Book reviews

Abstract

In the autumn of 1992 I was present at a large gathering of health services, local government and voluntary staff at a regional event to promote The Health of the Nation strategy. The Chief Medical Officer was billed to speak. Present under sufferance, the audience had the look of a group about to be lectured on the dangers of fast food and sun lamps by a civil service doctor. What they got was the very un-civil servant-like Ken Calman, and 20 minutes of Glaswegian eloquence, wit and powerful health messages about working together for the public's good. He won a huge ovation. Now, as he stands down after seven hectic years as CMO, Sir Kenneth Calman has edited and published these years of talks, lectures and speeches in The Potential for Health. By his own admission, this is a loose collection of 15 chapters, some short, with fleeting ideas and half-worked arguments; others substantial and detailed critiques on such `Calman' issues as medical training and specialist services. Prepared for different audiences and at different times, and spanning health crises, changing political masters, and landmark developments, the book is, perhaps inevitably, somewhat uneven in tone and treatment. Yet what comes across in extremely clear prose, is the breadth of interest of the writer and his strong conviction that medicine, and particularly public health, should be a humanising activity, which he powerfully describes as the art of `making it happen' Through this diversity, favourite topics emerge. The ethical framework of health delivery, both at the individual and societal levels, is explored in several places with particular emphasis on ethical issues in training, including a rewording of the Hippocratic Oath. Moreover, though he has been discouraged for most of his time as CMO from speaking about health inequalities, Calman'”s explanation of the distinction between health inequity and inequality is excellent. Several times, unsurprising for one at the eye of the BSE/CJD storm, he tackles public understanding of health matters, and particularly ideas about risk and benefits, weaving together, in one of the most skilful discussions in the book, an examination of attitudes to risk, the public's need to know about health care outcomes, and the openness and accountability of health services. Partnership for health is another mantra. An early marker is put down in the desire to change the WHO slogan `health for all' to `health by all', arguing that the 1978 Alma-Ata declaration has treated people as passive recipients of health care, rather than active partners in improving health. This leads Calman to his principal theme captured in his title, `the potential for health', that good health is not an end but a means to having a good life, a way of travelling, rather than a point to aim for. This perception could have some dramatic consequences for how health is portrayed and how it is approached, but often the author draws back from exploring these, leaving this reader, at least, frustrated by a want of conclusion. It is something of an irony that the author is moving out of the post that he calls `the best public health job in the country' at a time when potential changes in public health both here, and internationally, could lead to a fundamental rethink in much of what is done in the name of the public's health.