A better future for healthcare – series

This November (2020) the College of Medicine is 10 years old. We intend to use this as an opportunity for renewal. For some time it has become clear that we need a new medical perspective. Not only to withstand the ever-increasing incidence of long-term disease but also to overcome problems created by our current methods such as increasing antibiotic resistance and addiction to opioids. Covid has further shaken medical complacency.

Consequently, we have brought together some of the best talents and leaders within the College of Medicine to write 15 short chapters on how medicine needs to change in all its various areas from addressing inequalities and developing local communities to improving the lifestyle of our young and the elderly. The five extracts that follow are a preview of a manifesto to be launched later this year. It will not be just another think-piece; it outlines quite specifically how the college and others will extend the reach and effectiveness of medicine over the next 10 years. The time for talking is over and we need to be bold and challenging, which is exactly what we intend to do. You can be the judge of that and this issue of JHH will give you a flavour of our revolution to come.

Michael Dixon

Chair if Council, College of Medicine

The 5 extracts including this one:

  1. Reimagining a healthful environment
  2. Reimagining medical research
  3. Nurturing self-care
  4. Reimagining practitioner wellbeing
  5. Creating a fairer society and answering the challenges of Marmot

Creating a fairer society and answering the challenges of Marmot

Sir Sam Everington, GP, Bromley by Bow Centre; Vice President of the British Medical Association

Dame Donna Kinnair, Chief Executive and General Secretary of the Royal College of Nursing

Published in JHH17.3 – Beyond Covid

The death of George Floyd in the USA, the subsequent take-off of the Black Lives Matter movement and the disproportionate impact of Covid-19 on people from Black, Asian and minority ethnic communities, people living in areas of high deprivation and excluded health groups shows starkly the health inequalities which persist in the UK today. Many of these health inequalities start early in life or put the other way, schools have a major impact on ensuring that every child has an equal opportunity in life and leave school at the age of 18 with all the skills and mental, physical and social health to meet the challenges of adulthood. The news is not good for children and young adults with worsening health and massively increased unemployment due to Covid and the looming recession. On education alone in the Covid crisis two-thirds of children received no online lessons or tutoring from schools during lockdown and it is believed three-and-a-half years of inequality will have been created in less than six months. Education and health are inextricably connected.

So what is happening around the health of children? Obesity rates are highest in the most deprived 10% of the population, more than twice that of the least deprived 10%, and 35% of year six children are now overweight or obese; this is expected to reach 40% in the next four years. In the last six years there have been areas of improvement in child health but added to unhealthy weight is deterioration in immunisation rates and increase suicide rates in 15 to 24-year-olds. Type 2 diabetes is on the increase in children and inequalities persist. Child poverty has increased for those in working families, infant mortality has risen in parts of the nations, particularly for those living in the poorest areas.

With all these serious concerns about widening inequality in health in children and loss of life chances you would have expected an increase in investment in child health. Spending on children’s health services (5 to 19-year-olds) in England has declined by 6% and 5% in 0 to 5-year-olds in the last three years. Health visitors have declined by 24% since 2015 and according to the Royal College of Nursing, school nurses have decreased by 30% in the last 10 years.

In 2010, Sir Michael Marmot conducted a landmark review of health inequalities which concluded that reducing health inequalities would require action on six policy objectives:

  • give every child the best start in life.
  • enable all children, young people and adults to maximise their capabilities and have control over their lives
  • create fair employment and good work for all.
  • ensure healthy standard of living for all.
  • create and develop healthy and sustainable places and communities.
  • strengthen the role and impact of ill-health prevention.

This year, in his ‘ten years on’ report, he found that for the first time in more than a century, life expectancy has failed to increase across the country, and is declining for women in the worst-off decile on the index of multiple deprivation.

Practical action

And all these inequalities start in childhood and can be prevented by a sustained focus on equality of opportunity in health and education in all schools.

In the east end of London there is one school nurse for six schools. We believe that physical, mental and social health need to be the focus of all schools and this can only be done with a full-time nurse in every school and on every governing board. Artificial intelligence is predicted to take away 40% of the today’s jobs. Education needs to be focused more on wider lifestyle skills. Unemployment is directly linked to ill health; health is directly linked to the environment. All children should have lessons in all years on cooking healthy meals and the connection to nature and the growing of sustainable organic foods. Exercise has an impact on reducing weight, confidence, co-ordination and many other skills. All children should be taught to swim by the age of seven and every week there needs to be daily exercise of at least one hour.

Norway has national service for men and women, which is usually done on leaving school. We believe that every 18-year-old should be guaranteed an apprentice year which could be anything from voluntary work to military training but focused on developing skills and transition to adulthood.