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children, and widespread unemployment with practically none of the benefits
now available under the Welfare State. We are now suffering from a
permissive society, lawlessness, student and industrial unrest, the abuse
of social and educational benefits, road accidents, drug addiction, and a
plethora of planners.
What work is there to be done? How and by whom,
and where is it going to be done?
Because of the shift from "them" to "us" there
is a clear indication of the need to expand health education - to inform and
to educate people how they must accept their personal responsibility in the
pursuit of physical, mental and social health. There must be a positive
approach to health. They must be educated not to throw health away. There
will have to be an end to shrinking from discipline as evidenced by the
permissive society, laziness, meretricious pseudo-philosophy justifying
unwashed, unwanted workshys and hooligans. There must be a cessation of
shelving and disclaiming responsibility in the hope of peace at any price and
anything for a quiet life. There will have to be an acceptance of health
discipline personally, and by parents, teachers, those responsible for
enforcing the law and their supporters. Health education will be necessary
to ensure continence of behaviour, appetites and pleasures - for example,
in connection with alcoholism and drugs. In this regard the estimates of
alcholism in Britain range from 1.1 to 11 per thousand, age 20 and over, and
in addition to 1,100 heroin addicts still under treatment there is a much
more widespread misuse of amphetamines. Indeed, prescriptions of drugs
affecting the mood exceed 30 millions a year.
At the moment the emphasis is on "welfare";
trying to sort out the social, mental and moral problems and tragedies of
normal and abnormal individuals; problem families, victims of the permissive
society; drug addicts, drop outs, handicapped people, children suffering
from or causing suffering to their parents; and old age. But in this
modern preoccupation with salvaging welfare situations, sight must not be
lost of the fundamental preventive principles and services on which the
existing Public Health Services have been painstakingly developed over the
past century and a quarter: the fundamental essentials of environmental and
occupational health - drainage, sanitation, good housing, cleanliness,
including that of the atmosphere; pure and nutritious food and drink;
infectious disease control; immunisation against 7 or 8 diseases; maternity
and child welfare; the health of the school child; rodent and pest control;
and health education. These things ore essentially preventive, long term,
unspectacular and do not produce rapid or dramatic solutions. Over the
years they have come to be taken for granted, but the need for them still
continues. Indeed the emphasis on prevention will have to be increased
as a result of the economic pressure from the continuing rise in the cost
of curative care. In this connection pressing projects for the preventive
medical services of the future include a comprehensive occupational health
service, the prevention of genetic defects, health checks and the computerisation
of records.
The Local Authority Social Services Act
divorces welfare from medicine, puts it in charge of a lay Director of
Social Services and attempts to fragment the Public Health Services into
those with an allegedly social slant and those with medical emphasis.
The second Green Paper on the National Health
Service, adopting the reform of local government boundaries, divorces
personal and school health from local authorities and places these services
together with the hospital and general practitioner services, under the
control of Area Health Authorities, with negligible accountability to local
authorities. It is proposed that there shall be about 90 Area Health
Authorities in the main coterminous with the Unitary or Metropolitan
District Authorities suggested in the proposals for the Reform of Local
Government. These latter Authorities will be providing the social services