Emory University Summer Programme, 1976-2011

The link with sociologists at Emory University in Atlanta in southern USA has run like a thread through my academic and personal lives. This short blog is a celebration and expression of gratitude to the friends I’ve made, plus one or two reflections on change. Dick Levinson lit the spark in 1976 by approaching Margot Jefferys at Bedford College (now RHBNC) to see if she would be willing to host a six-week summer school for undergraduate Emory students wanting to learn about a very different ‘socialized’ health care system, ‘our’ NHS. Many of the students then and since were ‘pre-med’ (that is, concluding their undergraduate studies prior to applying to ‘med school’). Margot assented and spotted me, an impoverished Ph.D student of George Brown’s, lurking in the vicinity. For a modest fee, would I be willing to coordinate and contribute to the programme on her behalf? Yes I would.

Dick came over with his family of Linda and three young children. As unflappable then as now, he talked me through his expectancies and my duties. Between matriarchal Margot and Dick I survived to pocket the proceeds. It was a summer programme that was to last until 2011. Moreover, like the ancient games at Olympia, it did so without a break. It brought in its wake an unfolding of experience at once exhilarating and worrying.

With the inevitable handful of exceptions, the Emory students over this 35-year haul were bright and motivated. The programme’s hired speakers, a mix of sociologists, allied academics and practicing clinicians – Margot, John Carrier (a permanent fixture, like me), George Brown, Brian Abel-Smith, Michael Marmot, Geoffrey Chamberlain, Anthony Hopkins, Ray Fitzpatrick, David Blane, David Armstrong, Paul Higgs and so many more – rarely disappointed. Equally generous were those clinicians who welcomed the students on 10-day (latterly 5-day) placements or internships as well as one-off visits to clinical facilities. Emory’s pre-meds picked up more (supervised) hands-on ‘clinical’ experience than they could ever have anticipated. This experience fed their CVs prior to applying to med school in the USA.

Annette Scambler, integral to the programme as a lecturer on maternity care, made as many friends as I did: alongside Dick were Mike McQuaide, Terry Boswell, Karen Hegvedt, Al Boskoff, Tracy Scott and numerous others. We were invited to West End plays, Stratford-upon-Avon, Ronnie Scott’s and saw more ‘musicals’ than we might otherwise have wished. And we reciprocated, hosting the students and ferrying our friends to local sites like the Bignor, Hever Castle and, closer to home, Polesdon Lacey.

We also visited Emory more than once, and during Terry’s tenure as HofD in the spring of 1998 were both visiting Professors of Sociology for a semester. Three of many highlights from our trips: in an early ‘family visit’ we enjoyed Dick and Linda’s hospitality and took off for Merida in Mexico to drive across the Yucatan peninsular sampling a clutch of Mayan temples; in our mid-semester break in 1998 we drove our hire car (a Buick – a ‘safe’, sedate, middle-aged and middle-class vehicle according to Dick) from Atlanta via the Grand Canyon to LA and San Diego and back in 10 days, clocking up 5,500 miles (another blog perhaps); and we were guests in March, 2012, for a mini-lecture tour and ceremony of recognition for 35 years of service (I have a bronze plaque destined for the wall of the loo).

The downside has nothing whatever to do with my American friends. But it is symptomatic of the social change between 1976 and 2011 that I have alluded to in other blogs; and it eats like a cancer into our academic (and I think clinical) souls. It can be summarized thus:
1. If the NHS was never ‘socialized’ medicine, it was a remarkably cost-effective, state-centric system of health care that nodded to basic socialist principles; and in 1976 it had yet to be ‘reformed’ (Ted Heath’s organizational tamperings notwithstanding). More than this, it afforded a stark contrast with what the USA had on offer: students could see, sample and debate the differences. What Bauman characterized as the neo-liberalism mark I of Thatcher/Major (and it was the latter that fatefully introduced PFIs in 1992) and the neo-liberalism mark II of Blair/Brown obscured these differences: there was progressively less to differentiate the systems. Correspondingly, the educational return on the programme became harder to nail. My own participation in what is a continuing summer programme fortunately preceded the passing of the Health and Social Care Act in March the following year. What point now comparing our ‘Americanising’ health care (brand ‘NHS’) with the home brew?
2. Emory’s managers and administrators, like those in Britain’s Russell Group elite (including my home base of UCL), relaxed and trusting of their staff through the 1970s and 1980s, sought through the 1990s and into the twenty-first century to maximize their investments. League tables were composed and consulted in the shadows: ‘of course we know they are inaccurate – a game – and so to be taken with a pinch of salt, but …”. Emory had always been a private university, but the screw was tightening. UCL remained a state body, but business principles were trumping its historic ethos. The effects were twofold: (a) Emory and UCL each sought and took a greater proportion of the fees demanded of the former’s students (or their parents) for going on the London programme; and (b) the students had nothing like the social/cultural exposure to a great city by the twenty-first century that they had in the 1970s, ‘80s and early ‘90s (the odd ‘musical’ and meal out compared with an agenda that would whet anyone’s appetite).
3. Changes to the NHS, masquerading as ‘reforms’, paralleled those in higher education. Consultant physicians and surgeons, GPs, nurses and physiotherapists too, handed over charismatic, cultural and/or institutional authority to third-party managers and administrators – admittedly a good as well as a bad thing – and in the process circumscribed and curtailed the Emory students’ exposure to the delivery of NHS interventions. They stood to put their own reputations at risk if they carried on providing experiences of the kind, and at the price, unhesitatingly delivered in past years.
In short, the summer programme, although doubtless still worthwhile, is not a patch on its predecessors.

It would be remiss of me not to offer a sociological comment or two. Marx, Weber and Habermas come instantly to mind: commodification, iron-cage bureaucratization, system rationalisation and so on. Here are a couple more pointers:
• The NHS was between 1976 and 2011 subject to a series of ‘reforms’ less the offspring of evidence-based policy than of policy-based evidence. They were the issue of what in other blogs I have called the new ‘class/command dynamic’ of financial capitalism. In short, class interest became the dominant factor, culminating post-2010 in the no-holes-barred ConDem attempt to privatize or re-commodify health care. This proved a challenge for us as educationalists in two respects: (a) as the NHS became ever more like US health care, it became ever harder to accent the merits of evidence-based arguments for an alternative; and (b) it became harder also to make the case – bread-and-butter sociology though it might be – that governments only ‘do’ rational policy if it fits in with their wider and often hidden (class/command-oriented) agendas.
• As teachers, whether American or English, we were gradually subject to the same functional tick-box culture that afflicted my clinical colleagues. Instead of being trusted in the absence of any evidence to the contrary, it became increasingly necessary for us to demonstrate trustworthiness up-front; and modes of demonstrating trustworthiness are of course crass enough to be compatible with being untrustworthy. It’s ticking the institutional boxes that matters now. All my Emory and UCL colleagues, and each and every clinical professional, was and remains trustworthy. The new ethos and methodology insults them.

Of course I am ageing, so increasingly inclined to nostalgia; but some things actually were better! Long live the Emory programme nevertheless, and many thanks to past and present friends and colleagues from Atlanta.

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