Every Policy is a Health Policy

[box] Guest columnist and UCL student Joanna Sutton-Klein argues that politics and medicine are inextricably linked [/box]

Health politics doesn't just belong in the Department of Health.

Health politics doesn’t just belong in the Department of Health.

Medicine cannot be separated from politics. Centuries of research, double-blind, randomised, controlled trials and NICE guidelines go some way to falsely reassure us that the medicine we practice today is a politically and historically neutral science. That is a comforting thought, and an admirable aspiration, but to kid ourselves into believing that medicine exists in an isolated bubble is dangerous.

Yet, so many medical students I have met seem to be drawn into that belief. When a public health lecture is timetabled, our, normally packed out, lecture theatre empties until only a small handful of medical students remain. Why bother many will say… Whether medical students don’t have the time, or perhaps more pessimistically, don’t care about campaigning for political causes is a subject for debate, but from what I’ve observed, medical students, outside of a select few medicine-oriented organisations such as Medsin and Save our NHS,  seem to be hugely underrepresented in student activism and campaigning. Perhaps medical students consider their ‘contributing to society’ box to have been permanently ticked off on admission to medical school, or maybe our focus on fixing the down-stream determinants of health relieves us from any requirement to meddle with the upstream determinants. I believe this needs to change.

In general, medicine treats patients at the very end of their path from health to disease. Occasionally we try to tackle slightly more upstream determinants of health, prescribing exercise to our patients, or giving education on diet or motivation to quit smoking. This is undoubtedly valuable, but it shouldn’t be the limits of our remit. We need to know about and actively engage with the cuts to government spending, the Five Year Forward report and the Health and Social Care Act 2012.

It’s not just public health policies which we should concern ourselves with. No aspect of medicine is immune to political interference, and no governmental policy, be it on education, council housing or culture, can escape having public health implications.

Some may argue that we should allow surgeons to focus on their surgery, medics to focus on clinical medicine and leave the public health and political aspects of healthcare to public health consultants and politicians.  I believe otherwise. Every medic should engage with the political aspects of their work. For without regard for them, medicine can so easily fall into the trap of facilitating the failures of the state, rather than fixing them. The junior doctors’ contract furore has highlighted a clash between medical and political ideology, but this is just the tip of the iceberg of medical-political clashes.

Doctors don’t need to become MPs to affect political change, our voices are as loud outside parliament as within.

This year I attended the BMA medical students’ conference, excitedly anticipating in depth debates on the political determinants of health. Alas, I was disappointed. The motions were dry, to say the least, and almost every motion was either passed or failed unanimously. The ‘democratic’ process at the conference would have gone a fair way to make North Korea appear democratic. One timed speech for the motion, one timed speech against, followed by an unlimited length of time given to as many members of the all-male top table as would like, to speak for or against the motion. I can’t recall a single instance when the vote went against the speakers from the top-table.

By far the most frustrating aspect of the conference was the repeated adage that we should or should not vote for or against any particular motion because ‘the BMA is apolitical’. I make concessions for a few  students who may have confused the notions of being apolitical and non-partisan, but a large majority of the delegates at the conference, seemed to genuinely believe that not only is medicine apolitical, but the BMA is, as well. In fact, in writing this column, even in the middle of the junior contract furore, the BMA themselves have again reiterated to me the claim that they are apolitical.

In my mind, that is clearly not the case. The BMA is a trade union and its very existence serves as a strong political statement. I wonder how many MSC (medical students’ committee) representatives see themselves as trade union reps? I suspect, drawing on my experience at the conference, very few indeed.

Every policy and law passed in parliament has an effect on the health of our patients. Doctors are charged with promoting health and we should not pretend that we can fulfill that task within the walls of a hospital. Politicians dictate a false dichotomy between the NHS and other aspects of the welfare state, be it education, social housing or low incomes. It makes little sense to increase the budget of the NHS, whilst cutting the education or benefits budget, if the desired outcome is improvement in the nation’s health. Doctors don’t need to become MPs to affect political change, our voices are as loud outside parliament as within. For now, getting medical students to acknowledge the inherent, unavoidable politics in our studies would be a very good start.

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