Intended for healthcare professionals

Observations Life and Death

The NHS gift economy is in peril

BMJ 2012; 344 doi: (Published 25 January 2012) Cite this as: BMJ 2012;344:e590
  1. Iona Heath, president, Royal College of General Practitioners
  1. iona.heath22{at}

Those who regard the NHS as a gift economy feel betrayed by the current emphasis on the interests of for-profit businesses in government health policy, says Iona Heath, writing in a personal capacity

As the festive season recedes and children settle down to wait for their birthdays, it seems a good moment to think about the place of gifts within society in general and within healthcare in particular. The best gifts bring delight to both the giver and the recipient, and these delights are mutually reinforcing. Scholars, including the French sociologist Marcel Mauss (1872-1950) and, more recently, the US anthropologist David Graeber, have described the extent to which gifts have played a core role in societies throughout human history and that economies that are based on gifts preceded those based on barter. And how could I have discovered all this if not through Wikipedia, perhaps the pre-eminent gift endeavour of our time?

It was Mauss who coined the term “gift economy” in his celebrated Essai sur le Don, published in 1925. Mauss defined gifts as “presentations that are in theory voluntary, disinterested, and spontaneous but are in fact obligatory and interested.” In his 2002 book …

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