Emma Rose McGlone gets to grips with the wider picture
Most medical school applicants want to “make a difference” or help people. But for junior doctors frantically treating lots of patients or, cramming for membership exams, humanitarian ideals can get forgotten. Power and Politics in Global Health, Medsin’s 2008 jamboree, was an impressive and enjoyable reminder of the context in which every health professional works.
Student-led charity Medsin campaigns and educates about national and international health inequality. Its annual showpiece consisted of a diverse but carefully selected series of lectures and workshops, filled to capacity with an interactive mix of medics, academics and activists.
The first plenary, entitled Politics, opened with a fascinating lecture by author Dr Dibesh Anand. He explored the analogy between individual and national health evoked by political language, using concepts like ‘the body politic’ being threatened by ‘invasion’ from within and without. While vibrantly contrasting democratic health systems with authoritarian models, Dr Anand argued that the latter, though efficient, often restricts information and fosters fear, leading to a situation of “healthy body, unhealthy mind”.
Professor Colin Leys, of the Socialist Register, was up next. He addressed the privatisation of the NHS and argued that the corporatisation of the state, which is driven by business interests and financial markets, is progressing at an alarming rate. Not only is the provision of health services outsourced to private businesses, but the remaining NHS functions are reorganised along corporate models, for example Payment by Results. Negative consequences of this include decreasing efficiency, with up to 20% of the annual NHS budget being spent on administration; and “gaming” – hospitals cheating on coding to increase profits.
The debate on funding resurfaced in the Economics plenary. Consultant David Woodward outlined the basics: “Economics is about the allocation of scarce resources.” Two rival ways of allocating supply are according to “need”, a founding NHS principle; or according to “demand”, which reigns supreme in a free market. Woodward illustrated the mismatch between “demand” and “need” with a graph of wealth against population, which initially appeared about A3 size, but mysteriously only accounted for 90% of the population... With comic timing he gradually unrolled the graph, eventually mounting a chair, to reveal the huge relative wealth of the tiny proportion in a position to demand.
Some of the best-received speakers exuded rhetoric and drama. During the first closing speech, the flamboyant Dr Horton jabbed his finger at associate editor of the Financial Times Martin Wolf, and accused him of being wrong. Horton, editor of the Lancet, rejected Wolf’s tenet that development of free markets in poorer countries is essential for improving health. Despite being portrayed as the big-bad wolf of capitalism, the economist shrugged the accusation off in good humour. Somewhat radically, Horton then went on to urge the audience to redefine their moral horizons, reject their inherent species-ist attitude, and remember the plight of animals facing extinction.
All doctors have a responsibility to promote equality in healthcare
Between plenaries, delegates dispersed into groups for workshops. Several were led by campaigners who were keen for new ideas to improve their work, which encouraged lively brainstorming. Dr Salam Israel, of Doctors for Iraq, headed a the discussion on the post-conflict rehabilitation of Iraq’s health service. Delegates came up with diverse strategies to improve the safety and supervision for Iraqi doctors.
Former secretary of state for international development, Claire Short MP, closed the conference with an optimistic view of the future of international health. Short stressed that all doctors have a responsibility to promote equality in healthcare and other development parameters worldwide.
Despite the frustration and exhaustion of a doctor’s daily grind, it was difficult not to be inspired by her vigorous invitation to “go beyond the heart and engage the head”, to provide a contribution this is “not tokenistic but really intelligent”. But how?! Begin by booking a place at the next Medsin conference.
Dr Emma Rose McGlone as FY1 at Queen Alexandra Hospital in Portsmouth. The conference was held on 25/26 October.