The Battle for Health

Script for Socialist Medical  Association Health Exhibition, February 1946

(Three main themes are to be developed, with the second divided into three sections of which the second, on Health Centres should occupy the greatest proportion of space)

The scheme is therefore:-

1,     Health depends on environment.

2,     A Health Service is required now and probably always will be; it necessitates

(a) a Hospital Service.
(b) a General Practitioner or Home doctor service of which the key-note must be the Health Service,
(c) the education of the public in the meaning, preservation and promotion of health.

  1. The service must be a complete integration of all Health and Medical Services.

Section 1.

Health is a balance between the individual and his environment; but he is threatened by disease agents such as bacteria and parasites and may suffer from hereditary or congenital defects.

Caption 1. Hazards begin at birth; statistics of births, still­births and deaths immediately after birth.

  1. The most dangerous time is the first year of life -statistics for different countries; cities; social strata, and differential rates for different diseases in different social groups (see Stephen Taylor’s book or Titmuss – this may be 3 or 4 screens)

3.  Main environmental factors -Without adequate shelter health in our climate is impossible. Slums are great danger to health; so is bad town-planning and this affects all classes; bad house-plans may be injurious to mothers; over-crowding increases danger from disease (Statistics of infectious diseases in great towns; Madge’s book, The Rehousing of Britain for slums, etc; pictures of new houses – get plans of Carntyne Flats from Glasgow Corporation to illustrate needs of aged).

  1. Adequate Food is essential. Malnutrition was the fate of large numbers of people before the war (Quote Sir J. Boyd-Orr); in addition all may suffer special deficiencies such as Vitamins (Photographs of Rickets etc). What is an adequate diet?  (Photographs of present rations etc)

  2. Industrial Hazards.  Every industry has general hazards due to bad lighting, ventilation, spacing of machines, noise etc. Some have special hazards, radium, lead (Sir Wn. Garrett’s statistics very valuable) and machinery that is unguarded.

  3. Epidemics a danger to the whole world making health indivisible (Statistics of Influenza, Typhus, etc.)

7. Recreation essential to a healthy life (? table of hours of work during past century). Absence of open space leads to danger in roads for children; and for slackness and lack of interest in adults.

  1. In Man’s environment one of the great dangers is the occurrence of diseases due to various outside agencies, the bacteria and parasites (? photographs of germs, malaria, Intestinal worms etc.)  Infections cause many deaths (Tables of deaths from Tuberculosis etc.)

  2. Some of these diseases are due to viruses, agents so small we cannot see them and some to disease, like Rheumatism, which are of mixed origin (Rheumatism in Britain)

  3. Man has triumphed over some diseases by discovering specific antidotes to many of his enemies. Thus the Sulpha drugs are very successful against Puerperal Fever and Pneumonia (Statistics) and Penicillin is very successful against such varied conditions as Meningitis, Boils, Septicaemia (blood-poisoning) and Gonorrhoea.

Section 2a

11. One of the ways of fighting disease is by providing Hospital care for those needing special treatment or surgical operations. Early hospitals were religious foundations for the care of the sick poor and this grew into the Poor-law system of providing for the aged and infirm and the sick of the poorer classes. As a result buildings were often far from satisfactory (Photographs of old hospitals? can LCC supply)
12. Medical science developed, at first slowly, then very rapidly and all kinds of apparatus came into use -operation theatres, surgical equipment, X-rays (diagnostic and therapeutic), atom-splitting machines, laboratories, etc., etc,
13. Britain’s first attempt to plan a service was the introduction of National Health Insurance in 1911. This provided a general practitioner service for the industrial part of the population (Goldfinger’s diagram of population distribution) but no service for women and children and no provision for hospital care.
14. Dissatisfaction with service continued and Labour Party took up questions Later medical profession began to discuss possibilities of a better service, Dawson Committee in 1920 advocated national service with Diagnostic Centres; BMA. in 1929 suggested a General Practitioner service for the nation but meant 90% of the people leaving the wealthy outside the service. In 1934 the Labour Party put a National Health Service in the forefront of its programme
15. This was due to two events in 1930. One was the foundation of the S.M.A., which crystallised the need for a service; the other was the Local Government Act which made it possible for a County Council to remove its institutions for the sick from the Poor-Law and convert them into Hospitals. Many Counties did this and some, e.g. London and Middlesex have greatly developed their hospitals (Photographs of wards, apparatus etc; ?statement from LCC as to part played  in Blitz; ? some note and examples of supplies sent out by LCC to all laboratories during war)
15a. Present hospitals are of 3 types the unappropriated Poor Law institution and the Municipal Hospitals, and the so-called voluntary hospitals.
15b. How beds are provided in this country (a) numbers per 1000 people in each area; (b) number of beds in  Voluntary hospitals.
15c How the money is obtained (BHA recent figures and PEP)
15d  Our best hospitals.  Municipal and voluntary.
15e. The beds we need, 10 per 1,000 of the people in regions, all general but all having some special function within the region.  Extra-regional services.
15f. A free and full ambulance service is a necessity (Pictures of big and small ambulances. (London Ambulance Service photographs and figures)
15g. How they build hospitals in America Scandinavia, USSR.

Section 2 (b)

16. The foundation of the Health service will remain the Family doctor. He has suffered more than anyone else from un-planned services , The BMA Medical Planning  Commission decided that the chief fault of general practice was the isolation of the GP (Quote MPC report)
17. This isolation is complicated by the maldistribution of doctors (see PEP report with map) leading to over-doctored and under-doctored areas (A very telling map of numbers of doctors against a background of incidence of TB or Infantile mortality might be drawn in two colours)
18. Other factors are lack of time, the doctor’s own most frequent complaint and lack of equipment (Photographs wanted of worst possible surgeries)
20. The family doctor must be given a place of work where he can have the time, the equipment and the assistance that will make his job better for himself and the results better for the patient. Above all he must have a chance to work in a team with all other doctors and all other health workers.
21. The army that fights the battle of health, doctors,  nurses etc. (An isotype diagram, showing numbers of each would be good – but important point is to show that doctors are only 10% of the team)
22. The key-note of the service of the future will therefore be the health service. At present no prototype but many experiments – Peckham, Finsbury (Best photographically, inside and out), Bermondsey, America (? any photos in Reynolds file of Kaiser’s Health Centres in California) USSR (Polyclinics)
23. The functions of the Health Centre (SMA leaflet and Goldfinger’s earlier exhibition).
24. Sizes and types of Health Centres, Large ones, 10 doctors, 3 dentists etc. in towns, small ones 2 doctors and visiting dentists in country (This can be any number of screens, plans etc.

Section 2 c.

25. So far we have been dealing with treatment services. We must prevent disease as far as possible, and we must educate the public as to the meaning of health, methods of promoting health, etc.

26. Scientific methods of preventing disease – hygiene, immunisation, destruction of carriers of parasites etc.

27. Personal methods also have a place but especially in promoting health (I would suggest OO for HE be asked to summarise)

28.Place of the Health Centre, by poster, films, lectures, personal advice in promoting health; mass radiography etc.

29.When will we have periodic health examinations? (Peckham figures)

Section 3.

For no single citizen is a complete health service available by a single route. The service of the future must be a single complete service.

30.How a family gets a service today (Diagram from Future of Medicine or colour diagrams similar). This is a haphazard, wasteful and unsatisfactory method of providing a vital service.

31.How a family will get its service by a single route through the family doctor at the Health Centre.

32.How it is done to today in the Highlands and Islands (Photographs from Scottish Office) shows how it can be done, in the rural areas.

33. The services we have to amalgamate are at present run by many authorities and concerns.

34. The Maternity and Child Welfare clinics have had a wonder­ful effect on child and maternal health and on morbidity and mortality rates.  These should be inaugurated with the family doctor service and the hospitals; and specialists, doctors and midwives should be responsible for the obstetrical care of all mothers.

35. School medical services have endeavoured to look after the health of the child in the mass and play a valuable part in the raising of the standard of health of the school child.

36. The dangers of industry need special medical attention and an industrial section must be part of our new health service; with doctors who are experts in industrial diseases linked with the health centres.

37.  All other welfare services, health visitors almoners etc. must be working at hospital and health centre as part of the team.

38. When the patient is convalescent arrangements must be made for a holiday in the most suitable surroundings (A chance to introduce some photographs of the Riviera  and Crimea)

39.  The whole National Health Service must be a part of a great Social Security Scheme which gives subsistence payments, generously calculated for sickness, accident and unemployment.