Argument 1 – We need ‘Total Health’, not make do and mend.

This is not a piece on the Government’s attempts to privatise the NHS.  Excellent articles on this critical matter can be found elsewhere.

However, one part of the proposed changes to the NHS is relevant here.  The original version of the Health and Social Care Bill proposed removing the formal legal responsibility for maintaining the NHS as a comprehensive universal healthcare provider from the Secretary of State for Health.  Following the general outcry at the Bill, this change was abandoned.  But while this still remained a realistic part of the final Act, I remember thinking ‘What exactly would the Health Secretary do then?’, provoking the thought that the Health Secretary is little more than the Minister for the NHS.  This reflects a particularly narrow view of what health is.  The NHS is admirably broad in its functions, and is able to provide a world-class service.  But despite certain bureacratic moves towards promoting preventative medicine within the NHS (the GP contract introduced by the previous Labour governmenr), the NHS is still a ‘sickness service’.

There are solid reasons why this is so, despite a wealth of evidence that genuine commitment to, and investment in, preventative medicine, achieves great results, in terms of lives saved and improved.  The main one is that there has been a confusion between preventative medicine and ‘Public Health’.  Public Health (the capitalisation is deliberate) has come to mean hectoring (and sometimes bullying) from the State and its agents.  Yes, one of the best ways of preventing deaths from cancer and heart disease is to reduce smoking.  But the increasingly authoritarian measures being applied (egged on by the medical establishment) are an unedifying spectacle for this lifelong non-smoker.  We see similar efforts, not yet backed by such illiberal legislation – in England at least – being directed towards fatty foods and alcohol.  Increasing prohibition and hectoring about lifestyles is pernicious and reactionary.

Because doing so would raise serious questions about the nature of the unequal, atomised society riven with hopelessness that gives rise to many unhealthy lifestyles, these measures fail to deal with why so many people smoke, overeat/eat unhealthily or drink too much.  Instead, surveillance, proscription and inteference is ramped up.

Eating the occassional burger becomes a matter of national crisis, but the fact that tens of thousands are homeless (reducing their life expectancy by 30 years) and hundreds of thousands, including children and the elderly, live in accommodation that aspires to being sub-standard, goes uncommented upon.  No Jamie Oliver documentaries there.  The fact that there is a direct, statistical, epidemiological relationship between the level of inequality in a country and measures such as life expectancy, infant mortality and crime is never broadcast.

We should continue to fight for excellent, publicly-funded and run hospitals for those occassions when we will need them.  But let’s not forget that the way to prevent (or reduce) those visits will not be found in restrictive and illiberal legislation, but with a society that is more equal, with quality housing for all, and with all those other disease-preventing factors that scientists and social scientists have worked hard to identify.  As this means questioning much about the way our society is run, who runs in, and for whose benefit, you won’t find many politicians proposing these things.  Instead they’ll bleat about the number of units of alcohol people drink, or the fat content of school food, while comprehensively failing to give a shit about the young girl who keeps getting ill, not because of the things on her plate, but because of the damp which pervades her bedroom and all other rooms of her home.

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