Beyond Medicine for Profit
I moved to Britain in 1980. By the time I settled into Bayswater in central London in 1983, the Thatcher government was well on its way toward dismantling much of the manufacturing base of what had made the country the world’s “first industrial nation.” Unions were under attack, the unemployment rate was soaring, and there were plans to privatize the National Health Service (NHS). I became part of the struggle against that effort, as a member of the steering committee of the newly formed Public Health Alliance.
Much derided in the United States as “socialized medicine,” the NHS is a great achievement that most British genuinely value. Many remember or have heard what life was like before it. (On the eve of the Second World War, the infant death rate in the poorest working-class wards of Liverpool was as high as in Calcutta.)
The NHS changed all that in 1948. Yet, contrary to common belief, it was not a socialist program per se. Though the Labor Party created it in 1948, as part of the modern British welfare state, it owed much to the 1943 report by the economist William Beveridge, former director of the London School of Economics and master of University College, Oxford. But, most importantly, as John Marks, a former chair of the British Medical Association (BMA) council, has observed, “Before [the NHS] healthcare in this country was a disaster, particularly if you were poor. The unmet needs were not known until the NHS started, and people who had been ill for years and years came forward for help because they did not have to worry about paying for it.” The core transformative principle of the NHS was that medical treatment was free at the point of use.
In the nineteen-eighties, Bayswater bore the brunt of Thatcherite policies. According to Frances X. Clines, in the New York Times, “Homelessness and street squatters are on the rise…as the construction of housing for the London poor has fallen from an average of more than 20,000 units a year in the 1970’s to little more than 1,000 lately because of the Thatcher Government’s cutting local capital borrowing authority by two-thirds.” The worst affected boroughs were lodging families in bed-and-breakfast accommodation in Bayswater, where they suffered from diverse health and social problems. As Stella Lowry wrote in 1990, in The British Medical Journal: “The adverse effects…on health have been well documented. Homeless women are twice as likely to have problems and three times as likely to need admission to hospital during pregnancy as other women. A quarter of babies born to mothers living in bed and breakfast accommodation are of low birth weight, compared with a national average of less than 1 in 10. The children are more likely to miss out on their immunisations, while poor sanitation and overcrowding encourage the spread of infections and diarrhoeal illnesses. Good nutrition is almost impossible because of the poor facilities for storing and cooking foods. Accidents are common among the children, and their parents often suffer from depression.”
This stirred political activists, including socially conscious physicians, who realized that there could be no normal medical solutions for health problems created by political and economic policies. One outcome was the Bayswater Hotel Homeless Project. A leading figure in the Project was Dr. Richard Stone.
As it happened, when we sought a doctor, it was Stone’s practice that we happened to join. Of Lithuanian Jewish background, Stone was an exceptional physician, whose broad view of health reflected the spirit that gave birth to the NHS. In Britain, in the decades before the NHS, it was a vision that was kept alive by doctors such as Scottish-born A. J. Cronin. In the twenties, he briefly practiced in Tredegar, a mining town in South Wales that was also the birthplace of Nye Bevan who, two decades later, would be one of the chief architects of the NHS. As Bevan’s father, a coal miner, was dying from pneumoconiosis, Cronin served briefly as Inspector of Mines for Great Britain, until he moved to London, where he briefly practiced in fashionable Harley Street, before establishing a less financially rewarding surgery in Bayswater.
Facing the realities of health in pre-war British society, Cronin found it necessary to move beyond the normal boundaries of medicine. In the 1930s, he turned to writing novels that expressed his conviction that medicine should be an instrument of social justice. The most famous, The Citadel (1937), one of the most popular British novels of that decade, has been credited as an inspiration for the NHS.
It was like that for Richard Stone. We often saw him on the evening news, filmed on a picket line, protesting the consequences of Thatcher’s policies. It was because of that larger vision of what healthcare is all about that, at the age of 54, Stone left medicine. By the late nineties, he was the Vice Chair of the Runnymede Trust, an independent policy research organization that seeks to advance equality and justice in a multi-ethnic society.
I feel deeply privileged to have been Stone’s patient. But, what I most remember about the waiting room of his practice are the large black and white photographs on the walls. They were stills from the 1938 film of The Citadel. Why? The book and the movie tell the story of a doctor’s journey from his early practice in a Welsh mining village (like Tredegar) to when he abandons a lucrative London practice to set up a multi-doctor clinic in a small town. Cronin had established his own surgery in Bayswater. The pictures were hanging on the waiting-room walls because Stone’s was the literal descendant of that practice.
We had fortuitously found our way into the on-going story of what is best in Western medicine, a model for what may be the norm in the United States some day, when healthcare becomes a central element of a more comprehensive vision of social justice.
...John Marks, a former chair of the British Medical Association (BMA) council, has observed, “Before [the NHS] healthcare in this country was a disaster, particularly if you were poor. The unmet needs were not known until the NHS started, and people who had been ill for years and years came forward for help because they did not have to worry about paying for it.” The core transformative principle of the NHS was that medical treatment was free at the point of use.
Eric B. Ross taught for 16 years at the Institute of Social Studies in The Hague, where he ran the MA in Development Studies. He is currently Professorial Lecturer at The George Washington University. His best-known book is The Malthus Factor: Poverty, Politics and Population in Capitalist Development.