Social Medicine

Polarisation and Perspectives

Dorling, Danny

• Publisher: Policy Press
• Year: 2013
• eBook ISBN:
  9781447311133
• Topic: Medicine
• Subtopic: Public Health, Administration & Care

The second digital-only ebook taster of Unequal health: The scandal of our times by Danny Dorling. Competitively priced, it gives a flavour of one of the major themes: social medicine and contains three chapters from the book, preceded by an all-new introduction specially written by Danny Dorling. This 'must-read' will introduce an even wider readership to his work.

1

Medicine is a social science, and politics is nothing else but medicine on a large scale

Evidence that ‘the most powerful determinants of health in modern populations are to be found in social, economic, and cultural circumstances’ (Blane et al, 1996) comes from a wide range of sources and is also, to some extent, acknowledged by Government (Townsend and Davidson, 1992; Social Exclusion Unit, 1998; Department of Health [DH], 1992; Acheson, 1998; Wanless, 2004). Yet differences in health experiences between areas and social groups (socio-economic, ethnic and gender) remain…. How these inequalities in health are approached by society is highly political and ideological: are health inequalities to be accepted as ‘natural’ and inevitable results of individual differences both in respect of genetics and the silent hand of the economic market; or are they abhorrences that need to be tackled by a modern state and a humane society? (Bambra et al, 2008)

There is so much written on medicine and politics that it can easily overwhelm – Rudolf Carl Virchow’s quote,¹ the title of this chapter, is often repeated. In Britain the six reports referred to in Clare Bambra’s (and colleagues’) statement (above) give a summary that spans the field, from the work of David Blane and his colleagues, to Peter Townsend and Nick Davidson’s Penguin edition of the Black Report, to various reports of government departments and agencies, to the work of recent chief medical officers such as Donald Acheson and even of bankers such as Derek Wanless. Wanless, who was commissioned by Gordon Brown to give the view of a financier, wrote a report entitled Securing good health for the whole population, which, among other things, recommended that: ‘HM Treasury should produce a framework for the use of economic instruments to guide government interventions in relation to public health’ (Wanless, 2004, p 184).

There is an alternative way to frame thinking about how medicine and politics are linked, other than through following recent literature. This is to begin to routinely recognise politics and health in what you see in everyday life. You can do this even as you check your emails in the morning. The university I work in regularly sends emails with details of the deaths of members of staff, both current and retired. These list the post they held and the department they worked in. Almost invariably you read every notice even though you are very unlikely to have ever met the person named. Almost invariably (again) the professors live the longest and the cleaners live the shortest lives. All that varies is where the funeral is to be held and whether money should be given to a particular charity. Here is one:

The Vice-Chancellor regrets to announce the death of
Mrs XXXXXX XXXXXXX
Cleaner in the Department of Estates and Facilities
Management and a member of staff from 1999
Aged 59 years
which occurred on 8 January 2012
The funeral has already taken place

Very shortly after that brief 42-word announcement was posted, another mass email to all staff was sent. It included over 500 words announcing the appointment of a new member of the senior management team of the university. I often wonder if, rather like the ranking of items on deaths on the evening news according to how remote the country is, the number of words used in official declarations is in inverse proportion to the officially perceived importance of the event. A minor bureaucrat appointed, in his or her 40s, receives almost ten times the wordage befitting a 59-year-old cleaner’s death. All this sends out messages, about how much people are worth, about when they are expected to die, about how shocked we are, or should be, or are not.

A few months earlier the following 220-word letter was sent to members of the House of Lords. Five times as many words as the notice of the cleaner’s death, less than half as many as the celebration of the bureaucrat’s appointment. I reproduce it below to illustrate contemporary medicine on a large scale:

Addressed to individual members of the House of Lords

We write as public health doctors and specialists from within the NHS, academia and elsewhere to express our concerns about the Health and Social Care Bill.

The Bill will do irreparable harm to the NHS, to individual patients and to society as a whole. It ushers in a significantly heightened degree of commercialisation and marketisation that will lead to the harmful fragmentation of patient care; aggravate risks to individual patient safety; erode medical ethics and trust within the health system; widen health inequalities; waste much money on attempts to regulate and manage competition; and undermine the ability of the health system to respond effectively and efficiently to communicable disease outbreaks and other public health emergencies.

While we welcome the emphasis placed on establishing a closer working relationship between public health and local government, the proposed reforms as a whole will disrupt, fragment and weaken the country’s public health capabilities.

The government claims that the reforms have the backing of the health professions. They do not.

Neither do they have the general support of the public.

It is our professional judgement that the Health and Social Care Bill will erode the NHS’s ethical and cooperative foundations and that it will not deliver efficiency, quality, fairness or choice. We therefore request that you reject passage of the Health and Social Care Bill.

Yours sincerely,

Signed by 77 public health doctors and specialists in the NHS, and including eight professors.

Despite the letter being short, to the point and signed by many people, one signatory in particular was singled out for censure, Professor John Ashton, Joint Director of Public Health for NHS Cumbria.

Shortly after publication of the above text Professor Ashton received a letter warning him that under the NHS Code of Conduct it was ‘inappropriate for individuals to raise personal concerns about the proposed Government reforms’. It added that he was required to attend a meeting with the NHS Cumbria’s Chief Executive, Sue Page, to explain and account for his recent actions. Professor Ashton suspected the order to write the letter had come ‘… from the office of Health Secretary Andrew Lansley’ (McGowan, 2012). The Health Secretary insisted he knew nothing about that specific letter, but did not deny he had given more general instructions that resulted in that letter being sent (Williams, 2012).

Geography broadens the mind

A month after the letter to individual members of the House of Lords was written, I was with students on a geography fieldtrip in Athens. It was early November 2011. Again, just like the routine email about the cleaner’s untimely death, everyday events appeared far more telling than much current writing in academia, or even letters of protest that were being written by one set of professionals to be read by a set of Lords, Ladies, Baronesses and Barons. Here is what I saw:

After the cuts²

I travelled into the city after the cuts had been made. There were tourists on the train and people from other countries visiting their relatives. “What can I say?” the man opposite me shrugged, who was travelling from Germany to visit his daughter. “She fell in love, she’s settled here now, it’s a pity but she’s still in love and has children, they speak the language, this is their home now.”

The city was quiet, much quieter than I had seen it before. Last year I had seen people searching in bins for food for the first time here. They were probably foreigners. The foreigners always lose out first. However, this year there were far fewer visitors, far less food in the bins, this year was very different. I didn’t see anyone searching in bins. Instead what I saw, all the time, was begging.

There was begging in the streets, begging on the underground, begging quietly in corners, begging a bit more forcibly, people standing in front of me for a minute just looking in my eyes. Not the kind of begging I was used to. People begging while breastfeeding a baby. Not that fake begging with babies I had grown used to, I could tell by her eyes that she needed the money.

People were giving money. It was mostly the old people who gave, and they mostly gave the smallest of coins so those who were begging had to keep on begging, all day, just to get enough for a small meal. It was mostly older people giving to younger people and you knew that the older ones did not really have the money, that they would go hungry and cold for giving it.

The begging look was not just on the streets. Shopkeepers were sitting behind their glass fronts willing the few tourists there were to come into their premises. Most shops were empty almost all of the time but what else to do but sit and wait? There is no other way. Restaurants, even in what were the busiest of places, were more than half empty. Again it is the tourists who have money and there are not enough of them. Locals don’t appear to eat out much anymore.

The gas is being turned off in many apartment blocks. If you have some savings you can pay to run an electric heater. It costs more, but this situation is not about efficiency, it is about the money running dry. When there are strikes they are no longer about people wanting more, but about people demanding to be paid for the work they have done. They blockade until they are paid.

Every day you hear stories of people taking what money they have out of the country, to somewhere safer. Every day you feel that it is all spiralling down a little further, that more of the young people who can are leaving, that there is less and less to g...

Table of contents

• Cover
• Copyright
• Introduction
• 1 Medicine is a social science, and politics is nothing else but medicine on a large scale
• 2 Preserving sanity when everything is related to everything else
• 3 Less suffering
• References