Commentary: The context and outcome of nutrition campaigning in 1934

David F Smith

University of Aberdeen, Department of History, Meston Walk, Aberdeen AB24 3FX, UK. E-mail: d.f.smith{at}abdn.ac.uk

John Pemberton’s paper, published in the summer of 1934,1 was written shortly after an episode that significantly raised the profile of questions concerning the adequacy of the diet of the poor: a controversy involving the British Medical Association (BMA) and the Ministry of Health. The BMA Nutrition Committee report on the minimum cost of an adequate diet, published in November 1933,2 which Pemberton draws upon, caused a political storm, partly because of the publicity given to the same kind of calculations as he presented. Very quickly, the Labour Party prepared speakers’ notes supplying figures showing the ‘amount left after purchasing the minimum foodstuffs laid down by the BMA would not pay the rent alone in many thousands of unemployed households’. From this it was concluded that ‘in order to pay the rent and purchase the bare necessities, the housewife must economise on food’.3

The Daily Herald greeted the report with front-page headlines: ‘B.M.A. Exposes Inadequacy of Unemployment Pay’ and ‘Food Leaves only 6/81/2 for Everything Else’. In bold print the article declared: ‘The Ministry of Health’s figure is 3000 calories. The members of the British Medical Association committee of investigation say bluntly that this is not enough.’4 This point alludes to the fact that that the BMA’s calorie requirement, 3400 per man per day, differed from that used in a report of the Ministry of Health’s Advisory Committee on Nutrition (ACN).5 As for the protein requirement, the BMA used 50 g of first class (i.e. animal) protein, while the ACN used 37 g. The controversy focused largely on these technical differences, distracting attention from the broader question of whether the BMA’s findings implied that poor families were undernourished. This was in spite of the fact that if the ACN’s figures were used instead of the BMA’s, calculations of the kind carried out by the Daily Herald and Labour Party could still suggest the unemployed risked chronic under-nutrition. The BMA’s data were based on unrealistically low food prices and it was unreasonable to assume that family budgets could be confined to food and rent.

After a damaging exchange of letters in The Times,6 representatives of the BMA committee and the ACN were persuaded to meet to discuss their differences. One of the ACN’s members, Edward Cathcart, an acknowledged expert on dietary requirements, was especially offended by the BMA’s figures. During two joint conferences, however, it became clear that there was no possibility of the ACN simply putting their rivals in their place.7 Instead, a joint memorandum, published in May 1934, included a ‘Sliding Scale of Calorie Requirements’ according to which a man doing light, moderate or heavy work needed 2600–3000, 3000–3400, or 3400–4000 calories per day.8 This, along with a carefully worded statement about protein, covered up the differences between the committees and prevented the resurgence of public controversy. The BMA—ACN report was not available when Pemberton was completing his article, but he reinforced the BMA’s calorie standard by referring to standard textbooks, and noted that earlier calculations by Crowden were in broad agreement with the BMA figures. To Pemberton the logical conclusion was the same as that of the Daily Herald and Labour Party: ‘the majority of the unemployed and their families must ... be suffering from chronic under-nutrition’.1

An important part of the context of the BMA report and Pemberton’s paper was the passage of an Unemployment Bill through parliament. The Minister of Labour moved the second reading of the Bill in November 1933 and the Unemployment Act 1934 reached the statute book on 28 June 1934. It established the Unemployment Insurance Statutory Committee to run unemployment insurance, and the Unemployment Assistance Board (UAB) to run a system of benefits for those without entitlement under the insurance scheme. Unemployment Assistance replaced Transitional Benefit, which had been introduced after the financial crisis of 1931, when insurance benefits were reduced by 10%, and new regulations cut benefit from over a million claimants. Transitional Benefit was paid for by the Treasury, but was administered by local Public Assistance Committees, which were also responsible for the Public Assistance system (formerly Poor Law relief), financed by the rates. Transitional Benefit was means tested, and the local committees used their own scales in calculating payments. Unemployment Assistance would also be means tested but would be paid according to national scales and administered by a new network of local offices.9 These changes provided an opening for activists, politicians, and concerned doctors and scientists, to lobby for new scientific scales of benefit.

Lobbyists made frequent references to the BMA report during the year following its publication. Labour spokesman Arthur Greenwood, for example, during the second reading of the Unemployment Bill, argued that the UAB scales should be constructed on the same principle as the BMA dietary standards —to be sufficient to allow ‘health and working capacity to be maintained’10—and in early 1934, when a new pressure group, the Children’s Minimum Committee (CMC) was formed, led by independent MP, Eleanor Rathbone, the preamble of its policy statement declared:

The findings of the BMA Committee on Nutrition, and other authoritative estimates of minimum living needs, have focussed public attention on the wide discrepancy which exists between the cost of a satisfactory diet and the actual sums available to poorly paid or unemployed parents for the nourishment of their children.11

The document outlined four immediate objectives, the expansion of the milk-in-schools scheme, the compulsory provision of school meals, the introduction of rent rebate schemes, and ‘substantially increasing the allowances for the children of unemployed persons’. On 9 May, when the Unemployment Bill was re-examined in parliament on report, Rathbone and others invoked the BMA Nutrition Report. She observed that the Minster of Labour had declared that the level of assistance would not be less than ‘the minimum needs of healthy subsistence’. This, she declared, foreshadowed a ‘revolution in the scale of assistance that will in future be given to unemployed people’ because existing scales were ‘far below ... minimum needs’, as the BMA figures demonstrated.12

Another new pressure group, the Committee Against Malnutrition (CAM), was mentioned by Pemberton. This consisted largely of left-wing doctors, but the prime mover, secretary and editor of the bi-monthly Nutrition Bulletin, was the blind and disabled activist Frederick le Gros Clark. Its statement of aims declared that the founding members believed there was widespread under-nourishment among the families of the unemployed and low-paid, and that this would lead to ‘steady deterioration in the physical standards and health of the population’ of which ‘there are already signs’.13 But the CAM’s attitude towards the exercise conducted by the BMA was slightly different to that of Rathbone and the CMC. The Nutrition Bulletin declared that the committee did not accept ‘the principle of minimum standards of diet’ and would only make use of them in order to ‘show how inadequate is the food actually eaten by both employed and unemployed workers’.14

Once appointed, the first task of the UAB was to prepare regulations to govern the award and level of benefits, which were to be laid before parliament for acceptance or rejection in their entirety. It was envisaged that there would be two ‘appointed days’. The Board would become responsible for 800 000 people in receipt of Transitional Benefit, and 200 000 in receipt of Public Assistance on 7 January and 1 March 1934 respectively. During the summer of 1933 the lobbying intensified. In early August, in BMJ and elsewhere, there appeared a letter from 12 prominent doctors and scientists that broadly supported the campaigning organizations. The signatories including Sir Frederick Gowland Hopkins, president of the Royal Society, and Nobel Prize winner, member of the ACN, and chair of the ACN–BMA conferences. Other signatories included GCM M’Gonigle, VH Mottram, and John Boyd Orr. M’Gonigle, medical officer of health for Stockton-on-Tees, was honorary secretary of the BMA committee and had drafted the BMA report. Mottram had been a member of both the BMA committee and the ACN. Orr was director of the Rowett Research Institute in Aberdeen. The signatories declared there was a ‘grave danger of widespread deterioration’ if those relying upon the UAB were ‘unable to purchase sufficient food and other necessaries for healthy existence’. Welcoming the clauses in the Unemployment Act stating that allowances would be sufficient to cover the needs of applicants, they asserted that a satisfactory ‘standard of needs’ could only be arrived at by consultation with ‘medical and other expert opinion’. As for food, they suggested, the findings of the BMA–ACN conferences on physiological requirements, and the BMA committee’s ‘specimen minimum diets’ would no doubt prove useful.15

Two weeks later, a BMJ editorial supported the letter and also commended to readers a ‘Memorandum on the Scale of Needs’ that had been produced for the UAB by the CMC.16 A few weeks later a further CMC memorandum, on ‘Evidence on Malnutrition’, was submitted to the UAB. The latter document claimed that official figures showing low levels of malnutrition among schoolchildren, based on data produced through routine medical inspections, were unreliable. The argument pointed to the absence of satisfactory standards, and suggested that the detrimental consequences of under-feeding in childhood might only be manifested later. It was also argued that the condition of the children of the unemployed was masked in aggregate statistics by a general improvement in standards, and that the condition of children was sometimes only maintained because of the self-sacrifice of parents, whose own health suffered. The view was attacked that the main cause of malnutrition was unwise expenditure, or ‘maternal’ or ‘parental’ inefficiency.17 The memorandum was designed to counter the longstanding arguments of the Chief Medical Officer, George Newman, that the unemployment crisis had not led to any significant deterioration in national health or increase in the prevalence of malnutrition.18 Newman’s views were often deployed by government politicians and others in resisting demands for action, including increases in unemployment benefits, to counter alleged malnutrition. In October, the CMC issued a further memorandum, consisting of a detailed critique of the Newman’s report for 1933.19 Newman placed the best possible gloss upon trends in health statistics, in some cases by comparing current data with data collected as early as 1910.

When UAB scales of relief were debated in the House of Commons from 17 to 20 December, there were frequent comments on whether or not the scales were adequate in the light of the BMA report. Another CMC memorandum showed that a family of two adults and five children of 1, 4, 7, 11, and 13 years old would receive 40/6d according to the UAB scales, but that 51/4d was needed according to a scale incorporating the BMA data.20 The Minister of Labour argued that the deficit could be disregarded because there was a high allowance for milk in the BMA diets and they had been prepared before the cheap milk-in-schools scheme had been introduced. Greenwood, however, again drew attention to the fact that the prices used in the BMA report were unrealistically low.21

All the argument of the campaigning groups, and the concerned politicians, doctors, and scientists, appeared to have fallen on deaf ears. However, after the UAB came into operation in January 1935, their scales were quickly defeated, not by science-based lobbying, but by protest meetings, marches, and rioting, after many claimants found that their Unemployment Assistance was substantially less than the Transitional Benefit they had received previously. The Minister of Labour was forced to suspend the application of new rates in such cases, a situation that continued until November 1936 when more generous UAB scales were introduced, and the means tests were relaxed. This time, any increases under the new arrangement were introduced immediately, but decreases were phased in over 18 months.9

In the aftermath of the UAB debacle, the CAM devoted the April 1935 issue of their Bulletin to ‘Scales of Human Needs’. They criticized both the approaches of the ACN and the BMA and argued for planning on the basis of an ‘optimum diet’ rather than minimum requirements,22 a concept that was adopted in, for example, Orr’s Food Health and Income, published in 1936, which claimed that the diets of about half the population were deficient in one or more nutrient.23 The concept of the optimum diet owed much to studies such as that of JC Spence, which compared the height, weight, rate of anaemia, and other morbidity data of poor and well-to-do children, and which Pembertson discussed.24 Food Health and Income became a bible for the campaigning nutrition movement, but its findings were disputed, leading Orr to begin a large-scale survey and experiment financed by the Carnegie Trust, to which Pemberton was recruited as medical officer.25

As regards the paradox of hunger in the midst of plenty, which Pemberton mentions in his conclusions, Orr was a leading thinker and activist in this field, seeking solutions at international as well as national level. Politically conservative, he argued for cheap food policies that would both relieve the economic problems of agriculture and alleviate the nutritional problems of the poor.26 But the only large-scale success of the nutrition movement by 1939 was the widespread implementation of the milk-in-school schemes.27 It was not until after the military setbacks of 1940 that the influence of Orr and others was fully felt and comprehensive and equitable food policies were formulated to safeguard and improve the nutritional standards and morale of the whole population—at least for the duration of the war.28


    References
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 References
 
1 Pemberton J. Malnutrition in England. University College Magazine 1934;Jul–Aug:153–59. (Reprinted Int J Epidemiol 2003;32:493–95.)

2 British Medical Association. Report of Committee on Nutrition. BMJ Supplement 25 Nov 1933:1–16.

3 Labour Party Notes for Speakers on the BMA Report, 1 December 1933, Public Record Office (hereafter PRO) MH 56/55.

4 Special Correspondent. BMA Exposes inadequacy of Unemployment Pay. Daily Herald 24 Nov 1933:1a.

5 Ministry of Health. Advisory Committee on Nutrition Report to the Minister of Health on the Criticism and Improvement of Diets. London: HMSO, 1932.

6 See, for example, the intemperate contribution from the ACN chairman: M Greenwood. Diet and Health. (Letter to the Editor) The Times 8 Jan 1934:13e.

7 Smith DF. The Social Construction of Dietary Standards: The British Medical Association—Ministry of Health Advisory Committee on Nutrition Report of 1934. In: Maurer D, Sobal J. Food, Eating, and Nutrition as Social Problems: Constructivist Perspectives. New York: Aldine de Gruyter, 1995, pp. 279–304.

8 Report of Joint Conference. BMJ 1934;i:900–01.

9 Davison RC. British Unemployment Policy since 1930. London: Longmans Green, 1938.

10 Parliamentary Debates (Commons) 1933–34; 283: col. 1111.

11 Children’s Minimum Committee. Statement of Policy. (Submitted in connection with a deputation to the Prime Minister, 12 Mar 1934.) PRO PREM 1/165.

12 Parliamentary Debates (Commons) 1933–34; 289: col. 1219.

13 Statement of Aims. Nutr Bull Mar 1934;1.

14 Diet Standards. Nutr Bull Mar 1934;1.

15 Farquar Buzzard F, Cowell SJ, Haldane JBS et al. Unemployment Assistance: Determination of Needs. BMJ 1934;ii:235.

16 Needs of the Unemployed. BMJ 1934;ii:311.

17 Children’s Minimum Committee, ‘Evidence on Malnutrition’. PRO AST 7/32.

18 For further discussion of the health and nutrition statistics of the 1930s, and the long-running poverty versus ignorance debate see: Webster C. Healthy or Hungry Thirties? History Workshop 1982;13:110–29, and Smith DF, Nicolson M. Nutrition, education, ignorance and income: a twentieth-century debate. In: Kamminga H, Cuningham A. The Science and Culture of Nutrition 1840–1940. Amsterdam: Rodopi, 1995, pp. 288–318.

19 Children’s Minimum Committee. Some Observations on the Report of the Chief Medical Officer to the Ministry of Health for 1933. Oct 1934, PRO AST 7/32.

20 Family Allowances Memorandum by the Children’s Minimum Committee. BMJ 1934;ii;1203.

21 Parliamentary Debates (Commons) 1934–35; 296: cols 844, 867.

22 The conception of ‘Scales of Minimum Diet’. Nutr Bull April 1935;8.

23 Orr JB. Food, Health and Income. London: Macmillan, 1936.

24 Spence’s report is reproduced in The Purpose and Practice of Medicine. Selections from the writing of Sire James Spence. London: Oxford University Press, 1960, pp. 142–47.

25 Smith DF. The Carnegie Survey: background and intended impact. In: Fenton A. Order and Disorder: The Health Implications of Eating and Drinking in the Nineteenth and Twentieth Centuries. East Linton, Tuckwell, 2000, pp. 64–80.

26 Orr JB. As I Recall. London: McGibbon & Kee, 1966.

27 Webster C. Government policy on school meals and welfare foods 1939–1970. In: Smith DF. Nutrition in Britain, Science, Scientists and Politics in the Twentieth Century. London: Routledge, 1997, pp. 190–213.

28 Smith DF. The rise and fall of the scientific food committee during the Second World War. In: Smith DF, Phillips J. Food, Science, Policy and Regulation in the Twentieth Century. London: Routledge, 2000, pp. 101–16.





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