Health Citizenship – Whose life is it anyway? Whose health? Whose decisions?

As a friend of mine observed:

«When did we decide to outsource our health to the professionals?»

For centuries people relied for their health and health care on the wisdom of their people and the care of their families, churches and charities. There was little help available from health professionals, whose skills were uncertain and whose knowledge was patchy at best. Now, with medical science and the professions having advanced so spectacularly, the position is reversed. Mighty medicine and powerful health systems dominate our lives in the West to the extent that many professionals now talk about the necessity to engage and empower patients.

The need for a new balance with patients and citizens re-asserting their ownership of their own health has become urgent for many reasons. Common sense and research alike reveal that patient participation and citizen engagement is needed for many treatments to work effectively. We need only think of examples as different as diabetes, where patient self-monitoring and self-care has to be the norm, or vaccinations programmes where professionals often have to persuade citizens that the vaccines are safe and in their and their families’ interests.

Even more importantly, we now understand both how people’s behaviour affects their health and that education, economic status and social structures shape our chances of good health and long lives. These determinants of our health – and the actions we must take to influence them – are controlled by citizens not clinicians.

The need for a new balance between citizens and professionals is also about costs and limiting the power of the professionals to maximise their economic leverage. As tasks become the province of professionals, patients and citizens are disempowered and have to find new funds to purchase these new commodities. Moreover, it is generally the professionals who dictate the terms: deciding what remedies are needed and charging for supplying them. Safeguards are needed for the public to be confident of sorting out the effective from the snake oil.

It is also, crucially, about personal risks. As Professor Sir Cyril Chantler has said

«Medicine used to be inexpensive, ineffective and largely harmless but now it has become costly, effective and very dangerous.»

Patients and citizens need to be very confident that they understand the risks and either refuse or consent to them.

What is needed?

All these reasons, as well as the greater availability of information, the better education of the public, and the decline of deference and trust mean change is needed. The approach we have taken in the last 100 years or more, as we have increasingly given up our control to the professionals, has been one of seeking safeguards from the State through regulation and scrutiny and through placing trust in professionals, their Hippocratic Oath and their social mission. This approach is no longer sufficient by itself.

We need to become health citizens, respectful and appreciative of our health professionals, but also engaged in self-care as well as influencing policy, contributing our insights and wisdom alongside professional knowledge and experience. Pioneers around the world are already showing us the way.

Lord Nigel Crisp

Independent Crossbench Member of the House of Lords, United Kingdom /
Unabhängiges Mitglied (crossbencher) des britischen Oberhauses, Grossbritannien

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