So why would a retired professor of public health decide to write a protest song, get his kids to help him record it, his wife to help him with the graphics, and take his first plunge into the dangerous world of YouTube? Isn’t this the fellow that usually writes dusty academic works about evidence-based practice? The answer is that the song was indeed an attempt at evidence-based practice, just one more tool in the struggle to prevent a major threat to the people’s health, namely Andrew Lansley’s Health and Social Care Bill.
Over two decades ago at the start of my (short) spell as regular BMJ columnist, I argued that public health was a lot better at finding things out than at getting things done; that we needed to get smarter at the practice of making things actually happen. Today one of our chief problems is making something, Lansley’s bill, not happen.
By the beginning of this year the bill’s opponents had accumulated a wealth of arguments against it, but were frustrated at how little progress they were making in preventing the havoc it would wreak. The normal constitutional processes of negotiated amendments and parliamentary procedure were proving woefully impotent. It was time to go all out to stop the bill.
Some of us believed therefore that we needed a large swing in public opinion. If we could foment enough of a movement to scare the politicians about their chances of re-election, we might actually get somewhere. We needed to achieve the equivalent of Thatcher’s “Poll tax moment” (not the riots, of course, just a turning point where the government realises that the legislation is unworkable and capitulates by dropping it). That required us to tip the balance by persuading enough people to make a fuss about the threats the bill poses.
The practical problem was that not only did we seem unable to get the politicians to listen; we couldn’t get the message over to the general public or even (at that time) to many of our own profession.
Four lots of evidence struck me as relevant to solving that political problem. (As always, I use the term “evidence” broadly. This was no time for a Cochrane review). The first was a renewed wealth of authoritative findings that my public health colleagues were suddenly sharing online about the potential damage this bill may do—an invaluable source of ammunition. The second was the subjective evidence that most people’s eyes glazed over whenever I tried to explain those findings to them. It was all too complicated and too longwinded: it needed simplifying. The third was Malcolm Gladwell’s influential book The Tipping Point, in which he analyses the factors that lead to big shifts in public behaviour and concludes that it is a matter of getting a clear message that sticks in the mind, which is then spread like an epidemic, making the most of people who are well connected, respected, knowledgeable and good at selling ideas. Such people will flood the message through their natural networks until the moment comes when the balance tips and things begin changing.
The fourth piece of evidence was NxtGen’s brilliant Lansley Rap, nearly a year old now, which for a while did indeed threaten to tip the balance. An internet sensation at the time, and deservedly so, it reputedly played a large part in scaring Cameron, Clegg, and Lansley into their sham of a “listening pause.” Dammit, if that could get half a million views and cause so much excitement even though Lansley is not—whatever else he may be—a “greedy tosser,” then maybe we should emulate it with something up to date, aimed at an older audience not so attuned to rapping, and where you can see and hear the arguments clearly.
Bringing together those four strands the answer was to try and write a good old fashioned protest song that appealed not only to the heart (the verses that paint a dystopic picture of the post-bill NHS) and the brain (the choruses that summarise the arguments) but also a threateningly obvious repeated refrain (“We’ll never re-elect you if you wreck our NHS”).
Watch the video on YouTube and if you like it spread the link far and wide, asking those you send it to do the same. Along with everything else we are doing, the video may help tip the balance of public opinion enough to rid us of this dreadful bill. It’s had over 11,000 views in three weeks, but it needs a lot, lot more. You never know what a simple protest song can do till you really try.
John Gabbay is an emeritus professor of public health.