Poverty and health in Britain today

Abstract

Most countries of the western world are experiencing a crisis in Health Care Costs, irrespective of the structure of health services. Much of the increase in costs is caused by the technological innovation in treatment methods and an apparently limitless demand for medical care. The dominating role of treatment orientated medicine as opposed to prevention and care has been challenged and increasingly attention is being paid to alternative strategies on the basis of measures of need; such measures ultimately involve value judgements and the way in which value judgements should be made is increasingly a matter for public debate. The development of the bias towards treatment medicine is to be understood from an examination of the antecedents of health services. In this country the important factors have centred on the separation of the voluntary hospitals dealing with acute sickness from the poor law hospitals dealing with the chronic. The scientifically orientated medical schools came to be grafted on to the voluntary hospitals and this has led to a neglect of alternative emphases both in medical education and in practice. The intimate relationship between sickness and the social conditions of life which include poverty, education, housing and employment, have long been recognized and the development of the state social security schemes has been a reflection of this recognition. Keynes contribution to this was in showing that periodic unemployment did not have to be accepted as inevitable in capitalist societies based on social democracy. The Beveridge proposals for social insurance assumed that full employment would be achieved in post-war Britain. Increased Government involvement in social insurance and health services have not achieved the equalization of life chances that Beveridge envisaged. There are major inequalities of service provision both between classes and between regions. The separation of health from other social services and from employment and housing policy has prevented the development of rational policies based on a total systems view of health care. The reorganization of the National Health Service had as an aim the attainment of more rational planning and management but unless there is effective liason between all the agencies concerned with health in its broadest sense, there is little hope of escaping the straitjacket of a restricted technological view of the role of medicine. In particular there is a pressing need to take steps to equalize the life chances of all members of society and this can only be achieved by paying attention to the basic causes of ill health which still include poverty, unemployment and adverse living and environmental conditions. Such changes of emphasis are unlikely to be achieved without a major shift in the value systems of doctors and it is difficult to see how this can be achieved with the present recruitment of students from a narrow segment of society and the predominant treatment orientation of medical schools.