Ireland's history of health and welfare is intimately linked to its history of poverty and charity, and to conflicting intellectual and philosophical outlooks that repeatedly redefined the state's responsibility for the health, welfare and ‘well-being’ of its population in the modern period. Research into Ireland's social history developed relatively late with most welfare and medical histories privileging governmental policies and institutional histories. This work revealed the main legislative and policy innovations and delineated official and philanthropic conceptualisations of, and attitudes towards, Irish poverty in the nineteenth and twentieth centuries. In Ireland, the institutional model remained central to the delivery of health and welfare supports throughout the modern period. The poor, especially the sick poor, and the institutions established to provide for and manage them have attracted the majority of scholarly inquiry. Histories interrogating the health and welfare of other classes and alternative mechanisms of relief are less familiar to us. Reflecting current scholarship, this chapter is concerned with the development of official policy, the pursuit of health and the avoidance of poverty, diseases and ‘ill health’.
The Rise of the Institution
In post-Reformation Europe attitudes towards poverty and modes of assisting the poor altered significantly, reflecting a general reluctance to support what was regarded as indiscriminate charity. In England, these changes, coupled with increasing poverty, prompted the introduction of the Elizabethan Poor Law (1601), a parish-based system of relief that divided the poor between the ‘deserving’ and ‘undeserving’ and provided indoor relief, through workhouses, alongside outdoor relief. Similar legislation was not introduced to Ireland until the reform period of the nineteenth century. None the less, in its absence, rational, instrumental forms of medical and welfare relief, producing formalised and institutionalised mechanisms, which sought to discourage indiscriminate almsgiving, such as was evident throughout most of Europe since the Reformation, also emerged in Ireland. In the modern period there was an explosion in the number of institutions constructed to tackle the perceived problems of poverty and disease.