Last Updated: September, 2019

What is Prevention?

Prevention is the seemingly straightforward concept of trying to stop people from becoming unwell. This is an important part of any health care system. However, prevention as a concept, is being used strategically by the government,  NHS England  and local health leaders as a way to justify the viability of  efficiency savings .

In relation to 'efficiency savings' the idea of prevention is to redirect the emphasis of the NHS away from hospital services and into schemes intended to raise people's awareness of potential health risks; in theory improving people's lifestyles, identifying potential health problems earlier and thereby reducing demand for acute health services. Dovetailing with those ideas is the logic that most health care spending already goes to support people with long-term care needs rather than going into acute hospital services. It is implied therefore, that based upon need, there is already a natural case for diverting 'limited' resources into prevention and out-of-hospital services. Part of the narrative we are given is that resources can be safely cut, or transferred from hospital services into health promotion. Prevention also sits within the broader narrative that includes a myth about not being able to afford health services (see  Big Picture - NHS Funding ) and a need to increase  patient choice  and  personalisation . The broader narrative aims to sell cuts and closures (which are political choices to reduce public health services to a basic package in order to facilitate privatisation) as clinically-led, safe, rational, inevitable and actually leading to an overall improvement in our services and our health.

Three Pillars of Transformation

"Our three pillars of transformation" - South Tyneside and Sunderland  Clinical Commissioning Groups  - "Working together for clinical excellence"

The transformation of health services in our region as elsewhere, has been broken down into three 'pillars' or interlocking strategies. From right to left: The first 'pillar' is the downgrading and closure of front-line services -  efficiency savings  - sold to us as the  Path to Excellence (P2E) . The P2E is predicated upon the second and third pillars, which are all about keeping people out of hospital. The second 'pillar' alludes to  integrated care , which is primarily about privatisation and is the driving force for the P2E. The third 'pillar' is explicitly presented as prevention and is the main argument for the viability of the P2E, by encouraging people to take more responsibility for their own health.

The South Tyneside and Sunderland CCGs provide the following overview of their three pillars:

Changing hospital care alone will not solve the pressures facing local services. This is why the  NHS Long Term Plan  focusses so heavily on creating an entirely new NHS service model which is built around patient needs to provide properly joined-up care at the right time, in the optimal care setting and by the right healthcare professional. It places, quite rightly, significant priority on boosting 'out of hospital' care and practical steps to help people improve their health and increase life expectancy.

Across South Tyneside and Sunderland we are already actively working on how we provide more care to people outside of hospital in their local communities and how we support people to stay fit and well and live healthy lifestyles - these are what we call our three pillars of transformation.

Prevention is not a workable strategy in a climate of cuts

The choice presented to us between provision of hospital services or more spending on prevention is flawed in many ways. Even considered on their own merits, prevention schemes face significant challenges far beyond the control of the NHS and local health leaders.

We see prevention schemes taking various forms including Social Prescribing, public education, behaviour nudging, screening programmes and earlier interventions. While these measures will undoubtedly help some people, the bigger picture is that resources are not really being redirected into prevention in such a way as to make a significant difference to the general health of the population, and at the same time we are seeing a rolling-back of the welfare state and a general increase in the socioeconmic conditions that lead to many long-term health conditions. Against this backdrop there have been year-on-year cuts since 2014 to public health budgets that are supposed to fund schemes to help tackle obesity and reduce consumption of alcohol, drugs, and tobacco.

A 2015 analysis in the Journal of the Royal Society of Medicine identified 30,000 unnecessary deaths, linking the deaths to dramatic reductions in the social security budget and social care spending. The study ruled out causes such as data errors, cold weather, flu etc. The British Medical Journal published a report concluding that there have been 120,000 unnecessary deaths resulting from ideologically driven cuts to the NHS and social care system from 2010 to 2015. The report suggests that without a significant increase in health spending there might be an additional 150,000 deaths from 2015 to 2020.

Longevity is considered a good measure of health. Life expectancy began to decline in 2011 when the post 2008 austerity policies started to bite. This is mainly a problem for the most vulnerable who are dependent upon health and social care services. The death rate rose sharply in 2015, and this coincided with dramatic increases in A&E waiting times.

South Tyneside has a life expectancy that is below the English average, but within South Tyneside there is a large difference - as much as 15 years - between the life expectancy of people in the poorest and wealthiest areas.

Areas of the UK with the largest cuts to social spending have seen the highest increases in mortality rate. From research spanning decades, it is known that this is a warning that something is wrong in society.

Research from Lancaster University suggests that cuts to benefits and the 'ratcheting up of conditions attached to benefits' amounts to social murder. Dr Chris Grover says austerity can be understood as a form of structural violence. Violence that is built into society and is expressed through unequal power and unequal life chances, as it deepens inequality and causes more poverty. Austerity has led to:

  • An additional 6 suicides for every 10,000 work capability assessments.
  • Increases in deaths relating to malnutrition.
  • Increases in the deaths of homeless people.

Another effect of austerity is to force more people - including the ill and disabled - into low-paid work. The North East has been an experimentation ground for the roll-out of Universal Credit. Universal Credit is the latest phase (following Job Seeker's Allowance introduced in 1998) in a process of transforming social security assistance into 'workfare' (I.e. attaching work-related conditionality to all assistance), and privatising the social security system. This has made the act of claiming assistance highly complex and stressful, with a palpable atmosphere of negative judgement towards claimants. The situation in Job Centres is at breaking point, leaving people with mental and physical health problems waiting 3-4 hours to be seen. Private companies are being paid to offload as many citizens as they can into low-paid jobs, consequently many people are scared to claim, so they are not registered, do not contribute to the unemployment statistics, and live in great poverty. Further more, someone's fitness for work no longer depends upon the opinion of their GP. The power to make this judgement has been passed to people with no medical training. As of 2019, a private company called 'Maximus' runs the Work Capability Assessments scheme in South Tyneside, receiving £595-million over three years.

In May 2019, Philip Alston - the United Nations rapporteur on extreme poverty and an expert in human rights law - released a report that concluded:

The bottom line is that much of the glue that has held British society together since the Second World War has been deliberately removed and replaced with a harsh and uncaring ethos. ...[The DWP is] designing a digital and sanitised version of the 19th Century workhouse, made infamous by Charles Dickens. ...UK standards of well-being have descended precipitately in a remarkably short period of time, as a result of deliberate policy choices made when many other options were available.

The report highlights many facts including:

  • 4-million people in the UK - a fifth of the population - live in poverty.
  • In 2017, 1.5 million people experienced destitution.
  • Food-bank use has been normalised.
  • 60 percent of people in poverty are in families where someone works.
  • The cause of this systematic immiseration [economic impoverishment] is the government's ideological decision to dismantle the social safety net and focus on work as the solution to poverty.

By closing locally accessible hospital services, it is a double-blow to the least affluent people in our borough, many of whom will have the furthest to travel to find alternative services outside of the borough. As of 2019 it still takes 3 buses - with all the time and money that entails - to get from some parts of South Tyneside to Sunderland Royal Hospital, and there are no credible plans to address this.

So, even if a prevention health strategy was being used sincerely, it is operating in a climate of cuts, itself under-resourced, and up-against & driven-by an 'illness generating' socioeconomic system. The fact that prevention is being sold as part of the solution to a manufactured crisis in the NHS, conveniently justifying the preferred options to close vital but non-profitable public health services (ultimately in favour of building the market in health care) should itself raise questions as to the validity of any presentation of prevention schemes vs our local hospital services.

A climate of cuts is a full-spectrum attack on local services

The Three Pillars of Transformation diagram tacitly acknowledges the socioeconomic determinants of health. People are only human, the poorest people must yield to the pressures of work and life, and depend heavily for assistance and mitigation upon the commons of free public spaces and services that are available and locally accessible to them. As inadequate as it is, prevention also transfers more budget responsibility for people's health to cash-strapped local councils, while a wide range of municipal, mutually beneficial, life enhancing and enabling spaces and services continue to be cut, closed and corporatized:

Under Attack

  • Community and Mental Health Services (see  Social Care ).
  • Residential Care Homes (see  Long-term Care ).
  • Schools (see  South Shields School ).
  • Sure Start Centres (see Newcastle Sure Start Cuts).
  • Community Centres (see Save Brinkburn Community Centre).
  • Leisure Centres

    Decades of underfunding and neglect of the Temple Park Leisure Centre is culminating in the demolition of the swimming pool. At its peak this leisure centre, perfectly located in the heart of our borough, not only offered a large family-friendly swimming pool (with a wave machine, aqua-blaster water slide, and diving pool), it also offered gymnastics, trampoline, a sports hall with a gallery, and spaces for community activity and celebrations.

  • Libraries (see Four libraries to close in South Tyneside).
  • The Citizens' Advice Bureaux (see implications of cuts to legal aid and cuts to the CAB).
  • Green Spaces

    The land at Temple Park, more than any other piece of land in the Borough, belongs to the people of South Tyneside, because it is was gifted to the people of South Tyneside in 1961. There are now plans to build a private sports centre on a large part of the site.

    The Local Plan began with the publication of the Strategic Land Review (SLR) followed by a public consultation in 2016. The SLR threatens to place large swaths of green space in South Tyneside into an unprotected category in readiness for planning applications from corporate developers. Individuals and campaign groups from all over the borough - including Keep Boldon Green (also see KBG 2016 Website & KBG 2019 Website) - responded to the consultation. Many developments not dependent upon the SLR have already begun throughout the borough (see below for some examples). Keep Boldon Green's response to the SLR presented evidence demonstrating that the housing need for the borough is significantly overestimated, and is being driven in part by an explicit requirement to build housing in tandem with the development of the IAMP (see below). The bigger economic picture driving housing development on greenbelt is one of money looking for investment opportunities. Unless stopped, this economic paradigm will continue to destroy agricultural land and green spaces for leisure, it will continue to entrench corporate power, and still fail to provide more affordable homes for the majority of potential buyers and particularly renters.

    The International Advanced Manufacturing Park (IAMP) near Nissan is integral to the Local Plan. It is an industrial park covering 100 hectares (equivalent to 140 football pitches) of greenbelt. The aim is to invite multinational corporations related to car manufacturing to come to this region.

    A massive waste incinerator, integral to the IAMP, is planned for construction on land at Hillthorn Farm.

    Green spaces around Boldon, Cleadon and Whitburn are threatened.

    The needless felling of trees that line the streets of South Tyneside. Mature healthy trees are being felled as part of a scheme (that South Tyneside Council call Flags to Flexible) to replace paving stones with tarmac over a period of 20 years. This has already resulted in the felling of over 173 street trees. This is similar to the situation faced by people in Sheffield.

    The scale and rapidity of this corporate land-grab has not been seen for a generation. Some of the many other green spaces under threat in our region include: the greenbelt at Penshaw, green spaces in North Tyneside, greenbelt at Crawcrook and Ryton, Woolsington woods and many more green spaces in Newcastle including Havanah Nature Reserve.

    The Pont Valley is one several areas under attack by Banks - a development corporation specialising in opencast coal extraction. In addition to the Pont Valley, Banks is seeking to build opencast coal mines throughout the North East, including at Dewley Hill (near Newcastle), and Druridge Bay (a beautiful area along the Northumberland coast, within cycling distance of South Tyneside, and a popular retreat for many people throughout the North East). The site at Druridge Bay is projected to be the largest opencast mine in England. Recently Northumberland Wildlife Trust severed ties with Banks, stating that ...we do not approve of their [Banks'] constant applications and proposals for opencast coal extraction. ...We are concerned that these things keep coming forward when all of us are very very aware of the urgency regarding climate change.

With the election of the Con-Dem coalition government in 2010, we have seen the biggest cuts to public spending in the UK since the 1920s. In June 2010 alone, £80-billion a year was cut from public services and social security. The cuts are targeted at the poorest and most vulnerable, including people with disabilities.

Tom Crewe writes:

In the North-East, the poorest region in England, nearly a billion pounds has been sucked out of the economy since 2010. Middlesbrough - described as an 'infant Hercules' by Gladstone in 1862 - has its bright future long behind it. The council has the highest proportion of deprived neighbourhoods in the country, but is required to save £56 million over the next three years, on top of the more than £80 million it has already cut from its budget since 2010. Darlington will have lost £44 million in funding by 2020. ...Durham County Council has already made £180 million worth of savings, with another £64 million needed before 2020. Sunderland has cut £207 million, and plans another £110 million. Gateshead has cut £130 million, with an additional £92 million due to come out of its budget by 2022. Newcastle City Council has reduced its budget by more than £221 million, with another £100 million in cuts planned for the next three years.

South Tyneside is the third worst hit borough in the country, sustaining an unprecedented 60 percent reduction in central government funding in just 10 years. This continues to drive wide ranging cuts to services, the sale of public land and assets, and the rapid increase of service charges and Council Tax. By 2020 the Revenue Support Grant, currently worth £18-billion a year, will be phased out completely.

Underpinning all this is the wholesale restructuring of public services based on a massive expansion of  privatisation  dovetailing with the drive to shift responsibility for essential services from the nation state to local communities and individuals (reflected in the social care policy of  personalisation ). Councils, local communities and individuals are being deliberately rendered vulnerable to private profit-seeking corporations. Councils, just like  GP practices , are increasingly forced to accept tenders from the lowest bidders. Costs are disproportionately shifted onto the poorest; quality of service drops as private firms and charities compete to cut costs and drive down the wages and conditions of their staff. Local democracy is also damaged because once commercial contracts are in place, neither councils or local people have any control over them.

Better to break the law than the poor

Despite the broader economic and political force acting to shape undemocratic council structures at the same time as limiting their fiscal options, local councils are not as powerless as they would like us to think, and they could become a force for resistance if councillors had the necessary political-will. Tom Crew suggests that the once powerful Labour councils with democratic mandates were a potential counter-power that could have thwart[ed] Thatcherism's desire to impose monetarist discipline and liberate the economy from its social democratic baggage. Margaret Thatcher's goal in attacking councils was to achieve simultaneously the destruction of local government as a potentially rivalrous state-within-a-state, and the marketization of nearly every aspect of public policy.

In response to Crew, Clive Heemskerk argues that local councils still have the potential to become a catalyst for a new movement of working class resistance, and this chimes with Professor Allyson Pollock's assertion that local councils should be regularly publishing lists detailing services that have been cut, including how much they have been cut, and specifically who is affected. Professor Pollock argues that in the face of the most extreme cuts, councils have a responsibility to not paper-over the cracks and hide what is happening, but rather to help expose it, enabling people to see the root causes. In May 2019 The Director of Operations for South Tyneside  Clinical Commissioning Group  called upon their partners including South Tyneside Council to address the causes of the causes underpinning long-term health conditions leading to below average life expectancy for many people in South Tyneside. As we are seeing, the causes of the causes are systemic, and historically the most significant reforms that have benefited public health and well-being have resulted from social movements and popular councillors who were prepared to break the law and push back against policies for privatisation and the interests of big business.

The Illness-Generating System

Diseases that we have long taken for granted (many of which are becoming more widespread) including; cancer, diabetes, dementia, mental illness, chronic fatigue etc, are not normal in a healthy society. They are relatively common in our society and around the world where people have been subjected to the physical and mental stresses that arise when economic, environmental and/or social conditions disconnect people from ways of living that are fundamentally healthy. Further more, the North East (and South Tyneside in particular) already has a legacy of health problems resulting from the industries that have dominated this region.

The question of what is fundamentally healthy has a spiritual dimension as it goes right to the core of what we need as human beings. We intuitively know the foundations of a healthy body and mind. They include such things as; good quality food, clean water and air, a guaranteed safe warm shelter, plenty sleep, rest and relaxation, freedom from fear, physical exercise, community and democracy, education, a sense of meaning and fulfilment, friendship, creativity, beauty, simplicity, contentment, the ability to love and to be loved. Our socioeconomic system - Neoliberal capitalism - undermines these foundations of health. Everyone suffers, but the poorest suffer the most as more of their foundational needs are denied or threatened.

Dr Jill Stein took to political campaigning in the USA after she saw for herself the links between the economic system, the health of people and the health of the planet. She said:

I saw very clearly from my position as a medical doctor the state of emergency that our health is in, and has been for quite some time - at a grand level, we are in the [middle of] the sixth [mass] extinction right now. It's impacting our health as we feel the burden of pollution, economic stresses, poverty and homelessness etc. ...[As a society] we are very sick medically.

Even well-resourced prevention schemes amount to a fraction of what would theoretically be required to reduce the need for local hospital services. The need for prevention schemes has arisen in tandem with the rise of the socioeconomic system causing the illnesses they seek to address.

There is another risk to shifting emphasis away from front-line health services and into prevention schemes. Such schemes inadvertently transfer responsibility to individuals - and more costs to the poorest through service charges and indirect taxes - for the damage done by corporations who spend billions on promoting harmful products and behaviours, who pollute our environment and who - by undermining democracy - force people to live in poverty. The government does little to regulate them, but spends billions to subsidise them, to fight wars for them and suppress local people on their behalf.

The UK has a higher rate of obesity than most European and OECD nations. This is because we have one of the highest levels of inequality and therefore real poverty. Food corporations spend billions to hire biddable scientists and think-tanks to confuse us about the causes of obesity, and to promote the idea that weight is a matter of personal responsibility. The obesity epidemic is the result of corporations - enabled by deregulation and new opportunities - to manufacture sugar-loaded potentially-addictive food, and then market that food to the people most likely to become addicted (see mental health).

Author, George Monbiot, writes:

One government agency after another is losing its budget, its power and its expertise. The result, for corporations and the very rich, is freedom from the restraint of law, freedom from the decencies they owe to other people, freedom from democracy. The public protections that constrain their behaviour are being dismantled.
Food companies have invested heavily in designing products that use sugar to bypass our appetite control mechanisms, and packaging and promoting them to break down what remains of our defences, including through the use of subliminal scents. They employ an army of food scientists and psychologists to trick us into eating more junk (and therefore less wholesome food) than we need, while their advertisers use the latest findings in neuroscience to overcome our resistance.
On the left is Dr Shaz Wahid - Medical Director of South Tyneside  Foundation Trust  - backing the Public Health England 2017 "Stoptober" Quit Smoking Challenge.

As if to demonstrate the inadequacy of prevention in a pro-corporate pro-illness system, South Tyneside Council stated in 2012 that it was urging the Government to support plain packaging of tobacco products, this was in the light of statistics highlighting extreme health inequalities throughout the borough. However in July 2013 the government announced that it will not oblige tobacco companies to sell cigarettes in plain packets - end of! This is despite powerful evidence that plain packaging will discourage young people from smoking, and despite the fact that the public was overwhelmingly in favour. Of course, you might argue that this example is rather trivial since 2013 was also the year that the  2012 Health and Social Care Act  - the Act of parliament that effectively abolished the NHS - came into effect.

Smoking is the tip of the iceberg. We have had decades of this sort of deregulation leading to wide ranging health risks. In 2017 'The Lancet Commission on Pollution and Health' reported that pollution kills more people than tobacco, and three times as many as AIDS, tuberculosis and malaria combined. According to a paper in the International Journal of Environmental Research and Public Health, burning fossil fuels is now the world's most significant threat to children's health. Air pollution is related to 36,000 early deaths a year in the UK.

A major source of pollution especially harmful for children is pollution from roads. In 2018 the government announced £30-billion worth of road building projects. Our borough has not escaped the harm. A massive road expansion project is under way, centred around a massive new industrial park (IAMP) near Nissan. Those schemes are driving plans to build a massive waste incinerator near Nissan, and thousands more houses in South Tyneside, Sunderland and Washington (see above).

The proposed waste incinerator will burn refuse in order to generate electricity for Nissan and the IAMP. The government and developers claim that the health impacts will be negligible, but negligible does not mean that it is not harmful. Based upon all the lies the government has told about the NHS, not to mention the cherry-picking of evidence that it engaged in to impose the  Junior Doctors Contract , it seems that it is wise to question what official sources say. However, the incontrovertible facts regarding the incinerator include: the plant will be in the vicinity of a densely populated area and within a 2-3 mile radius of 12 schools, it will be operational 24/7, burning 215-thousand tonnes of rubbish a year (~110 truck loads of rubbish per day), the energy it generates is not for the use of local people but specifically for the use of Nissan and the other corporations who set up in the IAMP, and the incinerator is estimated to release 7-8 million tonnes of carbon dioxide during its lifespan. Incinerators do release a toxic mix of very fine particulate pollution, and the government is planning to double the number of incinerators over the next 10 years.

A report published in the Journal of Nutritional & Environmental Medicine states that:

The major air pollutants are fine airborne particulates, toxic metals, and organic chemicals. The precise content of the emissions varies with the material incinerated: emitted chemicals include persistent organic pollutants, hormone disrupters, and carcinogens, but not all the organic components have been identified. In addition, the ash produced includes large quantities of highly toxic fine fly ash (air pollution control residues), which pose important long-term health risks.

Fine particulates are inspired deep into the lungs and carry other toxins into the blood stream. They are associated with an increased incidence of lung cancer, but also with a linear increase in mortality (with no safe level), particularly from cardiovascular causes. Increased adult lung cancer and all cancers have been found in the vicinity of incinerators: the peak seems to occur at least 14 years after incinerator start-up.

All of the aforementioned development is being built upon green spaces and irreplaceable farmland, foreclosing upon a possible future of local production, and directing our futures firmly away from green jobs and green infrastructure projects. Our region is on course to be at the heart of expanding some of the industries who's products threaten our health and who's power curtails real democracy. Whether you support this example of economic planning or not, the point is that it takes us down the same socioeconomic road that has given rise to the underlying structural causes of illness that prevention schemes seek to address.

It should be no surprise to learn again that air pollution disproportionately affects poorer communities, exposing their children to further disadvantage as their lungs and brains are stunted. One study suggests that 38 million people in the UK - 59 percent of the population - are immersed in pollution above the legal limit. Only those who can afford to live in villages and the leafy suburbs escape. But the expansion of Neoliberal markets is coming home to roost in other ways for the people of Boldon, Cleadon and Whitburn as their green leafy suburbs (our greenbelt) are set to be transformed by massive urbanisation projects over the next 30 years.

Rather than funding health services - and other life enhancing services - vast sums are being squandered on road schemes, which as the Campaign to Protect Rural England has shown actually leads to an increase in traffic and more congestion (or at best it simply shunts the congestion down the road to the next bottleneck). Hand-in-hand with the expansion of roads is the transfer of potential funding from public transport to private transport, which exacerbates the problems that many people will face if they are required to travel out of the borough to access acute health services.

In 2018 Nissan joined the list of criminal corporations (along with Volkswagen, General Motors, Mitsubishi, Suzuki, Porsche, and no doubt other competing car manufacturers) who have been cheating on emissions tests. By putting their profits first, these corporations have not only delivered widespread inconvenience resulting from product recalls, but they have damaged the health of people worldwide. Toxic particles from exhaust fumes pass through the lungs of pregnant women and accumulate in the placenta. The risk of premature birth and low birth rate that this causes, is described in the British Medial Journal as something approaching a public health catastrophe. Among the likely impacts of repeated poisoning, researchers now believe, is a huge reduction in intelligence, and a study conducted in London suggests that people with the highest exposure to pollution also have a greater risk of developing dementia.

Chemical World

Corporations prioritise their profits over our health, that's just how they work! They lie, lobby, and break the law as a matter of course.

In 2018 the giant German chemical company Bayer purchased the giant American chemical company Monsanto. These two corporations are amongst some of the largest and most criminal organisations in the world. Their crimes range from (but are not limited to) patenting seeds, driving thousands of farmers to ruin and suicide, and supplying chemicals for war such as Monsanto's role in supplying Agent Orange that was used extensively in Vietnam, and Bayer's role in supplying Zyklon-B (Bayer was then called IG Farben) that was used to gas prisoners in Nazi concentration camps. Bayer and Monsanto like the other big chemical companies have been instrumental in driving the now globally dominant chemical-based industrial agriculture that destroys ecosystems and that vast numbers of people throughout the world are now dependent upon for their food and/or income.

In May 2019, Bayer-Monsanto was ordered to pay more than £2-billion to a couple who developed cancer as result of exposure to glyphosate. Glyphosate is used as a weed-killer and sold under the brand name Roundup. This is the third time that Bayer-Monsanto have been ordered by the courts to pay compensation for the carcinogenic effects of glyphosate. There are thousands more legal cases still pending. Roundup is used everywhere from farms, to streets, to children's play areas. It is sprayed liberally throughout the streets of South Tyneside, and you may well have purchased it yourself for use on your garden path. On July 3rd 2019 Austria's lower house of parliament voted to ban all uses of glyphosate.

A wide variety of chemicals are sprayed on the food we eat. In addition to glyphosate, which is classed as a herbicide, there are also various pesticides, fungicides and antibiotics, which are even used on fruit. You have to take the aforementioned classifications with a pinch of salt. The classifications themselves are creations of the chemical industry and create the illusion of specificity. For example, some herbicides (supposedly designed to kill plants) are highly toxic (if not more toxic) to certain animals. Jonathan Latham PhD is an expert in the history of chemical and pesticide hazards, and he has been warning for a long time about the ongoing deregulation of the chemical industry. He has recently warned that the EU regulations - which have for some time been considered the best standards currently in use for protecting human health - are being watered down. Dr Latham warns that the EU body responsible for setting regulatory standards has been effectively taken over by people aligned with the chemical industry. The result is that their latest report recommends drastically weakening the EU regulatory system. In a radio interview Dr Latham stated:

These [chemical] industries are unhappy with the fact that the EU has standards of chemical risk assessment that stand some chance of protecting the public.

In the minds of the public [regulations are for protection], in the minds of the chemical industry, what they are there for is to create a kind of smokescreen, to create the illusion of protection, and as barriers to the entry of [smaller enterprises]. ...[Regulations] have all kinds of roles, only one of which is to protect the public.

Despite even the best regulations currently in place, we are increasingly exposed to toxic substances. For example, have you ever wondered why you get labels on brand-new clothes advising that the clothes are washed before their first use? Extremely toxic substances that are already banned in Europe (E.g. Methyl Bromide, and the pesticide 'Confidor' manufactured by Bayer) are still used by manufacturers in other countries (such as India and China) who produce for retailers based here using cheap sweatshop labour. Sweatshop labourers are basically slaves by another name, and have little choice but to accept their harmful working conditions. However, significant traces of toxins used during the manufacturing process enter our local environment along with the products they make. Sometimes the concentration of residue toxins (in textiles and children's toys for example) is sufficient such that direct exposure can lead to serious illness.

Recently Amazon had to answer questions regarding slime toys after it was found that they breached EU safety levels for a chemical called boron. Boron is often found in flame retardants, but was used in slime toys in order to make them sticky, thereby endangering the health of young children.

Mary Cray - Chair of the UK Environmental Audit Committee (2019) notes that it is largely up to third-parties to identify the toxicity of products. Manufacturers and retailers don't take adequate responsibility stating - in the case of Amazon:

...there is lip service happening ...they don't want to do anything that gets in the way of business.

Jane Hoolahan, Vice President of Research for the Environmental Working Group, Washington DC says:

It's overwhelming what we are exposed to ...everyday we get a fresh flush of chemicals, no place and no one is immune. The most persistent chemical contaminants are carried across oceans and continents by water and air. ...[The contaminants] increase in concentration as they move up the food chain. ...They cross the placenta, so babies receive their first exposures in the womb.

Nena Baker, author of The Body Toxic - The Hazardous Chemistry of Everyday Things, states that:

Everyone everywhere now carries a dizzying array of chemical contaminants, the bi-products of modern industry and innovation. These toxic substances accumulate in our fat, bones, blood and organs, or pass through us in breast milk, urine, faeces, sweat, seamen, hair and nails. ...Scientists call the phenomenon 'Chemical Body Burden', it's the consequence of womb-to-tomb exposure to substances so common in our daily life that we never stop to consider them.

It's not that chemicals are bad per-say, its that costly societal [health] problems arise because we know so little about so many chemicals. In the time it takes to learn what harm a substance is doing to people, to animals, to places, the genie is long out of the bottle.

Chemicals known to interfere with the brain, body and behaviours are freely used in everything from plastics, soaps, toys, food wrappers, clothes and carpeting. Every child born today comes loaded with chemicals that may be contributing to various health problems that aren't apparent until later in life.

Nena goes on to say that linked disorders found in lab animals - disorders that are on the rise in humans - include such things as: cancers of the breast, testicles and brain, lowered sperm counts, early puberty in girls, defects of the female reproductive system, diabetes, obesity, Attention Deficit Disorder (ADD), asthma and autism. Nena and Mary Cray acknowledge that toxicity is often a matter of dosage, and that in most cases direct cause and effect has not been established for humans, but there are significant correlations raising serious concerns amongst scientists.

There was a time when it appeared that the chemical safety of everyday things had moved beyond the days when highly toxic heavy metals like lead were routinely used in household paints and petrol. However, while the safety of some products has increased, chemical contamination is now ubiquitous. Our entire planet, drinking water and air is awash with synthetic chemicals; many of these chemicals appear to be toxic under certain conditions or with sufficient exposure over time.

The examples given on this page only scratch the surface of the health problems we face as a society. Accident and illness are unlikely to decline significantly any time soon. It is not in our interests to trade our priceless local hospital services that are publicly-funded, publicly-provided and free at the point of use, for a smaller commercially-driven bed-less health service, dependent upon spurious prevention for viability.

Mental Health

Our society is in crisis. The link between mental and physical health is often overlooked. For many people capitalism creates strong feelings of alienation - from meaningful work, from nature and from each other. Once again the poorer you are then the more likely you are to be forced to survive by working in a way that undermines your health.

One in four adults in the UK has been diagnosed with a mental illness. The social determinants for psychological well-being (including; isolation, inequality, dissociation and even the ideology of materialism) are overwhelmingly important. Psychological stresses lead to addictive behaviours - from taking drugs and smoking to excessively watching TV, drinking alcohol, eating junk food, shopping etc. People develop addictions in response to coping with pain and trauma. Trauma can be passed from parent to child, and will most likely be perpetuated by a culture like this one, with social structures that predominately inhibit rather than promote the healing of trauma. A harmful state of mind can bring about physical health problems directly, but it is easy to see how trauma induced addictive behaviour can increase the risk factors for all sorts of common diseases in our society.

Rod Tweedy, an author of books on mental health, writes:

Many of the contemporary forms of illness and individual distress that we treat and engage with certainly seem to be correlated with and amplified by the processes and by-products of capitalism. ...Poverty, relative inequality, being subject to prejudice, displacement and a competitive culture increase the likelihood of mental suffering.

In 2019 the Chartered Institute of Personnel and Development (CIPD) published a survey of more than 2000 companies (involving 3 million people) across the UK. They found that 57 percent of all sickness absence is for stress at work, and 2/5th of them said that stress in the workplace is rising. Professor Cary Cooper of CIPD said:

Behavioural changes, that's how it first hits you. Difficulty making decisions, becoming more socially withdrawn, more aggressive. Then you start to get the physical symptoms, which could be anything, it depends upon where you are weak. For example, gastrointestinal problems, aches, difficulty sleeping. The first symptoms are behavioural, then beyond that it becomes physical, and then it can be even more serious; you can have stress-related heart disease and a whole range of 'proper' illnesses.

Work related stress can affect anyone from university researchers to HGV lorry drivers. Private sector workers have long been familiar with the tyranny of the corporate workplace and the resulting horrendous conditions that have been normalised for many people. However unprecedented government cuts to public services - dovetailing with sweeping privatisation - is taking its toll on people who provide many of our most essential services including nurses, social workers, teachers etc. One teacher describes how her workload increased to such an extent that she became addicted to painkillers and began drinking to stay awake in order to mark coursework, at the same time she became accident prone and lost a lot of weight. After working as a dedicated teacher for 21 years, she was described as natural waste by the college where she ended her teaching career, because the college saw this as an opportunity to further reduce permanent staff numbers in order to save money. Professor Cary Cooper said:

We employ people in not really permanent jobs, we have fewer people, keeping labour costs down, their feeling job insecure, their working long hours with massive workloads, plus they have poor management. ...We don't even cost in what the NHS has to do to repair people who are damaged by stress.

There is a whole new field of work-related illness called techno-stress. One group affected are office workers who are isolated at their computers, forced to communicate with each other via email rather than leave their desks to have social interactions. This problem can be 24/7 when employees are being emailed about work related issues outside of their working ours. The response that many companies have to these situations is to shift responsibility onto the victim, rather than change the regime of their business.

A survey in 2013 found that Britain was the loneliness capital of Europe. A report commissioned by the Red Cross in 2017 found that more than 9 million people in the UK reported feeling lonely. This revelation caused the then Prime Minister Theresa May to appoint a Minister for Loneliness. Even Theresa May had to admit Loneliness is the sad reality of modern life.

The number of households with a single occupant has doubled from 1972 to 2008. So more people are growing old alone and potentially unsupported. Mark Robinson, the CEO of Age UK, warned that the problem could kill saying: It's proven to be worse for health than smoking 15 cigarettes a day.

Loneliness is not just a risk for the elderly. A former United States surgeon general, Dr. Vivek Murthy, argued that loneliness needed addressing in the workplace. He said it can be associated with a greater risk of cardiovascular disease, dementia, depression and anxiety.

Capitalism tears people apart, George Monbiot writes:

Human beings, the ultra-social mammals, whose brains are wired to respond to other people, are being peeled apart. Economic and technological change play a major role, but so does ideology. Though our well-being is inextricably linked to the lives of others, everywhere we are told that we will prosper through competitive self-interest and extreme individualism.

In 2018 the results from a trial in the Somerset town of Frome found (unsurprisingly) that building community has significant health benefits. Subsequent papers have come to the same conclusions. For example, HIV patients with strong social support have lower levels of the virus than those without. Women have better chances of surviving colorectal cancer if they have strong connections with other people. Building real community has become a radical act that goes against the Neoliberal doctrine that was articulated by Margaret Thatcher - the prime minister who started the NHS privatisation-ball rolling with the  NHS and Community Care Act :

There is no such thing [as society]! There are individual men and women and there are families and no government can do anything except through people and people look to themselves first.
Margaret Thatcher

Monbiot identifies technological change as a potential force for alienation, and so it seems quite natural that digital technologies as outlined in the  NHS Long Term Plan , are gradually being implemented in tandem with a reduction in GP services, replacing the face-to-face contact that at one time was a stable and personal relationship that many had with their doctor.

Dovetailing with prevention is the pharmaceutical industry who have a long-held goal of direct involvement in 'disease management' - meaning they would prefer a health system that emphasises self-care, so that they are less dependent upon doctor's prescriptions in order to sell their drugs.

Capitalism is a system of domination, and the world under capitalism is extremely brutal even if we don't see it that way. Most of us have not known anything else, so we either don't notice the burden we carry, or we have learned to ignore it - the pollution, the noise, the speed of life and pace of change, the violence, the corruption, the competition, the painful contradictions (our comfort depends upon their exploitation), the background threat (a daily reality for many) of social and economic insecurity - all these erode our basic rights, needs and our health. Human beings are fundamentally creatures of love and creativity, but from a socioeconomic point of view, we are far outside of our natural habitat, the safe and just space for humanity. Consequently we develop 'behaviours', illness, and we suffer as all abused and captive creatures do. Tweedy cites Joel Kovel, a former psychiatrist and professor of political science who refers to the colossal burden of neurotic misery in the population, a weight that continually and palpably betrays the capitalist ideology, which maintains that commodity civilization promotes human happiness.


Health leaders who push prevention in this market context ignore the history of NHS privatisation and the inconvenient truth that their actions further facilitate privatisation, which emboldens and serves the market system that leads inexorably to inequalities in the delivery of health care, as well as significant inequalities in society that impact adversely upon the general health of the population. There is no way to square this vicious circle, the only true answer is to break it.

The current economic paradigm is a thinly veiled orgy of greed, but the vast majority of people are not pathological like the damaged elites and criminal corporations who by pursuing their own self-interest at any cost, are creating artificial social and economic conditions that both drive and (in a self-fulfilling way) aim to justify these new models of care.

Real prevention will require action to address the greed dominating our politics and the path that it has set us on. As we are driven ever further from ways of living that put everybody's basic needs and - inseparably - those of the natural world first, the unacknowledged trauma suffered by many people daily will only increase along with the harmful consequences for mental and physical health. The concept of encouraging people to be healthy so that they won't need front-line medical services is not only farcical in the face of total corporate greed, it is way beyond the scope of the NHS and our cash-strapped economically-disciplined local authorities. The irony is that Really addressing the root causes of preventable illness, would happen in tandem with the political-will to properly fund and guarantee hospital services.

Perhaps the most important point to understand is also the most direct. We are being fed a narrative that no change is not an option, but the only change on the table is a health service radically reduced in favour of  privatisation . We don't have to make a choice between prevention and our hospital services. That choice is false and stems from the architecture of NHS privatisation. As  Professor Allyson Pollock  said in the preface to her book NHS plc: The Privatisation of Our Health Care:

It took more than fifty years to build the consensus for the NHS, and it is a testimony to what can be achieved with the right sort of political will... A new generation [must] work towards reclaiming the rights and entitlements that the NHS once conferred, and a new vision of health care for all.