A few years ago, my dentist in Edinburgh went private; and because he is good at his job, I gave in and joined one of his care schemes. Now, I pay a hefty monthly subscription for one check-up a year, plus hygiene sessions; and any other treatment I need essentially costs an arm and a leg.

It’s not only the cost that makes me unhappy, though, but the change in atmosphere. I find that although I still like the dentist, I’m slightly more sceptical of everything he says, particularly when he’s recommending four-figure treatments. Worse, the waiting room walls now feature advertisements for expensive beauty treatments, alongside the dental health posters; as if dentistry were not so much a medical essential, as a branch of the notoriously daft and pricey beauty industry.

And the more I undergo this small-scale experience of a privatised health service, the more I understand what it is that we love about the NHS, which celebrated its 75th anniversary this week. It’s simply that at its core, the NHS is founded on the high principle that everyone needs and deserves equal care; and that doctors will treat people on the basis of need, and no other consideration. As a human institution, the NHS often fails to live up to that dream of equality, of course; the middle-class, mouthy and well-connected will often do better, in the NHS, than those who are poor, inarticulate or friendless.

Yet still, 75 years on, the ethos of unfailing care survives; and those faced with emergencies, or with a sudden crisis involving a beloved older relative, often express amazed gratitude at how this battered institution, under all the pressures it faces, still manages to produce state-of-the-art care, kindness, respect and attention for those who seem almost beyond help.

I don’t mean, in saying this, to discount the pain of those – and there are many – for whom the NHS fails to deliver. If the NHS is stubbornly loved, though – and if it is a rare “sacred cow”, in an increasingly divided society – it is because it so often does measure up to its principles, delivering not only practical medicine when people need it most, but also the feeling that however old, poor, foolish, unfit, or battered by life we may be, we all still matter, and have a right to be treated with something like love.

It remains true, though, that the NHS at 75 is in serious trouble, with doctors, nurses and other staff expressing levels of anger about poor pay, understaffing and overstretched resources never before seen in the history of the service. And although the causes of the current crisis are complex, there is one source of pressure on the NHS that seems to me to surpass all others, although it is rarely discussed except in vague generalities about preventive medicine; and that is that it now operates in a society which instead of broadly reflecting the same principles as the NHS – as Britain’s postwar governments sought to do, across all social policy – instead routinely undermines its work.

It’s now almost impossible to watch or listen to much news, for example, without someone appearing to deplore the shocking impact on public health of our weakly regulated food market, and the diet of heavily promoted, highly processed foods – full of salt and sugar, and highly profitable to the food industry – to which millions in Britain are now addicted. The result is an epidemic of obesity whose long-term health consequences are both frightening and expensive, as well as a generation of children now measurably shorter than their European age-mates, because of poverty and poor nutrition.

And poor diet is only one field in which our 40-year flirtation with poorly regulated capitalism and public sector austerity has damaged the nation’s health. Deliberate attempts to reduce security at work, and create a lower-wage economy, have put millions on incomes which were barely covering basic expenses even before the current huge cost-of-living hikes.

Drastically reduced public services in areas such as social care have led to a shameful recent decline in life expectancy. Privatised energy companies gouge consumers for cash, and leave millions in inadequately heated homes. The state of the housing market, 40 years after Margaret Thatcher’s sell-off of the council housing estate, is a national disgrace, for both mortgage payers and renters.

And the cumulative effect of this poorly balanced, badly regulated, and frequently heartless society – and its blatant inability to deal with the huge collective challenges now facing humankind – is that it drives people to breakdown. Physical health suffers in obvious ways; but these stresses are also substantially responsible for the current huge epidemic of mental illness, an epidemic which a struggling NHS cannot cure, because its causes are not medical but social, economic and political. Designed to operate in a society which shared its ethos, the NHS now often appears as a lone beacon of egalitarian care and respect, in a society shaped by very different values; and if the service is tottering, alongside its broadly comparable if differently organised European counterparts, that must be a substantial part of the reason.

The most effective long-term cure for the NHS, in other words, is to begin to heal our society so that it once again works with our healthcare system, and not against it. And on its 75th birthday, this is perhaps the best gift the NHS can give us, and that we can give it: the inspiration, and the will, to start rebuilding a society that is based on those same NHS principles – and which, if we have the nerve to invest in it as Nye Bevan’s generation did, will within a few years begin to deliver a nation that is happier, healthier, calmer, more resilient, and far better equipped for the mighty challenges ahead.

NHS crisis is being fuelled by broken Britain’s often heartless society – Joyce McMillan

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