Twenty years ago the advocates of a National Health Service asserted that capitalism need not be detrimental to the health of working men and women. Speaking as Prime Minister in the spring of 1944, Winston Churchill stated that it was the policy of the Government to establish a National Health Service which would make accessible to all, irrespective of social class or means, adequate and modern medical care. With the introduction of the Health Service four years later the Minister of Health, Aneurin Bevan, also promised that it would be a classless service. Thus both Labour and Conservative Parties committed themselves to the same objective and they have now had the best part of two decades to. achieve this end. Have they succeeded?
In Britain chronic bronchitis is a widespread and killing illness, to such a degree that it has become known as “the English disease." The Registrar General's statistics reveal that in 1963, in England and Wales alone, there were thirty thousand deaths from this cause. Bronchitis is largely due to atmospheric pollution, cigarette smoking and the unfavourable, dusty conditions associated with jobs such as foundry working and coal mining. Pick up any medical text-book and you can read passages similar to the following, taken from a standard work : “If the individual's economic status permits he should be advised to live in a warm, dust free area . . ." “If the occupation is a dusty one then the individual should be advised to change it although in many cases this may not be a feasible proposition.”
If working men and women are complacent about the general standard of health, this can only be due to ignorance of the facts. The trends in death rates reveal that while some of the older traditional working class diseases—such as tuberculosis—are on the wane, others are becoming more common to take their place.
(Respiratory diseases, including bronchitis, were of lesser importance in 1964 than for the previous three years, this was probably due to the exceptionally mild winter. The long-term trend still shows an increase.)
The causes of lung cancer and coronary artery disease are not known with any certainty. It has been noticed with the latter, however, that there is a very high incidence among men whose work provides considerable tension and anxiety, with little opportunity for exercise. How many millions of “white- collar" workers—chained to a desk for eight hours a day and then jammed into a commuting train for a further period—would meet this description?
One of the main causes of chronic bronchitis is atmospheric pollution. This is a feature of towns and cities in every advanced capitalist country; 133 tons of industrial dirt fall on to the town of Duisburg (about half-a-million inhabitants) in the German Ruhr every day and the sulphur dioxide level in the air is far above that which is believed to be dangerous for humans (see report in the Daily Mail of 5th April, 1965). The same kind of muck falls on to Sheffield, Birmingham and London. It is a withering criticism of capitalism that the “cleaner-air" campaign, conducted in the Ruhr during 1964/65, was judged to be a success for the simple reason that it resulted in the first winter when the German industrial belt was not brought to a standstill because of smog. Any benefits to the health of the inhabitants were of secondary importance.
Perhaps some of .the most frightening statistics are those concerned with mental illness, In barely 10 years the number of patients entering mental hospitals has virtually doubled.
In Britain today patients with severe mental disturbances (the psychoses), together with serious cases of neurosis, occupy almost as many beds in hospitals as those suffering from all other illnesses put together. In his book on social medicine, S. Leff, M.D., D.P.H., describes the situation in the United States: approximately four out of every ten patients there are said to consult doctors with complaints due at least in part to emotional disorders; some 600,000 mental patients are in hospitals and 150,000 are admitted every year; eight million persons are suffering from mental disorder and one out of twenty of the United States population at some time requires psychiatric care. One million of the twenty-four million children now in schools in the United States are likely to spend some portion of their lives in a mental hospital. There are between three and five million people suffering from amentia or dementia who are not in institutions and about six million are incapacitated because they are on the border line of mental disorders.
In Great Britain no comprehensive field survey has yet been made into psychiatric illness, but less extensive studies have been conducted. One such study, which was designed to give a conservative estimate, showed that in a typical group practice in South London psychiatric illness could be observed in one year in 14 per cent of all patients who consulted their doctor. In addition a further five per cent of the registered patients showed distinct “abnormal" personality traits. Two large surveys in factories have revealed that from one-quarter to one-third of the total sickness absences from work are due to neurosis. Another study of 30,000 workers employed in thirteen light and medium engineering factories showed that one in ten suffered from disabling neurotic illness, and two in ten from a minor form of neurosis. Although there has been controversy over the validity of some of these figures, these “findings have been reinforced by a series of estimates which have been made of the prevalence of psychiatric disorders in the total populace." (Modern Trends in Occupational Health—K. S. F. Schilling, 1960.)
We may be accused of taking every unpleasant feature of the modern world and using it unfairly to illustrate the social bankruptcy of capitalism. It might be said that we are not justified in concluding that it is the social environment which gives rise to mental disease. The Ewing Report on The Nation’s Health to the President of the United States argues our case for us:
Man's mental as well as physical health is very much at the mercy of what goes on about him. The economic insecurity of unemployment and old age, the lack of opportunity for education and adequate health services, poor housing and lack of good sanitation, prejudice and discrimination, failure to share in the civil liberties guaranteed to all citizens, inflation, the threat of atomic war—these are very real every-day problems and they are the kind of social factors that can wear away personal defences and destroy mental health.
It makes bitter reading to look back and see that in 1944 the workers in Britain were guaranteed “adequate and modern medical care.” The hospitals, for example, are in a sorry mess. The general situation is one of too few doctors struggling on with out-dated equipment and facilities. The Government’s official publications admit as much: " . . . under present conditions work properly belonging to consultant posts is being regularly discharged by senior registrars and members of more junior grades.” This is simply because the number of consultants “is still inadequate to the needs of the hospitals.” The reasons for this include “financial restrictions to which hospital authorities are subject” and “inadequacies in accommodation and facilities, especially operating theatres and laboratories.”
And what about that section of the working class which runs the health service? Probably if one conducted a census, at least 90 per cent of doctors, nurses, dentists, etc., would deny that they were members of the working class. But whether they choose to face up to reality or not is largely immaterial; every working day of their lives they are confronted with the hard facts of their wage earning status. They, too, are forced to conduct a ceaseless struggle to maintain their salaries and working conditions. On top of this they find themselves faced with the problem common to all working men and women—such is the pressure on them, they must work to a standard far inferior to that which they are capable of. One dentist recently referred to the “sheer vocational frustration induced by the fact that practitioners are virtually denied the opportunity of practice at the level which their ability and enthusiasm could achieve.” What other working man, forced to prostitute his skills and talents, could not echo this?
It is axiomatic in medicine that the doctor should concentrate on eradicating the disease itself and not waste valuable time and effort on palliative treatment for individual symptoms. The working class could do worse than apply this principle to capitalism—a system of society which brings each one of us little more than poverty, insecurity, frustration and ill-health.
John Crump
I believe John Crump worked in the NHS, as a dentist, before becoming an academic.
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