Select Committee on Health Appendices to the Minutes of Evidence

Annex 1


  The maintenance and improvement of standards of public health is a key element of all civilisations, what varies between them is the cultural, environmental and political context in which changes and interventions occur.

  The adage "prevention is better than cure" is well known and well used, and in cultures and societies where resources for medical interventions are low, the adage becomes a reality. Yet in "Western" civilisations, economic success has not only exposed the population to a wide range of health hazards, it has enabled society to regard health as something which deteriorates but which can be restored by medical intervention. (The so-called "medical model" of health).

  This focus on restoring health rather than preventing its loss was never better illustrated than in 1998 when the Government rightly chose to celebrate 50 years of the NHS but rather ignored the fact that it was also 150 years since the first Act of Parliament which required local government to intervene to remove hazards to health. Since 1848 the major interventions that have brought about sustained improvements in standards of public health have been primarily non-medical in nature. While no one would ignore the invaluable contribution made by doctors and scientists in developing immunisation programmes and screening systems, the contributions made by non-medical organisation and individuals need to be considered. These include:

    —  the provision of safe, healthy workplaces;

    —  provision of treated water supplies;

    —  adequate drainage systems;

    —  improved sanitation and waste disposal;

    —  removal of slum dwellings;

    —  smoke control measures; and

    —  improvements in food safety and consumption.

  Almost without exception these measures have been managed by local authorities and other locally based statutory bodies.

  The emergence of the inappropriately named National HEALTH Service in 1948 while welcomed unreservedly, actually did a disservice to the work undertaken by others over the previous century and deflected attention away from the work still to be done to protect and promote public health, In reality the NHS was not concerned with health but with ill health and its focus was, and is, primarily on repairing damage to health rather than preventing it. The evidence for this is quite simply the proportion of its budget (national or local) which is spent on providing medical services as opposed to information on healthy living. The pre-occupation of political parties and the media with waiting lists and treatment rates rather than with the level of ill health in the community simply puts pressure for this to continue.

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