Health Policy May 23, 2019
The democratisation of health: Placing citizens at the centre of healthcare

By Dean Fathers - Accountable Care Journal

At a time when parliamentary democracy is illuminated in the media spotlight, it is easy to forget that plebiscite democracy has, through the millennia, come to challenge the power of the ruling classes. Just as the plebeian of Ancient Rome fought to overcome the antiquated ways of the old Patrician rule, so might we be about to see a changing of the order in the system hierarchy of the current national and global health systems.

This revolution doesn’t come from civil unrest, though it might in some parts of the world, but instead from the relentless and unstoppable advances that are being achieved from the exponential growth of technological developments being derived from computer processing. This progress might soon enable genomic and phenomic intelligence to be contemplated as a norm, not an aspiration, and assist rich data to be generated on the human biological system at scales that bring new solutions to the physical and mental health challenges our mortal being presents.

Dean Fathers – Chair of Nottinghamshire Healthcare NHS Foundation Trust 

Social media has the capability to be used as a predictive indicator of our mental and physical wellbeing. Likewise technology can be used to place us in the specific environment where we each as individuals exist so as to help address the unique weathering impact on each of us within the wider context of our population base; empowering the intelligence of each individual through the creation of holistic knowledge pools where facts and feelings can equally be taken into consideration. This way the level of each citizen’s specific satisfaction with the real experience they have as an individual service user within the system can be evaluated as a distinct outcome, and valued as such for its uniqueness.

The digitisation of health is not about creating electronic medical records, as many believe, to enable practitioners to make more effective decisions about the care of patients, but about enabling the democratisation of healthcare, placing the citizen at the centre of the health, not the sickness, process. It is about enabling us to see the whole individual in the context of their current, past and future life experiences and expectations.

It is also about how clinical and medical support teams play a part in advancing the well-being of citizens so as to enable them to live with dignity in a place and style of their choosing. This new paradigm will enable the life course of the population to be enhanced through artificial intelligence and human empathy – the value of the latter increasing even more significantly in the future as the importance of mental health is more knowingly recognised as a key outcome.

Do not believe, however, that this new paradigm is about to be adopted straight away. There are many constraints, resistance factors and belief systems to be overcome, some more dogmatically held than others. Take for instance the Hippocratic Oath. No one would argue that we should ignore the ‘first do no harm’ principle, but the covenant taken within the oath, not to share the “precepts…and…learning” of medicine with the uneducated and illiterate, can no longer be considered to be defensible and could in fact be argued to be counter to the rights of today’s citizen, who expects to have no decision taken about them without them and to be a full party to that democratic process.


Dean Fathers is Chair of Nottinghamshire Healthcare NHS Foundation Trust.


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