A series of health conversations is being organised by Noclor to seek answers to the question of how best to target NHS resources to ensure human health and wellbeing.
They were opened in March by Sir Harry Burns, a leading expert on the link between social deprivation, poverty and ill-health, at an event at the British Library in London. The event – “What causes wellness? Research priorities for children and young children” – was organised in partnership with the Tavistock and Portman NHS Foundation Trust.
Sir Harry, professor of global public health at the University of Strathclyde, Scotland, said that British doctors are trained exclusively in pathogenic thought to address the causes of disease, but the answer to what makes us well is not as simple as that. It was while working as a surgeon at the Glasgow Royal Infirmary 30 years ago that he noticed that the wounds of poorer patients took longer to heal. Initially, he put it down to a combination of bad diet and smoking. But it became clear to him over the next few years that the cause was more complex.
Sir Harry cited the work of the Austrian psychotherapist and neurologist Viktor Frenkl, a Holocaust survivor, who said: “Those who have a ‘why’ to live can bear with almost any ‘how’.”
Things were beginning to make sense for Sir Harry. The link between biology and psychology, between physical health and social circumstances – or, as he puts it, “the biological consequences of sociological chaos” − had been dismissed for too long.
There is a spectrum between pathogenesis at one end and salutogenesis − focusing on factors that support human health and wellbeing − at the other, Sir Harry said.
Stressful events in early life change the way brain structures develop, with chaotic childhoods leading to increased risks of physical ill-health in adult life.
Poorer communities are plagued by what Sir Harry calls “cycles of alienation”. Early-life stress leads to mental ill-health in childhood, followed by behavioural problems in school, and ultimately unemployment, and poverty. Poverty, he said, is both the cause and consequence of the cycle.
The answer to the question of how meaning and purpose can contribute to one’s wellbeing is not as complicated as it may seem.
Parent-child attachment and cognitive function, for example, are vastly improved through telling children bedtime stories. And merely asking homeless people their names can create a human connection to help them off the street.
Rather than spend lavishly on drugs to fix the results of ill-health, Sir Harry argued, we should prioritise changing the circumstances that cause it.
Sir Harry Burns, Professor of Global Public Health at Strathclyde University, Scotland, has dedicated most of his career to understanding how societies create wellness.
His research and work in the field over more than three decades led to him being presented in 2014 with a lifetime achievement award for public service from the Scottish Government and the Scottish Parliament.
He trained in surgery in Glasgow, and it was during his time subsequently as Consultant Surgeon at Glasgow’s Royal Infirmary in the 1980s that treating patients from the city’s poorer East End districts gave him a deep insight into the complex inter-relationships between social and economic status and illness.
He was later appointed Director of Public Health for Greater Glasgow Health Board in 1994, continuing his research into the problems of social determinants of health.
In 2005, he became Chief Medical Officer for Scotland, and was knighted in 2011 for outstanding achievement and service to society.