Redesigning Health and Social Care

As NICE points out in its recent report on the matter, a lack of evidence doesn’t equate with evidence of ineffectiveness. Nevertheless, NICE will not approve NHS funds for interventions without a sound evidence base, and research points to the efficacy (and dare I say it, cost effectiveness) of many alternative therapies in the treating of back pain. A couple of trips to an acupuncturist or osteopath can work out far cheaper than a MRI scan, for example. A major stumbling block for CAM in the past has been a lack of funding to support the large quantitative trials needed to evaluate interventions, although some CAM practitioners have argued that alternative therapies cannot be measured in the same ‘scientific’ way as orthodox medicine and instead require a more qualitative approach to research. Either way, NICE’s decision is surely good news for patients who have, in the past, been forced to pay privately for services that GPs argued should be available to all.

Listening to an osteopath on the television this morning defending NICE’s decision, I was struck by how far the CAM community has come in terms of identifying itself with conventional medicine. The osteopath commented that a few years ago CAM was ‘a bit wacky’, but codes, regulation, accredited training had changed that. The CAM field is by no means a homogenous one, and I can’t help but wonder whether there is a feeling in some quarters that uncomfortable compromises were struck in order for CAM practitioners to ‘professionalise’ and secure legitimacy in the UK healthcare system.

I I am currently writing some course materials on identity, health and wellbeing. I have not given much attention to thinking about my own identity in relation to health until now, but on reflection it seems quite important. Before being diagnosed with asthma in my mid-thirties, and borderline high blood pressure in my forties, my contact with health professionals was minimal, whereas now there are regular check-ups with practice nurses and occasional consultations with doctors. Whilst these encounters are usually reasonably satisfactory, I often feel that my sense of identity in the consulting room is quite different to that in many other aspects of my life.  

As time is limited in these appointments there is necessarily a focus on the medical aspects of my being. Should I happen to mention something else that is going on in my life it might at best be briefly acknowledged, or at worst ignored as irrelevant to the business in hand. One practice nurse, who thankfully has now moved on, was terribly patronising and would make generalised statements starting with phrases like ‘I find that asthmatics …..’. I used to leave those appointments simmering with anger and feeling thrown back into a frustrated child-like state of weakened identity. In the end I started wearing a jacket and tie to appointments with that nurse to try and assert a more powerful identity for myself in the room! 

I can also remember experiencing annoyance with well-meaning friends who suggested that these long-term conditions were probably brought on by suppressed anxiety, anger or other emotions which could be sorted out with one brand of psychotherapy or another. Now I do agree that mind and body are linked and I know that the role of genetic factors in physical health is still being debated in some quarters, but this just did not fit with my sense of identity and I resented the implications of emotional vulnerability suggested by these people. Whatever the causes of my medical conditions (as I am choosing to view them) my sense of identity clearly plays an important role in my willingness to engage with others in finding ways of managing them so I can get on with my life.

Here at the OU we have lots of meetings and at the end of one of those meetings last week I mentioned to my colleagues that I would be writing this blog this week, and did they think that it was appropriate to be talking about swine flu? I was really surprised by the feedback I got (most of it very impassioned) and thought I’d share with you some of the concerns that were raised.

First of all, is the concern about swine flu a useful distraction for politicians (and the media) who have had to focus so much energy over the last few months on the dire news about the economy? Second, does the reporting of swine flu actually meaning that we are taking our eye off the ball with regard to the very real threats to health, for example heart disease? And my own thought – what is the role of the World Health Organisation (WHO) in all this? The WHO is a well established global organisation, and I’m not disputing its legitimacy, but it is now one of many, many agencies telling us what to do with regard to our health – so perhaps this current concern is also a way for the organisation to re-assert its authority?

All these lead me to wonder if swine flu is a health story or a political one. Time will tell as to whether or not a pandemic does occur, but in the meantime high levels of anxiety as a result of sensationalist reporting might turn out to be a real threat to health.

I spent a wonderful few hours in central London watching the London Marathon on Sunday. I knew three people participating in the race, and so went along with thousands of others to provide support and soak up the atmosphere.  Living with someone who has trained for the Marathon has given me insight into the dedication, time, energy and dogged determination req  uired to participate in an event like this. People run Marathons for all sorts of reasons, but setting oneself the challenge of overcoming a near impossible task of mental and physical endurance seems to be the driving force for many. Someone said to me: ‘if I can get through this, I can get through anything’.  

Despite feeling very inspired on the day, I know that I do not have the desire (or tenacity) to run a Marathon. If the truth be told, I’m not completely convinced that Marathons are all that good for you. I enjoy exercise, but avoid anything that pushes my body to the point of pain. However, my friend commented that the positive effects of long-distance running – relieving stress, exhilaration, and a sense of achievement – ultimately outweigh the physical side-effects of pounding the streets.  I suppose this reveals the subjective nature of health and well-being though.  After all, my version of ‘healthy’ will undoubtedly differ to many of Sunday’s runners!

One other thing that struck me this weekend was the fantastic sense of community spirit. On the tube journey home, strangers were stopping to congratulate runners – asking them about their finishing time, and the charities they were running for. It seemed to me that people are genuinely interested in feats of human endurance, particularly when they are achieved by non-professionals. However, I think many of us are also looking for opportunities to interact with people outside of our immediate circle of friends, family and colleagues. Events like the Marathon help to break down the rigid social barriers that occupy our day-to-day lives, if only for a few hours. I have no doubt that if someone boarded a tube train today wearing a finisher’s medal, they would be looked upon with bemused, indifferent, or perhaps even worried eyes.  However, Sunday gave us all a welcome excuse to put aside our usual urban cynicism and revel in the achievements of others. Bring on 2010! Anyone interested in signing up?…

While on holiday last week I woke up one morning to hear John Humphries on Radio 4’s Today programme interviewing a choir leader and a professor of music education on the benefits of  singing in choirs. So many positive features were identified that Humphries was led to exclaim “it is complete health and social care!”

This got me thinking. Many people probably see health and social care as being delivered by dedicated services rather than as something that could also be derived from taking part in pleasurable activities. However, it is not unusual to spend time looking after many of our health and social needs through mutual support and taking care of ourselves without any interventions from professional practitioners, so why not expand the concept of ‘health and social care’ to include activities such as singing?

Singing is said to be good for the heart, lungs, immune system, brain functioning and emotional wellbeing (see for example an article in the Guardian last autumn). Singing with others brings additional benefits of friendship and social support which in turn can enhance our health and wellbeing. Many people, myself included, have thought they could not sing, perhaps due to earlier negative experiences, but have discovered that in a supportive environment with the right instruction they can sing and enjoy it. This inclusive approach to singing is supported in the UK by the Natural Voice Practitioners Network who view singing as everyone’s birthright. Now that evidence is emerging of the health and social benefits could we promote the creation of thousands of community choirs as a desirable public health objective?

A piece of research at the University of Hertfordshire, reported today by the BBC, says evidence suggests that women’s spending habits are connected to their menstrual cycle. Hormonal fluctuations, the author of the report Professor Pine comments, may be linked to emotions and ability to control one’s behaviour, and hence spending hard earned cash could be explained by biology.

Upon hearing this, my first reaction was “Great! An excuse to go on a spending spree once a month!” But then I started to wonder – are pieces of research such as this useful for everyone? Or do they serve to generate reasons – as I thought an ‘excuse’ – for our behaviour? It really got me thinking, can we find reasons for everything we do that are connected to our bodies and biology? And where does one draw the line? Harking back to early medicine, the idea of cause-and-effect was so powerful that it was believed that facial characteristics could determine criminal behaviour. Is this research on consumption just a modern form of this type of idea?

After mulling that over for a bit I then started to feel that the research was a bit of a step backwards for women and equality in that explanations were being given for women buying things to ‘adorn themselves’ when they are most fertile in order to attract a mate. If we’re reducing shopping activity to that kind of assessment (which sounds rather animalistic to me) then arguably men should be picking up when women are fertile and doing comparable behaviour to attract the woman’s attention (a bit like you see on wildlife programmes). What do you reckon?!

More of this?

We may often think that our health and well-being is largely a matter of individual choice, or perhaps it is the result of the hand dealt to us by fate or our genes. However, when we look at the health of populations, social and economic forces can be seen to be highly influential.

One of the few sectors that seems to be thriving in the current recession is that of fast food outlets. Kentucky Fried Chicken and Subway have recently announced plans for new outlets and Dominos Pizzas are doing well. Similarly Cadburys announced healthy profits thanks to chocolate bar sales and the press has carried stories of a rise in the sale of ‘comfort foods’ such as treacle pudding. Will the economic downturn contribute to our ever increasing waist measurements and all the risks of heart disease, diabetes and other negative health impacts that ensue?

On the other hand the demand for allotments is high and the National Trust has announced that it will be making land available to allow more people to grow their own vegetables. So perhaps as a result of the recession we are facing the prospect of better health for some and worse for others. Now we need to know why are some people reaching for their spades whilst others are dialling for their pizza delivery?