THE CASE FOR PUBLIC HEALTH
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
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.