Abstract
In a year dominated by the politics of Brexit, the media presidency of Donald Trump, and a disintegrating political consensus about what’s best for our planet, health found its place. It emerged as a strong caution against Brexit. It further exposed Trump for his love of American wealth over multilateral progress. It suffered, for example, in the political games played with migrants, women’s health, and climate change. Yet civil society in every continent sent a clear message to politicians, and the message is that health matters. It is a message that politicians must heed, for unhappiness over health can damage any government – even in stable political regimes like China’s.
Equally, a struggle with ill health can affect any leader. These matters are rightly personal, but what if a leader’s health begins to affect their ability to govern? Isn’t it the public’s right to know that their leader’s judgement and effectiveness might be diminished? What is the duty of clinicians who care for heads of state? In the latest instalment in our series on Winston’s Churchill’s illnesses, we learn that Lord Moran, his personal physician, was faced with an ethical dilemma over two probable transient ischaemic attacks. Was Prime Minister Churchill fit to lead? Moran reasoned his way through the crisis, guided partly by his instinct, partly by wise counsel, and partly by Churchill’s own spirit. 1
Churchill was the first honorary fellow of the Royal College of Physicians. It was an honour bestowed upon him during the college presidency of Sir Russell Brain, a neurologist who Moran sought specialist support from in relation to Churchill’s transient ischaemic attacks and, in a fact to fascinate nominative determinists, was once editor of the medical journal Brain. At Brain’s invitation, Churchill unveiled a portrait of Moran at the Royal College of Physicians in 1951. ‘I also had the honour to be made a surgeon eight years ago, and now I can practise, in an honorary fashion, the arts of surgery and medicine’, said Churchill. ‘No doubt in these difficult times it will be a comfort not only to the profession but to the nation at large that you have me in reserve’.
As in 1951, we remain in difficult times although the need for reserves is now upon us with low morale and staff shortages. One answer, both for the UK and globally, is to turn to nurses and community health workers to take on tasks traditionally reserved for doctors so that a population’s health needs can be met, especially in preventative services. This month’s research paper argues the case for integrating community health workers into primary care with estimates for the benefits to service provision. 2 Another solution is better technology, but it also requires better regulation. 3 And any health service is best underpinned by better science and safer medicines. Pandora Pound and colleagues explain why better science also means moving away from animal studies. 4 Bringing an end to hard times in medicine, it seems, is a complex task requiring fortitude and wit of Churchillian proportions.