Reclaiming ‘health’ from ‘health service’ – This Space

This article is written in collaboration with This Space, a submissions-based blog dedicated to mental health and reducing stigma surrounding the topic. You can check them out here, and if you’d like to submit, please email [email protected].

We can’t rely on the NHS to provide us with good health.

No, you’re not reading the Mail and yes, I am a medical student.

Keeping the concept of “health” bottled up in the NHS is giving it the ‘Aladdin’s genie’ gig: phenomenal cosmic powers, itty bitty living space.

Let me state for the record: the NHS is an incredible institution and despite what the Mail would have us believe, I think it does its job very well. However, providing medical care to treat and/or cure diseases is very different from our daily challenge of maintaining ‘Good Health’, which according to the World Health Organisation is:

“a state of complete mental, physical and social wellbeing, and not merely the absence of disease or infirmity”.

By tackling disease, the National Health Service offers only a limited contribution to this project.

If we associate “health” with hospitals, doctors, nurses, operations and medicines, we risk unconsciously narrowing our understanding of what it means to maintain a state of wellbeing.

The NHS – definitely something to make a big song and dance about

The NHS adheres to R D Laing’s “Medical Model”, prevalent in medicine: a scientific approach to identifying symptoms, diagnosing specific diseases and providing evidence-based treatments.

But what can medicine really offer in the way of supporting a state of wellbeing on a daily basis?

In contrast to the medical model, a well-established concept in the field of public health is that of “social determinants of health”. Examples recognised by WHO include stress, unemployment, addiction and social exclusion.

These aspects of our social and physical environment, many of which we might encounter every day, contribute significantly to whether we experience good or poor health.

Here in the bubble, stress and social exclusion may well feel familiar to many of us. This model ties in with the idea of “social wellbeing” highlighted in WHO’s aforementioned definition – but the UK’s National Health Service does very little, if anything, to tackle any of these aspects of health.

In Cambridge, perhaps our greatest health concern is our mental health.

The potentially negative impact of a narrow, purely medical understanding of health is particularly important in this context – one of the reasons that Laing originally described his medical model was to criticise medical psychiatry.

In recent years, we have seen students begin to write and campaign more about the lack of support for those suffering from mental illness in Cambridge and similar institutions.

Basically, we’re talking about Whose University

Although it has possibly been less emphasised so far, the lack of support to prevent mental illness (i.e. maintain good mental health) by tackling important factors in our environment, is at least as significant a problem.

Beyond the University, services for dealing with mental illness are provided through the NHS, which is great. But to what extent are we able to access support to maintain good mental health on a daily basis?

I don’t think there are easy answers about how to improve this preventative aspect of maintaining good health. There are likely to be many practical barriers to fully embracing WHO’s broad concept of wellbeing. For example, any effort to maintain a state of good mental health may face the same stigma that has been associated with mental illness and its medical treatment for decades.

Even so, if we want to see long-term improvements in health, particularly mental health, we all need to consciously reflect on what the word “health” actually means to us.

If it is more than just what the National Health Service in its current form provides, what support do we need to demand – from society, from the University, from our government and perhaps from ourselves – in order to maintain that state of health?

If you’d like to find out more, check out:

R. D. Laing The Politics of the Family and Other Essays (1971)

Wilkins R Marmot M (ed) (2003). “The Social Determinants of Health: The Solid Facts, 2nd ed” (PDF). World Health Organization Europe.