A National Health Policy
13Y A MEDICAL CORRESPONDENT.
(AF all a nation's material assets, the bodily and mental health of its people is the most important. Wastage of this asset cannot be balanced by economy in other directions. The conservation of the national health, therefore, should ever be a prime consideration of the organized State. The environmental changes inherent in civilization demand corresponding changes in human re- actions. Deliberate interventions, both preventive and corrective, are needed if psycho-physiological harmony is to be maintained. It is the planning and carrying-out of these interventions which is the essence of an intelligent health policy. Whilst it must be recognized that the sciences on which the medical art is based are but in their infancy, very important results have been obtained, especially during the last half-century, by the application of such knowledge as has been collected. At the same time, it is certain that the knowledge available is still, through the faulty employment and distribution of our forces, but very partially utilized. Our medical services—preventive and curative—have grown up, not as parts of an organic whole, but anyhow, with but casual inter-relation and, consequently, with great wastage of personnel. The general practitioner or family doctor, the official administrator of preventive medicine, the school doctor, and the voluntary or provided hospital have no common currency, no satisfactory instrument of inter- communication, and, therefore, small co-operative effectiveness.
When most of these discrete services came into exist- ence, medicine had far less to offer than it has to-day. The competent general practitioner was in a position to apply pretty much all the diagnostic and therapeutic knowledge at the disposal of the healing art. Major surgery and one or two specialities—such as ophthalmology —were outside his province ; but, for the rest, varying individual intelligence and judgement alone distinguished one doctor from another. Things are very different to- day. With the best will in the world, no single practi- tioner can possibly cover the whole field of therapeutic technique ; nor can the individual doctor provide for his patients the elaborate machinery needed for the adequate investigation of any but trivial ailments. So far as the well-to-do are concerned, the difficulty is more or less effectively met by a sort of hierarchic departmentalism, involving -a series of expensive references to bacteriolo- gists, radiologists, bio-chemists, and other specialists. Obviously, this complicated procedure is altogether beyond the purchasing capacity of the poor. Moreover— though it has not been so generally realized—it is beyond the means of the great majority of professional and other middle-class individuals. The possibility of bringing the resources of modern medicine and surgery within the reach of the poor has been demonstrated by the voluntary hospitals of our great cities ; and the new staff-salaried hospitals of the County and Borough health authorities are rapidly following in their steps. The hospital habit is growing in all classes, and it is difficult to imagine any really effective alternative method whereby specialist treatment—major surgery, electro-therapeutics, dentistry and the like—and modern diagnostic technique can be brought within reach of the bulk of those who need them.
It is as likely as it is desirable that the hospital will come to be, in every area, the centre of local medical life and local hygienic effort. At present, there is great leakage of energy and skill through the lack of co- ordination between the hospitals and the outside practi- tioners, on the one hand, and between both and the pre-. ventive health services on the other. The public sanitary service—that is, the medical officers of health and their subordinates—in this country has been, and is, generally satisfactory. But preventive medicine is now recog- nized as having scope and potentialities beyond those hitherto assigned to it. It is becoming increasingly realized that most, even of the gravest, diseases have relatively minor and often remediable beginnings. No serious steps are at present taken to recognize disease at this stage. A careful periodic examination of each individual, well or ill, would, if carried out by doctors adequately trained and equipped for the work, have very great preventive value. The greater part of ill-health is associated with faulty environment or faulty habits of life. It is, therefore, foolish extravagance to concentrate on the palliation of evils due to such causes the time, energy and knowledge that might equally easily have been devoted to their prevention. The problem needs to be set out in due proportion—first things first.
A truly national health policy, then, is concerned with much more than the organizing of doctors and the pro- vision and equipment of hospitals—necessary though both these are. A complete and adequate medical service should be brought within the reach of all ; but the education of the people, the maintenance of their nutri- tional level, the provision of decent homes, and the pro- gressive decentralization of industry, are all matters that may have even more influence on the national health. Our general aim should be to provide opportunities for the attainment and maintenance of the highest standard of health of which each individual is capable. We need to get right away from the bottle-of-medicine fetish, and to look upon health as implying something more than the mere absence of illness. It is the particular ideal of human life which an individual or a nation holds that determines for that individual or that nation the explicit meaning of health. As Sir George Newman said the other day : " Whilst we readily avail ourselves of scientific discoveries which add to our comfort or con- venience, we have a curious tendency to overlook or fail to use advances in the science and art of living." It seems clear that, without any sacrifice of true economy, we could, by efficient planning and organization, enormously increase the value of the knowledge and skill at our disposal. In some future articles we may attempt to indicate how, step by .step, we may create a real, co-ordinated, national health service, founded on a common philosophy and having a common aim, yet giving full scope for individuality and personal initiative.
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