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originally drew it up were concerned with large-scale public health measures. It has often silently accompanied all major epidemiological work of this century. The power of a classification of disease can be seen, for example, in the debate about Britain's mortality decline in the nineteenth century (Szreter 1988). Three interest groups have at different times claimed the kudos here (and a share of funding and recognition appropriate to their contribution): medical specialists who claimed new forms of treatment rid the country of its major scourges (particularly tuberculosis); public health officials who asserted the value of sanitation in the cities; and laissez-faire economists who highlighted the general rise in the standard of living in a successful economy unburdened by expensive medical welfare. The stakes in the debate were clearly very high. As Szreter's careful revisionist history details, the debate's outcome hinges on a reading of the tables of mortality that listed causes of death by region. These tables show unequivocally that the new forms of treatment developed after the decline in mortality, not before. This is in accord with an earlier, brilliant demonstration by McKeown, in the context of a debate about national medicine (1976). But contra McKeown, who underscored the rise in the standard of living, Szreter shows the changes are in step with local public health measures. The core of Szreter's argument is an interpretation of disease classification in the nineteenth century (particularly the categories of airborne disease). |
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The ICD has thus played a key (albeit usually silent) role in determining the outcome of epidemiological, public health, and economic arguments. We will look at the way the ICD has been used by different groups, constituting both a common and a customizable object for these groups and a genre system in use. We will look at the tension between the desire to standardize (so as to be able to perform bureaucratic functions such as comparison over time and space, produce algorithms, compute etc.) and the drive of each interested party to produce and use its own specific list. We will also examine the tension between attempts to make a universally standard list and the idiosyncrasies and local circumstances of users. Both these tensions speak to the nature of all knowledge-based informatic policy and management tools. |
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To develop this analysis further, we first inventory the different classes of informational conflicts involved with building up and using the list and examine the types of informational needs and structures |
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