Health policy over sick policy
This is the first of a four-part series looking into health policy under the Progressive Labour Party
The objective of any health policy should be designed to ensure that people live a long and healthy life. Hence the promises made by the Progressive Labour Party in our early platforms.
The learning process comes as a result of association and repetition. There is nothing more closely associated with every human being than their own body. There is nothing they come in contact with more frequently than their own body. This suggests that any society should know more about health than anything else.
The health and vitality of Bermudians are critical to their productivity and innovation essential for our nation's future. Apart from any direct benefit to the individual who stays healthy, the entire community is better off if the individual is healthy. Students who are healthy and fit come to school ready to learn; employees who are free from mental and physical conditions take fewer sick days, are more productive and help strengthen the economy; and older adults who remain physically and mentally active are more likely to live independently. Therefore, we need to weave disease prevention into the everyday fabric of our lives, including where we live, work, learn and play.
What we generally refer to as a health policy is in reality a “sick policy”. That is, it refers to the treatment of persons who become sick, when in reality a sound health policy would seek first of all to keep a person healthy, so that they don't become sick in the first place. Today, with the internet and social media our attitudes towards health and sickness are changing. We no longer think of medicine as being the only cure for sickness, and its prescription as the exclusive preserve of doctors, who are for Bermuda the medically trained products of North American and English educational institutes.
While these attitudes are changing, we still see these doctors as having the last word on matters of health and sickness. But the advice of doctors depends on how they were trained.
Medical training today is very much dependent on the recommendations of a report published a hundred years ago by the Carnegie Foundation. That report was an assessment of medical schools in the United States and Canada. It was written at a time when there was a great deal of prominence given to acute, infectious diseases in young people. The report recommended, among other things, that medical schools adhere strictly to the protocols of mainstream science in their teaching and research. The report pointed to examples of schools that could be described as teaching quackery. The impact of the report was pervasive and even led to some doctors being put in prison. However, homeopathy and natural medicines were derided.
Abraham Flexner, the author of the report, made curriculum recommendations that may have been justified at the time they were made, but, increasingly, medical school curriculums are emphasising health and homeostasis — the process whereby living things actively maintain fairly stable conditions necessary for survival; for example, how the human body maintains steady levels of temperature and other vital conditions — rather than only an emphasis on disease and diagnosis.
Doctors must be trained to make healthcare cost-effective, and practitioners who do so must be rewarded. This leads to the suggestion that healthcare must be an interdisciplinary team profession. While this calls for radical changes in our approach to healthcare, such changes become necessary as the public get more cost-conscious because that cost falls on everyone.
Bermuda could become involved in bringing about this revolution. This can be done only if Bermuda becomes involved in the training of its health professionals. The training of such professionals is an area where Bermuda is far behind the Caribbean. There are some 80 medical institutions scattered over the Caribbean, both regional and offshore. For Bermuda to open a medical school, we would simply be playing catch-up to our nearest competitors, as opposed to pioneering some uncertain future.
The PLP has called for a university since its inception and, as has been pointed out in other context, such a school would be supplemental to our tourist industry. The students themselves would represent a form of steady visitor and, to the degree we are successful, a high influx of healthcare visitors would arrive to see why Bermudians live so healthily for so long. That is in addition to building a cosmetic industry that has been continuously recommended.
Both cosmetic surgery and plastic surgery deal with improving the appearance of a patient's body. For this reason, strictly speaking, this may not be the most appropriate place for such a discussion. It may be more appropriate to discuss it as a specialised area of tourism. It is being mentioned here only because it deals with medicine and the human body. Bermuda is an ideal location for persons to come to have their appearance altered and then return home with their new bodies.
Cosmetic surgery and plastic surgery are often thought of as being one in the same. They are not. A significant number of plastic surgeons choose to focus their practice on cosmetic surgery, so as a result the terms are often used interchangeably. But this is not technically correct.
Cosmetic surgery is designed to fulfil a person's sense of beauty. The goal is to improve aesthetic appeal, symmetry and proportion. Cosmetic surgery is performed on all areas of the head, neck and body, but since the body is already functioning properly, this type of treatment is elective. Breast augmentation, facelift, liposuction and Botox are all terms we associate with cosmetic surgery.
Plastic surgery is carried out to reconstruct body defects because of birth disorders, trauma, burns and disease. Plastic surgery is intended to correct dysfunctional areas of the body and is reconstructive in nature.
• Arthur Hodgson is a former Cabinet minister, Rhodes scholar and graduate of Oxford University in England, where he studied philosophy, politics and economics