The responsibility of civil society and corporations for public health
Edmund Stubbs, 28 May 2015
It is widely agreed that the NHS must change from an organisation that largely treats disease, to one which strives to prevent it. It is further agreed that prevention can best be facilitated in the community. Communities contain a plethora of non health related institutions which play a prominent role in an individual’s home, emotional and working life.
The Alma Ata Declaration of 1978 first publicly acknowledged the importance of tackling ill health through every institution of society and today the World Health Organisation emphasises that healthcare is no longer the domain of ‘medical specialists’ but must involve ‘politicians, economists, lawyers, communicators, social scientists and ordinary people everywhere’.
This week, Pastor Joe Wilcot of Mississippi USA, after noticing his own unhealthy size and that many of his congregation were overweight, initiated a weight loss programme in his church. After Friday service, Dr Erica Thompson, a community health specialist, has been invited to take to the pulpit at Pastor Wilcot’s invitation.
Dr Thompson had found that people were more likely to be more open and honest in a community setting such as their Church. She stressed the importance of the congregation ‘understanding themselves’ and their weaknesses espically when endeavoring to achieve their health goals. Knowledge, she holds, is power.
William Beveridge, as one of the founding principles for the NHS stated that ‘Social security must be achieved in co-operation between the state and the individual’, and that ‘The state, in organising security should not stifle incentive, opportunity and responsibility’.
What British culture seems to have lost is the recognition of this individual responsibility for health within the context of civil society. We need the NHS to go further than simply encouraging organisations to be aware of health issues; we need as many of our institutions as possible to take health preservative initiatives independently, as in the case of Pastor Wicot, for the good of their members.
Private businesses must also share responsibility for public health, both in terms of what goods it produces and in terms of responsible and truthful promotion of messages related to health. The media as an institution is obviously in an especially privileged position to influence lifestyle in health beneficial ways.
In a recent talk here at Civitas, Colin Mayer of the Saïd Business School spoke of the need for the revival of a corporate ethic where shareholders and executives have other objectives than simply maximising profit; instead wishing to pursue social objectives and endeavoring to maximise natural and human capital.
Professor Mayer proposes the creation of ‘public benefit corporations’, who’s executives are under obligation to state its public purpose, and from which share holders can legally withdraw their capital if they do not believe objectives are being met.
He holds that corporations which espouse these broader values last longer on average than those that focus on short term profit. Industrial Foundations (which own business companies) can set an example here, where directors are constrained by the foundation’s charter which stipulates that their businesses must serve a broadly defined beneficial social purpose. In terms of efficiency, empirical research has discovered that the profitability of such socially responsible business practice, such as that of Carsberg, Velux and Bosch, matches that of others.
A specific corporate example would be Tesco’s recent decision to reduce the sugar content of its soft drinks, this should be commended as a brave step to take in an extremely competitive market. The decision resulted, in part, from a concern for public health driven by the more health conscious taste of consumers.
The example of Pastor Wilcot, and many others like him around the world, needs to be followed by more institutional leaders. Although some British institutions already take measures to preserve the health of their members or employees, the practice must become more widespread if we are to challenge disease caused by excessive consumption and contemporary sedentary lifestyles. Doing so will not only preserve a company’s workforce but will also help to keep our health service sustainable. A ‘win win situation’ if ever there was one!
Edmund Stubbs, Healthcare Researcher, @edmundstubbs1
“It is widely agreed that the NHS must change from an organisation that largely treats disease, to one which strives to prevent it.”
Widely agreed by whom? Not by the general public as can be seen by the widespread neglect of basic practices for good health such as keeping weight down and not drinking to excess. Where is the evidence that preventing disease by any method other than procedures such as vaccination or the introduction of disease free water supplies which require no change of behaviour on the part of individual humans is effective in preventing disease. It just isn’t there. People may obey healthy eating rules for a few weeks or even a month or two, but they will rarely stick with such rules.
Then there are the illnesses of of old age. Most of those will have little directly to do with how people live their lives because, guess what, if someone lives to a ripe old age they will by definition not have abused their bodies too much.
The other thing to consider is injury. In principle a very large number of injuries could be avoided if there were manic health and safety regimes and people did not engage in sports which lend them liable to injury, but who would want to live in such a world?
The Department of Health and the NHS spend a good deal on preventative medicine in terms of telling people how to live their lives. This has little effect. Consequently, the NHS should concentrate on treating illnesses and injury where they arise, not wasting money and time on preventing illness or injury.