BMA presidency acceptance speech: fighting the alligators of health inequalities

It is midsummer. It is appropriate to have a midsummer night’s dream. In my midsummer night’s dream, what visions did appear!

Me thought I was translated: president of the BMA.

To quote Puck: Lord, what fools these mortals be!

President of the BMA? Surely not. Not me.

I confess to a rich fantasy life but, had I but thought about it, presidency of the BMA would have seemed marginally less probable than playing the viola with the English Chamber Orchestra or winning the senior tournament at Wimbledon.

That I should be surprised to be approached to be president of the BMA is not false modesty—remember: don’t be modest, you’re not that great—no, my surprise was entirely reasonable. My research has been focused on inequalities in health. Latterly the focus has been on what can be done to address the issue. Both in research and policy I have emphasised the circumstances in which people are born, grow, live, work, and age. These all loom larger as causes of health inequalities than defects in our healthcare system. Heart disease is not caused by statin deficiency; stroke is not caused by deficiency of hypotensive agents. I have emphasised not just the causes of health inequalities—behaviours, biological risk factors—but the causes of the causes. The causes of the causes reside in the social and economic arrangements of society: the social determinants of health.

My first reaction, then, was that I was an odd choice for BMA president. My inner monologue quickly changed that to: an imaginative choice. No one is more concerned about health inequalities than the medical profession, whether the …