Medical dramas seem to be continuously on our television screens. They are often very good viewing, many have the qualities of first-rate drama – a good story line, brilliant complex characters, changing moods, excellent dialogue and tension. Packed into a short period are medics battling against disease and injuries, finding cures for most but not all things. We forget sometimes, however, that these programmes – although excellent viewing – are works of fiction. But the power of the media is that it can influence our perceptions. In the same way the stories in the press of breakthroughs in medical research make us begin to feel that there are cures for many things and that it is only a matter of time before another breakthrough will occur.
Because of the successes in medicine we expect that we can be cured, a perception that is not surprising given the fact that as a population we are living longer. All of these influences are part of a changing narrative of risk that pervades all society, influenced in part by changing genuine advances but also rising expectations. However, reality sadly so often strikes and particularly as a society, as we grow old, more and more people will depend on the Health Service.
In the case of my late mother she sadly suffered from Parkinson’s disease, a disorder which resulted in her becoming increasingly dependent on care and medication. In the case of my Mum as the degenerative condition took hold we could not separate her health needs from her social and care needs – everything was interconnected. In Mum’s case she needed medicines, a roof over head, food to eat, 24-hour care, modified living accommodation and a social life.
All of these aspects were needed to give her a quality of life. A debate between budget holders as to who is going to pay misses the point and separating care from health makes a mockery of a so-called National Health Service.
In thinking about health we need to widen our perspective and see it in a holistic way. The World Health Organisation (W.H.O.), for instance, defines health as “…a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity”.1 This is a definition that includes not only a medical but a social dimension.
In its world health report 2008 (Primary Health Care), the W.H.O. identifies what it calls three “particularly worrisome trends” as follows:
- health systems that focus disproportionately on a narrow offer of specialised curative care;
- health systems where a command-and-control approach to disease control, focused on short term results, is fragmenting service delivery;
- health systems where a hands-off or laissez-faire approach to governance has allowed unregulated commercialisation of health to flourish.
What they argue for is a need for a “comprehensive and balanced response to health needs”. They point out that the continuing adoption of this narrow definition (and resultant limited health systems), has led to health inequalities and what is perhaps the most damning observation has led to “…the erosion of trust in health care…” which in their view constitutes “…a threat to social stability” (W.H.O 2008: Xiii)2.
Poverty and Health
Although there has been some progress in reducing health inequalities in the U.K., they remain a major issue for children and young people, because as David Utting eloquently observes, “Living on a low income in a run-down neighbourhood does not make it impossible to be the affectionate, authoritative parent of healthy, sociable children. But it does, undeniably, make it more difficult” (1995: 40)3
This observation is as relevant today as it was when made, particularly given the fact that the economy has gone into recession and increasing numbers of people are going to be suffering from unemployment. The latter issue is not just an economic problem: it is a health and wellbeing issue. Unemployment affects not only our own individual emotional and psychological state but also other family members – factors that will remain even after the economy has recovered.
Child poverty remains a major issue in the country, an issue that is not only a policy problem but a major health problem for children and families. Long term it may affect performance in school, it can lead to mental health problems, it can affect physical growth and it has consequences for the economy.
Health problems in our more disadvantaged neighbourhoods are greater and a more intractable problems than in the more prosperous neighbourhoods; health inequalities is a major societal issue. Sure Start, for instance, was a policy initiative that deliberately targeted disadvantaged communities; what it was not was a ‘quick fix’ for a long term issue.
Some of the more intractable problems such as obesity and alcohol misuse are not just medical problems but long term societal problems that require public health responses. These problems cannot be resolved simply by medication; they require long term multi-disciplinary societal responses. Health problems such as these are too important to leave to the medics.