The Treatment of Child Abuse as a Public Health Issue

The issue of child abuse raises challenging questions about collective responsibility and the privacy of the family. What is a desirable level of state interference in families that may (or may not) harm their most vulnerable members? If forcibly removing an ‘at risk’ child from the family unit is the most dramatic action that can be taken, at what point does this become necessary? Who is best placed to make this judgment? And when the wrong call is made, who should be held responsible? The boundary between domestic privacy and state interventionism has been contested throughout the twentieth century and has had significant legal and social implications. Two cases, decades apart, have drawn public attention to child abuse as a public health issue.

Child abuse as a public heath concern became a particularly powerful narrative in the 1960s and 1970s. This occurred against a background of rising living standards and increased expectations of health, as well as changed ideas about parenting. The child of the 1960s could expect to lead a life of greater longevity and in better health than any previous generation. The foundation of the National Health Service indicated that sickness was no longer unavoidable (if regrettable), but something to be actively resisted. The threats of infectious disease and childhood illnesses were receding, revealing other dangers to child health, including those posed by the family itself.

Medical technology made abuse visible: in 1946 John Caffey, an American radiographer, described the ‘syndrome’ of child abuse as revealed by x-ray images. The language of ‘syndrome’ gained popularity after a 1962 article by C. Henry Kempe in the Journal of the American Medical Association arrested the medical and public imagination. Kempe suggested that the possibility of abuse should be considered when the proffered explanation for injuries seemed implausible. This situated the doctor as responsible for verifying parental claims about the domestic space and the normalcy of familial relationships. Kempe’s influence extended to Britain, as he went on to be influential in the development of the NSPCC Battered Child Research Department (Denver House) in the late 1960s.

The death of ‘Baby P’ at the hands of his stepfather, his stepfather’s brother and his mother featured widely in the media between 2007 and 2008. Much outraged centered on the fact that 17 month old Baby P – Peter Connelly – was already well known to social services. Peter had been on Haringey’s child protection register since December 2006. In the months preceding his death he was seen by numerous doctors. Indeed, a doctor missed Peter’s broken spine in an examination just 48 hours before he died.

The troubling details of the case were laid bare in the press: how had social workers missed the warning signs that Peter was in such imminent danger? How could doctors have failed to act more urgently on the signs that Peter was being physically abused? Social workers were accused by tabloid newspapers of ‘betraying’ the child, and of having ‘blood on their hands’, and a petition calling for their dismissal and the disciplining of the last doctor to see Peter gathered over a million signatures.

The lack of effective communication and professional failures on the part of social services reiterated some of the issue raised in an earlier, similarly notorious, case of child abuse. Maria Colwell, aged 8, was killed by her stepfather in 1973, having recently returned to her birth mother after several years in foster care. Maria’s mother had maintained only erratic contact with her during this time. The inquiry into Maria’s death found that 17 people had formally expressed concern about Maria’s health in the months before her death. She was rebuked for failing to act decisively on Maria’s behalf. She was, however, inexperienced and had a caseload of 70. In 1974 the Committee of Inquiry into the Care and Supervision Provided in Relation to Maria Colwell criticized social service agencies’ communication, coordination, and investigative efficiency.

In both cases it was noted that doctors had been reluctant to challenge explanations for how the injuries came about. The Serious Case Review of Peter’s case encouraged skepticism of the narratives espoused by families suspected of harming their children. This professional skepticism challenges the privacy of familial relationships and positions the health professional as a gatekeeper to state interference.

In both cases social workers and medical professionals were deemed partially responsible for allowing events to spiral towards their tragic ends. The construction of child abuse as a public health issue has made managing the aberrant family a health concern. Whilst this has provided several routes for families to access and receive support, it has also left individual workers vulnerable to criticism. The public outcry over Peter and Maria’s deaths reflects the contested negotiation of the boundary between acceptable state intervention and the autonomous nature of the family.

Sarah Crook is a PhD candidate in the School of History at Queen Mary, University of London. Her work is funded by the Wellcome Trust and explores how medical language was appropriated to mobilize for change to the cultural conditions of mothering in mid-to-late twentieth century Britain. @SarahRoseCrook


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