Liam Farrell: The difference between health and healthcare

The first rule of Health Club is don't talk about health. Any discussion quickly morphs into a discussion on healthcare, though the two are quite different things.

Healthcare only contributes to approximately 10% of health, 90% being due to the social determinants, education, sanitation, housing and above all poverty; Richard Smith observed that the main contribution of the NHS to population health was in providing employment.

And healthcare is fighting the long defeat, trying to square the circle of ever-expanding needs, unrealistic expectations and limited resources. Every advance in medical science only augments the burden and makes the task even more unachievable; the more successful healthcare is, the more impossible it becomes. To paraphrase Somerset Maughan: ‘There are three rules for designing a healthcare system. Unfortunately, no one knows what they are.’

And as resources are sucked into healthcare, everything else suffers, the environment, stand-up comedy, sports, everyone having a dog and learning the banjo, the arts, our schools, those things which do much more to lengthen life and reduce suffering than medicine and doctors and hospitals.

Healthcare can’t be approached like an all-you-can-eat buffet, everyone grabbing whatever they can as quickly as possible whether they need it or not. Hard choices have to be made, but the right choices are always the hard ones (otherwise, everyone would always do the right thing).

Instead of, for example, ensuring that proven treatments are provided to everyone that needs them, there is always something new...

‘I’d like some precision medicine,’ said Joe.

‘Indeed,’ I said.

‘From now on,’ he continued, ‘I’d like my treatment to take into account the individuality of my genes, environment, and lifestyle. I’m tired of the one-size-fits-all approach, in which disease treatment and prevention strategies are developed for the average person, with less consideration for the differences between individuals. I am not Mr Average, I am unique, a child of the Universe, my very atoms forged in a dying star, noble in reason, infinite in faculties, in form and moving like an angel, in apprehension like a god; look on my works, ye mighty, and despair.’

‘No problem, Joe. Here it is,’ I said. ‘There’s precisely nothing wrong with you.’

  • Dr Farrell is a GP from County Armagh. Follow him on Twitter @drlfarrell

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