The Politics of Health.
By Dr. Terry Maguire, a Northern Irish Community Pharmacist, senior lecturer at School of Pharmacy (Queens University Belfast) and Belfast LCG member.
Health politics, like most politics in N Ireland, is still at a very immature level. Health is a devolved matter so our Assembly in theory makes decision on how we spend our £4.5 billion budget on providing health and social care to our population but sadly our politician remain very narrow in their focus. Our Minister of Health has, in our complex power sharing political system, a lot of power. He is on paper accountable to the Assembly’s Health Committee but can more or less do his own thing.
I suppose it comes from a generation in opposition that both the main political parties find it very difficult to show political courage and not to fudge important decisions for fear of getting penalised at the polls. Sein Fein for example are making hypocricy into an art form. Currently our Health Minister – a member of the DUP – is fudging a decision on having paediatric cardiac surgery performed in one location on the Island – Dublin. An exhaustive process has shown that Dublin should provide this Island wide service but now Minister has opted for another “assessment”. This is not a matter of money it is a matter of patient safety and professional expertise. Put this service on two sites Belfast and Dublin and children will die but then that’s politics.
It would be good to speak truth to power so it was with some delight that, in November, I accepted an offer to speak in the hallowed halls of Stormont’s Parliament Buildings about social inequalities in health in Belfast.
The problem with working on the Falls Road in West Belfast is that during my working day my life expectancy is 6 years below what it is in the evening when I return home to North Belfast and put my feet up. Across our city there are huge differences in the average age at which people die. Men have a habit of dying before women which is unfortunate but shows impeccable manners. For this reason alone health is a political matter yet most of us who work in the health service have little in put to the real politics that shape our health service or so it seems. Most of us are mostly much too busy providing services, turning the wheel, caring for patient that we fail to take a step back and look at how our services might be better delivered in the interests of patient rather than against them. The venue of Stormont filled me with great joy since the life expectancy in that leafy locality is a full 8 years above Beechmount. I was blessed. My audience too offered up a golden opportunity to engage with our power classes; Health Minister Edwin Poots MLA; the Chief Medical Officer, Pharmaceutical Officer and Nursing officer. In addition, a number of the Assembly Health Committee would be in attendance particularly Jim Wells – a DUP Assembly member – who often supports and advises Minister on health issues.
My central argument was to be that the human body was designed for life 100,000 year ago where it evolved on the grassy savannah’s of central Africa. A typical day for men was spent hunting wildebeasts which they were pretty useless at catching up with never mind killing, so it was mostly a matter of returning home empty handed and hungry. The women, who knew the score, had been out all day digging up roots and breaking them down into edible starches to feed their men and sooth the savage breast. Today in Belfast, for too many males, it’s a matter of struggling out of bed hung-over and lighting up the first fag of the day, lying on the sofa tolerating daytime TV and when peckish getting the misses to whip up an Ulster fry with brown sauce on the side before heading back out to the pub, in a taxi. This life-style favoured by those whose life circumstances compels them live in such circumstances, results in the main long-term conditions that make people ill and causes them to dies early.
As a Democratic Unionist Party (DUP) member this would, I thought, be music to the Ministerial ears. The DUP are essentially UK Conservatives at heart and their view is that much of the health and social care problems in the lower classes is linked to a failure of adherence to the work-ethic. But I couldn’t risk the 100,000 years ago comment on evolution since the minister is a committed Creationist and off course in his world our planet is only about 6,500 years old.
So I took a different angle. “Frankly Minister”, I started, “We have too much medicine and not enough health and well-being but then politically that is what, as a society, we seem to choose. Don’t misunderstand me we need the specialist consultants and the high quality medicines when we get sick; my point is why do so many of us have to get sick in the first place”. It was if he were a waxwork. The Chief Medical Officer started to move uncomfortably in his seat.
“Of the ten years of average life expectancy gained since the creation of the Health Service in the late 1940s, about half has been derived from factors such as; better food standards and collective protection from hazards such as infections and accidents. The other five additional life years have stemmed from better medicines and enhanced surgical techniques employed in individual care. But we have a public convinced that there is a “Pill for Every Ill” and this culture is worsening our social inequalities in health.” I’m wasting my time I thought as I saw his eyes blink repeatedly as he tried to keep himself awake.
I was clearly wasting my time. So I gave him a lecture on the need to support a better diet, stopping smoking, getting the populace more active.
“The answer?” I emphasised gazing at him and pausing after my rhetorical question for effect. “Greater investment in prevention and getting our population “fully engaged”. Raise our investment in prevention from 2% up to 20% – is there a politician that has the guts to do this when the additional 18% must come from re-profiling the current services provision”.
That was me finished. Minister was completely indifferent; it was as if he were in a different room. But nonetheless he thanked me for my very informative talk and apologised that he had to leave before the next speaker to attend another meeting.
I wish I could be politician.
