Health as a social goal

At its inception the NHS was designed to provide personal health care as a publicly organised service. It was to include all citizens and was a deliberate move towards social justice.6 Despite all the recent changes the NHS remains explicitly committed to equity.7 However, it is now expected to operate in the context of a wider society which apparently has no such commitment. Increasing socioeconomic polarisation has let the rich become richer and more complacent and the poor become poorer and more marginalised. Homelessness, unemployment, and the prison population have all risen.8 Poverty, marginalisation, loss of autonomy, unemployment, and homelessness are all destructive of health and so make the task of the NHS more difficult. During the 1980s social divisions in Britain accelerated at a rate not matched for a sustained period by any other rich industrialised country.9 Yet responsibility for health has been shifted from society to the individual10 and we seem to have lost any notion of the pursuit of health as a social goal. …