical Association (KNMG) and relevant government archives (such as those of Gezondheidsinspectie, Sociale Zaken en Volksgezondheid). The project will also examine relevant medical journals and the existing body of literature on Dutch and health care in the United States.