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EDITORIALS: David Haslam "Schools and hospitals" for "education and health" BMJ 2003; 326: 234-235 [Full text]

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Managers: Take Note.

charles e berrisford   (4 February 2003)

What have hospitals to do with health?

Peter Davies, Peter Davies and Seth Jenkinson   (23 February 2003)

Managers: Take Note. 4 February 2003
charles e berrisford, GP Bath Ba2 3JZ Send response to journal: Re: Managers: Take Note.	This is an excellent description of the vital role of Primary Care within the NHS. I hope that those making the decisions about the future funding of the NHS realise that Primary Care if the foundation upon which the rest of the service stands. Competing interests:   None declared
What have hospitals to do with health? 23 February 2003
Peter Davies, GPs Mixenden Stones Surgery, Mixenden, Halifax HX2 *RQ, Peter Davies and Seth Jenkinson Send response to journal: Re: What have hospitals to do with health?	We welcome Haslam's clear editorial (1) pointing out the role and extent of primary care and the importance of its risk sink function. We think the flaws in thinking that allow Tony Blair and others to conflate "hospitals" with "health" or a "health service" are deep, and go far deeper than Haslam describes. This false semantic linkage between "health" and "hospitals" needs to be broken urgently to help both Mr Blair and ourselves to clear our thoughts about health and illness. Hospitals have nothing to do with health. They are palaces of disease, dedicated to the provision of remedial fixes for illness. Their spirit is devoted to Panacea. This is a valid and useful role, but caring for illness is not the same as producing health. The present policy places far too much importance on the dramatic medical intervention, with the hidden false assumption being that treating illness restores the patient to a default state of health. As doctors we are illness professionals, and our training teaches us very little about health. Health, and the means to generate it, lies outside the boundaries of medicine. (2) The classical inspiration for health generation is Hygeia. As a profession, and a society, we have neglected the wisdom she represents for too long. We believe it is time to redraw the boundaries clearly. We need to distinguish between remedial illness treatment work which is where medical expertise lies, and generative work to promote health which comes from improving the interactions between individuals, their biology and their culture. A true health policy would concentrate on the generation of health. Indeed it would work to reduce the flow of patients to the medical service. It would have fewer patients visiting doctors, and fewer doctors needed, as one of its criteria of success! 1. Haslam, D “Schools and hospitals” for “education and health” BMJ 326; 234-5 (1/2/3) 2. Davies, P and Jenkinson, S End stage social pathology BJGP 53;168-9 (Feb 2003) Competing interests:   None declared