Back to the Future? Public Health and Politics

Dr Liz Charalambous is a Registered Nurse and Assistant Professor at the University of Nottingham. She has worked in Healthcare of the Older Person in Acute Medicine for many years as a Registered Nurse and has an interest in dementia care and delirium prevention. She tweets @lizcharalambou

"If history repeats itself, and the unexpected always happens, how incapable must Man be of learning from experience." George Bernard Shaw
I recently had a very nice weekend away in Haworth, West Yorkshire. The literary aficionados among us will instantly be familiar with this, as it was the home of the Bronte sisters of Wuthering Heights, Jane Eyre, and The Tenant of Wildfell Hall fame. There was an autumnal nip in the Halloween-season air as we found ourselves wandering around the world-famous church graveyard, perusing the inscriptions on the gravestones: ‘dearly beloved 17 weeks old’, ‘beloved daughter 18 years old’, with some reaching the ripe old age of 25 years (the average life expectancy).
Of course, this was in the days of cholera, typhoid, diphtheria, and tuberculosis - public health diseases we now see through the privileged lens of history. Thankfully, we have the NHS, vaccinations, and the public health knowledge gleaned through papers such as the Babbage report (published in 1850), which highlighted the cramped and insanitary conditions in which poor people lived back in the 19th century. Babbage reported excrement flowing through the streets, 24 families sharing one toilet, and pump water so dirty that even the cattle refused to drink from it on wash day (possibly because all drinking water in the village had filtered through the graves at the top of the hill).

We have different public health problems now: obesity, mental health, and suicide; all of which it could be argued are a by-product of poverty and poor living conditions. Infectious diseases are still around, as we know from the last 2 years of COVID-19, but challenges also remain with contributions to illness from individual factors (age, sex and constitutional factors), as well as wider social determinants of health (housing, employment, transport, education, healthcare services, water and sanitation, and even agriculture and food production).

Thinking through the recent political events affecting the economy, I couldn’t help but wonder if we have moved so very far away from the ghosts of our healthcare past? Social policy has a direct effect on people’s lives, particularly older people who are generally frailer and more vulnerable to becoming ill, not only because of their individual factors but also the wider social determinants of health.

To coincide with these challenges in caring for our population, we have increased stress on our health service. There are reports that the NHS may not last the winter: Doctors leaving in droves because of the pension tax crisis, nurses considering voting for strike action, and huge numbers of vacancies for NHS and health and social care staff. Not to mention the wider agenda of a ‘bonfire of human rights’ proposed by politicians, which would remove hard won workers’ rights such as maternity leave, paid leave, and sick pay; safeguards to environmental legislation; and international concerns regarding women’s reproductive rights.

I can accept the inevitable journey of new and different public health challenges as time marches on, but what I cannot accept is a return to the poverty-stricken times of our ancestors. I wonder what future generations will read on our gravestones in the coming years. It’s time to choose a side, get political, and defend our rights. If we don’t fight for this, who will?


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