Rickets, ‘Race’ and Public Health Strategies in the Twentieth Century

Key Messages

In Great Britain, rickets used to be a symbol of socioeconomic inequality.

Through highly interventionist nutrition policies, the disease was successfully targeted at the population level during World War Two.

The re-emergence of rickets among British Asians has been considered a cultural issue and thus not treated efficiently.

The Issue

This case study explores how a preventable, curable and non-infectious disease has had various political meanings attributed to it. It shows how the perception of causes of a disease can directly affect the strategies deployed in responding to it, and can operate independently from medical evidence. Public health responses to nutritional rickets in twentieth century Britain demonstrate this effect and its impact both on patterns of research and health outcomes.

Policies of active intervention, implemented when rickets was understood as a socially damaging disease of the majority population in wartime, were replaced by education-only interventions when rickets was reinterpreted as a condition of a culturally distinctive ethnic minority group in the 1960s.

Cultural Contexts

In the early twentieth century, rickets in Britain was regarded as a disease of inner-city infants and children, caused by environmental and lifestyle factors such as the proliferation of industrial slums, poverty, and the decline of breast-feeding.

Freighted with political significance as a marker of inequality, rickets was successfully targeted at the population level by highly interventionist nutrition policies during World War Two. However, from the 1960s and onwards, the public image and political meaning of rickets has changed dramatically with its re-emergence among British Asian adolescents and young women.

While some researchers attributed the return of rickets to continued income inequalities and declining nutritional intervention, others stressed the (presumed) impact of religion on dietary and clothing choices amongst immigrant communities. These attributions reflected political positions as well as clinical findings.

In the absence of professional consensus, efforts to eliminate rickets were delayed, diminished and limited to education-only interventions.

Policy implications

This study shows how changing perceptions of mass medical interventions and unvalidated assumptions about the cultural causes of a politically-charged condition prevalent among a socially stigmatized group shaped public health responses.

This finding suggests that close attention to the political and cultural meanings attributed to specific health conditions is necessary to understanding how public health interventions are selected, implemented and assessed for efficacy.

Links for further reading

  1. ‘Ideology and Disease Identity: The Politics of Rickets, 1929-1982’Medical Humanities, 39.2 (Dec 2013).
  2. Contagious Communities: Medicine, Migration, and the NHS in Post War Britain (Oxford: Oxford University Press, 2015).
  3. Re-writing the ‘English disease’: Migration, Ethnicity and ‘Tropical Rickets’, in Mark Jackson (ed.), The Routledge History of Disease (London: Routledge, 2016)