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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)
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.
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
Competing interests: No competing interests