Abstract
A recent debate at the Royal Society of Medicine passionately debated the future of the NHS. 1 It was a wide ranging conversation that encompassed funding, values, inequalities, and investing in prevention both inside and outside the health sector. One issue that neither panellists nor audience dwelt upon was climate change. Amid the high emotions and intense dialogue, the existential crisis above all existential crises was squeezed out.
This is probably entirely my fault since I chaired the discussion. There remain, however, issues that are in the back of our minds and aren’t debated enough. Climate change is one of these. The impact of the health system on climate change is well documented, and combined with the effects of climate change on health and wellbeing, provides a clear argument for health professionals to lead in the response to climate change.
Another, more extreme, example is the health of prisoners. Prisons are full and overcrowded, and the health of prisoners is easily overlooked. It certainly was during the covid-19 pandemic, and the only debate is how deep the neglect was of people imprisoned. This is on the background of inadequate routine care. Prison might be an opportunity for interventions that improve health and wellbeing of a hard to reach group, but the evidence tells us of problems with medication safety and access to healthcare services. 2
It’s important that patients feel safe in healthcare settings, and Margaret McCarteny highlights the concerns women have about safe spaces. 3 With the pressures that the health system is experiencing it can be easy to overlook the fundamentals of respect and dignity that define a highly functioning service – again aspects of care that need to move from the back of mind to the top.
To describe any of these issues – climate change, prisoner health, and safe spaces – as taboo is probably too strong a description. But what about envy towards medical colleagues? It’s certainly a feeling that few people would be willing to discuss openly, and it’s probably something we’d be unwilling to admit to ourselves. Yet, according to psychology science, envy is “widely experienced, deeply uncomfortable and socially isolating.” 4 Perhaps we need to talk more – even to our inner selves. Surfacing unheard voices, including our own, may well be better for our patients.