We are untethered. The world is unfolding faster than we as a social species can manage and unfolding in a way that drives separation not connection. We have a fundamental human need to belong and feel connected. We’ve confused online hyper-communication with connection and let go of the true sense of belonging that comes from being part of a community.
And we are surrounded by painful stories. Our collective stories include legacies of the patriarchy, dehumanisation and power over including racism, sexism and poverty.
If you don’t turn towards a painful story and own it, it continues to own you.
In February 2024 the Institute for Fiscal Studies (IFS) reported that health spending in Scotland is “to fall despite misleading Scottish Government claims”. They do not think that the NHS in Scotland will “survive” without additional funding. This is a painful story.
The UK already spends considerably less on healthcare than equivalent countries such as France and Germany. Data from the Kings Fund shows that relative to comparable countries, the NHS performs well on some efficiency measures, but has less medical equipment, fewer beds, fewer doctors and nurses and poorer health outcomes. The UK already has extraordinary levels of excess deaths due to health inequality. Michael Marmot recently wrote in the BMJ that if everyone in the UK had the good health of the least deprived 10% of the population there would have been one million fewer deaths in England in the period 2012-2019. Of these 148,000 were linked to austerity. Healthy life years have worsened in the UK compared with the average of the 27 EU countries. In 2014 men and women in the UK had a higher average number of healthy years than those in the EU27. By 2017 this had risen by two years in the EU27, but stagnated for men in the UK and fallen for women.
The UK has the largest female health gap (where women are worse off than men) in the G20 and the 12th largest globally. Women are underrepresented in clinical trials. Medical research proposed by women, for women, is not allotted the same funding as medical research proposed by men, for men. Women are prescribed less analgesia than men after identical procedures. Many women’s healthcare services are fragmented and difficult to access.
These are painful stories. These are just some of our legacies of the patriarchy, dehumanisation and power over.
We need to acknowledge and face the extent of our social problems and inequality. We need to actively work on these at the local and national level – “the source of the river” – by reducing poverty and improving available nutrition for example. We need to stop pretending that we can solve social problems using the medical model and offering futile “primary prevention” at the level of the individual, such as social prescribing and psychological interventions for people without mental disorder. This is wasteful and ineffective; in some cases, harmful; and it also diverts resource away from the severely unwell.
I was inspired to become a doctor by my GP growing up: Dr Susan Bowie. As a single-handed GP in a remote and rural practice, her job was not an easy one. As a child I’d always feared going to the GP (perhaps the result of expecting I’d be injected in the backside with something or other each time). When I met Dr Bowie though, she was warm, clear, knowledgeable, and compassionate. I trusted her instantly. She did not inject me in the backside, which probably also helped. She’s clearly very committed to her practice as she’s remained there since 1988.
The author bell hooks defines love as a combination of six actions: care, commitment, trust, responsibility, respect and knowledge. Dr Bowie I think demonstrates love for her patients and her island community.
Love is not present when we seek to gain or keep power over.
Love is not present when we lie or deny the reality of painful things like the extent of inequality and poor NHS funding in the UK.
Love is present when we act with fierce compassion in our response to our patients, our colleagues, our services and the inequality that we see – channelling “mama bear” to protect the things that we rightly care for.
Love is part of our answer.
We need leaders who act with self awareness and love and who share power rather than seek to keep or gain power over. We need a leadership culture that connects rather than divides. We need a culture that embraces female leaders as when more women are empowered to lead, everyone benefits. Women leaders are good for business: venture capital firms with a higher proportion of female partners make more profits. Women leaders also increase productivity, enhance collaboration, inspire commitment to organisations and improve fairness.
We all benefit from a world that’s more inclusive for women.
Dr Joanna Bredski is Deputy Chair of BMA Scotland’s Consultant Commitee
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