What does ‘health for all’ really mean?

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We spend trillions globally on ‘health’ – from high tech health services to health supplements and even health food.  I regularly go to meetings on health protection, health screening, health promotion, health education, health and wellbeing, health and safety – and I work in a National Health Service that spends £120bn a year serving the nation’s health. But nobody’s quite sure what health means. The NHS has a constitution that doesn’t even define health. And despite spending all this money on health, millions of people remain unhealthy. So what’s gone wrong?

If we want ‘health for all’, first we have to agree on a definition of health.

The World Health Organisation set a high bar in 1948 when – in the same year that the NHS was founded – it defined health as: ‘A state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity.’

With such an idealistic vision, those suffering a post-war loss of limbs, lung function and sanity, may have wondered if such ‘health’ was ever possible for them, as did those left scarred by TB, malnutrition and grief. However, the British are nothing if not pragmatic: spectacles, hearing aids and dentures flew off the shelves, so at least we could all see, hear and eat. There are three steps to heaven!

Then, in 1975, the WHO – with the backing of 134 governments – raised the stakes and promised ‘Health for All by the Year 2000’: as we marched triumphant towards the new millennium, every citizen of the world would not just be free from disease and infirmity, but in ‘a state of complete physical, mental and social well-being’.

Today, twenty years past that deadline – with the world in the grip of a pandemic – the WHO’s vision seems laughably naïve. But I would argue we need to relaunch ‘health for all’ – in order to rekindle our humanity.

One of the surest routes to health is to help others to it, just as the quickest route to happiness is to make others happy. The secret is to get right, the balance between freedom and responsibility.

The Coronvirus pandemic has taught us that our health is connected, collective and collaborative, rather than – say – the macho demonstration of how many press-ups Boris Johnson can do for the Daily Mail.

My definition of health is: ‘Our freedom to live a life that we have reason to value and our responsibility to value others and minimise harm’. Health forces us to do some thinking, to figure out what our values are and how we will value others. And we soon realise that one of the surest routes to health is to help others to it – just as the quickest route to happiness is to make others happy.

The secret is to get right, the balance between freedom and responsibility.

‘Health for All by 2000’ failed – not just because many governments who signed-up to it were not truly committed, but because HIV/AIDS struck in 1981. Like SARS-CoV-2, it crossed over from animals, and has since infected more than 70m people and 35m people have died. HIV is still with us – and we still don’t have a vaccine. But if you’re lucky enough to afford the anti-viral drugs – or to have an NHS which can provide them – they work very well.

Last year the WHO declared that global health threat-levels are now so high, that every government should make 2019 “the year of health emergency preparedness”. But the world’s governments were too busy squabbling to listen: WHO even named its top-10 global health threats, all of which are inter-connected: see how many you can guess without looking them up.

They were: 1. Air pollution and climate change; 2. Non-communicable diseases; 3. A global influenza pandemic; 4. Fragile, vulnerable settings; 5. Antimicrobial resistance; 6. Ebola and high-threat pathogens; 7. Weak primary care; 8. Vaccine hesitancy; 9. Dengue; and, 10. HIV.

The vision of ‘One World’ is nothing new, but we all need to keep it in our sights. We tend to think of ‘my health’ and ‘health for my friends and family’, while a lot of people extend their compassion to those in need in their communities. But to improve our collective health, and to reduce the risk of further pandemics, we have to widen that circle of compassion and action as far as it will go.

What’s clear is that just as health is inter-linked, so are these health threats – and a lot come back to climate change and air pollution: 9-out-of-10 people breathe polluted air every day, and these microscopic pollutants kill seven million people prematurely every year from cancer, stroke, as well as heart and lung disease.

Climate change is expected to cause 250,000 additional deaths per year – from malnutrition, mosquito-borne disease, diarrhoea and heat stress: mosquitos love warmer weather, and dengue and malaria are on the rise. Meanwhile, deforestation displaces animals into human populations, making the risk of zoonotic virus cross-over greater. Mass agriculture produces cheap, processed junk food that’s led to global warming, more animal viruses jumping to humans, and a global pandemic of obesity and type-2 diabetes. And food insecurity caused by climate change will likely cause a further 529,000 adult deaths a year by 2050.

The way we live on this over-crowded planet has come back to bite us.

Some may look forward to sunning themselves in 40-degree heat on the beach at Weston-super-Mare – while trying to avoid the mosquitoes. But if we want our children and their children to have a future, we have to make the health and well-being of people and planet our paramount political concern. Every other policy – particularly economic growth – has to be seen through that prism: if it won’t improve the health and well-being of people and planet, don’t do it.

‘Health for all’ won’t succeed for everyone – but trying to achieve it is our best hope for collective survival.

Dr Phil Hammond is an NHS doctor, Private Eye journalist, broadcaster, author and comedian.