A social memetic to save the NHS

By Ben Janaway
September 2, 2017

The National Health Service is failing. Years of underfunding, over-expenditure and reorganisation have left the service struggling. Reports show a £2.45 billion deficit. Regardless of 'record investment', the gap between what is needed and what is given persists. Privatisation will leave the poor without care, and the results will be devastating. New money is needed, and it may fall to ordinary citizens to take responsibility. And it is our approach to handling the crisis that must change. The solution is a reformation of public values and the creation of social epidemic.

Whilst the majority have little experience of NHS care,  one day, they will. Action must be taken now to tackle the effects of dwindling resources. The problem is complex. A social epidemic must take into account myriad contributory factors, including theology, philosophy, politics, economics, science and anthropology. The argument must find a common ground between these diverse and possibly incompatible areas. And it must take advantage of what we know about the nature of a successful epidemic.

Creating a successful epidemic

"The tipping point is that magic moment when an idea, trend, or social behaviour crosses a threshold, tips, and spreads like wildfire" . – Malcolm Gladwell

In his best-selling book,The Tipping Point, Malcolm Gladwell discusses the science of epidemics. Be it sales or stopping crime, he argues that understanding how the combination of context, 'stickiness' and the role of key players is the key to success. More often than not, the answer is based on factors that may seem counter-intuitive. Crucially, he points out that for an idea to 'stick' it must talk to people on a personal level and be able to mutate as it spread, whilst retaining its core elements. A good slogan can change the world.

To create a social epidemic to save the NHS will require the following:

  • Arguing a universal moral imperative in protecting the NHS
  • Understanding why people ignore disease and why the NHS is failing
  • Using the above knowledge to create a social memetic designed to overcome these barriers
  • Create a blueprint for beginning the epidemic and creating the best chance of success

A universal moral imperative

'Whatever is done for love always occurs beyond good and evil - Freidrich Nietzche

Any universal moral argument must unite religion and atheism. Professor Richard Dawkins makes a convincing argument for a common ground. He states that a modern believer picks and chooses which theological lessons they practise. Dawkins argues that this choice negates the need for religious text. The practitioner picks and chooses based on a contemporary cultural morality. In this way, the end practices are made using the same logic as secular practitioners. God provides the text and believers pick what works.

Secular philosophy comes to the same conclusion. Freidrich Nietzsche, tthe archetypal 'nihilist', argued that the inherent purposelessness of life creates the opportunity for relative morality. Immanuel Kant, an idealist, argued that humanity's inherent morality creates a 'categorical imperative' which seeks to benefit us overall. Both come to the same conclusion, offering a choice to act morally (except Kant would argue that ignoring the choice is inherently immoral.)

Underneath it all, the iconoclasts say the same. Regardless of whether it is perceived as a theological imperative or a personal choice, a universal moral imperative exists. And helping our fellow humans is part of that.

Understanding why people ignore disease

To understand why the NHS is failing is to appreciate the complexity of human behaviour. In broad strokes, if people cared more about disease risk and understood the economics, pressured politicians and took responsibility, funding would increase dramatically. To understand why people ignore the risk of disease, we may examine how it comes about. This includes accounting for genetics, psychology, anthropology, economics and politics. If we can understand why people ignore disease, it is possible to create an epidemic which will make people care.

As we age, disease becomes more prevalent. The reasons for this include a combination of genetics, chance and time. Using Gladwell's analytical technique, we can study the age related increase of disease as an epidemic. Reasons for the increase of disease with age are multiple and additive. Biologically, our bodies become less efficient at maintaining function. Psychologically we ignore symptoms, delay diagnosis or assume a greater efficacy of treatment than is possible. Over time we are exposed to more toxins and undertake more harmful behaviours. Together these work together to create a 'tipping point' where disease is inevitable.

Genetic science can explain how primal behaviours can contribute to this problem. Short-lived behaviours become hardwired in a species and can be used to explain complex social behaviours that may seem detrimental to the species. In essence, genetic theory translates into societal behaviour. Genes are concerned with replication. In The Selfish Gene, Dawkins explains that chance mutations which confer a survival benefit to a species will become honed over time. These 'adaptive' traits, physical or psychological, become a strong force in maintaining replication. Upon viewing how a species act, the influence of these adaptive traits is clear.

Adaptive traits tend to benefit reproduction. If a genes purpose is to replicate, it is done at conception. People tend to have children from their teenage years to mid-thirties. Disease risk increases with age, often many years after reproduction. Genes protecting against age related disease do not feature in the genetic game of chance and propagation, as they are not as important to replication. This includes psychology. There is no reason to fear dementia as our genes were never selected to experience it.

On an anthropological level, we can see the influence of this behaviour patterns emerge. As a culture, we tend to engage in behaviours that promise a short-term pay off (drinking alcohol, smoking, overeating, casual sex) and ignore those that would protect us in the long term (exercise, healthy diet, regular health check-ups.) The short term psychology of 'adaptive behaviours' does not extend beyond the near future.

A personal and cultural investment in the NHS is incompatible with our major behavioural traits. This, combined with what we know of biology, creates the combination of factors that Gladwell refers to. The 'tipping point' for personal experience of disease is a result of the above.

Understanding how and why the NHS is failing

Genetic theories of adaptive psychological traits suggest that an individual will act in a way that increases the chance of their own reproduction. A politician is no exception. If they can convince the population that they are doing them a favour, they may stay in power. By promising 'action' on the NHS (which sounds good), they can benefit from short term gain (votes) without dealing with the long term repercussions. Since many people don't think too far ahead, they are easily manipulated by empty promises. The lack of action is forgotten in the next election.

When economics is factored in, the influence of adaptive traits becomes stronger. Selling the NHS to a private company has an instant benefit to the politician and policy makers, and holds the same risks as the empty promise. Genes responsible for success up to reproduction are the same as those which create the psychology of privatisation. They are also the same as those which cause voters to ignore the long term consequences.

We have reached another 'tipping point', where the NHS may end. The influence of genetics, economics, politics and anthropology have created a situation where privatisation is becoming a reality. Our ignorance of the future allows political self-gain to run riot. By not considering our own futures, we ignore our best protection against disease.

Creating a new social memetic 'Love your neighbour, for his disease is your own.'

Using genetic theory, we think of traits as adaptive. On an individual level this means reproduction but on a societal level, our goals change. Instead of only rewarding changes leading to replication, we encourage those leading to increased life quality for all. The NHS is an example of a good 'societal mutation.' It means that people live longer and happier lives.

You may argue that the NHS was inevitable. Our intelligence as a species led to the development of the moral and, perhaps, religious philosophies that dictate our moral statutes. Part of this was to create a socialist health system. Our adaptive trait of 'intelligence' went beyond its primary purpose. In some, investing in the future was an adaptive trait, whilst for others, decision making relied on short term returns. So the question arises, how do we create a societal mutation that over-rides our main genetic drivers, overpowers politics and circumvents economic limitations? And how do we make it stick?

The answer is simple, we must create an idea that is powerful, generalisable and takes into account the nuances of all the above. It must use what we know about human nature, the common ground of philosophy and religion, the patterns of anthropology and it must battle the limitations of politics and economics. Societal responsibility must create a tipping point where investment in the NHS is inevitable. It can be as simple as a sentence, but must be appealing and unifying.

Love your neighbour, for his disease is your own. Save the NHS

The appeal of this slogan is clear. The first part is familiar, the second personal and the third part an imperative. The choice of a religious text is based upon creating the maximum potential for recognition within the UK population. The equivalence of another's disease with that person is an extension of the social memetic. The simple terminology of 'Save the NHS' is sticky. The statement can mutate, but would unlikely move beyond the core message. It is powerful, morally ubiquitous, personal, generalisable and placed in context. The slogan potentiates the NHS as an adaptive societal mutation.

Anthropologically, human behaviour can service society overall. This is clearly seen in the manner in which the world has progressed though socialist structures based on a common morality. The mantra also takes this into account, identifying and exploiting our cultural psychology and 'societal mutation' toward overall shared benefit.

Economics and politics are a problem but can be overcome easily. We know that at an individual level, the fiscal cost we would pay to save a loved one is irrelevant. We also know that on a primal level, we will vote for a politician whose ideas reflect our own. If we can create a big enough motivator for a politician so see protecting the NHS as a personal driver, the societal motivation wins out.

Creating the Blueprint

The slogan itself is not enough. It is a jumping off point for discussion and action. Gladwell concludes that the work of influential speakers, the creation of unified small groups and the use of context leads to a successful epidemic. Spreading the slogan will mean creating discussion, reaching out and sharing successes. Here is a simple plan, which should build a community, spread the word, engage influencers and record success;

1. Create a small group to discuss the slogan, considering health and how you may help the local NHS. Meet as regularly as you want. Bring food, drink, pens and paper. And a laptop.
2. Write a letter to your MP asking for more funding, contact radio, papers, news, organise local campaigns. Share your health care stories, successes and campaigns. Ask others to do the same.
3. Create a local Facebook group: 'Love your neighbour, for his sickness is your own. Save the NHS – Plymouth.' Encourage discussion, join efforts, create your community.
4. Reach out to others, ask them to do the same. Turn a community into an epidemic.

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© Benjamin Janaway is an NHS physician, journalist and author. His background is in Medicine and research Neuroscience. His interests include human rights, science and philosophy. He believes in consilience, the bringing together of excellence and experience from different fields toward the betterment of others. He contributes to The Canary, the Independent, Patient and other national news sources. He is chief editor for Trusted Medicine. You can follow him on Twitter @drjanaway

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