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The state of the NHS: a social psychological view

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Edited by Stephanie Taylor, Thursday, 12 Jul 2018, 08:43

As we celebrate the 70th birthday of the NHS, Stephanie Taylor has been watching tv programmes about health. She considers some of the issues confronting the health service and the health of the UK more generally. Are we taking enough care of ourselves? Could we manage without a national health service? Is the NHS a support system for 'us' or for 'them'?

To mark the 70th birthday of the NHS, there have been a number of tv programmes about its achievements and problems. The programmes generally present the stories of people who have turned to healthcare providers and received support, for instance, when babies were born or accidents occurred or serious illness was diagnosed. The message of the programmes is that as a society, we need the National Health Service, but it is struggling because we are making too many demands on it.

Somewhat differently, there continue to be many more light-hearted television programmes about the UK's health which focus on personal responsibility. Adopting a 'before and after' format, these usually begin by introducing a group of participants with a current or potential health problem that is linked to bad lifestyle choices  – going to the pub instead of the gym, eating takeaways instead of home cooking, using the cooler bin of your fridge for chocolate bars instead of vegetables. The programme's experts examine the participants, collecting statistics and conducting medical tests (blood samples tend to feature heavily). The participants then change their behaviours and are judged to have improved their health. At the end of the programme, they promise to persist with the healthier choices. They leave, looking forward to a problem-free future.

The clear message of the second group of programmes is that people should take more responsibility for maintaining their own good health. This might seem entirely compatible with the valuing of the NHS – by looking after ourselves, we will make fewer claims on already overstretched health care providers. The idea that health problems are a consequence of individual wrong decisions and actions can even seem encouraging, because it suggests that each of us has control and can avoid the need for care, if we live properly.

However, this focus on the individual has some less positive implications, as many social psychologists would note. It suggests fault, as if people only ever get ill because they haven't made the necessary effort (not so!). The focus also closes down any consideration of larger-scale factors that might impact on people's health, such as poverty and overwork, or the increasing air pollution which is almost unavoidable in many parts of the UK. And of course the focus also avoids difficult discussions of why seemingly rational people might make bad 'choices', as in the complex problems of substance abuse and addiction.

More subtly, the emphasis on individual responsibility normalises independence, as if a claim on other people is something shameful, to be avoided. (It is interesting and ironic to note here that people who are celebrated as successful 'individuals' almost inevitably mark their celebrity, wealth and political power by surrounding themselves with supporters, such as servants, bodyguards and admirers – for these 'top' people, dependence is apparently not a problem!)

The general stigmatisation of need and dependence is the reason that so many people attempt to manage in difficult circumstances without help, determined not to be 'a burden'. Yet everyone requires support sometimes, and not only when they are ill, or at the very beginning and end of their lives. Indeed, there is a persuasive argument that no one can be entirely self-sufficient. Even those of us who might claim to be 'free' of personal ties of family and friendship are dependent on the complex interconnections that maintain markets, and keep society functioning.  

This is why social psychologists insist on the importance of looking at people in context, not as detached individuals. A social psychological interest extends beyond interpersonal contacts and linked activities to the shared ideas and values that enable all of us to communicate (and disagree). The same ideas make sense of who we are and what we do.

So what does this kind of approach indicate about the NHS? There seem to be two conflicting ideas in play. The first is that the NHS is the safety net that is required when normal life is interrupted, because people have been exceptionally unfortunate or, in many cases, because they have not taken enough responsibility for themselves. This view invites us to see NHS users as other people, because we all like to think of ourselves as responsible, and lucky. The second interpretation is that in the NHS today we can see all the care needs of our society exposed and brought together to be dealt with by a single institution, including needs which originate, for example, in an economy which excludes many people from the steady employment and secure housing which would enable them to live 'well'. In this second view, the NHS users are ourselves, all of us, because it is in the NHS that we see our real nature as human beings, as inevitably interconnected and in different ways dependent on each other.  

This blog refers to ideas discussed in DD317 Advancing social psychology, an interdisciplinary Level 3 module. To learn more about the module, you can watch a video here  https://youtu.be/dbzF4hBeBkk You can also look at the new Open Learn course course DD317_1 Social psychology and politics: http://www.open.edu/openlearn/health-sports-psychology/social-psychology-and-politics/content-section-0


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