The state of our NHS and the health of our nation are deeply intertwined. Recent check-ups on how the health service functions and how we as a population are living reveal we’ve a lot of work to do, and remind me of the Waterfall Story.
Imagine a waterfall. At the bottom, doctors and nurses are fishing injured people of the water, trying to save lives. One medic instead heads for the top. “Where are you going?” “Upstream, to find out why so many people are falling in.”
If we examine who is pushing people down that waterfall in Scotland – that is, who is causing ill health in the first place – we find a lot of wealthy industries such as tobacco and alcohol, and austerity policies that leave people with little hope, reliant on food banks and zero-hours contracts.
These points were brought home to me at the recent Scottish Greens conference in a talk by the government’s former chief medical officer, Sir Harry Burns. Harry pointed out that Scotland’s poor health record is the health of the poor. People in the most deprived areas are more likely to die than those in the richest, and our biggest causes of death are suicide, drugs, violence, chronic liver disease and other disorders due to alcohol.
Scotland had one of the lowest death rates from alcoholic liver disease in Western Europe from the 1950s to the 1970s. As Harry pointed out, back then drinking was largely done by men, drinking beer, in the pub, at the end of a working week. These days it seems everybody drinks everywhere all of the time. And what do they drink? Anything they can get their hands on! This is why policies such as minimum pricing are so important, as is the need for local licensing boards to act on over-provision.
It’s clear that if we want to improve public health, we need to head for the top of the waterfall, not just fish people out of the water and attempt to patch them up. In preventing ill-health we can ease the pressure on our NHS. It’s an area the Scottish Greens have consistently prioritised. If we invest in good health now through everything from warm homes and safe walking and cycling routes to good food and a living wage, we can lighten the burden on the service. “Preventative spending” is a phrase ministers like to trot out in speeches and soundbites but look for it in the Scottish budget and you won’t find it.
Last week Audit Scotland highlighted that the Scottish Government has not made sufficient progress towards more home and community-based healthcare. As our population ages and as our health needs become more complicated, it makes sense to be treated and looked after in or near our homes and our families.
The auditors found limited evidence of health boards or government evaluating whether health and care services can adapt to changes in demand. Ministers must prioritise planning ahead. After all, prevention is better than cure.
Alison Johnstone is the Scottish Green MSP for Lothian