I am a psychiatrist. I love people. I believe in happiness and opportunity as basic human needs. As a teenager, I thought that if we could just live in a true democracy, we could have a peaceful world, where everyone could have equal opportunities to reach their potential. I was truly a product of the era of that great song “I’d like to teach the world to sing in perfect harmony”.
However, having no singing talent, to play my modest part in creating happiness and equality, I became an NHS doctor! This blog is written through the lens of my experiences with patients and communities.
Defining & redefining democracy The common dictionary definitions of democracy are interesting, and fascinatingly, quite contradictory.
"The belief in freedom and equality between people, or a system of government based on this belief, in which power is either held by elected representatives or directly by the people themselves."
Others define it as "A system of government by the whole population or all the eligible members of a state, typically through elected representatives."
But, democracy is also often quoted as the "rule of the majority".
We now live in a global world where the influences on our lives are changing fast. What does this mean for our understanding of democracy? Do world events and life changing trends alter its meaning? Post Brexit, how is the ‘whole population’ and ‘majority’ defined? Is our current interpretation working to deliver freedom and equality among the ‘whole population’, or is it just working for a ‘majority’?
In this fast-paced world of greater global influences, of devolution and localism, of a new recognition of generational needs and skills, is it time for a new ‘disruptive’ definition?
Our democratic system should mean that national policy reflects the ‘whole population’ view.
In my role as mental health policy maker, clinician and academic, my view of democracy has been through the lens of delivering health and social justice for my patients and their communities. It can feel like these two viewpoints, the national and local, don’t quite align. In order to generate the ‘whole population’ view, I’d like to leave you with four things to ponder:
1. Consulting the ‘whole populations’ on health and social justice In order to have a democracy, we need to find ways to consult and obtain the views of the ‘whole population’ across generations. It used to be about who came out to vote in elections. How do the digital and social media worlds enable a more in-depth understanding of what the population want, for their active participation in their own local and national democracy?
2. Time to re-balance quantity and quality of life? Younger generations seem clearer that they want good mental health and a work-life balance. So why is there such a continuing emphasis in our high-income countries on just longevity?
The research on QUALYs and DALYs makes interesting reading, and show how this narrow focus could arguably lead to many ‘less democratic’ decisions being made. If we did ask the ‘whole population’ which they valued most, what would they prioritise?
3. Information is key to enabling ‘whole populations’ to make informed choices Can we show we are providing the population with the information they need to make informed choices about their democracy?
New transformational social media means are now at our disposal. In 2012 mental health was a taboo subject in the public eye, but fast forward 4 years and 32 million visited the NHS Choices website mental health section.
Could analysing this information-seeking help us set more ‘democratic’ health priorities?
4. Informed decision making For our hard pressed democratically elected leaders, what information is available to help them make informed decision for the short, medium and even long term?
For the induction of every leader in every sector at every level, could we give them the information they really need about their patch?
This is no longer just a pipe dream: in 2017 the first ever international guidance on how each local area can identify the mental health needs of their populations was published in the Joint Strategic Needs Assessment Guide.
These different lenses have left me with many questions, not least: do we need to re-examine our definition and practical application of democracy, in order to generate fitting national policy?