Issue 180 of SOCIALIST REVIEW Published November 1994 Copyright © Socialist Review
A regular column
contributed by our readers
It is a simple concept that the prevention of disease is far superior to treatment after its onset. It is far less debilitating to retain good health than to suffer illness followed by treatment often more unpleasant than the original symptoms. It is also a simple concept that disease prevention is far more economical than medical treatment for a severely underfunded health service.
The theory of health promotion has been around for years, but when the Tories identified it as an ideal excuse to cut funding to the NHS, health promotion was suddenly on the national agenda. It appeared in the contracts of all NHS health professionals and openings for specialists appeared throughout the jobs pages. Health promotion became the only expansion area in an otherwise declining National Health Service.
However, health promotion has not always been so attractive to the Tories. In 1980 the Black Report identified huge inequalities in health between the classes in the UK, resulting from poverty and poor working conditions. It recommended that resources be poured into the areas of greatest need and urged an immediate attack on poverty, emphasising the need for prevention of ill health. Such was the embarrassment of Thatcher's government that it restricted publication of the DHSS report to 263 copies.
Seven years later, having published similar research, the semi-independent Health Education Council had its government funding withdrawn. The Special Authority status forced upon it effectively placed the new Health Education Authority (HEA), and any activities it undertook, under direct government control.
Detailing the cost of coronary heart disease and alcohol and smoking related harm in millions of pounds and lost working days, the new HEA declared its main functions to be the promotion of 'cost effective alternative strategies to disease treatment'.
The government's latest and most dishonest venture into health promotion is the 1992 White Paper, the Health of the Nation (HoN).
Coronary heart disease and stroke are understood to be caused chiefly by poor diet, lack of exercise, nicotine and alcohol intake, and stress. Eliminating the costs of treatment is clearly in the Tory government's interest, but so too is retaining the revenue from cigarette and alcohol sales and the vast sums paid to their party by tobacco and brewing industries.
HoN places the responsibility for such lifestyles on the individual by offering them 'healthy choices' that they effectively do not have. There are also penalties such as risking refusal of NHS treatment for smoking related illness. Even war veterans' pensions can be cut if their illness results from nicotine addiction, first encouraged by the state to calm their nerves on the battlefield.
Cancers will account for 30 percent of all deaths this year. Treatment is costly, despite Tory purchaser/provider reforms effectively denying many patients access to relevant specialists. Before HoN, the Tories' only hope of cutting costs was in patients dying between diagnosis and getting a hospital bed.
Certain preventative measures can be taken for some cancers, so the Tories can shift blame again. As skin cancer can result from over exposure to ultra violet rays, the cheap package holiday so long pushed to the working classes is suddenly a dangerous choice. Lung cancer is widely caused by smoking, so they have the 'choice' to give up. Breast and cervical cancer can be treated with early detection, but there is low take-up of screening services by working class women.
Mental illness is less costly for the Tories after the closure of many long stay institutions under the Care in the Community Act. HoN shows the only Tory interest in mental health to be in the reduction of publicised suicide rates. Again, responsibility is offloaded on to already overburdened acute and community professionals.
Sexual health is a tricky area for the Tories. Teenage pregnancies and sexually transmitted diseases are on the increase. Traditional heterosexual family units are contracting HIV. For the Tories, these represent moral decline, and their own failure to impose Victorian family values. The problem for the Tories is how to teach the kids sexual health without teaching them sex.
Suddenly even the HEA, vanguard of the Tories' notion of safer health promotion, has become a political embarrassment. The organisation whose campaigns usually run at the level of 'Packet in' (anti-smoking) sponsored a surprisingly good booklet on sexual health for young people. When a minor government minister condemned it as 'smutty', a fearful HEA immediately suspended production of all its sex education materials.
Accident statistics belie the Tory theory that it is safe to close accident and emergency departments. HoN worthily targets the under-15s, 15-24s and 65 and over as the most vulnerable, explicitly entrusting the safety of most of the working population to employers (a group not known for its concern for workers' welfare). Simultaneously, the Tories are bent on restoring Victorian accident rates by scrapping the health and safety laws.
Nevertheless, despite the dishonesty of HoN, it is only a thin disguise for the Tories' attitude towards public health. it is a ham portrayal of a caring government with the interests of the nation's health at heart, and a concern for the quality of life. But this is incongruous with our experience of 15 years of cuts in health, education and social services.
All of this is not to undermine the worthiness either of the concept of health promotion, or of the professionals engaged in its practice at present. Most health promotion specialists tend towards the left, having both studied and witnessed the effects of inequalities of health. In a socialist society, there would be equal access to decent health and services and quality of life which would drastically reduce the detrimental use of any substances. Funding would be poured into honest health promotion, into treatment of incurable conditions and into maintaining decent working and living environments. There is a textbook model of health promotion which goes beyond the giving of 'healthy choices', to fundamentally changing conditions in society to facilitate health living. At present, it remains untested, but there can be few other so succinct definitions of revolutionary socialism.
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