The Vault

Welcome Address

Professor Ian Webster
Chair, Faculty of Medicine, The University of New South Wales, Sydney.

 

You have come from many different communities and countries; I welcome you to the University of New South Wales.

Being in the same medical school as David Garlick and sharing his interest in prevention and social well-being, I have naturally been exposed to the teaching and philosophy of F.M. Alexander through David.

When we think of health, we think of harmony; when we think of improving health, we should aim for integration.

Community

At the very minimum, the food we eat, the water we drink, and the air we breathe should be safe. And for health to be truly maintained everyone should have access to the resources, benefits and services that are available. Thus, for community health, there should be a real sense of community—support—in the deepest meaning of that word.

Individual in the Community

No person is an island. In health, that is especially so.

When medical students see patients in hospital, I ask them to appreciate the life experiences of their patients under their care. I enjoin them to "lift their eyes" from the patient in front and look beyond—to where they have come from, and to where they will go. There is a rich life experience and history of health and disease locked into the narratives of everyone. It can be likened to the growth rings in the trunk of a felled tree.

Many of the people in hospital at present come from unemployed groups. The communities they come from—with high rates of unemployment, are unhealthy from social unease and because the unemployed lack a sense of worth, their esteem is crushed, their mental state blunted and their physical health affected.

Integration of Body and Mind—and the Social World

Health is affected by such diverse factors, factors not usually listed in medical textbooks. This diversity must mean that the situation requires a comprehensive and integrated approach. Super-specialisation isn't able to solve these problems.

F.M. Alexander advocated that health and well-being depended on the integration of the mind and body. He started with the physical and reached towards the psychic; and I would add the social dimension.

Community Medicine

Twenty or more years ago, community medicine was a response to the fragmentation and over-specialisation in medicine.

Many people were looking for alternatives in many aspects of community life, and at a global level. ELF Schemata's book, Small is Beautiful, was published at about that time. He believed that we should look for alternative low cost technologies.1

In the same period, Dr Julian Tudor Hart, a Welsh general practitioner, wrote a telling account of the mis-direction of medical services in the British Medical Journal.2 He coined the phrase "The Inverse Care Law", which, put plainly, means doctors in the UK worked in areas where they were least needed. That is true of Australia, other countries, and Sydney at this very minute.

Alternatives

What are the alternative and community orientated ways to prevent disease and to lessen dis-ease in the community? Are there low cost and appropriate technologies available?

Some of these alternatives have been found, and depend on:

  • changing behaviour;
  • altering life-style;
  • patient and community education;
  • early detection of disease;
  • self care and self-management;
  • self monitoring;
  • low cost methods;
  • government actions, eg controls on advertising.

David Garlick's interest in the Alexander Technique crossed the path of community medicine, and we have discussed these ideas. In many aspects of thinking about alternatives, the Alexander Technique meets the gold standard expected of health interventions:

  • it does no harm (primum non nocere, as we say in medicine);
  • it is behaviourally appropriate; by which I mean it is consistent with normal patterns of daily living;
  • it introduces no foreign agents into the human body;
  • it is cheap.

Attitudes and Behaviour

I work with people affected by alcohol and other drugs. It is said that attitudes determine behaviours, but often it is the other way around.

One example comes from the medical profession. Doctors know very well that cigarette smoking and alcohol consumption adversely affect health. Yet they often do not identify these problems in patients. They have been pessimistic as to whether anything could or should be done at all.

We now teach in medical school how to assist patients to stop smoking and to moderate drinking, and doctors are developing more positive approaches to these problems in general practice. If you can show people what they are capable of, and encourage them to do this, attitudes become more positive.

So, planned behaviour change can affect a person's attitude, belief in themselves, confidence and their capabilities. There is no doubt that regulation of the physical body can influence a person's mental subjective experience of well-being, pain and discomfort. Take, for example, the hyper-ventilation of anxiety, the pain of childbirth and the chronic pain syndromes. The Alexander Technique does this too. Posture and physical relationships in muscles influence the way people feel about themselves and their health, and how others regard them.

I wish the conference well over the next few days. In your discussions there will be opportunities to reflect on the wide contributions to community health.

FOOTNOTES

1. Schumacher, E.F., Small is Beautiful: A study of economics as if people mattered. Abacus Books, 1974
2. Hart, Tudor Julian, "The Inverse Care Law" in Lancet, 27 February, pp.405-412, 1971

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