Why health missionaries fail

Britain is awash with health missionaries.  These self appointed characters fill all sorts of positions, in Government, in Parliament, in quangos, in councils, in the NHS, and in society at large.  They are generally liberal, middle class, and have a great sense of self-satisfaction at the holy work that they do.  Their patron saint is St Jamie Oliver of the Dinner Party Set.  Their targets are smoking, drinking, over-eating and sloth.  They work assiduously to spread the message that smoking, and eating and drinking too much while not exercising enough is not healthy.  They attribute failure to accept and act on this advice to ignorance and laziness, as they dish out salad (with sporks of course) to their professional friends.  They lobby for, and get, increasingly authoritarian measures passed by Parliament and local authorities.

Now, I speak of course from prejudice and distaste at these people, but that doesn’t invalidate what I say.  As the excellent Ben Goldacre points out, my intentions and motives don’t affect the validity of my argument.  Amateur psychologists might like to know that I don’t smoke, drink heavily at the week (but not all in the week), am overweight, don’t exercise much but eat healthily, plenty of rice and pasta, fish and white meat.  I am also a passionate advocate for real ales, real pubs, and publicans themselves.  I am opposed to the smoking ban for this reason, as well as the rather shaky evidence about second-hand smoke that provided the basis for it.

That declaration over with, I will continue.  I believe that the only successful public health campaigns over the last twenty or so years have been vaccination campaigns and the general drive to reduce smoking.  While I believe that vaccinations should be compulsory (another post, another time), I do not believe that compulsory or authoritarian measures work in reducing smoking, drinking and over-eating.  I do believe that fundamental changes to society can.

In his fascinating and insightful book Better, the American doctor recounts efforts to try and reduce hospital-acquired infections such as MRSA in New England hospitals.  One such initiative involved an engineer being sent into a ward, assessing it with his engineer’s eyes, and institute changes to try and reduce infection.  These changes did have an effect, but despite communicating this to other wards, nothing happened elsewhere.  And when the engineer left to pursue a different project, the reforms slowly disintegrated, and the situation slowly reverted to how it was before he arrived.

A different approach was tried at another hospital.  The organisers simply gathered groups of hospital workers, explained the problem of hospital-acquired infections, and gave them free-rein to come up with solutions.  They were then given the time and resources to institute those changes, and did so.  The result was an MRSA rate of zero.

I’m sure this strikes you as it does me, as a remarkable confirmation of Marxist views about workers, popular control over institutions and society.  The missionary, however well intentioned (though I believe the health missionaries are at least partly motivated by a sense of moral superiority), cannot effect change by dictating change from the outside.  The change has to come within the group.  Only the working class can solve problems the working class suffers, in a hospital, in a neighbourhood, in a town, in a county, in a country, in a planet.

In the case of health, it is my contention that if we were to take control of our lives, and our society, we could find 101 different ways to live healthier lives, by reducing inequality, by reducing hours, exploitation and oppression at work, by creating hope and meaning where once there was fear for the future and a vacuum.  A millionaire celebrity chef and an army of well-paid evangelists just will never cut it.


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