Second Opinion: A reel opportunity to explore complex healthcare issues

‘Just enjoy the film, Dad, you don’t always have to write about it,” is a familiar refrain from my family on our sporadic outings to the movies.

Yet cinema was the great art form of the 20th century and this century is continuing the same way, according to Philip French, the masterly film critic of the Observer who retired this month after more than 50 years in the post.

The broad appeal and high profile of the medium provides a fantastic opportunity for commentary, powered by the cocktail of entertainment, aesthetics and information, that characterises good art.

As a teacher in medical humanities – where we try to open students’ eyes to the complex relationships between medicine, personal experiences of illness, and societal currents – film is a treasure trove for exploring these complex ideas and debates.


In some instances this is a primary focus of the film, such as stroke in Amour and The Diving Bell and the Butterfly, pandemics in Contagion, and alcohol dependency in The Lost Weekend.

Perhaps more interesting are films where the themes are a byproduct of astute perception.

Clint Eastwood almost certainly did not design Gran Torino to be a remarkable commentary on ageing, and the carefully crafted Revolutionary Road provides telling insights into depression.

Last week's release of Elysium once again showed the opportunity to provoke timely reflection nested in a summer blockbuster.

The first movie from its South African director, Neill Blomkamp, was the superb District 9, a transposition of apartheid into an alien science-fiction movie. By removing the topic from its familiar roots and context, we experienced the horror of apartheid afresh.

In his next movie, Elysium, the themes have a clear resonance with the current debate on US president Barack Obama's healthcare reforms – for those who are willing to see them.

In an overcrowded, impoverished and polluted future Earth, the super-rich have removed themselves to a huge space station – the eponymous Elysium – with cutting-edge health technology denied to all remaining on Earth.

Rather like current migrants attempting to reach European shores, the desperate pay criminals to try to reach Elysium.

While many die on the way, those who arrive are barred from healthcare and returned, mirroring the current debate in the United Kingdom to charge illegal immigrants for NHS healthcare.

Universal healthcare
In a divided and politically partisan United States of America, opposition to the extension of universal healthcare has often been driven by party loyalty, doctrine and raucous polemic (and the role of the medical profession has not been inspiring).

Perhaps moviegoers from across the divide, on a night out to see a spectacularly executed action and science fiction movie, might see afresh the cruelty of a healthcare system where almost 50 million people do not have health insurance, but in a context that is free of the usual political prompts and spurs.

Class and health
However, at a deeper level, the director has also planted a more subversive message on class and health.

One of the most important discoveries of the past decade has been the recognition that the health of a population depends more on the social gradient – the gap between the rich and poor in a country – than on the average wealth of its citizens.

This is a subtle concept, and one that runs counter to the tenor of much political discourse in the US, despite explaining the relatively poor life expectancy in the face of a high spend on high-tech care.

In Elysium, the instant cure scanners for the rich are clearly not ever feasible at any stretch of the imagination. At the end of the movie and thanks to the heroics of the taciturn hero Matt Damon, we see that these scanners will now be accessible to all, but on reflection we also realise that this access in itself will not fix the huge gulf in health and wellbeing between the impoverished masses and the extravagantly rich super-elite.

So a film recommended to all, and providing entertainment as well as unobtrusively giving food for thought on many levels.

However, the trailers accompanying the movie put me on notice that my next commentary on ageing on celluloid – Bad Grandpa from the makers of Jackass and due for release in October – might prove far more challenging, if not equally entertaining.

Prof Des O'Neill is a consultant in geriatric and stroke medicine