History Matters: The Critical Contribution of Historical Analysis to Contemporary Health Policy and Health Care

History is popular with health policymakers, if the regularity with which they invoke historical anecdotes to support policy change is used as an indicator. Yet the ways in which they ‘use’ history vary enormously, as does its impact. This paper explores, from the perspective of a UK academic historian, the development of ‘applied’ history in health policy. It draws on personal experience of different types and levels of engagement with policymakers, and highlights mechanisms through which this dialogue and partnership can be made more efficient, effective, and intellectually rewarding for all involved. History is popular with health policymakers, if the regularity with which they invoke historical anecdotes to support policy change is used as an indicator. Yet the ways in which they ‘use’ history vary enormously, as does its impact. This paper explores, from the perspective of an academic historian, the development of ‘applied’ history in health policy. It demonstrates, through UK case studies, that historical analysis can improve policymaking and service delivery. By focusing on the actual process of policymaking and implementation, especially what happens when earlier policies have been forgotten or deliberately side-lined, historical analysis helps to open up wider opportunities. The paper highlights the similarities between history and improvement science: both disciplines are concerned with change over time, and have developed methodologies to cope with complexity. There is a case to be made for a greater use of historians in health policy and health care, but this requires policymakers and service providers to be aware of what they offer and where to find them, and to routinely engage with them at the start of new policy or service planning. It requires the development of shared objectives, language and planning schedules. The paper first outlines how history has become a key component of popular culture, especially in the UK, and suggests that this has enabled UK some health policymakers to feel they can ‘do it themselves’ to the exclusion of professional historians. Second, it sets out some of the methodological issues and challenges around historical analysis, especially in the setting of periods of study, in comparison with improvement science. Third, it discusses how historians of healthcare in the UK have chosen their research topics, and crucially, the style of output, and how this has facilitated or hindered their engagement with policymakers and service providers. Fourth, it provides two case studies which demonstrate how history can be used at different scales: at the local level using an anniversary (of the first UK public health team in 1847) to provoke a city (Liverpool) to reflect on what has enabled population health to improve; at the national level (UK Department of Health) to demonstrate the impact of cuts in medical expertise in the civil service (1980s–1990s) on the ability of the government to respond to emerging infectious diseases (HIV/AIDS; BSE; MRSA). Fifth, it outlines how UK historians are using new methodologies (witness seminars) and new modes of engagement and dissemination (the History and Policy organisation) to become more proactive in working with policymakers. Although history students are now often taught that their discipline is ‘useful’, or has practical significance, because ‘intelligent action’ invariably draws on past experience, some academic historians are unwilling to see historical ‘lessons’ applied to current ‘real-world’ situations.Footnote1 They would suggest that the uniqueness of a historical event cannot translate perfectly to the present, and so has limited relevance. And, as the US historian Richard Hirsh puts it: ‘More practically, many historians realise that universities rarely provide rewards for work that has direct application outside the ivory tower’.Footnote2 Yet in the UK historians have been developing external work for many years across policy, creative and other arenas, and indeed ‘impact’ is now a key indicator of success for research councils and for the Research Excellence Framework (REF) that helps determine state funding allocations for universities