Published: 19/09/2002, Volume II2, No. 5823 Page 20

Dominic Harrison's letter (15 August) argues that health is a 'social product arising from the cumulative impact on individuals of what happens in families, workplaces, schools and transport systems'. The key sentence in his letter is: 'there is almost no convincing evidence... that spending money on health services has any impact on population health - as measured by life expectancy.' I fear he will not convince most people - including most politicians.

Life expectancy may be a useful measure for some comparisons, though I suspect it is used mainly because it is one of the few bits of health data which is fairly universally collected - a classic case of measuring what can be measured.

Life expectancy is the last thing on the minds of most people who engage with health services in countries like the UK. What they are looking for is a happier and healthier time while they are alive - to be, if possible, free from physical and mental pain and discomfort. For the better off, I would argue that much of what is called healthcare has, in a sense, become a commodity; it is something they want, rather than need.

I certainly agree with Mr Harrison that, for the less well-off, health is a 'social product', and hospitals should not be the top priority for investment. However, for the people who vote in the constituencies that matter to our major political parties (Kidderminster being a recent prime example), hospitals also seem very close to being a commodity. The effect they have on 'health' is a matter of little or no interest.

The paradox is that the endless stream of recent 'health initiatives' designed to appeal to this constituency often actively work against the interests of the people who have the least healthy lives. The middle classes win again - and health workers lose out as they battle to sustain the unsustainable.

Kate Orchard Senior manager North Somerset primary care trust