Dr Zoe Rog looks back on the health campaigns that inspired change, and laments politicians’ focus on quick solutions
Early in my GP career, an incentive was funded to provide free baskets of fruit in our practice for patients to help themselves. This was accompanied by vouchers for subsidies on fruit and vegetables in local shops, and a colourful poster campaign encouraging people to eat their ‘5 a day.’ On one occasion, a young boy accompanied his Mum to her early morning appointment with me. He was dressed in school uniform and clutching the remains of a large bag of crisps. As they sat down I could see him looking eagerly at the fruit basket on my desk. I encouraged him to help himself.
‘No! Eat your crisps,’ his Mum admonished him. He looked furtively between his Mum and the fruit basket and grabbed an apple which he proceeded to devour whilst she and I conducted her consultation. As they were getting up to leave I noticed him looking longingly back at the fruit. I suggested he take another piece of fruit to school with him. ‘No! Eat your crisps’ said his Mum. He followed her dejectedly to the door and glanced back at me. I smiled conspiratorially and he darted back, grabbed a banana and zipped it into his school bag before running after his Mum.
A week later a young girl accompanied her Dad to his appointment with me. Whilst her Dad and I were speaking, she studied the ‘5 a day’ poster on my wall. Before they left, she pulled her Dad over to the poster and told him that they needed to eat five of the things on the poster every day. She pointed longingly at the picture of a papaya and asked her Dad what he thought it would taste like. He jabbed the picture with his finger and tapped it forcefully along the images one by one.
‘You won’t like that, you won’t like that and we can’t afford those.’ He paused at the picture of some peas. ‘We’ve got those in the freezer, you can have five lots of those”. Undeterred, the little girl pointed out to her Dad that they needed to have five different types of fruit or vegetables every day and not five all the same. In retrospect whilst it has always been difficult selling lifestyle change – or even free fruit – to our adult patients, it felt as if there was a chink of hope with the children.
At the same time as we had the free fruit scheme, ‘Sure Start’ centres were doing great work in our area. It has recently been reported that children who grew up living near Sure Start centres got higher grades in their GCSEs than those who did not, especially those from low income backgrounds. There were also demonstrable reductions in hospital admissions for those children and improvements in their social, emotional and behavioural development. Employment in parents of these children increased. But by 2010, the Sure Start budget had been cut by two thirds and many of the centres had closed entirely.
We live in an age now of instant gratification: people can order fast food to be delivered directly to them within the hour; next-day delivery for literally any other item you could want is the new normal; and, they wake up and want us to see them urgently today for the minor medical problem that they have had for months. Everyone wants a quick fix whether it be weight loss injections, antidepressants to “cure” their stressful circumstances, or strong and addictive drugs for chronic pain.
Politicians too want a quick fix vote winner. Hence ill-thought through strategies are proposed such as a legal mandate for everyone to see a GP within a short timeframe, or replacing doctors with other clinical staff who can be trained and put in place within a four year cycle of government. Strategies from the past that worked well are discarded by the Governments who didn’t think of them. The potentially impactful smoking ban, for those born after 2009, may never be legislated due to the impending election. Lifestyle change, a well thought-through workforce strategy and training experienced GPs take years to come to fruition. The best solutions are complex and don’t fit neatly into 45 second soundbites. No matter who forms the next Government, and the one after that, patience and long-term strategic planning are vital.
Dr Zoe Rog is a GP in Runcorn, Cheshire
It won’t work if we get another Government with ADHD !