On the surface it seems like a glib question. But what is your gut answer? Is it you, your family, your GP, the NHS, the government?
Something has changed without us noticing it over the last 30 years. I remember my parents stoically working on through coughs, colds, flu, stomach bugs and any of the other myriad health irritants around. You had to be at death’s door to warrant a visit from the doctor. In fact surgery visits were a day trip out for the whole family and the proceeding 9-12 months of health issues were dealt with in one go for the each family member. Health was clearly a personal responsibility and the NHS was only called on to intervene at moments of serious need or for our family ‘check ups’. So it was with everyone else in my community.
A generational shift in attitude
Somewhere along the line though something shifted subtly. Now it seems that the burden of responsibility for health is lying firmly at the feet of the medical profession. In fact I recently heard a participant in a daytime chat show proclaim, ‘it doesn’t matter if I get obese, ‘cos its my doctors job to fix it’. Wow! That’s quite a generational shift in attitude. What happened?
We could perhaps consider different aspects of this issue. The first is the medics role.
The research of Rollnick, Mason and Butler (1999) looked at the methods medical professionals were taught to use, which centred around giving factual information of consequences together with a prescribed health change process. The result was that this approach reinforced a ‘superior/expert knowledge’ view, with no allowance for patient responsibility in the health change process. Many of us might suggest that not much has changed however, doctors themselves might counter that they are put under increasing pressure to hit targets, have less time to consult and have to respond reactively to what is put in front of them. Quite frankly, they don’t have time to be as proactive as they would like.
Government, by trying to respond to increases in chronic diseases such as obesity, heart disease and diabetes etc has become more and more prescriptive to both the public and the medical profession. The UK has seen ‘Move for Health’ (England 2011), Change4life (England and Wales 2008), Health Challenge (Wales 2010), Take life on (Scotland 2008), Get a life-get active (Nth Ireland 1999) in order to encourage healthier lifestyles. ‘Eatwell plate’ (2011) is the most recent promotion for a sensible diet, which has succeeded ‘five-a-day’ (2002). Terry Wogan wrote in 2011 moaning about the over interference of the state in regard to waistlines. This over interference may well be having the adverse effect of government appearing to take responsibility for health.
Thus the negative wheel turns faster. More people present at their doctors or A&E with less and less acute problems which puts financial and time/resources pressure on the services which creates more legislation and policy making by government which creates a bigger impression of the nanny state which further erodes a sense of personal responsibility.
Interestingly, many of the major health charities such as British Heart Foundation, Diabetes UK etc all encourage healthy lifestyle change and exercise uptake as a cheap, effective and successful way to manage and improve many diseases. If many of these diseases were started by sedentary lifestyle, how many doctors visits could have been avoided by a daily stroll?
Rollnick, S., Mason, P. and Bulter, C. (1999) Health behaviour change: A guide for practitioners. London: Churchill Livingstone
Wogan, T. (2011)’The obesity scare raises its weighty head again’. The Telegraph 3/9/11. Online. Available at: http://www.telegraph.co.uk/comment/columnists/terrywogan/8739680/The-obesity-scare-raises-its-weighty- head-again.html.