Benefits and Risks and Medical Care: a Symposium Held by the Office of Health Economics

Taylor, D. ed.

July 1974

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The physical health and longevity of the people of countries such as Britain has improved dramatically during the course of the past 100 years. In the middle and later decades of the 19th Century the average Englishman had at birth a life expectancy of around 40 years. Today it is nearly 70 years. In 1898 the pioneer social investigator Seebohm Rowntree recorded in a survey in York an infant mortality of 247 per 1,000 live births amongst the poorest class and one of 94 per 1,000 amongst the well-to-do. Today infant mortality in Britain is on average well below 20 per 1,000 live births, although the class related differentials remain.

The roots of these demographic changes lie in the gradual social and economic development of Western Europe during the course of several centuries. The transition in the now economically developed world from the previous situation of high and fluctuating mortality linked with high fertility to one of low mortality balanced by low fertility cannot be directly attributed to medicine and its allied disciplines at least until its later, post First World War, stages.

But in the past 50 years the growth of modem pharmacological knowledge together with factors like improved surgical techniques has given the medical profession the power to make major changes in the level of physical health and the chances of survival enjoyed by the population as a whole. Advanced medicine now ensures that the great majority of people in the richer parts of the world survive into old age. And in the poorer nations its potential for accelerating the changes in standards of health which took Europe some hundreds of years to achieve are immense, although limited by general factors associated with economic and social development.

The symposium which this book records concentrated its attention on assessing the value of modem medical care mainly in the former area, that is in the economically developed world. It was in particular concerned with questions surrounding the risks and benefits of medicine in societies like that of present day Britain. What are the limitations to its growth? How far is the extension of life threatening procedures justified in the pursuit of a better quality of life? What social changes is the health service indirectly promoting and what are their likely effects? How can we best control the use of medical techniques which are potentially beneficial but which carry with them relatively high levels of risk to individuals or to the community?

Yet a careful consideration of all the data presented in this volume and of the references which were made during the course of the papers' presentation and discussion suggests one rather more important conclusion. This is simply that in many areas we already know, and have known for some time, enough about the root causes of much current morbidity and premature mortality in Britain to be able to avoid its occurrence. Where it is related to occupational and associated economic factors or to scarcity of resources available for compensating the handicapped for their disadvantages or to behaviour stimulated by fashion or by advertising, as in the case of smoking, the opportunities for intervention are already apparent, OHE hopes to examine these issues more fully in a future symposium on the social determinants of health. But even now it is clear that, in the near future at least, significant improvements in the physical and mental wellbeing of much of the population will probably depend on the extent to which health care ceases to be the preserve of narrow professional interest and becomes instead a general social and personal responsibility.