AbstractThis thesis examines the emergence, evolution and professionalisation of the environmental health practitioner (EHP) from the sanitary reform era to the award of a Royal Charter in 1994. The approach was chronological and historiographic, with analysis using sociological theories of professionalisation.
The EHP evolved from the ancient offices of 'inspector of nuisances' and 'leavelooker', but the true genesis came in the 1840s when 'nuisances' became associated with disease and it was necessary to appoint full-time inspectors with a dedicated public health role. The thesis provides inter alia the first published evidence of the appointment by a UK local authority health committee of an EHP, in Liverpool in 1844; pre-dating Liverpool's celebrated appointment of the UK's first Medical Officer of Health. The thesis elucidates the role of the Health of Towns Association and the significance of the Liverpool precedent. It fills the gap in knowledge surrounding the constitution of the first examination board and explains the sequence of changes of the inspectors' official designation.
Professionalisation was characterised by a struggle against medical dominance and the related power asymmetry at critical junctures, in particular during the initial establishment of the examination board. Social class was the principal structure that influenced the early evolution of the EHP. The main facilitator was an increasingly powerful occupational association. Full professionalisation was not attained until the qualification incorporated the full body of professional knowledge, from 1966, and complete professional autonomy was achieved in 1974 when the MOH function was removed from local government.
The thesis reveals two historically unique forms of 'state-mediated medical subordination': in the linking of state closure with the sustained exclusion of the inspectors from the examination board, and in subordination through title change. It also proffers the concept of 'institutional medical dominance' to explain an extreme form of embedded medical domination.
|Date of Award
|William Williams (Supervisor), Alan Cribb (Supervisor) & Gerard Lum (Supervisor)