© 2017 The Harpenden Society

The Harpenden in Question - being a series of editorial commentaries on important Harpenden issues that should challenge thought and encourage inquiry and action.

19. Life and Death Matters

Shuffling through my own lecture notes at a conference, I was discourteously inattentive of the current speaker until he announced that 'if expenditure on the NHS were doubled, the health quotient of the nation would increase by one per cent; if it were halved the health quotient would decrease by one per cent.' It was a dramatic reminder that overall health is determined by the choices we all make all the time. The NHS is  simply where you turn when you are ill. As David Law of the Herts Community NHS Trust recently told a meeting of the Red House Forum, at any one time only 5% of the population are using 40% of  NHS and social care resources. If you take the average individual NHS budget over a lifetime, 90% is expended in the last five years of life.

The eminent Scottish geriatrician Sir Ferguson Anderson insisted on calling the NHS the 'National Illness Service' as it is curative rather than preventative. And, as David Law further explained, the old-style NHS construct is becoming outmoded. (See page 3 for more) The killer illnesses of old were savage infectious fevers. They were met with superb public health interventions by way of fresh water and sanitation backed by a vast array of long-stay hospitals. Most of these perils have been bested.

The present-day killers are of the same epidemic proportions but they are social rather than physical in origin. Cancer, heart disease, hypertension, depression, stroke, mental illness, drug and alcohol addiction and obesity – they are often the consequence of adverse social conditions. Smoking, chronic stress, poor diet, lack of exercise and pollution account for much illness. Public Health England's latest report estimates that 40% of British ill-health is determined by lifestyle.

Alcohol is implicated in 33,000 deaths a year and one in six A&E department admissions are alcohol-related. 1.5m in and out-patients annually have alcohol-associated problems, at a cost to the NHS of £3.75m. It is estimated there are 1.6m dependent drinkers in the UK, compared with 332,000 dependent drug-users. Tobacco usage continues to cause of 114,000 deaths each year.

One in five British adults is seriously overweight, with 1m of them morbidly obese – and with 31,000 premature deaths the dire consequence.1.5m children aged two to ten are either obese or overweight, with 500,000 children sadly at risk of liver disease. Half of the 16,500 deaths from bowel cancer are thought to be related to poor diet.   

It is for these kinds of reasons that the NHS are attempting to shift to more community and less institutionalised systems, with the proposed Red House Health and Wellness campus, one hopes, a future example. It is for these reasons that a civic society, such as ours, should take an abiding interest in health matters.

As the medical sociologist Laura Stark has concluded, 'death is now socially constructed...the outcome of politics not biology.'

Eric Midwinter

Winter 2015 Newsletter