The eminent sociologist Zygmunt Bauman summarised the paradox of our era as: “Never have we been so free. Never have we felt so powerless”. Increasingly this paradox has been matched with calls from many psychotherapists, counsellors and psychiatrists, and Susie Orbach in particular, that austerity programmes and our 'win/lose' economics have had lasting and damaging consequences for society’s health.
Epidemiologists behind The Spirit Level have long since demonstrated that a highly stratified society where power and wealth are unevenly distributed, makes society as a whole less healthy. From a public health perspective we must challenge the dominant ‘either/or’ logic that pits prevention and acute services against each other. In short, the need is too great to kowtow to short-termism.
As the UN World Happiness Report 2017 launched yesterday lays out: “Happiness is both social and personal”.
As such, our political economy and our public services cannot begin to start answering the challenge of powerlessness without tackling the far deeper provocations outlined by Bauman, namely: why in the age of such relative plenty are we working longer, suffering relationship breakdowns and high levels of mental distress?
At the RSA’s Citizens’ Economic Council meeting in Manchester last weekend, citizens, assembled to try to improve the public dialogue around economic policy, demonstrated a depth of feeling that mirrors this challenge. The citizens placed an economy that “supports the health of people, society and the environment” as their top priority. While wellbeing initiatives like ‘resilience’ and ‘mindfulness’ are useful, they are wholly insufficient to achieve this vision.
Indeed within education, recent emphasis on resilience appears all too comfortably beside a culture of competition that causes widespread emotional distress. The better question therefore should be: what are we asking our children to be resilient to?
Tackling the causes, rather than the symptom of distress and un-happiness can help us move to towards a positive vision of society that will be required to get us out of our current malaise.
How could the NHS respond to this?
The NHS was set up under the conditions of a transforming society which required a shift from a war to a peace economy and the timing is right for the NHS to respond to another set of societal shifts.
The conditions on which it was founded, based on a curative model of health focused on the eradication of disease and huge advancements in public health, as pioneered by Joseph Chamberlain at the turn of the 20th Century, have dominated our understanding of health. While this model is successful, it is ripe for renewal.
Indeed the model of a normative depiction of an economically productive nuclear family in which it was also based is not only outdated but often results in shaming those outside of the mold. This still persists, and people living with chronic conditions, are socially isolated or have severe mental illness know too well the limits of health services.
However, glimpses of a way forward exist. The Health as a Social Movement programme funded by NHS England, is helping to understand the way that movements from breast cancer and the emergent adverse childhood experiences movement can turn systems that focus on deficit to one’s that challenge the structural causes of ill-health and unhappiness. Think of the HIV movement’s famous epitaph: “Hoping Ignorance Vanishes isn’t enough”.
So, wellbeing isn’t important?
Society is made up of cultural, economic and political forces, much like our individual health. It’s not heretical to say healthy societies produce healthy people. Wellbeing – particularly the New Economics Foundation’s 5 Ways to Wellbeing – offers practical steps to help each other – but is not set up to answer what the citizens in Manchester identified as a pressing need for our economy and society.
Much like social innovation, without guiding principles of a better society, a focus on wellbeing risks becoming a hallmark of an age too happy to react to symptoms of wider economic and cultural problems rather than challenge the causes.
The march for wellbeing is paved with good intentions, but the dip in health spending by proportion of GDP and heightened prevalence of mental ill-health is no coincidence. The vision of the healthier, happier society can’t be found in one-off interventions but a persistent and unified call for investment and a commitment for a “country that [actually] works for everyone”.
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Anthony Painter argues that the state expansionists will win over small statists as healthcare expenditure is destined to increase. But their victory may be a Pyrrhic one unless the growth can be limited so better support can also be given to housing, economic security, education and lifelong learning.