Ziekenzaal in het Binnengasthuis, circa 1900 (Stadsarchief Amsterdam)
Ziekenzaal in het Binnengasthuis, circa 1900 (Stadsarchief Amsterdam)

Unequal treatment?

Exploring the transformation of hospitals and investigating health inequalities among hospital patients in the Netherlands, 1830-1940

This PhD research delves into the fascinating evolution of healthcare during the long 19th century by exploring the ‘health transition’ within hospitals and investigating inequalities in hospital care. The first part of the study focuses on investigating the health transition within Dutch hospitals. The development of hospitals from 'gateways to death' for the marginalised to true medical centres serving an ever-expanding part of society during the long 19th century – through processes of medicalisation, professionalisation and modernisation – and the impact of this transformation on the composition of the patient population will be at the centre of this analysis. In the second part attention shifts towards health inequalities: can we observe differences in the burden of disease (morbidity) and death (mortality) or in opportunities to achieve optimal health (result of treatment & length of hospitalisation) within hospitals? In this part health inequalities and its determinants will be examined.

The research will be conducted through a mixed methods approach, by employing quantitative methods, innovative digital humanities tools and utilising qualitative sources from hospitals, city governments and historical medical literature. This study employs a long-term and comparative perspective to discern variations – in space and time – in the hospital health transition and inequalities among patients, by focussing on various case-studies of hospitals in the Netherlands.

The research uncovers and transcends the limitations of existing historical research. Firstly, while most studies focus exclusively on the history of doctors and medical discoveries, this project places the understudied hospital patients in the centre of analysis. Secondly, up until now the health transition and inequalities are almost exclusively studied through mortality (rates), life expectancy and causes-of-death. Exploring this topic through new perspectives – inequality in healthcare, hospitalisation and morbidity – contributes to new insights on health divergences. Lastly, the rapidly expanding body of literature on health disparities has already demonstrated the existence of inequalities in present-day hospital care. There is, however, no research on the historical roots of these contemporary inequalities in healthcare.

Overall, this proposed PhD research seeks to enrich our understanding of the transformation of hospitals and the historical roots of inequalities in healthcare, while also providing valuable insights into the experiences of understudied groups – hospital patients – through a history from below.

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