In August 2020 Sally Sheard reflected on society during the first months of COVID-19 through the lens of the work of LSE academic Brian Abel-Smith (1926-1996), who was one of the most influential figures of the twentieth century in shaping health and social welfare.
The potential economic and social impacts of the COVID-19 crisis can be likened to nothing the world has faced since the aftermath of the Second World War. And while its effects have touched all citizens globally, it is clear that the virus thrives primarily on inequalities and the poorest. The World Bank has estimated that the pandemic could push around 49 million people into extreme poverty in 2020. Research by the Institute for Fiscal Studies (IFS) has found that British Black Africans are dying from COVID-19 at more than three times the rate of the British White population, and the Office for National Statistics (ONS) has shown that inner-London and deprived urban areas of England and Wales have suffered far higher death rates than more prosperous and rural locations.
The crisis has exposed the depth of social divides internationally and here in the UK – divides that Brian Abel-Smith sought to close through his long career based at LSE (from 1955 until his death in 1996). He is now regarded as one of the most influential figures of the twentieth century in shaping health and social welfare. His career as an academic, political adviser and welfare services expert in the UK and worldwide made him famous as “a modern-day Thomas Paine, driven by a strong socialist mission to improve the lives of the poorest.”
From his days as an Economics student at the University of Cambridge, Brian was determined to make a difference in the UK and in the rest of the world. While still studying for his PhD he was serendipitously selected to be the researcher for the Guillebaud Enquiry into the Cost of the National Health Service. That was set up in 1952, only four years after the NHS was established, and partly in response to Conservative government concern that the NHS was too expensive. Yet the report showed that spending on the still-infant NHS was far from spiralling out of control as the Treasury feared. To the contrary, the report affirmed the significant benefits to health that the NHS yielded. The report temporarily removed any threat to the continued existence of the NHS.
We can be grateful that Abel-Smith’s work helped to save the NHS from this early threat. But now, despite the millions of people across the country who took to the streets for the first twelve weeks of the COVID-19 crisis to applaud health workers, the NHS faces serious threats yet again. While Prime Minister Boris Johnson has described the NHS as the country’s “greatest asset”, COVID-19 has tested the Service beyond its limits after a decade of underinvestment. The slowdown in annual NHS budget increases has hindered the preparedness and response to coronavirus and has only widened the social divide.
Abel-Smith lived, as Julian le-Grand wrote in his obituary in 1996, by “a religion of doing good”. His important work concerning poverty would become his chief legacy. To this day, students benefit from studying the contribution he made to the early debates on the rediscovery of poverty in the United Kingdom, to which he was a major contributor.
In 1965, he and Peter Townsend published The Poor and the Poorest, a study of poverty in post-war Britain, which argued that the welfare state that the Beveridge reforms brought into being had not eliminated poverty. Instead, they identified a rise in poverty between 1953 and 1954, and again in 1960, at a time of relatively strong economic growth. Social scientists have a key role to play in highlighting how COVID-19 will impact on the longer-term relationship between poverty and health inequality.
The news that people living in the poorest parts of the country are dying from COVID-19 would sadden Brian Abel-Smith and his colleagues, but it is unlikely they would be surprised. The adviser in him would be urging the government focus new resources to reverse health inequalities, and as spread of the virus eases, to ask how we can strengthen and sustain a focus on public health resilience after the crisis.
Policymakers and special advisors could learn a lot from Abel-Smith’s example. He was innovative and realised at an early stage that he did not want to be “just an academic”. He energetically supplemented and enhanced what he did in academia to take on roles within the NHS, in the form of appointments to the governing bodies of London hospitals and hospital committees. This gave him critical evidence and practical hands-on experience of what it is like to run a hospital – experience which served him well when he advised government ministers, and particularly when he was chosen as Richard Crossman’s first special advisor in 1968.
Perhaps Abel-Smith’s work to expose social divides in the UK has never been more relevant than it is about to become. He would have lauded Marcus Rashford’s campaign to provide free school meals during the summer and would likely have a thing or two to say about the failure to produce timely data to enable test and trace systems run by local authorities – which seems to have been determined by political will not technical capability. The impact of his pioneering international work in health and social welfare – advocating universal health coverage – is evident now in the relatively low rates of COVID-19 experienced by some of the Asian countries he advised up to his death in 1996.
Abel-Smith had a reputation for being uncommonly kind and unpretentious but also (sometimes brutally) honest and transparent. These are traits which are of vital importance to the Government now to support economic decisions and public confidence and welfare, both mental and physical.
This post originally appeared on the LSE Social Policy blog