Why the reality of Infection drives a powerful argument for universalism in policy.

In 1966 I took an A level Economic History exam.

One of the questions for which I prepared, as it was frequently set, was “‘Cholera Kills all Classes’ – How does infection explain the drive for 19th century social reform?”.

In the curriculum we had learnt that from the 1840s onwards there were regular outbreaks of cholera in Britain that would kill thousands of people from all social classes. It was true that there were always more deaths amongst poorer people, but rich people died too.

For decades those that resisted reform had a theory that the disease of cholera was carried to people by a ‘miasma’, a sinister kind of mist. If you were rich enough to live above the miasma, on higher ground, you would be free of it. This seemed to be true as more people who lived nearer the rivers (where the mist was) died and those who lived further away and higher suffered fewer deaths.

But as the 1840s became the 1850s it became clear that people who lived up the hill also died. However far they built their houses away from the river, they died. This led to an alternative theory – that the disease was carried by an infected person and that it was contact with them that caused the disease to be transmitted. This explained how the disease was carried to people above the miasma.

When the poor infected people left their homes within the mist and went to the rich people’s homes, above the mist, to change their beds and cook their meals, they were infecting their employers. Even when they didn’t meet them they were infecting them because the infection was left behind by their labours.

Of course, the infection was strongest in the rookeries – later to be known as the slums – where sanitation was worse. These were the places where the disease would incubate, infect a lot of people, develop and become rampant. The problem was that these people were a part of an economy which required them to move about.

This was a very expensive discovery. From the 1860s onwards the modern day equivalent of billions of pounds was spent on clean water and sewerage for everyone. And that’s the problem with infection. The policy solution has to be for everyone. The problem was that if you just spent it on the rich, if they had sewage and clean water, it still wasn’t enough to stop the deaths.

For infection to be defeated everyone, every single person, needed clean water and sewerage.

In a modern Victorian city where the economy needed people to be mobile leaving only one ‘cholera den’ untouched would retain the danger of infection. For infection to be defeated everyone, every single person, needed clean water and sewerage. The poor people couldn’t pay for it, so the money had to come from local and national taxation. It needed clean water and sewage for all.

At a time when the argument for universalist policies was not a part of majority political discourse – infection made that argument. It was no good saying “look let’s just have a policy of good sanitation for 90% and ignore those feckless migrants who have just arrived in this country”. That argument wouldn’t work because the needs of the economy would require the feckless to carry that infection from locations without sewage.

This is how infection drives the case for the necessity of Universalist policies. Dismiss one group as being beyond society and they will bring the infection to you. They – all of them – need to be clear of infection.

The point of my A-level question was to raise the historical fact that a dangerous infection created an argument for collective and expensive action that was, in the end, unanswerable. This is NOT to argue against the importance of agency and politics, but clean water and sewage did not come about as the result of ideological argument but as the consequence of the universal nature of infection .At the time it was possible to ignore the Chartists and their arguments for greater equality because they were ideological arguments.

You could not ignore the infection.

It was a material argument which always won in the end.

What might this mean for us now?

I have – a little laboriously – made this argument to explain why, in the current infection crisis, the government, most of whom have never argued for the extension of universalist state policies, are now very strongly enacting them.  This radical change has not come about because in some way the left has won the argument for universalism (It hasn’t) – it has come about because of the universalism of infection.

We now have a strongly individualist government carrying out collectivist policies striving every day for a universalist policy that will reach everyone.

And they really, really mean it.

In trying to carry this out they have uncovered problems that most people knew about intellectually but before this crisis didn’t matter enough. The problem of sick pay not being universal is one example. The problem of sick pay being £94 is another. People with the virus on zero hours contracts won’t have sick pay and will continue doing their job as their livelihoods depend on it. Government was not interested in changing that. They are now.

So, for example, every rough sleeper needs to be included in society. If we pretend they are not they could infect everyone in that society of which they are not a part. People of uncertain citizenship status are not allowed to access non- emergency NHS services. This is another dangerous policy which will be changed. Some foreign clinicians have to pay for their own health care and yet are expected to risk their lives on the front line of the fight against infection.

None of these inequalities will survive the next few weeks.

This is not just a matter of ideology. “We are all in this together”. Infection means that this must be a matter of implementation. Practical universalism in action must be the way in which all policies work. When they don’t they endanger the entire nation.

This is a major political moment for all those that believe in universalism. The Government is not choosing to do this. Infection is driving them to do things that two short months ago they didn’t believe in.

People will be very relieved when this crisis is over. We will all ‘want to put it behind us’. How we argue that infection taught us we were all equal will, in the future, decide who wins the afterwards argument.

One Reply to “Why the reality of Infection drives a powerful argument for universalism in policy.”

  1. It didn’t lead to universalism after the Cholera epidemics and it won’t now after COVID 19. The Cholera epidemics led to better ways of reducing outbreaks of cholera and better sanitation for all which was hardly universalism. But the 2nd World War did lead to greater universalism, but to wish for such a cataclysmic event for such an outcome (only partial at that), which would itself almost certainly only be effective for a generation or two is hardly desirable.

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