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Editor's Choice

What has social injustice to do with medicine?

BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c842 (Published 11 February 2010) Cite this as: BMJ 2010;340:c842

Rapid Response:

Social Injustice to Health Care Access & Quality is here to stay!

Many words, which arouse subjective understanding, have surfaced in
this very interesting editorial.
"Will Michael Marmot’s crucial review of health inequalities in England "
– I ask, when has there ever been a time in this great land, or any other
place on this planet, since the beginning of time where has not been
health inequality for any of the multitude of reasons- finance, access to
service, quality/quantity of health services and personnel etc? The same
goes for in other spheres of life - education, career, quality of life,
taxation etc.
Even in a system to overcome such an irrevocable fact.

Thus it is frankly no surprise that neither Marmot’s or Black's
report would differ. The same parameters and their values exist back in
1980 as they do in 2010 and will do so in 2040 onwards.

No report will shed anything new. for what these reports and others
to come, will show a fact of nature, a fact of life, a fact of human
society. Thus to say "Over time, greater understanding of the complexities
of how things work at the national and global level has added
sophistication to his message while removing nothing of its power", I
disagree - such statement shows only now people are becoming aware that
always was so before.

"Are we—doctors and politicians—as powerless to act as she suggests?"
- this is an automatic suggestion that we as doctors have the onus ontop
of being medical clinicians, to also be "priests" and clinical
sociologists, to be like prophets to resolve this situation of social
injustice!
So with Dr Hedge I agree that "Civil engineers, politicians, social
workers, philanthropies, and the altruistic social organizations should be
able to do something in keeping the health of the public.", and thus
minimize the social injustice to health care.

Yet the WHO report does point to an ethical and moral issue "why
treat people...without changing what makes them sick?" - for this involves
not only doctors, but an array of others involved for this to work - and a
break in any part of the line (be it due to complacency, corruption,
ineptness, low morale, low quantity/quality staff, bad communication, high
level bureaucracy) can cause no alleviation to the social injustice to a
minimal. Thus I concur with Marmot that action has to take place across
ALL sectors homogenously and in synch, all singing the same hymn in
solidarity.
Thus wise advice that is not being done already should be by Marmot:

1. providing universal access to good quality care.

2. collaborating with other sectors such as transport and social services.

3. understanding and measuring outcomes.

Thus I disagree it is not that countries are failing to answer for
all know the answer; but to implement it is harder than it is with. In the
NHS, we have too many "cooks spoil the broth" i.e managers, and managers
for managers, and managers for this and that, and government targets and
performance level, that we are missing the whole point of what is the
health system and to maximize the true potential that we have to help
those indeed - the medical clients (patients as one may still like to call
them). In addition the average doctors have hardly any say in how to get
things more efficient on a ward level, so let alone on a social system, is
rather too much to ask!

My peers from Africa and South Asia, tell of growing corruption and
complacency to help, and hinders any level to help, which if overcome at
the front line, is envisages at a higher level to get things done. It is a
lose lose situation it seems as it has always been so.

Some may sasy the closes was in communist Russia, where health care
system was free and all be it poor or rich (mainly the politicians) were
entitled to full level of care and treatment - no postcode lottery (as in
NHS), or ones insurance (as in USA), and many doctors from the Baltic’s
and East Europe have told me how system was much better for all and money
and technology was on object to treat the patient. A great contract where
today in their home countries many even regret becoming capitalist or part
of "new empire"/European Union with a great disparity of health care and
the social health systems are all but in name, with huge numbers of doctors and
nurses laid off and wards closed, and hospitals are as in dark medieval
times acting more as infirmaries to care only before one passes away.

The NHS is socialist whale swimming in a cesspit of capitalism, in a
right-wing "EU" neighbourood, as part of a defragmented city of different
cultures, ideologies, prejudices and bias, let alone priorities of each
household ("country").

Let us pray that whichever Political Party wins the upcoming
English/"British" General Elections of 2010, will revive the NHS from its
embittered coma status, and bring it back to life with regain of status
and respect duly deserved to the doctors and allied health professionals,
that our cousins across the waters - East and West - and our past wise
doctors in NHS had, more than we do in NHS this new century in parallel
to avoid the great disparity of health care not just across the engrained
British class system but across geographical locations that I have noticed
varies substantially across each deanery in England and Wales.

Peace to you all!!

Competing interests:
A British Pro-NHS, NHS working doctor of old school thought of medicine as an art and a way of life not as a career.

Competing interests: No competing interests

15 February 2010
Taiyyab Mehmood
ST2 General Medicine
UK