CHAPTER TWO

What Health Is Not

 I need now to clear away some of the ideas that are wrongly attached to the word “health”. Most educated people probably feel they understand it, but I don’t think they do.

To illustrate why, I remember a remote spot on the edge of the town where I lived until recently. By a sign reading “No Tipping” was a large pile of household rubbish.

Put yourself in the place of an innocent stranger, visiting from another continent and trying to cope with our language.  What are they to make of this scene? It looks as though a “No Tipping” is a place where it’s OK to dump your rubbish, or that “to tip” is to clear rubbish away.

It doesn’t take much exposure to contemporary English culture to correct that naïve mistake. But our culture has something very similar embedded in it, and far harder to correct - our abuse of the word “health”.

Medicine is not Health

This lack of understanding is quite modern, and dates from 1947 and the inception of the National Health Service (NHS) in Britain. This major change in public policy was conceived in the period before the Second World War, and formulated by a commission under the chairmanship of Lord Beveridge.

I referred in the previous chapter to The Peckham Experiment, which arose at about the same time as Beveridge was arranging his ideas. This was not an isolated publication. If you check newspapers and books published at that time, health was thought of in quite a different way. During this period the Scout Movement, the Allotments Association, the National Playing Fields Association, the Vegetarian Society and the organic movement in agriculture and gardening all associated themselves with health. The Green Belt policy was invented, not just to separate towns but to provide them with lungs. The post-war Garden Cities Movement stemmed from the success of the tuberculosis treatment colonies founded at this time – Papworth Everard in Bedfordshire, for example.

So Beveridge really meant “health” when he set about designing the NHS in 1941. The problem was the medical profession, who perceived this development as a threat to their prestige. Doctors receive no training about health, but light up when something goes wrong. So long as people get ill, doctors feel at home. It was lobbying by the medical profession which eventually perverted the intention behind the NHS Act, and made it create instead a National Medical Service. The Act included provision for Public Health but it has been the Cinderella service ever since, unable to attract the best brains.

A central principle of a health service was that it would make people more self-reliant and reduce to a manageable size the national demand for medical care. People who scoff at Beveridge’s naïvety in believing this, only expose their own. A medical service - which is all his critics understand - cannot remotely achieve this; but a service that directly fosters health certainly can. Perhaps we could not be certain of it in 1947, but subsequent history has made it very clear that medical care cannot satisfy the public appetite for it. On the contrary, however many medical services are available, more are always demanded. (This is because medical care cannot create health – it can only suppress the appearance of disease and disorder, which in the absence of health are irrepressible. But this is the theme of a subsequent chapter.)

In the public mind, and even amongst supposed experts, after 1947 the noun “health” became virtually obsolete. The word became an adjective meaning “medical”. Health centres, health visitors, healthcare are all terms that describe services for the needy, not the healthy. (Health shops have the same difficulty, dealt with at length in a separate chapter. Though motivated by the best of intentions they deal mainly in alternatives to medicine, or alternative forms of medicine. “Health food” is available at the greengrocer’s, though it has deficiencies that require replenishment by supplementation.)

In conclusion: purge from your mind any idea that health has to do with medicine. There are points of contact, of course, which I shall discuss later. But you cannot make people healthy by treating their diseases, however well you do that.

Fitness is not Health

It’s good to see how many people now take exercise regularly. All kinds of people run, skate-board and cycle – far more now, I suspect, than take an active part in sport. Walkers on pedestrian pavements seem to be the endangered species now, but perhaps better manners will come to their rescue in time.

If you were to ask people why they exercise, most would say it’s for the good of their health. So it is, because using all your abilities regularly is much more wholesome than allowing desk-work or TV to predominate. And it’s nice to be able to run for a bus when you have to, without feeling ill.

But fitness for physical exertion is not the same thing as health. Exercise can increase wear and tear to joints, as many professional footballers will testify. Exercise you dislike is not doing you much good, either.

Feeling well or happy is a little different, and highly desirable, but does not necessarily indicate health. Many drugs induce well-being artificially, including the cup of coffee sat beside me. I expect a bully feels good about him/herself after kicking seven bells out of a “disrespectful” victim, but that does not mean violence is healthy. The winner of a race, or a sales trophy, is not necessarily healthier than the runner-up.

Beauty is different again. We shall see that beauty results from health, but a beautifully formed body is not necessarily healthy. I once had to design a simple health check for participants in a television series in Northampton. It included measurements of body fat and muscle. Two production assistants volunteered to try it out, one slender and elegant in a modish sort of way and the other curvaceous and buxom. To my surprise, the slender one was quite fat and had hardly any muscle, whereas the buxom one was lean and muscle-bound. She was undoubtedly healthier than her more modish colleague, and has far better future prospects. Nevertheless, health cannot be defined by matters like body weight and shape.

Confused?

All these attributes – beauty, fitness, happiness, well-being, even disease – stand in the same relationship to health: they are consequences or symptoms of health, or its relative absence. If you are healthy you will over time achieve the first four of these in decent measure, and manage largely to evade the last. But you will not achieve health by aiming directly at any of these goals. Nor will you achieve any of these goals sustainably without being healthy.

It’s time to come to the point and tell you what health is. 

Prelude

People say that a picture is worth a thousand words. I cannot say, but I know is that a vision is worth millions. Mine occurred in September 1971 and I have been acting it out, writing and talking about it ever since. Yet I have come nowhere near doing it justice.

I am rapidly approaching the statutory age of retirement. I have no intention of retiring completely – perhaps no self-employed person ever really does. I am currently in excellent health and thoroughly enjoy the work I still do – and the fact that I can choose not to do work I like less.

It preys on my conscience, however, that I have not managed to share my vision with more people. In particular, any dents in the edifice I have challenged are barely discernible. So I am resolved to set out what I know in full and in the round, once and for all to see. I do not take longevity for granted, though I come of long-lived stock and have tried to respect the needs of my body so far as my little wisdom allowed. I want to finish this, and I know it will take time and many revisions before I can say – yes, that is the full meaning of what I saw that November, and this is what it offers to those that follow me. So I am starting now, while I still have the small gifts of insight and expression that I can bring to bear.

The Beginning

I grew up with a strong sense of my personal destiny. By fifteen I remember saying, when asked, that the job I wanted hadn’t been invented yet. This amused my parents’ friends, who had heard that I showed promise. Most of these were neighbouring colleagues of my father. He was the eldest son of the Chief Engineer at Tate and Lyle’s factory in Silvertown, East London, and was by then rising through the management ranks in Unilever, whom he served for his entire career. My first memory of him was in Royal Air Force uniform, returning eventually from war service in the spring of 1946.

I had won a place at Harrow County School for Boys, one of the grammar schools around London that still flourished in the 1950s. I don’t think I was really all that clever, but I worked hard and took my studies seriously. Consequently I coped well with most subjects, as well as throwing myself into the other opportunities that the school offered. Very few escaped membership of either the School Scout Group or the Combined Cadet Force, which was all but mandatory. I joined both, which was equally unusual. So to academic life I added many camps in fields or RAF stations, military field days and scout wide games, some leadership responsibility, a gliding course and a flying scholarship. I don’t remember my parents’ paying a penny of any of these, apart from accommodation costs. I eventually became a Queen’s Scout, a Senior Under-Officer and Head Boy. In photographs from that time I look a bit of a berk.

The school measured its strength by the number of scholarships and places its pupils won at Oxford and Cambridge Colleges, and after considering direct entry to the Royal Air Force College, Cranwell I trod the expected path. To everyone’s surprise I landed a major open scholarship in physics at a Cambridge college of which I had not heard six months previously. They probably wish I never had. I did not get the hang of physics at that level, and could not see what I was going to do with a physics degree in any case. I changed to medicine in my second year, and am probably still the only major scholar to keep his award for the whole three years without getting a First at any stage. I did, however, include mathematics as a half-subject in my final degree examinations, which later proved to be a good call.

Having no background in medicine I left Cambridge with only a vague notion of what physicians did for a living. We were required to find places in clinical courses elsewhere, since Cambridge had none of its own. With several others I arrived in London in September 1965 to train alongside graduates from University College London, across the road.

I was never quite able to devote my attention to formal study, at Cambridge or in London. The habit of engaging in the less formal life of a university town stayed with me. I became involved in the United Nations Student Association, helped to found something called the Society for Anglo-Chinese Understanding and led an unofficial student expedition to Egypt during the summer of 1965. I still regard that with pride - certainly the high point of my education, and a large determinant of my career.

In London I was allowed to continue flying at the expense of the Royal Air Force, which had been denied me at Cambridge. Not enough London candidates had passed the medical, apparently. I don’t think I oozed insubordination, but nor perhaps did I radiate military vibes.

This spell of about two years involved flying camps, which did not always coincide with flying weather. Our officers had various ploys up their braided sleeves to retain our attention during a wet spell. One of those was a flying navigation exercise programmed to take as long as the hypothetical flight. We were all to imagine ourselves the navigator of a transport aircraft of given performance, setting out from A and bound for C via B whence we were eventually diverted to D. We were briefed in advance as our alter egos would have been. Then reality began to hit. The real time of take-off, and a succession of off-track fixes, were supposed to trigger in us corrections in time for the imagined pilot to do something useful with them.

Since this test was designed originally for much more senior trainees, the class fell by the wayside one by one, unable to keep up.  When the flight time had expired, and therefore the examination, I found that I was the only one still on message. Apparently I had scored 94%.

Then followed the lesson that lingered. After some murmurs from behind closed doors, I was called before the Commanding Officer to explain myself, in the presence of several flying instructors who may also have been under some suspicion on my account. When had I seen the paper before? How had I cheated? Who had helped me? I could only protest that I had done none of these things. I had learned pilot navigation not once but three times, and perhaps I had a small talent for it.

Silent submission would probably have served me better. Nevertheless I got off with a dressing down, when I might have lost my place on the Squadron. The cream of the Royal Air Force do not end up running Air Squadrons, clearly; but I realised that I would not have prospered as a career officer.

The whole truth only dawned many bruising years later. The best people never seem to wind up running anything. It pays to conform to expectations from above, and I have never been any good at that.

How far any of this determined what was to follow, others must judge. I only know I had quite an education. Many people did then, if they grabbed their chances with both hands. From among my generation rose what someone later called the meritocracy. We are rapidly passing into history, and with it the institutions that nurtured us. It is already hard to credit that such opportunities ever existed outside fee-paying schools.

Most of them have gone, but not all. Our older universities devote much of their considerable talent to survival and self-preferment, with a first class track record spanning a thousand years – and counting. Graduates face not two certainties only, but three: death, taxes and entreaties to swell College funds.

Steps Into Medicine

My clinical studies took the form of brief postings to specialist doctors, looking after patients admitted under their care and attending their out-patient departments. The only real work I did was to take blood for tests ordered by the medical team, so I made myself expert at this. I paid much attention to the individual inpatients allotted to me, and made their case histories the backbone of my study notes.

Each new medical specialism stirred enthusiasm for a while, which faded well before the end of the posting. One department only kept my attention for longer than this, the infant Epidemiology section staffed by just one senior lecturer. Eventually I became his research fellow, appointed specifically to manage research in a projected Health Centre in Kentish Town. My boss had by then pointed out the excellent prospects opening up to GPs with an academic interest, and I thought I had my career made.

Two events upset my forecast. The first was the discovery that the best service was being given by the small medical practices nearby, not the six-handed partnerships who would move into the new Health Centre. Small practices had fewer obstacles between them and their clientele, and spent nearly all their time engaging directly with individuals in need. Larger practices spend much of their time organising themselves, and not very well. These discoveries did not go down well with my employer, nor with my GP colleagues who were glad to receive my resignation three years later. The remaining two years of the research programme were managed from Bedford College, and fudged the issues. My interim report had disfavoured large medical centres, and at least since then the Department of Health, and most Local Health Authorities, have stopped funding them directly.

Damascus Road, Sevenoaks

The second discovery was in the course of my training as a general practitioner, at the hands of a giant in the profession. This was part-time and spread over three years, to make space for my other responsibilities. Somewhere in the course of our tutorials he had me prepare a presentation entitled “What is Health?” He gave me a sheaf of papers and cuttings to prepare from, and one book. I had not read the book ahead of the presentation, but did so afterwards – and was hooked.

The book was “The Peckham Experiment” by Innes Pearse and Lucy Crocker. It was first published in 1943 and described the experience of a team of doctors and educators who had opened a leisure centre in Peckham, which still stands. It differed radically from the leisure centres of today, however. Families in the neighbourhood joined, spent a good part of their leisure time at the centre, and submitted to an annual health overhaul – an examination of what was right, but using medical techniques originally intended to discover what was wrong. Meanwhile all the activities in the centre were being observed and catalogued by the experimenters, whose objective was itself inspired: they wanted to discover the nature of human health.

I told my trainer of this new enthusiasm and he offered to introduce me to Innes Pearse. So began a series of visits to a mill house in Sussex, interspersed by intensive reading. Eventually it took me to Ireland to meet Lucy née Crocker, by then married to Philip Pearce. They had founded a pottery, near friends who set up Ballymaloe House Hotel and Restaurant, now with its well-known cookery school. All but one of those people have since died, but I have kept in touch with life in Shanagarry ever since.

So came that Sunday evening in the autumn of 1971. I don’t think it’s chance that favours the prepared mind, but something does. During the return from a meeting at the Mill House, I was driving up the new bypass road round Sevenoaks when it hit me.

“It” was a momentary vision, an intense spark of vivid insight. A similar event is recorded in The Acts of the Apostles Chapter 9, Verse 3. It was over in less than an instant, but its effect on me can never be erased. I pulled over, excited and bewildered, and let my wife drive home. I was unable to work for more than a week, while my mind struggled to digest what it had received. When I resumed, my outlook and ambitions had altogether changed.

I have, ever since then, known with complete clarity and conviction exactly what health is – which is to say, what life is. My life and career, bizarre and regrettable to those who thought they saw all that early promise, has held faithfully to one firm purpose – to set out what I know, and to turn it into action.

INTRODUCTION

“What Is Health?” is a book, except it will not appear on paper unless you print it off.

It is being written in chapters as usual, which will be published one at a time as they are prepared.

These chapters may change after their appearance, in which case details of the change will appear in the contents document.

There is no need to register or pay for access to this folder. It is there for anyone to see. If you wish to make yourself known, look at www.goodhealthkeeping.co.uk and send a feedback message. This will not result in any marketing etc, but if you wish you can subscribe to the free monthly e-mail newsletter “ReThink Health”.

The contents of this folder – the book “What Is Health?”  represents what I have learnt from answering that question, and details the experiments I have made to put that answer into action. I particularly include the experiments that failed, because in other places and at another time they may succeed. At least, they may trigger a new train of thought and lead to success by some other route.

I am not about to make any claim based on what I am writing or on your response to it. What I was given came freely to me, enabled me to make a reasonable living perfectly honestly, and gave me true independence. It did not give me influence over the movers and shakers who formulate policy, even if I saw into their minds. But I know that when sufficient people see clearly the nature of health, feel how much health they have and live confidently from the power that gives them, movers and shakers will no longer move or shake the lives of nations.

You will find some sort of a CV on the website, but I was a family doctor in the British NHS for 26 years, and directed Good Healthkeeping Ltd and Templegarth Trust for about 20 years until September 2006. I also strive to keep pilots healthy enough to fly aeroplanes. I receive my state pension in March 2008 at the age of 65. I enjoy excellent health, a sound mind, and the love of a good woman.

Why should you read on? Because medicine is not delivering health and never can. But health can cut your need for medical care by at least half, and set limits to our needs at last. That should rouse the movers and shakers, but only seems to give them sleepless nights. Because………….

Peter Mansfield    8^th August 2007   doctorpetermansfield@yahoo.co.uk