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By P. Lares. Union Theological Seminary.

The White Paper later asserted that ‘the strong association between low income and health is clear’ and immeditely added that ‘for many people the best route out of poverty is through employment’ (DoH 1999:45) discount 10 mg bentyl with amex. For the many people for whom that route was not practicable, the White Paper offered no alternative. Given the continuing controversy around health inequalities, it is worth briefly tracing its evolution during the 1990s. The concerns of the 1980s that increasing differentials in income were resulting in a growing gap between the health of the rich and that of the poor, became an increasingly prominent focus of medical research and discussion in the 1990s. Encouraged by Donald Acheson, the Kings Fund sponsored a series of investigations and seminars which culminated in the publication of Tackling Inequalities in Health in 1995, subtitled ‘an agenda for action’ (Benzeval et al. The BMA produced a report in the same year recommending a wide range of economic and social policies in 90 THE POLITICS OF HEALTH PROMOTION response to this problem (BMA 1995). Both before and after its 1997 election victory, New Labour adopted the issue of health inequalities as one of its major themes, a preoccupation that is reflected in its public health policy documents. At first inspection, the extent of medical and political concern with health inequalities appears puzzling. Though, as we have seen, class differentials have persisted, in real terms the health of even the poorest sections of society is better than at any time in history: indeed the health of the poorest today is comparable with that of the richest only twenty years ago (see Chapter One). Furthermore, it appears that the preoccupation with social class in the sphere of health (as indicated by the scale of academic publications) has grown in inverse proportion to the salience of class in society in general. After the emergence of the modern working class following the industrial revolution in the mid-nineteenth century, the question of class and its potential for causing social conflict and, for some, social transformation, dominated political life. It appears that after this era finally came to an end with the collapse of the Eastern bloc and the Soviet Union in 1989–90, and the political and social institutions organised around class polarisation lost their purpose, the subject suddenly became of much greater medical and academic interest. No longer subversive, class had acquired a new significance in relation to the social anxieties of the 1990s. A closer examination of recent debates about issues of class and health reveals some of the concerns underlying the discussion of health inequalities.

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She was reticent until I told her I was uninterested in the actual number of pounds she weighed; I simply wanted to know if she weighed more at night than in the morning and how much buy cheap bentyl 10 mg on line. She reluctantly agreed to observe this before her next visit, which we scheduled for a week later. I called her psychiatrist and enlisted his help because I wasn’t sure she would come back after this discussion, and I had a strong inkling I might Is Your Weight Problem Really Diet-Related? At her next appointment, Ruth indicated there was somewhere between a four- and six-pound difference between her night- time and morning weight! I asked her to raise her lower leg for me and said I was going to tell her what was wrong and how she could definitely lose some weight. When she extended her leg, I pressed on her lower leg and showed her the indentation mark it left for several seconds after I released it. This physical finding, together with all her other symptoms, indicated a medical condition known as edema, or the abnormal buildup and reten- tion of fluid. It is often associated with pregnancy (when it’s known as preeclampsia). It is commonly seen in the feet and ankles, usually because of the effect of gravity. As the fluid accumulates, it often pinches off the nerves temporarily to the hands and feet, causing neurological symptoms such as numbness. Fluid also builds up in the front of the shins where it makes the skin tight and causes pain. It also accumulates in the hands— which is why Ruth’s rings were sometimes tight and she couldn’t perform fine motor functions. Clearly, this condition was also the reason for her constant urination during the night. As fluids build up during the day, the body naturally tries to rid itself of all this extra fluid at night.

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However buy bentyl 10mg without a prescription, an uncooperative or distressed child might have to be carried by a paramedic or parent in as neutral a position as possible, and be comforted en route. For transportation, the patient should be supine if conscious or intubated. In the unconscious patient whose (a) (b) airway cannot be protected, the lateral or head-down positions Figure 2. The flexion can be relieved by inserting padding under the neck on the spinal board, the semirigid collar must be the thoracic spine (b). Only the physically uncooperative or thrashing patient is exempt from full splintage of the head and neck as this patient may manipulate the cervical spine from below if the head and neck are fixed in position. In this circumstance, the patient should be fitted with a semirigid collar only and be encouraged to lie still. Such uncooperative behaviour should not be attributed automatically to alcohol, as hypoxia and shock may be responsible and must be treated. If no spinal board is used and the airway is unprotected, the modified lateral position (Figure 1. In the absence of life-threatening injury, patients with spinal injury should be transported smoothly by ambulance, for reasons of comfort as well as to avoid further trauma to the spinal cord. They should be taken to the nearest major emergency department but must be repeatedly assessed en route; in particular, vital functions must be monitored. In transit the head and neck must be maintained in the neutral position at all times. If an unintubated supine trauma patient starts to vomit, it is safer to tip the casualty head down and Figure 2. However, patients can be turned safely and rapidly by a single rescuer when strapped to a spinal board and that is one of the advantages of this device.


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