“Health is made in the home – hospitals are for repairs.” This African proverb is quoted in a paper in the BMJ by Lord Nigel Crisp, previous Head of the National Health Service in England, “Everyone has a role in building a health creating society.” (1) He points out that WHO in Europe has said that modern societies actively market unhealthy lifestyles (2) alongside the glamourisation of indulgent lifestyles in a celebrity culture. There are huge commercial pressures marketing cigarettes, sugar rich drinks, alcohol, pornography … and against that we in healthcare have to try and persuade our patients not to smoke, not to drink more than a single alcoholic drink in a day, to avoid promiscuous sex. What, asks the author, if instead of the marketing of unhealthy lifestyles our societies marketed healthy lifestyles – with all sectors working towards a healthy and resilient population? How could we begin to build a health creating society? (1)
This made me reflect that much of what we call “healthcare” is in fact the repair shop, putting right the effects of bad lifestyles, poverty, inequality or helping people cope with that which can’t be mended. Much of our education is designed at creating us as highly competent at disease treatment and management. Certainly mine was, and it came as a revelation when studying for the DTM&H (Diploma in Tropical Medicine and Hygiene) that the cause was integrally connected to outcome, and my responsibility as a doctor was to help correct the causes – not just with advice to individual patients but with taking up issues of problems that affect communities with those people who have the power to change things.
Medical education has improved in many places and now examines causes as well as diagnosis – but that knowledge should not remain as head knowledge alone. Does it give us extra responsibility? In matters of health we are better informed than most and enjoy on the whole respect in the wider community. So what role is there for healthcare professionals to play a role in creating this health-creating society? Do we have to be in a prominent place in our careers?
PRIME is increasingly involved in this area. For instance, in Northen Uganda, where church leaders got the vision to work together to improve health in their community, and in various other places – but there is a long way to go. But we can make a difference.
When I was involved in a programme for improving primary care in a North African country some years ago, we ran three day programmes on skills and attitudes for practicing doctors, all of whom in the province had to attend. One of the things we did was to help them see the need to be involved in becoming carers for health in their communities in addition to treating those suffering from disease. When we returned three months later for a follow up, the Director of Health Services made them write a feedback on the difference the course had made to their practice
One team of four doctors reported that they had called a conference for the politicians, teachers, village heads and others with responsibility and, sharing the teaching with presentations by the nurses in their clinic, presented our teaching materials to them. 200 had attended!
Another doctor reported that he was doing his clinic one day and seeing many children with diarrhoea. He felt frustrated because the water supply to the village was polluted and he had pointed this out to local politicians but nothing had happened. He said, “I remembered what you had said. I took three days leave and went to the capital. I sat in the lobby of the Ministry until I could catch the minister himself as he came in. Within a very short time there was clean water, almost no diarrhoea – and I have less work to do.”
One that made a deep impression on me was a young doctor who simply put “I became a doctor!” I hope that we can, like her, realise that as health practitioners be doctors and nurses who are committed to health in our communities rather than just treat disease. If we really care about people, maybe we should explore how we can bring positive attitudes towards health into the thinking of our local politicians, business people and faith leaders. And the real challenge – how to get beyond the issues of smoking drinking and exercise, in which some progress is already being made, to the deeper and more intractable issues of inequality, poverty and exploitation that bring about, directly or indirectly, many million deaths, mental illness and disability worldwide. If we really care about health – maybe these should also be our concern?
1. BMJ 2015;351:h6654
2. WHO Europe 2013: Health literacy: the solid facts