Second Opinion: Healthy living centres - millennial healing
In his foreword to the recent public health white paper, Saving Lives: our healthier nation, Tony Blair observes that 'many people realise the value of better health'. Hence, they 'already take exercise, eat prop- erly, and don't smoke'. The problem is - what is to be done with the rest, who don't conform to the virtuous lifestyle prescribed by New Labour? Part of the solution is 'healthy living centres', an initiative financed by the national lottery and designed to tackle the unhealthy lifestyles of those people who are presumed by the prime minister not to realise the value of better health.
In preparing our bid to transform our rather old-fashioned GP group practice into a healthy living centre, we have been guided by the mix of counselling, complementary therapies, exercise classes, 'breast is best' videos and anti-crime and drug prevention programmes offered by the pilot schemes. All this is right on as far as it goes, but, for us, it doesn't go far enough. As Tony Blair should not need to be reminded, healthiness is good, but cleanliness is next to Godliness.
Our bid to become the first 'Clean Living Centre' includes the following elements:
Personal hygiene: research data collected by the prestigious Institute of Evidence-Based Medicine reveals that an astonishing 18.24 percent of patients attending GP surgeries have dirty feet. Furthermore, a disgusting 27.65 percent of men have smelly trousers. Our centre will offer bathing facilities, with onsite laundry and dry cleaning. Proposals for a sauna with massage have been held back because of concerns about the level of unmet need for 'extras' that might be unleashed among those in our community suffering from social exclusion.
Exercise: though we currently offer 'exercise on prescription' at a local leisure centre, we are concerned about the lack of equity in this scheme, which excludes those who are too idle to get down to the gym. Why not use the waiting room? Instead of allowing people to sit about for hours, we propose to get them started with some gentle Tai Chi (practice staff will join in) followed by more strenuous aerobics. We will provide a DIY defibrillator - as recommended in the white paper - in case such unaccustomed exertions prove too much for some.
Smoking: current 'smoking cessation services' offer group therapy and nicotine patches - but only to those who attend. We recommend an aggressive outreach initiative, targeting the familiar huddles outside shops and offices - starting with the one at the back of the health centre. A squad of anti-smoking health promoters, perhaps dressed in the Buttman costume popularised in the USA, could explain the dangers of smoking to this captive audience and spray them with high-powered water pistols if they continued.
Crime: gunshot wounds are a significant cause of morbidity and mortality among young people of Afro-Caribbean origin in our area. As leaflets and posters explaining the dangers of guns have apparently had little effect, another outreach project could tackle this health risk. It would have to be staffed by workers trained in the underworld patois of the Yardies - perhaps by Tim Westwood, the Radio 1 dj. Given the unsocial hours and the risks of drug toxicity, not to mention lead poisoning, in this job, there might well be some turnover of staff.
Sexual health: though young men have already been targeted by health promotion workers, other sections of society - notably certain ethnic minorities - have been neglected. For example, there has been virtually no HIV awareness campaign among the substantial local orthodox Jewish community, an outrageously discriminatory policy. The particular needs of the diverse varieties of transsexuals have also been ignored.
Spirit zone: an area set aside for prayer and reflection, along the lines of the Millennium Dome, featuring a multi-faith selection of icons and a dark corner for agnostics and atheists.
Complaint zone: a soundproofed studio with video recorder and dummies with changeable uniforms (policeman, politician, parking warden, etc) to allow people to make complaints, to abuse and harangue those against whom they feel a grievance. They could take a copy home for friends or family - and the tape could be erased at the end of each day.
Consultation zone: following a recent health authority consultation exercise, to which the public was invited and a security man appointed to cope with the crowd, but which was attended by nobody, we suggest a different approach. The bus-stop outside the health centre should be linked to the NHS website, allowing people to ask - or answer - questions through a simple interactive system. They could also vote on matters such as whether doctors should prescribe antibiotics for sore throats or how many Viagra tablets a man should get per week. (This would exclude car drivers, but they are a menace to health anyway.)
Once the Clean Living Centre got underway, patients complaining of medical problems would be advised to phone NHS Direct, the 24-hour nurse-led telephone helpline. If they still need to see a doctor, we are hoping that the local supermarket will soon be opening a walk-in GP clinic, giving us more time to run classes in parenting skills and domestic violence, and advising on the dangers of mobile phones and the next solar eclipse.
Dr Michael Fitzpatrick
Reproduced from LM issue 123, September 1999