3 - Politics and policy: historical perspectives on screening

Summary

Introduction

This paper grew out of the realisation that the governing context of my appraisal of contemporary AIDS policies was the historical material that I was dealing with in my research on tuberculosis policy and health education. The debates surrounding HIV serotesting had a deep resonance in the correspondence in the Public Record Office (PRO) files of the Ministry of Health dealing with policy formation on mass testing and health surveillance. Here too there was long, careful and critical consideration of the mandate and responsibility for the extension of routine health services into new territories. There was also concern at the Cabinet level about international co-operation in epidemiological data collection and the consequences of exclusionary immigration controls. I was struck too by the problems, both epistemological and practical, which the notion of ‘presymptomatic illness’ had posed for policy makers.

In saying this, I must, however, be cautious of the methodological trap of ‘presentism’; i.e. attempting to interpret past actions and actors in terms of the cognitive structures, analytical paradigms and critical agendas of the present. This is a particular danger for sociologists such as myself who look for the broader dynamics involved in policy changes over and above those which are situation specific. However, it would be overcautious in the extreme to fail to bring to the table of contemporary discussions the longer history of experience of creating preventive health programmes.