Politics is Nothing Else but Medicine on a Large Scale

Thursday, 12 January 2017

Suttie Conference Room

Dr Andrew Fraser, Director of Public Health Science, NHS Health Scotland

“Politics is Nothing Else but Medicine on a Large Scale"

Andrew Fraser is Director of Public Health Science with NHS Health Scotland.  He graduated from the University of Aberdeen in 1981. He was Director of Public Health in NHS Highland from 1994-97, then Deputy Chief Medical Officer in the Health Department of the Scottish Office, then Scottish Executive from 1997-2003.  He was responsible for advice on Public Health Policy, taking a particular interest in health protection matters, alcohol-related harm, public health laws and, increasingly, health inequalities and the health of marginalised groups. From 2003-2012, he worked in the Scottish Prison Service as Director of Health and Care.  His focus is on ways to narrow health inequalities in Scotland.


Note of meeting of 12th January 2017

·       The President welcomed the company to the meeting and announced the names of our two newest members.

·       The newly engraved golf cup was on show but neither of the winning pair was there to have it presented.

·       Dr Foster apologised for the late notice of the meeting having to move from the refurbished Med Chi Hall to the Suttie Conference Room, explaining that while the refurbishment of the hall is complete, and teaching has begun there, the contractors are still dealing with snagging and have not yet cleared their things from the Chamber meaning is was not yet available for our use. The stored paintings are also still there and the President advised that the Heritage Group are actively seeking a solution to where they may be exhibited or stored. The hope is that the Chamber will be cleared in time for the February meeting to be held in the Med Chi Hall.

·       Arrangements are progressing well for the Burns Supper which will be held on 20th Jan at the Douglas Hotel in conjunction with the students of the Aberdeen University Medical Society. Tickets sales have been quite good; there was just time left for late additions.

·       It was intimated that the Famous for Five Minutes charity concert will go ahead in Queens Cross Church on the first Saturday in May (6th).

·       The Heritage Group are likely to host their annual event on the evening of 18th May; further details to follow in due course.

·       Reference was made to the previously circulated announcement about the sale of surplus chairs from the Society Hall and members reminded to lodge an interest in purchasing these by 13th Jan as previously intimated.

·       The President then introduced the main speaker, Dr Andrew Fraser, a fellow Aberdeen medical graduate with whom she had first worked when she was a House Officer, and later when both were in Public Health…..


Dr Andrew Fraser, Director of Public Health Science with NHS Health Scotland gave a talk entitled ‘Politics is Nothing Else but Medicine on a Large Scale’.

Dr Fraser explained that the title came from Virchow – the Pope of Medicine and Father of Modern Pathology – who, to give the full quote, had said “Medicine is a social science and politics is nothing else but medicine on a large scale”. He acknowledged the input of several members of the audience in his medical training and professional career. He then talked about two little-known fellow Aberdeen medics who had been influential in his career path and who he described as great social scientists of their time, but who probably knew little about the medico-political interface that dominates his current work.

The first, Dr Robert Hill (1922-2004; MB ’51, MD ’76) was a single-handed GP in Barra who somewhat improbably managed to produce an MD thesis based on his researches into genetically determined conditions among his practice population of only 1500. The second, Dr Alex Gatherer (1929-2013; MB ’51, MD ’60) was major name in Public Health research winning high honours in the UK and USA; he held the post of DPH in Oxford for almost 25 years. He and the speaker had worked together over several years, relatively recently, in the area of improving health in prisons.

The talk then moved to the central topic of health inequalities, stating that these are unfair and reversible, rather than inevitable. A graph illustrating average UK life expectancy over the past two centuries showed that this remained below 40 until the early 19th Century but has risen at a rate of around 10 years per 50 years since, with some visible dips associated with epidemics and wars. Further analysis across different countries shows a recent flattening of the life expectancy projections in former Soviet republics. It also shows Scotland’s position which was described as ‘at the bottom of the premier league’. Drilling in further, shows considerable variation across Scottish regions and this was illustrated most markedly with a figure showing a drop in life expectancy between wealthy and poor areas of Glasgow that are only 5 miles apart (male 78y to 64y; women 84y to 72y)). Even more alarming on the east side was the assertion that for males, a derived concept of so-called ‘healthy life’ stops at an average age of only 47y. In addition to the inevitable association of poor life expectancy with poor income, data also shown from three Scandinavian countries (Denmark, Finland, Sweden) showing a fairly uniform 20% reduction in individuals with mental health problems.

Having shown a tiny fragment of the data in just a few social and geographical contexts, the talk turned to the question of how to tackle inequalities and the core importance of engagement with politics was stressed. The Black report, around 30 years ago gave an analysis of what was wrong and in the time since, increasing evidence has been amassed about potential interventions that do (and do not) work. The Marmot review published in England in 2010, under the banner ‘Fair Society, Healthy Lives’ proposed approaches that use the evidence base in attempted interventions. The Health Inequalities Policy Review followed in Scotland in 2013, of which the speaker was a leading contributor; this document added the dimension of ‘upstream intervention’ in public health as a prerequisite for improvement in ‘downstream outcomes’. The work of Professor Sally McIntyre, in describing the most effective (e.g. legislation, income, access to public services) and least effective strategies (e.g. information campaigns, whole population messages, reduced price gym memberships), for effecting change, was acknowledged as having been influential in the preparation of the Scottish document.

Another data graph was shown – displaying an impressive 7% fall in the rate of dental caries in Scottish children over only 4 years, attributed to a programme of teaching tooth brushing in nurseries and application of fluoride paint. Good though this was across all family income levels, it did not materially alter the gradient in prevalence across deciles of population affluence. The point was then made that as government policies – principally via taxation levels and structures – can generally determine levels of poverty in populations, so politics can determine the distribution of wealth and poverty (and hence health). So the challenge in improving public health, the argument continues, then becomes the challenge of influencing government policy.

Dr Fraser next turned to the exquisitely named phenomenon of ‘epistemological bricolage’ in relation to considering how practitioners make sense of learning and hence how best evidence may be turned into action. Waiting for the right time to present evidence, and seeking to align interests of parties involved in promoting/legislating for change was encouraged. Karen Stronks’ work on ‘understanding truths’ was referred to – and the means by which politicians’ engagement and understanding can be distracted by non-medical factions with vested interests (e.g. Grocer’s federation, tobacco producers) was noted with caution.

In considering the ethics and values implicated in effecting health policy change, we were told that it is crucial for involved parties and organisations to remember their respective roles – a unit responsible for producing evidence of implementation of changes will compromise its function if simultaneously working to promote (or resist) that change. The work of Kate Pickett was acknowledged in encouraging a need for academics to engage effectively with the press in seeking to make evidence effective. Building constructive relationships among different interested groups is important but must not lead to over-zealous campaigns to influence. And the involvement of the public voice in strategy and action around public health improvement is needed now more than ever before. However imperfect current knowledge may be, it is nevertheless intelligent for intelligent decision making.

There followed a lively question and answer session including the paramount importance of focussing public health interventions on early years of life, how to overcome the sense of hopelessness in the poorest, least healthy sections of society, the need for clarity in medical (and political) messages given to the public, and the need for ongoing effort to reduce the number of families living in poverty and poor housing.

The President proposed a vote of thanks and closed the meeting.

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