The gift relationship: from human blood to social policy
Richard M. Titmuss’s The Gift Relationship has long been acknowledged as one of the classic texts on social policy.
When The Gift Relationship was first published in 1970 by Allen & Unwin it was named by the New York Times as one of the ten most important books of the year.
Is it better to pay for blood, or to rely on people giving it freely? Richard Titmuss’s answer to that question — published in 1970 and reissued in this Policy Press edition — became one of the most celebrated arguments in British social policy. But The Gift Relationship is more than a study of blood donation: it is a profound meditation on altruism, solidarity, and what holds societies together.
A seemingly straightforward comparative study of blood donating in the United States and Britain, the book elegantly raises profound economic, political, and philosophical questions. Titmuss contrasts the British system of reliance on voluntary donors to the American one in which the blood supply is largely in the hands of for-profit enterprises and shows how a non-market system based on altruism is more effective than one that treats human blood as another commodity.
By treating blood as a gift rather than a commodity, Britain had created a system that generated higher quality, more reliable supply at lower cost, while simultaneously binding citizens together in a relationship of mutual care.
For Titmuss, the blood supply was a case study in a much larger argument. Drawing on Marcel Mauss’s concept of the gift and on his own lifelong commitment to the welfare state, he showed how the commodification of altruism — the reduction of giving to a market transaction — corrodes the social bonds that make collective life possible. The lesson was not merely about blood: it was about the NHS, about social security, about the entire architecture of post-war welfare provision. And it remains urgently relevant today, as successive governments have sought to introduce market mechanisms into public services.
The book’s history lends it a particular poignancy. Titmuss wrote it in direct response to a proposal from the Institute of Economic Affairs, the same think tank that underpinned the Thatcher government’s privatisation agenda, to commercialise blood donation. Despite his warnings, the voluntary system was run down and Britain purchased contaminated blood from American commercial suppliers, much of it from prisoners and drug users already infected with HIV.
The long-running public inquiry into the contaminated blood scandal has given The Gift Relationship a renewed and painful topicality.
Updated edition
This updated edition contains the original text along with new chapters that:
- consider the relevance of Titmuss’s arguments to the AIDS and current health care crises;
- outline recent developments in blood donation and transfusion systems;
- examine the systems for human milk donation; and
- assess the response to the original edition and make the case for its continuing relevance today.
At a time when health and welfare systems are under sustained attack from many quarters, this new edition of The Gift Relationship is essential reading for everyone interested in social policy and the future of our society.
About Richard Titmuss
Richard Titmuss (1907–1973) was Professor of Social Administration at the London School of Economics from 1950 until his death in 1973, and one of the architects of the intellectual framework underpinning the British welfare state. He was an influential adviser to the Labour Party and to governments around the world, and played a central role in establishing social policy as an academic discipline. The Gift Relationship was his final book.
Reviews
“A first-class study — moving from the relationship between blood donor and blood recipient to that between patient and physician, and thence to the very foundation of human societies.”
Washington Post
“Richard M. Titmuss’s The Gift Relationship has long been acknowledged as one of the classic texts on social policy.”
New York Times
“Titmuss’s argument about how altruism binds societies together has proved a powerful tool in the analysis of welfare provision. His analysis is even more topical now in an age of ever-changing health care policy.”
Policy Press
- Richard Titmuss and social policy at LSE (26 September 2017)
