Sometimes, while attending a World Health Assembly (WHA) in Geneva, I get the feeling that I am in a parallel universe where diplomat speak serves to smooth over unresolvable conflict and where we are discussing not the world as it is but a fantasyland. That feeling was never stronger than when listening to contributions from the US delegation during the worst of the Bush era. Maintaining a connection with the reality of inequality and preventable death and disease is made more difficult by the grandeur of the Palais des Nations with its marble halls and stunning views over Lake Geneva.
The WHA provides an irresistible platform for Ministers of Health to extol the virtues of their domestic health achievements while telling the rest of the world what should be done. I have been waiting all week for the Department of Health in London to put on their website the text of Monday’s speech to the WHA by the UK’s Secretary of State for Health and the leader of the UK delegation, Andrew Lansley. It hasn’t appeared. I did, however, eventually find it on the website of the UK Mission in Geneva and now understand why it isn’t for domestic consumption.
If you work in public health in England you might be forgiven for not recognising the following sentence: “We are recognising and acting on the effects which employment, education, housing, and the environment have on health outcomes.” I could point to the ending of the highly successful Healthy Schools programme, and Jamie Oliver might have something to say on school meal standards. That’s without getting into the growth in unemployment, cuts in educational allowances and housing benefits, and the failure to deliver promises about being the “greenest government ever.” According to a YouGov poll only 2% of the population believe the UK has the “greenest government ever;” and the people are right.
Other statements that may surprise audiences in England include; “Back home our investment in the National Health Service is strengthening our universal primary care infrastructure. We are focused on developing preventative services, on early interventions and minimising unnecessary hospitalisation.” I wonder how many people working in the NHS, and primary care trusts in particular, will recognise that version of reality. They would perhaps point to the systematic dismantling and fracturing of the public health system in England with the creation of multiple splits in responsibility for key areas such as immunisation, sexual health, and screening. Not a good basis for preaching to the world you would think.
The atmosphere at the WHA is however generally friendly, highly co operative, and committed, but it is necessary to step out of it occasionally in order to, as we would say in the North of Ireland, “get your head showered.” My favourite escape is to go next door to the Ariana Museum (pictured). It is a most gorgeous building housing a wonderful collection of glass and ceramics. It also has a small and very quiet café with a lovely balcony. The minutes of quiet and stillness make it possible to cope with even the most outlandish speeches.
Gabriel Scally is a public health physician and holds visiting chairs at the University of the West of England and the University of Bristol.