One of the favourite analogies of those who work in public health is that clinical doctors, such as GPs like me, are standing at the mouth of a river in their waders dealing with all the flotsam and jetsam that comes their way. They, on the other hand, are working upstream to try and prevent the rubbish getting into the water in the first place.
When I ignored the warnings of my colleagues to spend four years as a public health doctor, I found myself spending time in nightclubs, fast food outlets, sunbed parlours, gyms and on refreshing country rambles – all in the name of making the nation healthier. One afternoon I was even scheduled to focus on occupational health with a group of individuals who termed themselves ‘working women’ – a rather different experience to the one I had originally envisaged.
The overarching principle of public health is that rather than attempting to address health problems once they have developed, it is much better to prevent them occurring in the first place. Hence that river analogy.
The only trouble with this approach is that just as rivers generally have more than one source, health problems have often got more than one cause. Preventing heart disease, for example, is not simply about stopping smoking but also about controlling blood pressure, reducing cholesterol, preventing diabetes and encouraging exercise, along with a whole host of other factors.
Nevertheless, public health is an area ripe for debate. A great example is the proposal put forward by John Ashton, President of the Faculty of Public Health, that we should all cut our working hours by a fifth in order to reduce stress.
He has called for the country to switch to a four-day week to help combat high levels of work-related illnesses, allow people to spend more time with their families or exercising, and to reduce unemployment. He cites evidence that long working hours are associated with a variety of illnesses such as high blood pressure and mental health problems.
The flaw in Professor Ashton’s argument, of course, is that four days’ work would mean four days’ pay. Losing a fifth of their salary might not be a major issue for an individual earning £100,000, but for families struggling to survive on £20,000 it could tip them over the edge.
One way of looking at it, I suppose, is that if we have less money it at least means we are more likely to get regular exercise, because we will have to walk or cycle to work to save on transport costs. Our drinking would also fall, and we would probably eat less. All of which would be a boon for my colleagues working in public health.
As a GP, though, I can’t help feeling that this would all be outweighed by the increase in stress that a drop in income would bring and that part-time working won’t have everyone beaming with smiles, as Professor Ashton seems to imagine.
Then there is the impact on public services to consider. The NHS, for instance, is already overstretched by the current limitations on working hours and John Ashton’s proposal could make a bad situation even worse. More worrying still is the thought that some NHS managers might use this as yet another excuse to avoid investing in local mental health services.
We all recognise that juggling life at work and life at home is difficult – and it has become even more challenging in recent years as employees have been expected to work longer and harder. However I do think many employers are becoming increasingly aware of the importance of a healthy workforce and the enhanced creativity and productivity associated with giving employees more freedom and flexibility.
In America, Forbes Magazine recently published a ranking of companies in relation to their ability to allow employees to strike a healthy work-life balance. The company at the top of the list provides flexible working, additional paid time away from work and reduced gym membership.
An alternative ‘public health’ approach might be for companies to assess the health of their whole workforce as part of an annual occupational health screen – including an assessment of stress. In addition to providing each individual with guidance on improving their own health, the aggregated data would also allow the organisation as a whole to identify areas where it might be able to enhance the wellbeing of all its employees.
That strikes me as a far more sensible, not to mention realistic, solution to workplace stress than that proposed by John Ashton.
• Dr Nick Summerton is a GP in East Yorkshire