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our hospital and medical services in relation to
those other countries of Europe. But from the
preventive point of view these figures demonstrate
in no uncertain terms that certain aspects of our
environment must militate against us as a nation.
Is it the atmosphere we breathe, polluted as it is
by our particular brands of cigarette smoke, our
domestic coal fires, our industrial concentrations
and processes and our vehicle exhausts, or other
pollutants? Is it the food and fluids we eat and
imbibe including the excess of refined and
whitened sugars or unsuitable animal fats? Is it
our excess of weight or lack of exercise or a
combination of these and other factors? In what
ways do we differ from our more long-lived
European cousins who do not even have the
benefits of a comprehensive National Health
Service?
The above figures clearly point to the fact that
it is preventive measures rather than curative that
are all important if our healthy survival is to be
brought in line with others. One of the most
important of these measures is undoubtedly the
attainment of clean air and in Hounslow the
public health inspectorate is sparing no effort to
achieve this aim. Of equal importance in the
achievement of healthy living standards is the
reasonable but rigorous application of the
requirements of the Housing Acts, the Food and
Drugs Acts, the Public Health Act, The Offices,
Shops and Railway Premises Act and many
others too numerous to mention here. A full
account on environmental health is given by
Mr K J Smith, chief public health inspector,
later in this report. Early detection of disease,
though of secondary importance to primary
prevention, is nevertheless the next step along
the road to overall improvement. In this context
I discussed the question of the provision of
screening techniques by both the local health
authority and the general practitioner at some
length in my preface last year. There are however
in all forms of human endeavour certain limits
beyond which it becomes questionable whether
the effort is justified by the results, the law of
diminishing returns. Also no community has
unlimited resources and therefore many difficult
decisions regarding the relative priorities of a
variety of services are frequently demanded. This
law particularly applies to preventive medicine
and for this reason it is our duty to review our
services at regular intervals to ensure that they
continue to be relevant to the needs of the
community.
Our National Health Service will however be
truly comprehensive only when it blends curative
and preventive medicine so as to attain optimum
health throughout life. Perhaps the following
functional divisions may illustrate more clearly
what I tentatively suggest is necessary to form
such a comprehensive service—
1. A General Practice and Community Health
Service embracing all aspects of family and
individual health in the home with special
emphasis on infant and child health and
development in conjunction with a risk/
observation register and also on health in
retirement.
2. An Occupational Community Health Service
embracing school health, student health and
health at work or in other words health in one's
occupation whatever one's age.
3. A Hospital Service embracing acute and severe
medical and surgical illness needing hospitalbased
diagnostic and/or therapeutic care in order
to return the patient as quickly as possible to the
care of the community health services with as
complete restoration of health as is practicable.
My brief here is on community health as
illustrated by 1 and 2 above, and I will now
consider 2 first mainly in relation to the
Borough's service. Between the ages of 5 and 65
the greater part of one's waking hours is spent a.
work and the rest mainly at home, in contrast
fortunately for the majority of us, only a minute
fraction of our useful life is spent within a
hospital. Needless to say care in hospital at such
a time is of vital import to us as individuals but
the future here seems beset with increasingly
expensive treatment procedures and frightening
ethical problems occasioned by organ transplantation
and the possibility of prolonging life
by artificial means after death would normally
have supervened often in an individual who
would no longer be able to live a separate
existence. In these circumstances cold surgery
such as the repair of hernias would appear after
the first forty-eight hours to be more a problem
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