Unfit Heroes

Conscription in Britain revealed the precarity and ill health that afflicted millions of ordinary people. Conservative domination of the House of Commons acted as a brake on Lloyd George’s efforts to improve living conditions.

In a speech in Manchester in September of 1918, with victory in sight, Lloyd George made the problem of poverty and widespread poor health quite clear:

We have done great things in this war. . . . We could have accomplished greater if this country had been in condition; and a war, like sickness, lays bare the weakness of a constitution. What has been our weakness? Let us talk quite frankly. We have had a Ministry of National Service, and carefully compiled statistics of the health of the people between the ages of 18 and 42. . . . Now, that is the age of fitness, the age of strength. . . . You have these grades, I, II, and III, and all I can tell you is the results of these examinations are startling, and I do not mind to use the word appalling. . . . What does it mean? It means we have used our human material in this country prodigally, foolishly, cruelly. I asked the Minister of National Service how many more men we could have put into the fighting ranks if the health of the country had been properly looked after. I stagged at the reply. It was a considered reply, and it was “at least one million.”

Lloyd George’s coalition government set itself the task of confronting two of the great scourges of post-WWI Britain: inadequate housing and insufficient health services — and not just for ex-servicemen. Reforms were intended to improve the health and well-being of everyone. Christopher Addison, Liberal MP for Hoxton, was appointed the UK’s first minister of health. He held the post for less than two years and yet, in that time, initiated what was to become one of Britain’s signal achievements of the twentieth century.

The 1919 Housing and Town Planning Act, colloquially dubbed “the Addison Act,” sought to address Britain’s housing shortage. The war effort had halted almost all private construction, and the postwar economy was too anemic to revive housebuilding at the scale required. It was estimated that Britain needed at least half a million new houses to meet demand. Under the Addison Act, new housing was paid for by central government and delivered by local authorities and housing associations. Colloquially, this scheme was called “Homes for Heroes.”

Social reformers of the day had far more in mind than simply guaranteeing a roof over every head. The Tudor Walters Committee provided design guidance to the government, resulting in the Manual on the Preparation of State-Aided Housing Schemes. Residential accommodation provided for under the act was on low-density estates — either semi-detached or in short rows, typically with space for a garden to encourage occupants to grow food. The interior specifications of houses were just as important. The act mostly called for three-bedroom houses with modern amenities to ensure proper hygiene and comfort: indoor toilets, baths, and hot water.

This was a genuine commitment by the government to provide housing that would contribute to good health. Regrettably, only a small fraction of the overall number of houses needed were built between 1919 and 1921. The provision of council housing, while revived in later periods, ran afoul in the 1920s to penny-pinching and ideological opposition by the Conservatives.

Business Sector Opposition

Social reformers also pushed for ways to help workers in times of sickness. As Chancellor of the Exchequer, Lloyd George had passed the National Insurance Act in 1911. National insurance required that employees of sixteen to seventy years old, earning less than £160 per year, would have compulsory insurance through their workplaces. Employee contributions were on a sliding scale, based on pay. Sickness benefits were ten shillings per week for men and just over seven shillings for women, paid out over twenty-six weeks.

The National Insurance Act required insurance to make lists of doctors who were able to attend to workers on medical benefits. The act also called for workers to be insured against periods of unemployment, although these provisions were limited to workers in insured trades: building, construction, and mechanical engineering.

But by the mid-1920s, it was apparent that Britain’s fledgling Ministry of Health was failing to develop adequate medical infrastructure to meet the needs of the people. Workplace insurance was one thing but delivering general health care services to the British population would have required radical change for which the coalition government had little appetite. The coalition was beset by administrative obstacles, territorialism, increasing austerity in the face of Britain’s mounting economic woes, and outright ideological opposition from the business sector. In the December 1918 election, “two-thirds of the 265 members returned to the new House of Commons who were associated with business were company directors.”

The first official account of Britain’s Ministry of Health record was published in 1925. As sociologist Philip Abrams explains:

[T]he official history of the new Ministry admitted sadly that virtually nothing had been done to develop the country’s medical services. And it called for the “root and branch reform of local government” that the Bill of 1918 had “intended” as “the only way out.”

Addison resigned from government in July 21 when the cabinet decided to end the government’s support for public housing. Disillusioned with his former party, Addison authored The Betrayal of the Slums and Practical Socialism, joined the Labour Party, and became the Labour MP for Swindon in 1929.

Addison would get another chance at radical reform in the 1940s. He became Labour’s leader in the House of Lords, helping shepherd forward key pieces of legislation for one of the most ambitious governments in British history — Prime Minister Clement Attlee’s government of 1945 to 1951, which created the National Health Service.

Warning From 1920s Britain to 2020s Britain

To follow the long arc of British history from the post-WWI era to our own, few guides are better than Harry Smith, who wrote Don’t Let My Past Be Your Future. Smith was born in Barnsley in northern England in 1923, the son of a coal miner. In the book, Smith recounts the normalized desperation of his working-class childhood, writing, “At the coal mine, my dad toiled in inhumane conditions for his crust of bread, knowing that was the best he would ever get out of life. Our neighbourhood was a place where one lived to work until you were too old or injured to earn your keep and then you died.”

The formative trauma of Smith’s boyhood was witnessing the declining health of his sister Marion, who eventually died of spinal tuberculosis. “I can still see her wasting away in our cramped one-up one-down terraced house,” Smith remembers. “The disease had made her an invalid so she was imprisoned on a wicker bed that had wheels, which allowed my mother to push her outside and enjoy the sun caressing her face.”

Smith is a keen observer of social class, noting that David Wedgwood Benn (brother to famous Labour MP, Tony Benn), also suffered from tuberculosis, and yet while Marion died, Benn survived, thanks to the top-notch health care and other advantages he enjoyed being part of a wealthy family.

Prosperity in the 1920s didn’t simply buy a better chance of survival. It bought something else: the opportunity to actually enjoy life. “The ordinary people of Britain were too poor to afford happiness,” writes Smith. “It was a theft of joy by the elites.”

Smith watched his parents’ marriage deteriorate into bitter acrimony after his father was injured in a mining accident. From this point on, Smith’s boyhood was marred by crushing poverty. His family fled from cheap rental to cheap rental, often by the cover of night. He scavenged in rubbish dumps for salvageable goods to resell. He witnessed his mother pawning her wedding ring for money to survive another few weeks. Smith, who helped with the election campaign for Labour under Ed Miliband and was the subject of a moving tribute by Jeremy Corbyn, has spoken and written passionately about Britain’s slide into the inhumane inequality of a century ago.

This Armistice Day, to give honor where it is due, we should salute the spirit of social reform that was once seen as veterans’ just reward for service. To ensure the creation of a social fabric of the highest calibre, systemic reforms to improve health and well-being should be for everyone. There is no contemporary war on the scale of WWI, yet the COVID-19 pandemic similarly exposed the weaknesses of our social systems, and the sacrifices ordinary people were asked to make should prompt a second effort to build lands fit for heroes. If Western counties such as Britain follow policies of austerity or allow reform to be marred by incrementalism, obstructionism, and timidity, the results will surely be as calamitous for the health of the population as anything seen in the twentieth century.