Healthy life expectancy is shorter in the UK than abroad
People in the UK enjoy fewer years of good health before they die than the citizens of most comparable European countries as well as Australia and Canada, a major report shows.
The health secretary, Jeremy Hunt, said Britain’s performance was “shocking” compared with that of other countries, and called for action to turn it around by local health commissioners, who are about to take up their new responsibilities.
The UK ranked 12th out of 19 countries of similar affluence in 2010 in terms of healthy life expectancy at birth, according to a detailed analysis from the Global Burden of Disease data collected by the Institute for Health Metrics and Evaluation (IHME) in Seattle.
Despite big increases in funding for the NHS in recent years and many reform initiatives, the UK was in exactly the same place as in the league table for 1990, according to the IHME report, published in the Lancet medical journal.
Emphasis added. The report’s authors, and the Guardian article from which I quote, are at pains to say that
the problem is only in part to do with hospital care – much of it is about the way we live. Our diet, our drinking and continuing smoking habits all play a part
In other words, Britain’s relatively poor average life expectancy partly is to do with NHS hospital care, but they would rather not say so. As for the remainder of the problem that is not caused directly by the failings of the NHS, I wonder if the report’s authors have considered the possibility that the “despite” might be a “because”? Why do the British do worse than other nationalities of similar wealth when it comes to living an unhealthy lifestyle? It is no answer to just say “culture”; why is our culture as it is? Have we always been thus? We have a long tradition of getting drunk, I grant you, but my impression is that the British were not considered any fatter or any more drug-addled than comparable nations a few decades ago… before 1947, let us say for the purposes of discussion.
It is often said that one of the great blessings of the NHS is that it has lessened the fear of illness. The fact that they do not have additional worries about costs or insurance does come to those already worried about illness as a huge relief, and NHS-sceptics like me have to engage with that, sometimes in our own lives. So let us do so. I submit the hypothesis that a certain amount of fear of getting ill is salutary – both in the general sense of producing a beneficial effect and in the more specific, and original, sense of promoting health.
Naturally, I speak here of averages over a large population. Many illnesses cannot be avoided by human action; that is what insurance is for. When considering any one individual, I doubt that when making the many small bad decisions that have the cumulative effect of making him or her unhealthy, “hey, I don’t have to worry about paying for healthcare” often comes consciously to mind. But, like the proverbial mills of God, the mills of incentives grind slow but they grind exceeding small. In some countries those many small decisions take place under the shadow of “I might end up with a bill for this”. In Britain they do not. My hypothesis might go some way to explaining Britain’s anomalously poor average health. Something must explain it.
By the way, I shall take it as read that every human being has a perfect right to eat, drink, smoke and inject as he or she pleases. I shall also take it as read that the authors of the report and 95% of its readers wish to deny others that right. If the hypothesis above is correct, Britain has set up a system that, besides the inherent wrong of being based on coercion, removes one of the incentives for people to take care of their own health. How to solve that? More coercion, of course.
In April, my friend Elena Procopiu is going on a trek through the Atlas Mountains of Morocco, to raise money for a charity called the Moroccan Children’s Trust. Elena writes about MCT’s activities,and her fundraising activity for it, here.
There are hundreds of children on the streets of Taroudant suffering daily harassment, humiliation, physical abuse and exploitation as they try to earn a living off the streets. …
… and MCT is trying to do something about that.
Elena’s many friends have started chipping in. I will shortly be doing likewise. I have already learned some geography, by googling Taroudant.
I am looking forward to hearing about this expedition when Elena returns to London. Just as interesting as her report of the trek in the mountains will be what else she will then be able to tell us all about the work of MCT. After the trekking is done, the trekkers will spend a further few days meeting some of the local Moroccans involved, and some of the children and parents they are trying to help. If anyone reading this is inclined to donate also, Elena assures us that this is the sort of thing that all their donations will be spent on. The trekkers are all paying their own travelling expenses.
It makes a difference to me that Elena is personally acquainted with the people who run MCT, which as of now seems to be quite a small operation, with no big London HQ or any such nonsense. The boss of the enterprise is a British doctor. I’m guessing that MCT began when he was doctoring in Morocco, but then realised that many of his patients, or potential patients, had other problems besides medical problems.
I say “or potential patients”, because it is a sad sign of the times we live in that an important part of MCT’s work is helping people fill in forms, so that they can then visit doctors, attend schools, and so on. Sadly, being a bureaucratic un-person can be a slow sentence of death to someone already on the poverty line, in a country like Morocco.
Really helping total strangers can be very difficult. Time and again, people who are trying to help, or who say they are, only end up making matters worse (for coincidental evidence of which you need only note the immediately previous post here this very morning). Which is why, for me, having a personal friend involved in a particular charitable effort makes the difference – all the difference, actually – between me saying no and me saying yes, to a request for a donation. That way I will get the lowdown on how the money is really being spent, and whether it is reasonable to go on hoping that it is doing some actual good. Meanwhile I am genuinely doing a favour for a friend, who I already know I really will be helping.
I hope to be reporting further about this, perhaps with photos that Elena says she will be taking on her travels.
“More regulation” is the cry in every gagging throat, following the revelation that numerous cheap meat dishes in several supermarkets that were labelled as beef or lamb actually contained horsemeat.
Regulation caused the problem in the first place.
From today’s Times (subscriber only):
The Government knew last summer that a sudden ban on cheap British beef and lamb meant it was “inevitable” that unlawful meat would be imported from Europe.
Unintended consequences, again. It would make a horse laugh.
Jim Paice, the former Agriculture Minister, warned the committee last summer that unlawful meat would be imported from Europe as manufacturers sought cheap sources to make up for banned British supplies.
The warning came after the FSA [Food Standards Agency] suddenly told meat processors to halt the production of “desinewed” beef and lamb, which was used in tens of millions of ready meals, burgers and kebabs each year, after orders from European Commission inspectors.
The committee demanded in July last year that the Government set out its plans to prevent illegal imports, stating: “The Agriculture Minister’s evidence suggested that it was inevitable that wrongly labelled or unlawful meat products would be importing into the UK to replace UK produced desinewed meat.”
Emphasis added. Do not, however, expect this aspect to be emphasised in the Radio 4 Food Programme. I could be proved wrong; there is a podcast here which I am not in the mood to listen to, but so far the BBC’s coverage has been a relentless flow of, if you will forgive yet another revolting processed meat metaphor, pink slime.
Yes, the Liberty League Freedom Forum 2013 is coming to London soon, and yesterday I booked my place at it. This cost me twenty five quid plus a small booking fee, and that price includes meals, so this would be quite a bargain even if all that the product consisted of was the meals. And if you are one of those peculiar people who does not live in London or nearby, and you take the “with accommodation” option, that will cost you a further … ten quid! For two nights of “hostel” accommodation. What that means I am not sure, but if a roof is involved it is also quite a bargain.
Common courtesy, however, demands that if one takes one of these amazingly enticing deals, as I just have, that one will also pay at least some attention to the events during the day, in between the eating and the hostelling.
So it helps that there is an impressive array of speakers. There are names that are familiar to me, like: Baker, Bowman, Davies, Dowd, Singleton, Wellings, to name but a few of the ones I know well. And there are others I hardly know at all, which you also want when you attend something like this, like Abebe Gellaw, exiled Ethiopian journalist and activist, and Wolf von Laer, Chairman of European Students for Liberty. And there are in-between people, whom I approximately know or know of, but would love to get to know better. Here is the full list of speakers and subjects. (Well, fuller, see below.)
The talk I am most looking forward to is the one by libertarian historian Steve Davies, entitled: “Health Costs: Always Up?” Good question. And given what a great speaker Davies always is, great answers are bound to be supplied.
Recommended. Given the prices being asked, I would recommend that you consider, soon, if you would like to go, and if you decide that you would, to book soon also.
Plus, I just re-read the email I got from Liberty League yesterday, which got me thinking about this event, and it started like this:
The UK’s biggest pro-liberty conference is only a few weeks away. We have even more speakers now confirmed, with legal expert Professor Randy Barnett on libertarian law, Professor Terence Kealey on the “Innovation versus Leviathan” panel, Peter Botting leading the public speaking workshop, Dr Tim Evans on anarcho-capitalism, Linda Whetstone on liberty movements around the world, along with the Institute of Economic Affairs’ Mark Littlewood, and author JP Floru.
They’ll have to talk fast.
Many months ago I recorded a BBC documentary called “Health before the NHS”. Not having much of a stomach for statist propaganda I had been putting off watching it. The other night I finally got round to doing so.
Now, you will be shocked (shocked I tell you!) to hear, that the conclusion they reached was that the creation of the NHS was a very wonderful thing indeed. The problem was that if you actually looked at the evidence they presented – without making allowances for cherry picking – you’d have to reach precisely the opposite conclusion. This is what the BBC thought counted as evidence:
- There have always been state hospitals.
- They have always been awful. Dirty, miserable, useless.
- Before 1900 most operations were carried out at home
- Almost all developments in medicine in the first half of the 20th Century were pioneered by voluntary hospitals (ie private hospitals).
- It was voluntary hospitals that pioneered the idea that you might have an operation in a hospital and not at home.
- Voluntary hospitals were able to survive on charity until taxation in the 1920s got so high that this became increasingly difficult.
Something they did not cover was the introduction of a state general practitioner service in 1912. This was the real beginning of the NHS. At the time, I assume, no one in government thought voluntary hospitals particularly important, so they were ignored and, of course, they went on to transform healthcare. It really is amazing what a little freedom can do. It was only in 1948 that the government realised its “mistake” and nationalised the voluntary hospitals as well.
The BBC even opined that the NHS “integrated” healthcare (whatever that might mean) and managed to give the impression that it brought forth infinite resources for its activities. You have to admire their chutzpah.
Hospital subscribers in 1916. For further info see here.
It is officially calculated that, between 2005 and 2009, up to 1,200 patients at Stafford Hospital died needlessly. Let us imagine that a comparable disaster occurred in any other institution or enterprise in this country. Suppose that hundreds of customers of the cold food counter at Sainsbury’s or Tesco died of food poisoning. Suppose that, at an army barracks, large comprehensive, steelworks, bank, hotel, university campus or holiday theme park, people died, and went on dying for years, at rates that hugely exceeded anything that could be attributed to the normal course of nature.
What would happen? In all cases – though more quickly in the private sector than in the public – the relevant management would be sacked. Indeed, the very idea of unnecessary deaths taking years to notice is almost inconceivable. Criminal charges would be brought. In many cases, the offending institution would close down.
But this is the National Health Service, and so we approach it with superstitious reverence, as if the fact that Stafford Hospital performed so many human sacrifices is so awe-inspiring that little can be done about it. For all its rhetoric of condemnation, this week’s report of the Mid Staffs inquiry by Robert Francis QC argues, in effect, that those in charge should stay in charge.
- Charles Moore
“Imagine a British politician saying: we’re so worried by the abuse of prescription drugs that we’re going to reduce the supply of powerful painkillers to our hospitals. And if people in genuine pain suffer as a result, too bad. The protests from the #WELoveTheNHS lobby would be deafening. The politician who said it would be out of office by the end of the week. But that’s exactly what Michael Bloomberg, Mayor of New York, has just announced.”
- Damian Thompson.
In some ways, Michael Bloomberg is merely being more honest than most puritans are prepared to admit. He openly says what they think. It is shocking, but in his own, depraved way, people like this man are doing us a favour in putting the horror of their views right up there, front and centre.
I have had a brief period of being in bad pain and thanked those brilliant scientists out there for inventing the drugs to remove it. And millions of people who have suffered excruciating pain have managed to get through thanks to painkillers. He would rather they suffered “a little bit” than that anyone should get addicted.
It is hard to be charitable and hope that he never suffers extended pain.
My son always wants to watch motorbikes on the telly. While watching an old episode of motorcycle adventurer Charley Boorman traveling through India by various means, I took note of Charley’s description of the ambulance service in Mumbai. He said that until recently there were no ambulances, so a group of entrepreneurs set up a service.
It is called Dial 1298 and it provides scheduled and emergency medical transportation. Even the poor are catered for:
The principle of cross subsidy is used wherein:
- Full charge to a patient going by choice to a private hospital.
- Subsidized charge to BPL (Below Poverty Line) patient going by choice to a government / municipal hospital.
- Free service to accident victims, unaccompanied, unconscious individuals and victims of mass casualty incidents.
One of their investors is Accumen Fund, who say: “We use philanthropic capital to make disciplined investments – loans or equity, not grants – that yield both financial and social returns.”
All good, voluntary stuff. Socialists hate it.
Is insomnia the big disease of the twenty first century? Famously, markets are now open for business twenty four hours a day, and have been for several decade. Someone somewhere always to buy or to sell, and has the electronic trickery to do it.
Goddaughter 2: One of her teenage bizarrenesses was doing social media – gossipping as we used to call it – until 5am, while still starting school on time. The word is she’s over this now, thank goodness. But, it wasn’t just her. She was gossipping with fellow teenage insomniacs.
Me: My sleep during the winters is now deranged by cricket matches all over the world, most of it played in my night time. (I have recently learned how to watch such cricket, at no monetary cost, on my computer. I’d rather not say how.) Last night, I woke up at 3.30am, to watch England beat India in Kolkata. I also got to bed last night, again, at 5am.
Everyone: Just able to live, virtually, all around the clock. And it’s a positive feedback loop, a network effect. The more people are doing things all around the clock, the more excitements there are everywhere, all around the clock, and the more sleep patterns everywhere are deranged.
In former centuries, without the ability to communicate cheaply and interestingly with places where it was broad daylight, there was, at night, a lot less to do. Other than the obvious. The obvious has always caused insomnia, for those who can’t get enough of it. Now all the fun you can have with your clothes on (or not, it doesn’t matter) has joined the obvious. As culture (including politics) goes ever more global, there are ever more inducements to keep paying attention to your particular thing, as the small hours get bigger.
The other big techno-trend I think I see now is computerised mobility. For my generation, the two big technological dramas were the arrival of television and the arrival of computers and the internet. But perhaps historians will see those two dramas as just the one. People stopped going out, and instead stayed at home, staring at electronic screens and listening to electronic boxes. The first upheaval did indeed culminate in television, having been preceded by radio and gramophones, because all of that stuff kept people at home, as did the early internet. The second upheaval was all these toys becoming mobile. Looking at things this way, the Sony Walkman becomes more significant than the first personal computers. The first computers made the telly a bit more intelligent and a bit more fun, but you still stayed at home and got fat and lazy. The Walkman got people up off their fat arses and out and about again. And now the iThings and their non-Apple progeny are making the Get Out More life even more attractive, to the point where you can do all your work on the move.
Mobile technology is all still a bit clunky, I think. All those wires and headphones and little thingies to put in your pocket somewhere. Which is why I think the development of computerised glasses – or spectacles (merging the two meanings of that word into one again) – may prove to be so significant. And in the age of total surveillance and universal face recognition, great big non-see-through glasses are going to become very popular, even if they merely look like head-held TVs. (Clever spectacles will of course make photographing other people, literally in a blink, even easier and even harder to spot.)
I have the feeling that somehow or another techno-induced insomnia and techno-mobility are pretty closely connected. One rather obvious connection is that people who take exercise sleep better. But there are surely many other connections.
Here’s one. There is a class of semi-mobile technology which I find invaluable for getting to sleep. A problem for insomniacs is that whereas they (we) can doze off in front of the telly with ease, once in bed, the combination of the effort involved in actually getting to bed, and then the silence, can be hideously arousing. Silence now being an oddity, it keeps many of us awake. (This may be why I write better when no music is playing.) Two tricks I have learned for getting to sleep are (a) watching dvds on my little portable telly, and then (b) playing music very quietly beside the bed. I soon get drousy, and the slight effort involved in putting aside the telly and swtching on the music, or just switching the telly over to music, is not enough to seriously wake me up.
So anyway (I have only recently noticed that “anyway” means “I am about to disconnect from you, for no obvious reason other than that I just am”), blah blah blah. Discuss. Or, I have bored you so completely that you will now go to sleep.
Ann Clwyd: my husband died like a battery hen in hospital
Ann Clwyd has said her biggest regret is that she didn’t “stand in the hospital corridor and scream” in protest at the “almost callous lack of care” with which nurses treated her husband as he lay dying in the University Hospital of Wales in Cardiff.
Clwyd, the Labour MP for Cynon Valley since 1984 and Tony Blair’s former human rights envoy to Iraq, told the Guardian she fears a “normalisation of cruelty” is now rife among NHS nurses. She said she had chosen to speak out because this had become “commonplace”.
Describing how her 6’2” husband lay crushed “like a battery hen” against the bars of his hospital bed with an oxygen mask so small it cut into his face and pumped cold air into his infected eye, Clwyd said nurses treated the dying man with “coldness, resentment, indifference and even contempt”.
Owen Roberts died on Tuesday, 23rd October from hospital-acquired pneumonia.
For what it’s worth, my own experiences of watching people die in NHS hospitals have been around as good as it is reasonable to expect such a thing to be. However this is not the first such blast of raw emotion directed against the NHS from a bereaved relative that I have read, merely the first from a Labour MP.
To take another example, Anthony Browne, former health editor of the Observer, and former passionate believer in the NHS, wrote:
Last week’s report into the case of Thomas Rogers, the 74-year-old grandfather who bled to death after lying undiagnosed on a trolley in an accident and emergency ward at Whipps Cross Hospital for nine hours, is shocking. What is even more shocking is that it is hardly unusual. Equally awful stories worm their way out past NHS obstruction every week. And nothing changes.
He was right about nothing changing; the “last week” mentioned in the article was in 2001. I have reposted that article several times over the years. It does not stop being relevant, alas. Again, for what it’s worth, my own experience of Whipps Cross Hospital was quite a lot better than that – I take a forgiving attitude towards the fact that the midwife had to run out into the corridor and yell, “Where’s the fucking obstetrician?”, given that they were trying to deal with multiple women in labour. Things tend to get fraught anywhere when there is a crisis. However the deaths of Mr Roberts and Kane Gorny, who died of thirst due to neglect, or the baby Edward Brown, who was born and died in a hospital toilet while nurses declined to assist because they did not have the training, did not happen as a result of any overwhelming crisis. Whether the problem is that efforts to make nursing more academically prestigious have made some nurses believe it is beneath them to supply the most basic needs of patients, or increased paperwork, or some other factor, NHS nursing care seems to fail more often than it used to. It cannot be because of “cuts”. The last financial year for which there was a reduction in the percentage of central government expenditure devoted to the NHS was 1996/97. And that was one of only seven decreases in all the years since 1950/51. No government has dared blaspheme against the state religion.
A recent blog post by Tim Worstall describes the lack of understanding that surrounds this embarrassing condition. He recalls his experiences as a chronic sufferer since childhood:
When at primary in Bath, good strong Bathonian. And the standard Eng middle class at home, like what I speak now. Of[f] we move to Italy to the Forces school when I’m 8. My mother still remarks on the near cockney (probably closer to what we would call estuarine now) that my brother and I both picked up in weeks. And started speaking as we walked through the doors of the school and dropped the moment we left them.
A SORAS survivor among his commenters, ‘Chris’, had an even more overwhelming attack,
“When I came back to England from British Guiana at 11, to attend an almost all-white boarding school, I had a strong Guianese accent – for about 10 minutes”
Another commenter, ‘Richard’ was a witness as the syndrome struck down a friend.
“… [he] said he could hear his accent change, in 2 or 3 stages, over the train journey home at the end of term.
Be aware that initial symptoms can seem trivial – hearing a person who has lived in England for half his life say, “put it down by there” within seconds of setting foot of the platform at Swansea station may not, at first, seem cause for concern. However without treatment “by there” can become interjections of “mun” or even “Ych y fi” with terrifying speed.
Although the disease is most common in its homolocutic form, in which people suddenly revert to an accent they thought they had abandoned years ago but did actually have at one time, it also has a heterolocutic variant.
At the London SORAS support group, I recently met Berenice (28) who blames the loss of her job at an advertising agency specialising in political campaigns on the heterolocutic form of the disease. At a creative meeting, she prefaced her query as to whether an advert suggesting that first time female voters might like to grant Ed Miliband the traditional jus primae noctis would really resonate with the youth demographic with the words “Not being funny or nuffink”, and was fired on the spot. Berenice was infected after discussing the weather with a work experience girl.
Some sufferers choose to carry an information card or medical alert bracelet in order to assist first responders when the victim himself can no longer communicate verbally in a way normal people can understand. ‘Quentin’ (not his real name), a plumber’s mate struck down with the disease after installing a combi boiler in this right posh house up on Primrose Hill, is very grateful he did. While just about still able to speak comprehensibly he called an ambulance to say he had “the most frightful case of SORAS” before lapsing into a kind of idiodialect in which the only words medical staff could understand were “yah” and “darling.” It was only his desperate gesticulation towards the bracelet while strapped to a medical trolley that stopped him being wheeled into the genito-urinary ward.
Related conditions such as TIGFAF – Talking In a Generic Foreign Accent to Foreigners – can be even more distressing.
“Many explanations have been offered to make sense of the here-today-gone-tomorrow nature of medical wisdom — what we are advised with confidence one year is reversed the next — but the simplest one is that it is the natural rhythm of science. An observation leads to a hypothesis. The hypothesis (last year’s advice) is tested, and it fails this year’s test, which is always the most likely outcome in any scientific endeavor. There are, after all, an infinite number of wrong hypotheses for every right one, and so the odds are always against any particular hypothesis being true, no matter how obvious or vitally important it might seem.”
Gary Taubes. I was going to use this for the Samizdata quote of the day but the SQOTD slot has been taken but this is too good not to put up. Taubes – as discussed recently by Natalie Solent here – is one of those people uprooting some conventional wisdom about diet and health. Here is Taubes’ website.
This is probably very unscientific of me, but my approach to a lot of these views on health and fitness is to take a slightly Aristotelian “middle way” approach: moderation in all things, decent exercise, balanced diet, and plenty of sleep. (As my wife reminds me, this also means I watch my intake of red wine, which I have over-indulged in over the past).
I suffer from gout, a nasty sounding term which is also bloody unpleasant. One of the contributory factors, from what I read, is sugar. So I am on a very low sugar diet, drinking lots more water and exercising a lot in the gym, with a blend of weights and interval training. It seems to be doing the trick for my general health and physique and the gout is at bay, although I get the occasional twinge. One of my colleagues at work runs triathlons and suffers from gout, so it is not necessarily caused by drinking port all day.
The US business and health guru, Timothy Ferris, has some interesting things to say about gout and how to defeat it.