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munity, reserving costly hospital beds for those in need of the special
skills and services which can only be provided in that setting. Hence
also the tendency to concentrate such specialised facilities in large
hospital units where they can be used to the full. This policy carries
the disadvantage for both patients and relatives that the distance
between home and hospital tends to grow, with the concomitant
inconvenience and costs in terms of both the time and money involved
in travel. Thus the proposed adoption of a district general hospital
system—in which a large hospital with at least 500 beds will serve
a population numbering some 200,000—can only be justified from the
standpoint of the community if solely essential cases are admitted and
the actual stay in hospital is kept to an absolute minimum consistent
with the welfare of the patient. In turn this depends upon a hig
standard of medical care being provided by the family doctor, an
objective which cannot be attained without both a sound undergraduate
and postgraduate preparation for general practice and adequate facilities
for consultation, investigation and domiciliary treatment. The
district nurse and the home help are key figures on the home front.
To be successful, therefore, care in the community requires intimate
co-operation between the medical and social services so that the necessary
support is forthcoming not only for the sick but also for the
young, the physically handicapped, the mentally disordered and the
aged. Above all, it is in the interest of both the individual and the
nation that a proper emphasis is placed upon the promotion of health
and the prevention of illness. Here the health visitor has a crucial
role to play in close liaison with the general practitioner.
Today, notwithstanding the remarkable progress which has been
achieved during the twentieth century in improving the health of the
nation as a whole—attributable to a great increase in medical knowledge,
coupled with an equally significant improvement in general
living standards, a corresponding rise in the level of education and,
not least, the sustained efforts of the public health movement—prevention
has never been more relevant, for major preventable factors
abound amongst the leading causes of death and disability. Indeed, at
the present time it is true to say that never before has the health of
the individual rested so largely in his or her own hands. The facts
speak for themselves.
Each year more than 500,000 deaths are registered in England and
Wales and nearly one-half of these can be attributed to diseases of
the heart and circulation, mainly taking the form of heart attacks or
cerebral strokes. A fifth of all deaths are caused by malignant disease;
over a quarter of these relate to the lung; one-tenth to the breast, and
one-thirtieth to the womb in which cancer of the cervix is prominent.
Diseases of the respiratory system other than cancer—princinallv pneumonia
and chronic bronchitis—exact a toll in excess of 10% of all
deaths. A heavy price indeed in the form of coronary thrombosis,
chronic bronchitis or lung cancer may be paid for over-indulgence in
some of the pleasures of life. In this context the magnitude of the task
of changing human attitudes should not be underestimated—approximately
two out of every three men and every other woman smoke,
and one in every five adults is overweight—nor should its importance
be overlooked for it is estimated that cigarette smoking is responsible
for a tenth of all deaths and a similar proportion of all sickness
absence from work; the association between obesity and such