Harry Cayton: To lead healthy lives, we must look beyond the health service

We are less sick than we've ever been, but we certainly don't feel well. We live longer than ever; we have more treatments, more drugs, more research. So how is it that we are so sick? How come expenditure on the health service continues to rise but patient satisfaction continues to fall? How is it that health, or rather ill-health, is always news, and personal and political anxiety about health is the constant theme of news bulletins and front pages?

Modern life is making us sick because we have created a healthcare industry which is rewarded by how it deals with ill-health. Without illness, doctors, nurses, clinical scientists, pharmaceutical companies, hospital managers, research charities and health policy-makers would be redundant. The global pharmaceutical industry is the most obvious investor in ill-health, creating new illnesses for new products, but they are ably supported by tobacco and the junk-food manufacturers.

Part of the problem is that we have come to believe that it is medicine that has improved our health, and that it will continue to do so. We look to medical research, to doctors and nurses, to complementary therapies and vitamin supplements to put us right. In truth, it is clean water, proper sewers, warm dry housing, decent food and employment which have together done far more. That is why reclaiming our health from the food and sickness industries, including the governments seduced by them, is vital for our wellbeing.

Most of the public health campaigns of recent years have been based on the assumption that knowledge changes behaviour. But preaching and teaching do not have a great record of success in making people healthy.

Public health policy fails when its does not include the public. To include the public means to start where they are and to build on everyone's reasonable desire to live well. Wellness comes from all the aspects of our lives; home and work, relationships, money, good food, exercise. Wellness does not come about by abstinence from life but by participation in it. That is what Health Citizenship means.

Harry Cayton heads the Council for Healthcare Regulatory Excellence. This is taken from 'Health Citizenship', which he co-wrote with Michael Blomfield and which is published by the Smith Institute