It is my belief that higher levels of education and financial support allow a patient to be more direct in their approach to healthcare. The main reasons, outlined below, can be reduced to empowerment.

Surely it is a doctors job to provide a patient with all the facts, pros and cons? The real skill of a clinician, therefore, is the ability to do this in a manner that is patient-centred, establishing the understanding level of the patient in question and tailoring the consultation to that level; hence allowing a patient to make the best informed decision. It must be remembered that it is only a patient that has lost mental capacity that can have decision making taken away. However, often patients are left confused, too scared to ask for clarification, leading to agreement with a management plan that has been decided for them.



A higher education level provides a stronger foundation for a clear conceptual understanding of the clinical situation a patient finds themselves in. The resources that are available to those with more money provide a patient with the ability to be more direct with their decision making over their lifetime. Both of these facts enable a patient to be more empowered in decision-making about their care. This extends from food, to physical activity (Murray and Rodgers, 2012) and to hospital treatment (Laudicella et al., 2012).



The decisions made in a modern day clinical consultation may fall on the shoulders of an individual (the patient, or the consultant), but education and societal healthcare constructs heavily influence this patient experience. In 1948 the NHS was born thanks largely to Aneurin Bevan, leading to a golden decade for healthcare in the UK. In 1953 the structure of DNA was revealed, in 1954 a link between smoking & cancer was found, in 1958 polio & diphtheria vaccinations were discovered, and in 1959 the Mental Health Act was established (NHS, 2015).



Today, the NHS remains a leading visionary in healthcare, helping shape global trends and advance medicine. Furthermore, the NHS is unparalleled in its efficiency, shown by The Commonwealth Fund’s international healthcare system comparison in 2014 (figure 1); the UK spends the second lowest on healthcare compared to the 11 countries analysed, yet scores highest in access to, quality of and efficiency of care. Comparatively, the USA puts the most amount of funding in to its healthcare system, yet it performed the worst of all 11 countries (K. Davis, 2014). The deserved praise for the efficiency of the NHS ignores its underfunding, and the growing health inequality in the UK (Osborn., 2018). The fact that we are proud of ‘efficiency’, and not the overall state of the service, shows that there is still endless work that needs to be done to save the foundation that we hold so dear.



Figure 1: Ranking performance of healthcare systems of 11 countries, by The Commonwealth Fund (K. Davis, 2014)

Health inequality remains a global problem, even in the richest countries with the most resources. Individuals and families with the least face the hardest challenge to achieve a full health span: hungry children age faster (Abeliansky and Strulik, 2018), lower socioeconomic children achieve lower IQ (Marcus Jenkins et al., 2013), and that’s without mentioning the immediate environmental dangers present in most situations of poverty. Mere logic can explain the lack of availability of good food and health routines, including exercise, that evade those most at need in our global society. These issues in modern healthcare are due to get worse in time with the burdens of chronic illness, obesity, and the ageing population. The rising costs of health and social care, alongside its future exponential increase, point to a need for a solution that can be integrated sooner, rather than later. Therefore, our current global situation represents that of a wider poor investment in the future of world health. The burden of chronic illness on the economy is astronomical, and an issue that needs to be tackled for the mutual benefit of all citizens within society (Scarborough et al., 2011).



The current WHO definition of ‘health’ is “a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity”; however, it can be said that any interaction or event in the world that is received as input to the human brain affects health.



Within the context of health inequality, the increasing price and pace of living amplifies the widening gap in quality of life. The competition and rewards (status and capital) that accompany modern capitalism, I believe, has led to a ‘trickle-down selfishness’. Why would those without be willing to give up what little they have, while they witness the wealthiest in society evading tax and remaining selfish with their assets (as seen in the recent Paradise and Panama papers)? I believe it is this infectious selfishness that has led to the loss of community health, and simple kindness for members of our fellow species. I truly believe that the long term health of a community, large or small, is dependent upon the health and wellbeing of its individual members.



Richard Layard, somewhat paradoxically, framed a fantastic mathematical argument for the acknowledgement that there is no relation between average income and reported happiness across wealthy countries (Layard, 2006). If happiness can be thought of as independent of wealth, therein lies the implication that solutions to societal wellbeing can be found that are separate from financial outlay. I believe that properly evaluating the differences between Western, Eastern and alternate approaches to health, and taking positives from each perspective, can provide evidence for alternate approaches to the wider context of health. Incorporating everyday life (namely finance, diet, mindfulness, exercise and education) in to our definition of health would certainly be a starting point that would go some way to preventing many of the conditions that have become endemic in the UK and beyond. I hope that by evaluating all opinions, each approach to healthcare and every piece of relevant research, different societies could help each other advance the investment and structure debates underlying all healthcare systems; after all, it does not have to be costly to be effective, and it is well known that considering others’ perspectives is a powerful tool for growth.



Ultimately, establishing a society that provides at least the minimum required to live healthily is not just the pipe dream of many medical students, but a reality we could eventually live in. Sadly, these problems always come back to that of a political basis, and often become a tool or ‘political volleyball’ used to gain public trust or the trust of much needed ‘swing’ voters.



On the importance of politics and healthcare — the rapid progression of society since the industrial revolution, and its continued changing conditions, highlights the need for a more proactive political system that has the ability to adapt and progress alongside its environment. ‘Behavioural economics’, and its recent popularity, has improved understanding of the irrationality in human behaviour and has forced questioning of the constructs with which we live and work in. I believe that learning from a system’s own history and data would allow daily problems to be tackled efficiently and learned from in the future; I am essentially arguing for the introduction of the scientific method to the way in which we run our society. All data tried, tested, documented and available to all for interpretation. Scientific, statistical methods could allow an approach to sociology, politics and education that’s as close to rationality as humans can muster…using data to learn, implement and grow; like an anaesthetist adding a few drops of solution to balance a patient’s stats. Dominic Cummings, somewhat ironically (given his role in the leave campaign), writes eloquently on this topic in his essay on an ‘Odyssean’ education (Cummings, 2013).



It is expected that any large shift in society or policy, or suggestion of one, will be met with scepticism (at the very least!). In 1942, The Beveridge Report caused outrage, yet the NHS was born 6 years later; the initial reaction by the Chancellor of the Exchequer, Sir Kingsley Wood, was that it was ‘an impractical financial commitment’ (Day, 2017). I find blissful irony in today’s politicians arguing against healthcare investment for similar financial reasons. Perhaps it is the fear of the unknown or the worry of the initial financial outlay that remains preventative, despite the clear long term benefits. The truth is that it is very obviously within the interests of humanity for society to progress, and to keep progressing.



Our once small tribal communities led to the invention of agriculture, which led to formalised writing and language, eventually leading to the organised societies we live in today; progress over the long term cannot be questioned. In recent years the West has stood in defence of open societies, decolonisation, gun control, same sex marriage, and democracy; and against capital punishment. Even wars over the past few centuries have been reducing in quantity of deaths and severity (Roser, 2018). However, it is understandable that some may take the view that recent progress has stalled; especially considering the recent events of Brexit, Trump and Russia’s international influence. Moreover, it is understandable that many millennials are left wondering if the system itself needs a rethink. Perhaps, alongside a general rise in education level, our moral standards have risen and a liberal mindset has begun to spread.



The aforementioned recent events, or perceived backward steps, have certainly helped to spread pessimism and point towards a cessation of progress. While these events may yet reveal their worst side, an optimist will be forgiven for thinking this is just a blip in 21st century history and a future party line that is far from its finest hour. We must not forget the long term backdrop of improvements in safety, peace, lifespan and healthspan (Crimmins, 2015). The tendency of the media and politicians to focus on the negative causes an availability heuristic, which, when combined with the human negativity bias, can foster pessimism at a societal level (Pornpattananangkul et al., 2014). This is to say that individuals are left estimating risk and danger by recent memorable examples, normally negative events, rather than statistical data-sets that aggregate good vs bad.

The issues raised hitherto may all be helped by a change in societal opinion, and may not necessarily be reduced to funding issues or political ideals. It is the biggest issues affecting all humans that require the most collaborative approach to solve. I believe that preventing the association between lower socioeconomic class and poor neural development (Hackman et al., 2010) can be achieved by more liberally spreading resources throughout society. Nurturing all minds from the moment they are born would enable a collective approach to the challenges of the environment, science and sociology. Einstein once said ‘look deep in nature, and then you will understand everything’, and I firmly believe refocussing our attention on nature and the environment will pay dividends to the generations to come.

Specifically, with regards to health, a holistic approach with a greater outreach is the end goal that should be held in mind. I would suggest the immediate starting point being a societal treatment enabling re-development of community living, taking influence from the recent ‘Compassionate Communities’ model in Frome, to re-infect society with selflessness, dignity and respect (Monbiot, 2018). From this point, I believe that, morally, we should be concerning ourselves with how the poor are doing and not focussing on the trials and tribulations of the rich. We should be emphasising a moral obligation to listening to those we disagree with, learning from new and unconsidered points of view (which remains a privilege of the open-minded clinician). Finally, I believe that people just want the same opportunity for a path upward, the opportunity to work towards something new and greater than themselves. Unfortunately, the reality is that socioeconomic and political situations change daily, and the potential for unpredictable catastrophic events is always present, enabling distraction from the wider issues explored hitherto.



To conclude, perhaps we should try asking ourselves the following: if there is enough food, water, shelter and support for everyone, are we not hindering our own progress by preventing people access to it? Are our egos becoming too big to allow sharing to the point that common goals are met with the upmost efficiency?