Friday 22 March 2013

Working for a fairer distribution of health

Working for a fairer distribution of health

The Institute of Health Equity released a remarkable report this week. Its plain title belied its radical intent, Workingfor Health Equity: the Role of Health Professionals.

The world of medicine has changed, for the better I would argue. When I first started making the case to doctors for social determinants of health, a common reaction was: our job is the individual patient, first, last and always. Of course it is. But, as we said when arguing for the necessity of setting up the WHO Commission on Social Determinants of Health: what’s the point of treating illness and then sending the patient back to the conditions that made them sick in the first place.

Doctors who argued that it was not their business might have been reminded by this year being the 200th anniversary of John Snow’s birth what a concerned doctor can do. Snow, an anaesthetist, was horrified at the numbers of people in the Soho area of London dying of cholera, during an outbreak. Rather than wait for more cases and deaths, he set about determining what conditions made them sick. He sorted it out. He used good scientific reasoning to identify the causes in polluted water and, in a wonderfully dramatic public health gesture, removed the handle from the Broad St. pump. The fact that it may have been too late simply argues for evaluation of our interventions. Good intentions are not enough.

Our workforce report has brought together a remarkable group of 21st century health professionals in the John Snow tradition. Nineteen organisations, including our own, made commitments to use their best efforts to promote health equity not only by improving access to care but by addressing social determinants of health.

Reaffirming the BMA’s commitment to this area, the launch meeting was opened by the BMA President Baroness Hollins. Malcolm Grant, was there in his dual role. As Provost of UCL he supported the IHE. As Chair of the NHS Commissioning Board, he was keenly interested in what the health workforce can do to reduce health inequalities.

Dr Cecil Wilson is current President of the World Medical Association and former President of the American Medical Association. In his inaugural presidential address in Bangkok last October, he said that a theme of his presidency was the social determinants of health. Listening to him, then, I thought: if I should die now, I’ll die a happy man. (Be careful what you wish for. Four days after I returned from Bangkok I had a dreadful bicycle accident and nearly did. I came away with a fractured femur. Luckily it wasn’t worse.)

Cecil spoke at our launch as did Anna Reid, President of the Canadian Medical Association. The CMA, working with us, has developed its own programme of work on social determinants of health. Anna herself, practices in Yellowknife in the North West Territories. A large proportion of her patients are First Nation or Innuit. She sees the operation of social determinants in her daily practice.

We heard, too, from Jonathan Sexton representing the Academy of Medical Royal Colleges, and Adrian Tookman telling us what the Royal Free, an advanced teaching hospital is doing. Inspiring stuff.

We see the launch not as a culmination but as the start of a process as all of the nineteen organisations that made commitments make them real. It really is exciting.