In the past, the choice might have been easy. Health care was strictly hierarchical and doctors were at the top of the pyramid. No health professional could become established without the patronage of the medical profession. But is that still true today?
Health care consumers now have much greater choice when it comes to health providers and they are exercising their choice in innovative and interesting ways. Over-the-counter remedies, alternative and complementary therapies, self-help programmes and personal health promotion strategies, are all subtly changing the power dynamic that has long existed in health care.
Billions of dollars are now being spent on health care by people who never see an orthodox health professional, and a trend is emerging whereby people only meet a health professional in the first and last years of life, and when they are in dire need. For the rest of the time, people are looking elsewhere.
So a newly designed health care system might not have doctors and nurses at its centre. Instead it might have consumers, families, communities, teachers and rest home staff.
A recent report by the Royal Society for Public Health in the UK (link), looked at the Wider Public Health Workforce, and argued that there were at least two million people who could be offering basic health assessments and health advice. These included 803,000 kitchen, bar and waitering staff, 639,000 cleaners, 452,000 public service and associate professionals such as postal workers, and 222,000 hairdressers and people in related services.
The RSPH argue that ‘with appropriate training, the wider workforce could support public health activities in areas including the following:
- Point of care testing including body fat measurements, finger prick testing, blood pressure, BMI
- Behaviour change programmes, healthy conversations, and signposting the public on to more specialist services
- Social prescribing including screening the public for lifestyle health conditions such as inactivity, low level anxiety or social isolation
- Assisting the public to overcome physical and emotional barriers to health advice including access to GPs and initiating conversations about health.’
Notwithstanding some critically important questions about the declining funding for public health care, and the serious concerns about a growing surveillance/blame culture emerging in public health care, it is clear that the political economy of health care is changing.
As Tom Waits once said ‘you can’t unring a bell,’ and we will surely never return to a time when the ‘doctor knows best.’ Given that, should professions like physiotherapy be spending more time looking at ways to collaborate with hairdressers, postal workers and cleaners, and should health care consumers be the first people we look to collaborate with in our newly designed fantasy health care system?