ABSTRACT
This chapter explores the historical dynamics of three ‘types’ of medicine productionist, communitarian and consumerist — which might be said to be successively characteristic of the political economy of medicine during the twentieth century. The maintenance of a standing army and navy involved some investment in medicine and especially hygiene, and the lessons of enlightenment hygienists were reinforced by nineteenth-century sanitarians. The rapid advance of a new empiricism — evidence based medicine, is further evidence of a political economy of medicine focused on the cost-effectiveness of services rather than directly on the heath of the population, as was once the case. Consumerist medicine is prominent at the start because public-medicine was then relatively small, and at the end because the century has seen a massive growth of medical industries and the spread of consumer attitudes to many areas once immune. In Britain and America the impact on civilian medicine was probably more limited and more restricted to times of war.
