A healthy society?

Nick Spencer, November 2002

wikimedia commons author nhs nhs_logoNigel Lawson once wrote that the NHS was the closest thing the English had to a religion. Having spent five years convincing voters that New Labour was an economically prudent outfit, it was for the purpose of funding the health service that Gordon Brown decided openly to raise taxes and risk his party’s hard earned reputation for frugality. Similarly, twenty years ago, it was the health service at which Margaret Thatcher’s all-conquering free market reforms were halted. The NHS does indeed appear to have a quasi-religious power.

It is easy to see why. In a typical week 1.4 million people receive help in their home from the NHS and more than 800,000 are treated in NHS hospital outpatient clinics. In the 24 months up to January 2001, 95% of the population had visited or had a close family member who had visited their GP. Over the last two decades the NHS has been the top spending priority in the public’s mind every single year. Nearly one in thirty of the working population is an employee. The National Health Service is a national monument.

Yet for a national monument it appears to be in rather poor condition. Stories of under funding or medical malpractice are rarely far from the headlines and although the Chancellor’s pledge of £40 billion has helped shift the media focus, few doubt that the organisation is in need of some treatment itself. How is it, if we are so religiously attached to it, that the NHS comes to be in such poor health?

The diagnosis

The history and politics of the NHS are labyrinthine in their complexity but reveal several key factors which have conspired to exert an enormous pressure on the health service today.

Firstly, there are demographic issues. Over the next two decades there will be fewer tax payers to pay for more health service users. An increasing number of elderly people will place an ever greater strain on the service and although the funding increase will address this to some degree, money is not a panacea. The NHS’s problems have deeper roots.

The twentieth century witnessed the triumph of medicine in the West. Life expectancy increased by over thirty years and infant mortality fell from 14% to 0.5%.  Conditions which were fatal a generation ago are today routinely treated. The great killers which plagued mankind for thousands of years have been (at least temporarily) defeated.

And yet, ironically, this has proved to be one the NHS’s biggest problems. Life has been medicalised in a way that was unthinkable one hundred years ago. We are increasingly encouraged to think of ‘my problems’ as ‘my body’s problems’, or ‘my mind’s problems’. ‘I’ am removed one step from them, as is my responsibility, and it becomes all the more reasonable for me to expect someone else to fix them for me. As Malcolm Muggeridge wryly observed, our song today is, “I will lift up my eyes unto the pills.” This is compounded by the fact that the medical world is no longer as clear about its remit as it once was. The national improvement in health which was initially assumed would alleviate costs has not occurred.   Where acute infectious diseases have, for the time being, been defeated, ‘lifestyle conditions’ such as lung cancer or coronary heart disease have taken their place. This has caused something of an ideological crisis in medicine. How far should medics be responsible for preventing ‘lifestyle disorders’?  How far should they treat non-physical disorders? Where, indeed, is the dividing line between a medical disorder and sense of personal disaffection?

The culture in which the NHS operates also contributes to the pressure on the service. Society has a very different attitude to trust and authority in 2002 than it did in 1948. Authority is questioned and scepticism is the accepted norm. Operational transparency is a necessity – anything that goes on behind closed doors is automatically suspect. Medics are no longer the authoritative and trustworthy figures they once were.

This may not sound like much of a problem but as Onora O’Neill pointed out in her Reith Lectures this year no society or organisation can operate effectively without trust. In an institution which employs a million people and treats ten times that many every year, an atmosphere of mistrust can have seriously detrimental effects.

Similarly, Britain in 2002 is a consumer culture, with choice, rights and service dominating the public vocabulary and mindset. Health may have very little in common with consumer goods but if consumerism is our dominant mode, it becomes very difficult to think differently. As patients become customers and choice a birthright, the health service is under increasing pressure to deliver to the standard demanded by marketplace ideology. Failure to do so has resulted in the rapid growth of legal claims against the NHS, an immensely costly trend in terms of confidence and morale as well as finances.

These problems conspire to present a troubled future for this most valued of British monuments and Christians have a duty to ask how they might think and live in such a way that helps rather than hinders the situation.

Towards a recovery

Biblical societies had no awareness of the biomedical causes of disease or any concept of institutionalised healthcare. Although a number of Levitical laws had their roots in a concern for hygiene and health, they were at least as much ceremonial and theological as medical. Similarly, to talk of a modern healthcare service for a pre-modern society is simply anachronistic. On one level, the Bible has nothing to contribute to the debate.

It does, however, provide an ideological lens through which to examine the issues and think through various popular notions. An example of this is how the Biblical concept of health provokes us to examine our own ideas. Biblical health is best seen in the Old Testament concept of ‘shalom’. Although often translated ‘peace’, shalom incorporates physical, mental, emotional, and spiritual wholeness and, when used of a community, societal and relational health. To be truly healthy in Biblical terms is not simply to be physically fit.

This idea is of particular use when one is faced with the temptation to reduce patients to conditions or wounds, a danger recognised as early as the 19th century   “Medicine”, insisted one lecturer in 1882, “is about treating sick people and not diseases.” “The good physician treats the disease,” said another, “but the great physician treats the patient.”

It is also an important factor when considering the role of the caring professions. Historically these have been somewhat subordinated to biomedical areas of expertise and yet in terms of hours contact, most patients will spend a far greater time being cared for than being physically ‘mended’. If health transcends physical well-being, healthcare should transcend ‘pills and potions’.

Beyond this, the biblical model of covenant can be profitably used as an antidote to modern consumerism. Consumerist principles are, at best, of limited value as a model for healthcare provision. Rather than requiring simply a one-off transaction, true health demands the ‘consumer’s’ long-term, full-time, high-intensity commitment, just as much as it does the ‘provider’s’ efficient and professional use of resources.

Although Biblical models of covenant vary considerably according to situation and participants, the general emphasis on mutual loyalty, obligation, trust, and responsibility are instructive. Not only should we not expect the same relationship with hospitals as we do from our High Street retailers but we need to recognise our responsibility to them, just as we do theirs to us.

Exactly how this mutual responsibility works itself out will differ from one situation to another but it will require us to ask some searching questions of our own motivations. Are we sufficiently aware of the fact that God created us bodily creatures in order to look after those bodies? Do we take our responsibilities to our ‘brothers’ sufficiently seriously to be prepared to prioritise their needs over our wants? Are we willing to care for the vulnerable and marginalized in our lives even though it may be an uneconomical use of our time or energy?

A third pointer is in the Biblical commands to care for those who have difficulty caring for themselves. In an age when the natural demographic shift in the country points towards seeing the elderly as a burden on the state, and family and community breakdown has left many without a natural support network, it is important to remember the Torah’s emphasis on the fatherless, widow and alien. Biblical teaching counsels strongly against the tendency to ignore the more demanding individuals within society.

Rather than simply being a nice-sounding moral pointer this is an uncomfortable command. It asks individuals to put other people’s needs before their own wants and to look beyond purely economic arguments. Are we really prepared to care for the vulnerable and marginalized in our lives even if it is an ‘uneconomical’ use of our time or energy?

An analysis of Biblical teaching can offer guidelines such as these to our thinking about health and healthcare today. But perhaps the most revolutionary Biblical viewpoint on health, however, is one which has little bearing on the NHS itself. Put simply, it is ‘the long view’: the recognition that whilst health and the ‘here and now’ are hugely important, they are not the full story. Suffering can be redemptive. Ill-health is not the end. Love, not pain, is the final word.

Nick Spencer’s booklet ‘Health and the Nation: A Biblical Perspective on Health and Healthcare in Britain today’ is available from the Reports section of our resources.

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Category: News and Reviews

November, 2002

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