Chronicity and the care team in Britain’s New Jerusalem

Abstract

, J. J. A. Reid-a well-known public health practitioner-addressed a familiar theme. 'In this country', Reid began, 'the problems with which all branches of our profession are faced are very different from those of the past, when poverty, ignorance and infectious diseases were the main enemies of health. ' 'Nowadays', Reid continued, 'it is towards cardiovascular disease, cancer, bronchitis, accidents, mental disorder, and such chronic conditions as diabetes mellitus and arthritis that we must look for the principal sources of mortality and morbidity. ' For Reid, medical advances, increased education, and economic growth might have conquered the diseases of the past, and they were probably the sources of progress in the future. In the present, however, this combination had also provided the conditions for 'smoking … overeating, and … [lack of] exercise' that caused 'maladies of plenty'. 1 For Reid, and other Medical Officers of Health (MOHs), doctors, and lay persons involved in public health activity, this changed profile of morbidity and mortality required new approaches. On the one hand, these practitioners spoke of a 'New Public Health' , based on persuasive health education campaigns that would help individuals to manage the imbalanced lifestyles supposedly underpinning novel burdens of disease. 2 On the other hand, they recognised that such campaigns could form only one component of efforts to confront chronic disease. For conditions like diabetes, even contributory factors to onset were unknown, and complete disease prevention was not considered possible. Moreover, patients managing such illnesses were believed to encounter psychological challenges, discrimination, and often painful long-term complications. For these problems, it was argued, early diagnosis and treatment by a multidisciplinary team of medical, nursing, and technical staff offered the best solutions.