Undoing MacBeth's legacy

Abstract

Just prior to writing this editorial, SARRAH received requests from the Department of Health in Scotland about remote service models. The reminder of Scotland's more desolate regions stirred images of bloody intrigues such as enacted by MacBeth who united Scotland in a 17 years reign that ended in 1057.1 Now that we have a parliamentary form of government we are inclined to think that we are well and truly past the thinking that forged such kings. Yet when we look at the signal inequities in health and opportunity, that this form of government is unable to resolve, we might wonder whether our society's attitude about power and government is a carry over from those middle ages. In act IV scene I of Shakespeare's ‘MacBeth’,2 MacBeth seeks out three witches to foretell the future of his power struggle to be king. Their answer was not at all to MacBeth's liking and when they saw this the three witches did a dance and disappeared. These witches can be seen as the inner conscience of MacBeth himself and therefore could only reflect the outcomes of MacBeth's own mindset. The community and the health industry shares something of the dilemma of MacBeth and the three witches. The community, who would be master over their own destiny, expects that the philosophy (values) and vision of the health industry will foretell a successful health outcome for them. The community often fails to realise that its own values and vision, or lack thereof, is reflected in the provision of health services and to a large extent health itself, and that the considerable power they hold over the future lies not in the wrestle for power itself, but in determining the philosophy and vision that underwrites their future. Professor James Little of the Centre for Values, Ethics and Law, supporting the notion of values-based medicine as fundamental to refreshing the paradigms of medicine,3 and Mooney and Blackwell supporting processes for the community to identify their values as part of health planning systems,4 both provide thoughtful appeals to include reflection on values as part of health planning. Implicit in their discussion is that, apart from a broad and deeply felt value for quality and quantity of human life which sustains the large expenditure on health, there is not a congruent community philosophy and vision about health. The incongruence of values in the community ensures that the resources available for the provision of health services are vulnerable to MacBethian struggles within the parliamentary system with some major losers. It is possible that this same incongruence of values allows the high level of health-risk behaviour in the Australian community. It is becoming increasingly unlikely that there will be a large enough health professional rural workforce to provide the current intervention levels for many of the afflicted, at a diminishing rate over the next 30 years. Minimising the rates of all afflictions must be our most urgent work. Yet those features that are closely linked to a better health outcome such as area and characteristics of upbringing,5 education and wealth,6, 7 locus of control,8 are found in the broad philosophy and values of an equitable society.9 Without a congruent vision of society that is caring and robust in its various relationships, healthier rural communities seem improbable. I would like to suggest that there are several notions that cover the spectrum of life, which would strongly influence our emotional and social attitude toward an equitable society, and also have positive, pragmatic value to health, economics and community: the human life has the right to every opportunity to realise its potential the worth of a human life is measured by its efforts in caring for other humans, animals and the environment the purpose of a human life is to better the world for everyone the betterment of the world can only be achieved through a life of service trials are essential to the improvement of human understanding and our relationships happiness is the result of the effort applied to the search for insights that assist us to improve our relationships with others death is a deeply respected part of the order of things. Society should be engaged in an enthusiastic discussion about these notions. What are their implications? What personal actions would derive? What policy? If we want to achieve an equitable, healthy society, these questions should be addressed in dialogue and action by the collaboration of all players – non-government organisations, industry, business, the health industry, education and training sector, the scientific sector, the justice sector, the health industry, politicians and political parties, local governments and individuals in the community.