I have long been a fan of the work of the philosopher Ivan Illich. Many people don’t like his writing, which has often been described as polemic, challenging and rhetorically intoxicating. Part of his appeal for me is not just in the subjects that he chose to write about, but also in his use of words. Like my artist friend Urpu Sellar, Illich liked to use words outside of their normal context and generally accepted meanings. Whereas Urpu uses words to produce tongue in cheek ceramic sculptures, Illich produced trenchant accounts of his analysis of many of societies social institutions (education, medicine, the law and so on).
In his book the Limits to Medicine he argued that the medicalisation of so many of life’s vicissitudes (birth and death for example) often caused more harm than good, and introduced the wider public to the concept of iatrogenesis. He described the concept in both its strict sense of the word – harm that comes from direct medical intervention and also in its wider sense, a cultural use where as a society we become, over time less reliant on ourselves to look after ourselves and others, and more reliant on the state (in this case medicine) to look after us.
I was prompted to recall his work by a couple of things last week. One was being asked to choose which antimalarial medication I wanted prescribing for a trip next weekend to Uganda. Anyone traveling to Uganda is advised to take precautions against malaria including taking antimalarial medication. It makes sense, as there are approximately 750,000 deaths a year from malaria, most of which occur in sub-Saharan Africa. Some 3.2 billion people worldwide are at risk of malaria. Despite the news last week that the pharmaceutical company Glaxo Smith Kline, after nearly 30 years work, had developed a malaria vaccine, preventative and control measures are still required to reduce the number of deaths.
Antimalarial medication is part of these preventative measures. However, the side effects of the medication can be pretty awful, ranging from a sore mouth, headaches, diarrhoea through to unusual bleeding, and mental health problems – however unpleasant, all of which are obviously better than death. I am going to Uganda as part of a team from the NHS Health Education England Global Health Exchange. I will write more about this trip and what the initiative involves in future posts, but is both important for the School, communities across Uganda and the wider NHS.
The second Illich memory prompt came from reading the publication ‘the art of the possible – what role for community health services', published by the NHS Confederation. I found this a rather archaic paper. Aimed at meeting the needs of people with long term health problems, it appeared to state the obvious. For example, that practical support from community health services those with chronic conditions would enable primary care to work faster and at a larger scale.
To be frank, I was more inspired by my Friday morning meeting with Jim Taylor and Charlotte Ramsden. Jim is the City Director, Salford City Council, and Charlotte is responsible for children and adult services in Salford. They were both a breath of fresh air. Totally switched on when it came to integrated care, new future for social work and how we might look for the added value in initiatives such a ‘devo manc’. I was really pleased at the range of opportunities we discussed for working more closely together, particularly so as last week I was sent a ‘storify link’ which showed the contributions our social work colleagues made at the recent Joint Social Work Education and Research Conference (JSWEC). The range of papers on their research, new approaches to teaching and service development they presented was fantastic. See for yourself here.