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Inequity needs attention in the race of target compliance
- Udaya S Mishra (9 March 2007)
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One sided view
- Miles Fox (16 March 2007)
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The state of education and the health services.
- William G Pickering (18 March 2007)
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Udaya S Mishra, Associate Fellow Centre for Development Studies, Trivandrum Kerala 695 011
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While inequity has drawn attention of everyone, what remains to be seen is its being accounted for in all evaluation and monitoring of health targets. In fact many achievements have to be pronounced provided they qualify equity concerns otherwise they need not be stated as progress. In the recent race for complying with MDGs there is every possibility of overlooking equity and this is a risk which should be avoided. Competing interests: None declared |
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Miles Fox, Retired Consultant Urologist Sheffield S10 3PR
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I read your leading article in the BMJ of 3rd March 2007 with a great deal of sadness, for as the editor of a prestigious medical journal you have presented your readers with a biased one sided view which the majority of its professional members have increasingly learnt not to subscribe to. Pursuing relentlessly the hunt for equality with the aim of fairness has proved tragically to be both unfair and destructive in various fields particularly in medicine and education. The unhappiness in the professions, desire for early retirement and resulting emigration with loss of a trained workforce present ample evidence of disillusionment. Nations will thrive only by allowing its people to express and pursue their individuality and inherent qualities to the full. No one is equal in that respect. Talent and ability require to be recognized and should be given every opportunity of support to do so. Growth of knowledge, contentment and also wealth are thus generated, service is improved, and in medicine those not as mentally or physically able can thus be better cared for. Excellence as well as wider care will be achieved in this manner and not by forceful equalisation resulting in continued regression into increasing mediocrity. Do we have to stand alone with Cuba in a deteriorating state of medical care by blind obsession with the tragic pursuit of equality? Competing interests: None declared |
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William G Pickering, Doctor Newcastle upon Tyne. NE3 4AL
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The state of education and the health services. Mr M Fox’s piece is a welcome précis of a subject other luminaries have written about in countless tomes since before the inception of the NHS [1]. State control, including of both medicine and education, leads to wasteful mediocrity and worse. Some wonderful things happen within notwithstanding – in both spheres. But in the UK health services, considering the rocketing proportion of the nation’s wealth tipped blindly in, there is little cause for celebration. Abuse of the ‘system’ from within and without is endemic. Just stay the course and you’re on a monthly payroll for ever, irrespective of quality (though not quantity). Altruism and a hefty salary should work beautifully insist self-deluding politicians and elite philosophers. It doesn’t. The lullaby of ‘equality’ and ‘free at the point of use’ has led to sleepwalking through careers and hideous inefficiency. It is so often left to the superannuated to say what Mr Fox says. It is the same in all the state services: retired generals, teachers and doctors hit the nail as soon as their pensions kick in. (Politicians call their own convulsions of honesty their ‘memoirs’). Just enough life left to at last disregard compliance and ‘correctness’, to at last urgently stamp some truth on the world, and to at last assuage consciences suppressed over a working lifetime — the very time they should have been most active. Ms F Godlee, it will be noted, in her piece on ‘health inequalities’, ‘liberal policies’ and ‘redistribution of income’, omits the word education; no small omission in an article on an ‘unequal society’ [2]. Mr Fox’s accusation of her being “one-sided” is near the mark. If it is true that a sound education makes one healthier (and even Ms Godlee’s ‘liberals’ would surely not doubt that), is it not clear where the money and effort should best go? [3]. Though if quality and efficiency are the aims, the extant state model of education, like that of health, is conspicuously not the correct system for redirected expenditure and policy. William G Pickering 18.3.07 wgpi@hotmail.com 1. Fox M. One sided view. http://bmj.com/cgi/eletters/ 334/7591/0#162440, 16 Mar 2007 2. Godlee F. Our unequal society. BMJ, Mar 2007; 334: 0 ; doi:10.1136/bmj.39140.571759.43 3. Sir Donald Acheson. Independent Inquiry into inequalities in health. 1998. published by The Stationery Office as ISBN 0 11 322173 8. (Part 2, Education). www.archive.official-documents.co.uk/document/doh/ih/ih.htm Competing interests: None declared |
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