Nation’s Health, The

Synopsis

A six part series in which Jonathan Miller examines the development of the nation’s health since the end of the Second World War. Since the war the nation’s health has improved dramatically but the maintenance of a healthy society requires the full co-operation of all its members; the health of each individual is dependent on the health of the wider community. During the making of this series, Jonathan interviewed eminent historians and medical ethicists, pioneering doctors, surgeons and epidemiologists and hopes these thought-provoking programmes will contribute to the continuing debate about the best means of delivering healthcare in the twenty-first century.

Language

English

Country

Great Britain

Year of release

2005

Year of production

2002

Notes

Broadcast on Radio 4 in 6 weekly parts from 5/9/2002

Subjects

Social Studies; History; Medical sciences

Keywords

blood transfusions; geriatric medicine; health care; history of medicine; immunisation; intensive care nursing; kidneys; National Health Service; social history; vaccination; organ transplants; blood donation

Online availability

URI

http://www.bbc.co.uk/radio4/science/nationshealth.shtml

Price

free

Delivery

Streamed

Sections

Title

Getting started

Synopsis

In the first programme, Jonathan Miller talks to medical historians Chris Lawrence and Charles Webster about the origins of the ‘nation’s health’. Health is something we now regard as a social right - but it has not always been that way. Victorian military planners were alarmed by the poor health of recruits for the armed forces, and well into the twentieth century, poverty coupled with inadequate diet blighted the lives of millions of Britons. It wasn’t until the creation of a National Health Service in 1948 that political steps were taken to improve the lives of ordinary citizens, in terms of better housing as well as improved medical care.

One of the groups active in the 1930s that provided much of the impetus for the creation of a National Health Service was the Socialist Medical Association. Jonathan talks to three of its surviving members, John Pemberton, Richard Doll and Jerry Morris, all of whom saw at first hand the impact of poverty and malnutrition on the nation’s health. Jonathan also talks to Anne Oakley about the innovative statistical work carried out by her father Richard Titmuss - work which, for the first time, established clear links between poor social conditions and ill health. One of the most dramatic pieces of post-war research analysed the experience of childbirth among women of different social classes. The research showed beyond doubt that malnourished women were likely to have longer and more dangerous labours. Jonathan speaks to Barbara Thompson, who was one of the researchers on the original Aberdeen project.

Duration

30 mins

Title

Public Health

Synopsis

In the second programme, Jonathan Miller talks to some of the pioneering epidemiologists whose statistical work underpins our ability to track illness and disease across society at large. As well as establishing beyond doubt that poor social conditions, particularly malnutrition, have a profound impact on public health, epidemiologists also began to investigate links between illness and social behaviour. Richard Doll showed that smoking caused lung cancer; Jerry Morris demonstrated the importance of exercise to combat coronary heart disease; Alice Stewart proved that exposure to TNT could lead to the development of leukaemia.

As the links between ill health and social conditions became an accepted part of medicine, it became even more important that the public should have access to good healthcare as and when they needed it. With the help of Tony Ryle, Sheila Silcox and Howard Baderman, Jonathan discusses the post-war development of General Practice and Casualty. But the more we learn about the impact of social behaviour on our health, the greater the amount of information we have to absorb. The challenge facing present-day public health epidemiologists like Klim MacPherson is to find ways of delivering a health message that sounds neither patronising nor irrelevant.

Duration

30 mins

Title

Risks of Safety, The

Synopsis

In the third programme, Jonathan Miller investigates some of the issues surrounding immunisation. While vaccines against infectious diseases like polio, tuberculosis, diphtheria and measles have undoubtedly played a part in reducing mortality, improvements in hygiene, nutrition and living conditions have also had a major impact on life expectancy. However vaccines carry risks of their own.

With the help of health professionals Elizabeth Miller from the Public Health Laboratory Service and Ian Chalmers from the UK Cochrane Centre for evidence-based medicine, and medical ethicist Jonathan Glover, Jonathan explores the complexities of how we assess information about immunisation - and how, in the final analysis, subjective impressions tend to carry more weight than any amount of objective, statistical data.

Duration

30 mins

Title

Amiable Juice, The

Synopsis

In the fourth programme, Jonathan Miller traces the development of what used to be called the National Blood Transfusion Service. With the help of haematologists he discusses how on-the-spot transfusions for blitz victims led to the development of blood banks - and how the introduction of plastic bags in the mid-seventies revolutionised our ability to fractionate whole blood into its respective components.

But blood donation is much more than a physical transaction. He argues that giving blood is a symbolic act which ‘dramatises our social solidarity’. He describes blood as a ‘rich liquid asset, a priceless deposit which can neither be spent nor accumulated’. With sociologist Ann Oakley, the concept of blood donation as a ‘gift relationship’ is explored, an idea first put forward by Richard Titmuss who had himself been inspired by the French anthropologist Marcel Mauss. Some, like Peter Howell, archivist for the British Blood Transfusion Society, argue that as society becomes more individualised, it becomes harder to persuade people to act altruistically and donate blood regularly. Could our growing reluctance to give blood be a reflection of our loss of a sense of community?

Duration

30 mins

Title

Doing what comes naturally

Synopsis

In the fifth programme, Jonathan Miller discusses organ transplants, and the developments in our understanding of the body’s immune system which makes transplants possible. He talks to Leslie Brent, one of the pioneering immunologists who, together with Nobel prize-winner Peter Medawar, made the theoretical breakthroughs that opened the way for surgeons like Sir Roy Calne to begin a programme of organ transplants. Kidney specialists Hugh de Wardener and David Kerr describe the development of an Artificial Kidney - and how, despite early setbacks, Artificial Kidneys now support more than 15,000 dialysis patients in the UK. But while increased organ transplantation demonstrates how dependent we’ve become on our fellow citizens for a regular supply of organs, John Harris, a bioethicist at Manchester University, believes we have to find ways of increasing the availability of organs for transplantation. He argues that we have to overcome our scruples about removing organs from cadavers - in his view people are not entitled to an intact body after death.

Duration

30 mins

Title

Who cares?

Synopsis

In the final programme in the series, Jonathan Miller discusses the beginnings and endings of life, and how the development of Intensive Care has made it possible for machines to take over when the body’s regulatory systems fail. Technological advances have prolonged our expectation of life, and there’s now a pressing need for long-term social care to support the very old. Can we provide our old people with a quality of life they deserve?

Duration

30 mins

Production Company

Name

BBC Radio 4

Web

http://www.bbc.co.uk/radio4 External site opens in new window