Recently in Health & Medicine Category

happy young people After much debate the Government has finally announced that Personal, Health and Social Education (PHSE) will be compulsory in schools at a level appropriate to each child's age. This decision has been widely welcomed - though strangely not quite by everyone. All children need to understand their own bodies and relationships. But only a few years ago some of us, as educators, were still battling to save this entitlement and embed it into the curriculum.

In 1990 the Cambridge University Press published a book entitled The New Social Curriculum. Edited by Barry Dufour, it was intended as a 'guide to cross-curricular issues', for teachers, parents and governors. I wrote the chapter on 'Health Education: Education for Health?'.

How different things were such a relatively short time ago.

Quotes from another era
Even as recently as 1990 I find, looking back, that I was obliged to write as follows (please forgive the self-plagiarism.):

[My first thesis is] that health education is far too weighty a matter to be left to the varies of visiting speakers, odd sessions, leaflets, films, etc... and the whims of individual teaching staff...

[The second thesis is] that meaningful (or even plausible) Education for Health can only be achieved in institutions where the teaching staff as a whole have a competent grasp of [these] curricular issues and where the mores of host institutions themselves support an alert and sensitive response to the social and personal needs of learners. Isolated 'lessons' on the 'nightmares of adults' (to use Chris Brown's apt term) are unlikely to meet effectively the aims of an informed and humane programme of Education for Health [where] health can be viewed as a positive feeling of well-being....

Any institution which means what it says about Education for Health will recognise the necessity for:
1. a curriculum which acknowledges the overlap between different aspects of social and personal experience;
2. an adequate allocation of resources - financial and personnel - to develop and deliver such a curriculum;
3. careful attention to the dignity and welfare of all who are involved in work or study within it....

But the majority of developments in Health Education continue to occur outside the context of the mainstream curriculum, and certainly outside the professional remit of those who manage formal educational organisations [which..] may account for the lack of impact which many health messages appear to have on their intended recipients.

Contentious issues
It has to be remembered - or retrospectively understood - that this was written in the context of what amounted to moral panic and the Victoria Gillick campaign on the subject of 'Sex Education', which had become the almost singular 'topic' focus of the then-Conservative Government's educational legislation.

Teachers had to contend with, and at their peril remain within the requirements of, the Education Act (Number 2), 1986, the DES Circular 11:87, and, until it was clarified, Section 28 of the Local Government Act, 1988. All these legal frameworks had the effect of putting teachers of anything to do with sexual education, not to mention student counsellors dealing with issues such as homosexuality, at personal and professional serious risk.

A wait eventually worthwhile
Much water has flowed under the bridge since then. In 1990 I ended my chapter by remarking that, whilst much good work was being undertaken, there was 'as yet little evidence to encourage the hope that national educational structures, combining the experience of health promotion personnel, health educators and classroom teachers firmly within the context of the National Curriculum, will soon emerge to encompass and consolidate this good practice.'

Now however the Government has at last announced that all pupils will Get Healthy Lifestyle Lessons, including age-appropriate information on sex and drugs, and a review by headteacher Sir Alasdair MacDonald will be carried out into the best way to shape and deliver this essential new core curriculum.

A positive step forward for children
This development, in the context of Every Child Matters, is enormously to be welcomed by anyone who wants every child to receive what is surely their basic entitlement - to understand, in ways suitable for their age and maturity, their own bodies and behaviour. How else can small people grow up to be sensible big people?

Across age, gender, social class and marital status, most adults have recently been found by a BBC survey to support this initiative. It's been needed for a very long time and at last nearly everyone seems ready for it.

Read more about Education & Life-Long Learning.

See also: 'Where do baby rabbits come from? Sex education to begin at five in all schools' (Polly Curtis, The Guardian, 24 October 208).

Mums & prams High Infant Mortality Rates (IMR) are a distressing measure, but they tell us a lot about the nation's health. In the UK today the risk of infant death is about one in two hundred live births. But still seven times as many babies die in some working class Northern towns as do in the wealthiest parts of the South East. The Sure Start programme, alongside the Government's IMR health inequalities initiative, shows promise in addressing these massive inequalities; but the next step must be to strengthen Sure Start's interdisciplinary framework.

Fundamental issues such as human health and well-being are rarely a challenge for only one part of public sector services.

The really big problems almost always straddle a wide range of service provision, which can add substantially to the difficulties of resolving them - no one service provider alone 'owns' the issue, and it is often unclear who should head up programmes to address the problem.

Differentials in life expectancy
A classic example of this is the challenge in the UK of reducing the gap between the life expectancy of richer and poorer people, to achieve the goal of everyone who possibly can enjoying a long and healthy life.

The better the start in life, the more likely a person is to have a good outcome also in the future. For this reason there has been much emphasis in recent years on Infant Mortality Rates, which are generally agreed to be amongst the most sensitive overall indicators of a nation's health.

Infant Mortality Rates (IMR) are usually stated as numbers of deaths per 1000 live births. The figures are often broken down into rates for the first four weeks of life (neonatal rate) and then for the rest of the first year of a child's life (post-neonatal rate), i.e. from the end of week four till first birthday.

Infant Mortality Rates in Britain
The national statistics show that even since the 1970s, in the UK IMRs have fallen by about 60%. In 1978 the neonatal (first four weeks) rate was 8.7 deaths per 1000 live births, and the post-neonatal rate, up to a child's first birthday, was 4.5.

By 1988 the rates were 4.9 and 4.1 respectively, and in 1997 they were 3.9 and 2.0.

In 2007 the UK neonatal mortality rate was 3.3 per 1000 live births, and the post-neonatal rate was 1.5 - in other words, a child born in the UK in 2007 had a probability of dying before his or her first birthday of just about one half of one percent. (You can see international comparisons here.)

Regional differences
Sadly, these national statistics include both good and bad news. The good news is that decent housing, income and environments can support people in long and healthy lives.

The bad news is that the opposite conditions can be lethal. There are parts of the North of England, for instance, where IMR is about twice that national average, and up to seven times that of the very best outcomes.

Specifically, high IMR and low life expectancy often go hand-in hand in the Spearhead areas; the 70 local authority areas with the worst health and deprivation indicators, and for which a programme of public service interventions has been developed.

High risk factors in health inequality
The target does not however take into account all dimensions of health inequalities in infant mortality. The statistics show e.g. that in 2002–04, the infant mortality rate of babies of mothers:
* born in Pakistan (10.2 per 1,000 live births) was double the overall IMR;
* born in the Caribbean (8.3 per 1,000 live births) was 63% higher than the national average;
* aged under 20 years (7.9 per 1,000 live births) was 60% higher than for older mothers aged 20–39;
* where the birth was registered by the mother alone (6.7 per 1,000 live births), was 36% higher than among all births inside marriage or outside marriage or jointly registered by both parents.

Improving life chances
Obviously, these significant inequalities are just not acceptable. The Government therefore introduced a Public Service Agreement (PSA ) Target in 2007 with the express objective of reducing the IMR gap, so that more babies will live to have long and healthy lives. (Healthy babies also have better long-term prospects, sometimes dramatically so.)

The deal is that the UK Treasury provides the money, and the public sector delivers the agreed outcome, to a clear timescale and against clearly measured outcomes.

Particular emphasis has therefore been placed in terms of health inequalities on achieving a ten percent reduction (between 2003 and 2010) in the IMR deficit between people in routine and manual (R&M) jobs, and the general population.

Practical steps forward
The practical ways in which the Health Inequalities Infant Mortality PSA Target Review (February 2007) can be achieved are focused on two things: sensible day-to-day actions and provisions, and interdisciplinary co-operation. In the words of the NHS summary of the Implementation plan for reducing health inequalities in infant mortality:

'The plan describes how commissioners and service providers can develop local services to help reduce health inequalities in infant mortality through:

* promoting joined-up delivery of the target with Maternity Matters and Teenage Parents Next Steps. This includes
* improving access to maternity care;
* improving services for black and minority ethnic (BME) groups;
* encouraging ownership of the target through effective performance management;
* raising awareness of health inequalities in infant mortality and child health;
* gathering and reporting routine data, including specific maternity and paediatric activity;
* undertaking joint strategic needs assessment to identify local priorities around health inequalities in maternity and infant mortality;
* giving priority to evidence-based interventions that will help ensure delivery of the target.

It emphasises the importance of partnership working; outlines the role of government departments, strategic health authorities (SHAs), primary care trusts (PCTs), local authorities and Sure Start Children’s Centres.'

Specific, realisable targets for practical action and delivery
Progress may be slow, but none of this is rocket science.

Large-scale studies have demonstrated that just a few health messages about avoiding early years risk can have a big impact. Indeed, the Review of Health Inequalities has been able to quantify four measures, and suggest another one, which would have appreciable impact on the ‘10% reduction in IMR gap’ target. These were:

* reduce prevalence of obesity in the R&M group by 23%, to current general population levels – 2.8% gap reduction
* reduce smoking in pregnancy from 23% to 15% in R&M group – 2% gap reduction
* reduce R&M group sudden unexpected deaths in infancy by persuading 1 in 10 women in this group to avoid sharing a bed with their baby, or letting it sleep prone (on its front) – 1.4% gap reduction
* achieve teenage pregnancy target – 1% gap reduction
* also, early booking and improved teenage pregnancy services – not possible as yet to quantify probable gap reduction, but positive impact on gap anticipated.

Getting it right
The scope for getting this right in very simple ways is therefore enormous. Whilst guidance at national level, such as the Department of Health's Child Health Promotion Plan (June 2008) is essential to provide a framework, much of the responsibility for success has to lie with the authorities 'on the ground', who have to co-ordinate the action.

In reality, only at the local level is it possible to get practitioners to work together well, to ensure that all those - including so-called 'hard to reach' minority ethnic familes, travellers and e.g. very young parents or parents with mental health problems - who would benefit from services, advice or support, in fact receive them. Although programmes such as the Family Nurse Partnership (a joint Department of Health / Department for Children, Schools and Families project whereby specially trained midwives and health vsitors work closely with vulnerable, first time, young parents) are starting to reach those with most disadvantage, in some places still this doesn't always happen.

It is disappointing therefore to read claims in this month's Regeneration and Renewal that the PSA Inequality target will be missed, despite the many billions of pounds (£9bn in 2007-8) which have been invested in Sure Start services to deliver early years provision.

An expected move
This probably why the Government is launching a public consultation on proposals to give Sure Start Children's Centres a specific statutory legal basis, as part of the forthcoming Education and Skills Bill.

Such a move was indicated as a possibility when The Children's Plan (the ten year programme for Every Child Matters) was introduced in December 2007. It would establish Sure Start Children's Centres as 'a legally recognised part of the universal infrastructure for children's services, so their provision becomes a long term statutory commitment and part of the established landscape of early years provision'.

The best way forward
This is a much better idea than the alternatives proffered in some quarters - more Health Visitors as a stand-alone, for instance. (What about the GPs / family doctors? How do they fit in?)

A review of progress has shown (as my own consultancy work also indicates) that the PSA infant mortality target was not known or understood by practitioners (NHS, local government and Sure Start staff etc) despite individual examples of leadership and good practice.

Reaching out
And nor, in my experience, do practitioners and policy makers automatically know that impact has to be measured across the whole relevant population of infants, not just those who attend particular service provision, be this Health Visitor clinics, Sure Start or whatever.

About 80% of early years formal care is actually undertaken by small private concerns, child minders and so forth, a 'group' which, whilst of course the subject of statutory regulation and monitoring, it is particularly difficult to bring together in any meaningful way. But what happens in small relatively isolated provision will have a big impact on children's future lives.

The PSA IMR Review has therefore identified the criticality of making the 10% gap reduction target part of everyday business – integrating into commissioning plans and provider contracts; taking responsibility and engaging communities; matching resources to needs; and focusing on what can be done.

Multi-disciplinary and future-facing
The challenges of equipping professionals to work together across disciplines are complex; not every practitioner would say, if asked, that they actually want to be so equipped and so far out of their comfort zone. But these challenges must be met, as is beginning to happen, with skills audits by NIACE which indicate the centrality in Sure Start provision of effective multi-agency leadership and partnership development.

The National Audit Office reports that, whilst most Sure Start Children's Centre managers understand they must approach the work in a multi-disciplinary way, this is not always so for local authorities, who 'had not all developed effective partnerships with health and employment services'.

The onus is now particularly on local government and NHS providers. If it takes more legislation to ensure they all collaborate properly with Sure Start Children's Centres (and vice versa), so be it. It's children's futures which are at stake.


Read also: Early Intervention In The Early Years

See also: 'Changes for the better?' - The Every Child Matters policy, published in 2003, was a landmark proposal for child social service reform. Five years on, Ruth Winchester asks the professionals how things have developed, and what progress has been made (The Guardian, 22 October 2008)

Crowds Today is World Population Day. On this day in 1968, world leaders proclaimed that individuals have a basic human right to determine the number and timing of their children. Forty years later, population issues remain a real challenge even in Britain, where greater cohesion is still needed for policy in action.

Inevitably much of the focus since then has been on women, and especially maternal health and education.

There can be no doubt at all that a failure of health care during pregnancy and birth takes a terrible toll on lives, both maternal and infant. Multiple unplanned pregnancies are a leading cause of premature death and tragic disability for many women and their children, especially in very poor countries.

Access to family planning
UNFPA, the United Nations Population Fund, says active use of family planning in developing countries has increased from 10-12% in the 1960s to over 60% today. But despite these improvements, a World Bank report just released says that 35 countries - 31 of them in sub-Saharan Africa - still have very high fertility rates and grim mortality rates from unsafe deliveries or abortions.

According to this World Bank report, women in developing countries experience 51 million unintended pregnancies each year because of lack of access to effective contraception That is a great deal of heartache, even apart from the enormous issues it raises for global ecosystems.

Not just a a 'Third World' issue
But this is not a problem only for people in the poorest developing countries.

Most of us are aware that people in the 'developed' countries use hugely more energy and other resources than do those in poor countries. Even with our much lower fertility rates we are currently much more of a threat to global sustainability than are people in Africa.

Blighted lives in the Western world too
"Promoting girls’ and women’s education is just as important in reducing birth rates in the long run as promoting contraception and family planning," says Sadia Chowdhury, a co-author of the World Bank report.

That is also true even in places such as today's Britain. Teenage pregnancy - and unintended pregnancy overall - remains a serious issue for many families in the U.K. even now.

There is an essential synergy between prospects for women in education and employment, and elective motherhood. Each benefits from the other. And each also brings benefit for the children who are born, including better prospects even for their very survival.

IMR inequalities relate to social class
Currently differences in infant UK infant death rates can be huge, and can often be attributed to occupational and class differentials. In 2002-4 a baby born in Birmingham was eight times more likely to die before its first birthday than one in Surrey, with rates of 12.4 and 2.2 infant deaths per thousand live births respectively. (Bradford is another very high-risk area, and set up its own enquiry to see how to improve.)

This is not an easy matter to discuss politically, but it could not be more important, even in Britain, one of the wealthiest nations in the world.

Improving family health
One main health objectives of the British Government is to improve infant mortality rates (IMR: the number of babies who die before their first birthday, against each one thousand born), so that the infants of poorer parents have better outcomes, like those of more advantaged parents.

The target for England is a 10% reduction in the relative gap (i.e. percentage difference) in infant mortality rates between “routine and manual” socio-economic groups and England as a whole from the baseline year of 1998 (the average of 1997-99) to the target year 2010 (the average of 2009-2011).

Life outcomes and expectation
To focus this up: for each baby in the UK who dies before his or her first birthday, there will be about ten who survive with enduring disability, and often with diminished life expectancy.

At present, often through lack of knowledge, or sometimes difficulties in accessing appropriate care, this distressing outcome is much more likely to affect families where women are poorly educated, than those where women have a good education and good jobs or careers.

Preventable tragedy
It does not have to be like this.

The Government is absolutely right to tackle this difficult matter, but effective action requires co-ordinated delivery by all who provide care and support for parents and children. There must be no room for professional maternity care in-fighting, such as is reported by Sir Ian Kennedy, chair of the Healthcare Commission to exist between obstetricians and midwives.

Children's Centres as a way forward?
The national transition from Sure Start to the encompassing provision of Children's Centres, underpinned by the fundamental philosophy of the Every Child Matters initiative, is now underway.

To date there has been little discussion about how family planning support needs to be built into this really important development.

Professional obligation
This may be a tricky issue, but it's one where the professionals could, if they chose, much help the Government to help all of us.

When are we going to hear those who provide early years and family support saying, loud and clear, that 'every child a wanted child' is a basic requirement for everyone in Britain as well as elsewhere?

A not-to-be repeated opportunity?
The need for effective family planning in parts of the developing world remains desperate, and must be met.

But that doesn't excuse skirting the issue here at home, just at a point when new and joined up services focusing directly on families and children are being created, with the aim of eradicating child poverty and increasing wellbeing for everyone.

And given the political sensitivities, surely it's the practitioners - in health, education, welfare and the rest - who have to lead the way?


Read more articles about Public Service Provision.

08.04.02 place laid for dinner 140x78 010a.jpg Food is rising rapidly up the agenda. Allotments, biofuels, calories, customs, eating disorders, famine, farming, fats, fibre, foodmiles, GM, health, organic, packaging, processing, salt, seasonal, security, sell-by, sustainability, vitamins, water.... Where do we begin with what to eat and drink?

Modern society has moved from food as nutrition and survival to food as an element of our leisure experience. Until recently it's been seen by many as an issue to be left to dieters or even ‘health freaks’.

But now people are beginning to ask what food's about. The immediate answer to this question could be, it’s all very confusing. There are 'facts' and there are, it seems, 'food factoids'; and there are some consequences for action, when we think things through....

Here are some general headings and questions about food which may help:


Nutrition (Should we eat it?)
Strange as it may seem, for most adults there is still more concern about calorific value and ‘losing weight’ than there is about the nutritional value of what we eat. Almost everyone wants to be slim; yet despite concerns in many parts of the world about obesity and health relatively few people actually eat their fruit and veg ‘Five A Day'.

We as consumers still don’t fully appreciate nutritional information or understand the significance for our health and well-being of salt and other minerals and vitamins, various sorts of fats, fibre, ‘additives’, sugar, glycaemic index, units of alcohol and so on; and in some respects nor, completely, do the experts.

The healthy eating message is beginning to sink in, but questions around nutritional labelling and how to project the public health message continue to loom large.


Children eat too (Is food for kids especially important?)
Even (especially) for children, the health impact of being overweight, along with issues around longer-term well-being and educational outcomes, are now major concerns, as Jamie Oliver and his School Dinners campaign keep reminding us.

It is not altogether clear however that poor children necessarily have ‘worse’ diets than better off ones – possibly because even wealthier children eat ‘the wrong things’, albeit from choice (kids of all sorts it seems won’t eat their greens). But perhaps some groups consume ‘nicer’ food than others, even though the direct nutritional value - or not - of food consumed by children may (sometimes) vary independently of income.

So what more if anything needs to be done about family eating patterns, or advertising food to children, on the television and elsewhere? How much value should we put on meals together as a way to promote family well-being and cohesion?

And how important, as a good start, is breast-feeding? Should we as a society do more to encourage it?

Or should we emphasise exercise more than nutrition, to protect children's physical and mental health?


Organic? GM? Nano? Sell-by date? (Is it wholesome?)
Confusion reigns when we look at the science behind modern food production.

Is organicWho says so, and why is it so pricey?) What about free-range? What's a superfood? And do superfoods really exist?

Has the product we're about to eat, or an antecedent of it, been genetically modified? Is that good or bad? – and for whom? consumers, farmers or other people in the developing world? Also, how has it changed the food?

What of new techniques? Are any food nanotechnologies involved? Whatever would they be for? Are they good or dangerous?

Who decides ‘sell-by’ dates? And by what criteria?

Can we trust the Food Standards Agency, the government and European legislation and everybody else involved in food regulation and statutory labelling? What about the consumer organisations and the supermarkets? Who knows best?


Presenting, preserving and not wasting our food (Is tinned OK and who needs packaging?)
How can we tell whether tinned food is as good as frozen or fresh? How much packaging is required for hygiene and how much is, for instance, simply there to make food look good?

What's the relative energy and resource cost of different ways of preserving food?

And, crucially, how can we ensure that food we buy is not wasted? At present one third of food purchased - in restaurants, shops or wherever - in the UK alone is simply thrown away: hence the Love Food Hate Waste campaign. Perhaps even with today's relatively higher prices we are more careful about food if we're locavors, when we know locally who grew or prepared it, and where, than when we don't?


Food miles (Does it cost the earth?)
Food travels the world in strange ways. We (in the UK) get tomatoes and lamb from the other side of the globe, yet we also grow them ourselves.

How to tell people usefully about the food mile cost of what they eat may be a moot point. It’s not just how many miles, or even carbon footprint: it takes some eight units of grain to produce one unit of beef; but some people still reckon that good value - including, no doubt, growing numbers of consumers in China and India, who have a preference for an affluent Western diet.

So sometimes the real cost or value can only be calculated by comparing what would happen if foods of equivalent nutritional or other sort of value were produced in a different way. And how would you put that on a label?


Biofuels (Is growing 'food for cars' acceptable?)
We all know that we're using too much oil, charging around in cars and planes when often we don't need to.

Biofuels seemed for a while to be the perfect way out of this - grow crops to substitute for more usual oils. But now, as the UK's Chief Scientist has said, we know there are costs too; some biofuels are neither sustainable, nor ethical.

And on top of this we must acknowledge that biofuels, like food for people, takes up valuable land space. The question is, what's the 'right' balance - if there is such a thing?


Water used (Will it increase global tensions?)
There is an emerging awareness that food is mainly water, and that water is the also the most precious (and sometimes wasted) commodity in its production.

If the beef-to-grain carbon ratio is high, the equivalent water ratio is many times more so. (Let us pass on the comlex issues around food for domestic animals and pets - there is an important balance to acknowledge here between these animals' functions as sources of security and comfort for people, and their costs to the environment - but who has looked at this balance?)

There are those who believe that water, not oil, will trigger the next global disputes; but as yet few of us have thought how to approach the global issues of water scarcity and food.


Food prices (Can we afford it?)
The cost of food against income has fallen for most of us in the first world over recent years. Now it’s beginning to increase again to more traditional levels – though it will probably stabilise - as global issues such as draught, climate change and biofuels impact on the market.

Food habits have changed from agrarian times, but often seem nonetheless to lag behind the reality of what's available, and may say more about cultural expectations or how a person ate when they were young, than about what's now regarded as 'best' for them (or, indeed, with modern advertising the converse may also be true on occasion).

Perhaps people need to know about less expensive and more nutritious alternative foods, if the ones they’re used to become more expensive, or may now be known to be less 'healthy'? But who can best tell them?


Commercial advantage and competition (Do supermarkets cause ‘food deserts?)
Allied to this is now a fear that supermarkets placed in disadvantaged or poor areas will result in so-called food deserts, where poor people can no longer afford to buy even the basics of a decent diet.

But some observers say that food deserts are really different types of access, or actually an urban myth or 'factoid'. Evidence for these food deserts is to date far inconclusive – indeed, some research indicates that when supermarkets come to poorer areas, both the economy and local people’s diets may improve.

So how can we indicate economic ‘value’ and nutritional benefit in the contexts of where people live, what they expect to eat and how they get access to their food?


Customs, symbols and traditions (What sort of foods for whom?)
Shared food has always been a way of bonding - we cut cakes and 'raise a glass', offer potlatch, drink tea and conduct many other ceremonies across the world to denote belief, position or togetherness.

Then there's the fascinating question of why different people in different places and at different times eat different sorts of food. Sometimes it's easy to explain - 'luxury' and difficult to obtain foods are reserved in almost all cultures and communities for conspicuous consumption on special occasions, for instance - but often there are other styles and patterns to eating too.

And what do we know about 'healthy' diets across the world? Why do people in some places live longer and fitter lives than others? What traditions and customs help us keep our communities intact? And is any of what we might learn about customs and habits of food consumption transposable from one community or culture to another?


Seasonal, allotments and home grown (Should we grow it ourselves?)
Locally produced foodin season' is the new mantra, but it can’t be the whole story. There are many localities which can’t provide the full spectrum of nutritional need. Varied diets often require varied sources.

Nonetheless, an appreciation of the cycles of nature helps us to understand how our food is produced and what makes it special. ‘Seasonal’ recipes draw attention to the possibility of ingredients with a low carbon footprint, just as allotments, smallholdings and local market gardens offer the possibility of learning about how what we eat grows.

Producing and sourcing food locally may not resolve all our problems, but they certainly have their place in the spectrum of things we as consumers can enjoy and need to know. How about allotments for everyone who wants one (there are long waiting lists in some places), and special efforts to grow – and eat - vegetables and fruit in schools and other community locations?


The food economy (How does all this fit into UK plc?)
There are many things to think about here; just ask the politicians, farmers and market gardeners. And that's before we get to talk about European subsidies and farming compensation packages...

That however is not the whole story. Slowly, we are grasping the interconnections between the economic impacts and needs of farmers and growers, and how official policies affect the welfare of the wider rural and urban economies. Never again, hopefully, will problems like foot and mouth be addressed without understanding the fragile complexities of the rural economy as such; and hopefully too in future the wider public will perceive the business and scientific complexities of matters such as animal vaccination.

But let’s understand that not all food needs to be produced in rural areas. There’s plenty of scope also for townspeople to develop opportunities and skills via commercial companies and social enterprises around food, as is evident from the popularity of city-based organic foodstores, local vegetable deliveries and farmers’ markets... not to mention the universal interest in restaurants and cafes in modern day society!


Food, farms and famine (What about the developing world?)
If opportunities for stabilising the food economy remain to be developed efficiently, effectively and well in Western economies, how much more so is this true for those parts of the globe where even the grain supply is critically under-resourced, and where water and food are in desperately short supply. These were the sorts of concerns of the Downing Street Food Summit in early 2008.

Many people would like reassurance that the food they purchase is ethically sourced and gives a fair return to the farmers who produced it. And we need to understand much more about the food supply chain, as Professor Tim Lang of the Centre for Food Policy has been saying for years.

Movements such as Fairtrade are gaining wider recognition – plus a greater share of commercial shelf-space - and are critical to our understanding of food as a global issue.


Sustainability and ‘food security’ (Will there be enough food for everyone?)
There are those who fear we are sleepwalking into a global food disaster. We need to find ways of adjusting our eating habits (and other consumption) without delay.

Currently it’s said that humankind acts a though we had three planets-worth of resources at our disposal, not just one. And that's before we start to look at how population is increasing (in the UK as well as almost everywhere else).

It is also suggested that, in contrast to the current situation, the UK (and doubtless numbers of other nations) could with ease be self-sufficient for food if everyone were vegetarian - even though our lifestyle in the Western world is many times as water and carbon intensive as that of people in developing countries. Veganism, of course, is even more effective as a way of feeding everyone. Becoming 'selfsufficient-ish' (and largely vegetarian-ish?) can be achieved in most, except perhaps the most extreme, locations.

These last few observations offer a rather pointed context for all the other matters discussed above.


Read more about Food
and about Sustainability As If People Mattered.

What questions and views do you have about food?

08.3.22 Sefton Park Easter Bunny hats! 262x92  051.JPG Sefton Park is the venue for a very organised fitness training programme. The wearers of these cheery Easter bonnets are amongst those for whom even the Bank Holiday weekend offers no let up on the exercise regime.

08.3.22 Sefton Park Easter keep-fit enthusiasts 491x456 051a.jpg

See more photographs at Camera & Calendar,
and read more about Sefton Park.

Dusk at Aigburth Vale 07.10.27 116b 95x125.jpg 'Incremental' is the mode of choice when we talk about the massive changes required for the sustainability of ourselves and our planet. People find it hard to make large or sudden changes, so we try to do them bit by bit. Seen like this, the benefits of daylight 'saving', keeping lighter evenings, become increasingly compelling.

The big health news of the past week or two has been obesity... how it's becoming an epidemic and how difficult it will be to reverse the demands which people being overweight put on the health services and on the exchequer.

Then we are told that we must conserve energy in every way possible. Carbon expenditure must, urgently, be reduced, climate change is happening even more quickly than we had thought.

Looking for solutions
In these contexts it is surprising that the sensible advice about behaviour adaption - go gently, to take people with you - has not yet been applied to the benefits of 'daylight saving'.

We know that lighter evenings offer more encouragement for people to take exercise; we know that the extra light also reduces fuel demands. (Jim Fiore estimated recently that in the US context 'only' 0.25% savings would be achieved - but that's a massive amount of oil which could be conserved with no effort by anyone.)

Joined up thinking
The clocks go back on Sunday, tomorrow, 28 October, at 2 a.m. From then on until next March (British Summer Times begins on 30 March, with the new US Daylight Saving Time starting on 9 March) we shall have afternoon murk.

Scottish farmers may be happy with these murky afternoons, and they are of course welcome to any arrangement the Scottish Parliament wants to make. For the rest of us, a bit of (evening) light needs to be shed on the subject of incremental health and energy improvements.


The full debate about BST is in the section of this website entitled
BST: British Summer Time & 'Daylight Saving' (The Clocks Go Back & Forward).....


See also:
Making The Most Of Daylight Saving: Research On British Summer Time
Save Our Daylight: Victor Keegan's Pledge Petition
The Clocks Go Forward...And Back... And Forward...
British Summer Time Draws To A Close
Time Is Energy (And 'Clocks Forward' Daylight Uses Less)
The Clocks Go Forward ... But Why, Back Again?

Join the discussion of this article which follows the book E-store...

The New Harvest Festival

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Seasonal vegetables harvest festival pumpkins 2520 (88x103).jpg This is the time of year when churches urban and rural across the nation urge us to attend their services for Harvest Festival. For many of us however this annual celebration is now marked more secularly, observed at one remove, via our newspapers, rather than physically in our communities. Media celebration of seasonal food is the order of the day.

The Guardian, like other similar publications, is hot on seasonal food. A story in that newspaper today gives a flavour of that theme: 'Green' shopping possible on a budget, watchdog says.

What then follows is that irresistible combination of knocking the supermarkets (fair enough if they're not up to scratch), going rustic with references to in-season fruit and veg. (why not, it really is good for you), and angst about affordability and carbon footprint (fair enough again).

Contemporary perspectives
So here is the contemporary version of We plough the fields and scatter...

Way back over the centuries people have known about crop rotation and storage and the seasons, and have celebrated all this with Harvest Festivals of one sort or another. Now we know about food miles, sustainability and ethical buying.

Appreciating our sustenance
This is the better informed (or at least more techno) version of the wisdom of the ages, translated for those of us who hope for the future but have no bedrock of faith on which to base an annual thanksgiving.

Perhaps it doesn't matter how we demarcate the changing seasons and the beneficence they offer. What does matter is that at least we notice.

Hope St & Mt Pleasant-  Science Centre  06.7.15 011 (81x87).jpg Who owns Big Science in the UK? Does government science policy sit within wider public policy, or is it stand alone? The Cooksey Review has stirred strong feelings amongst medical scientists, and also further afield. Few science policy questions can be determined without understanding the wider public policy context.

Who pays for what in the constant race to stay at the global cutting edge in science and technology is a hot debate. Often neglected is an acknowledgement of the multiplicity of stakeholders, but this is an area which the scientists themselves sometimes ignore.

Getting to the bottom of who can / should pay for science and innovation in the UK is a difficult task. When all relevant interests - science and technology, policy makers, the economy / electorate - are perceived there is more clarity, but only rarely does this happen. The issue is however making headway as a result of changes resulting from the 2007 Budget, which promises an increase in investment in public science of 2.5 per cent from 2008-09 to 2010-11..

Both the Cooksey Review on funding for health research, and the (connected) introduction of the new Department for Innovation, Universities and Skills focus on ensuring that progress in scientific research and wider value for money go hand in hand.

Value for whom?
The really big question here is, who benefits from investment in what sort of science? This is surely the nub of the issue, but it needs a wide perspective to answer the question properly.

The emphasis seems so far to be on the 'translation' of blue sky research findings into marketable commodities - an entirely sensible idea in general., but not a complete one. The core issue of how much benefit accrues to whom when commodities become marketable is not easily resolved.

Whether the product eventually taken to market is a medical drug, a form of renewable energy or a development in nanotechnology, there are likely to be direct and indirect benefits and costs.

Medical priorities in research
One person's or sector's gain may be another's loss - an obvious but frequently forgotten matter from the perspective of practising scientists.

This may be particularly true in the case of medical scientists, who are currently it seems most agitated, and who often have a specific, and possibly tragic, individual human condition in mind as they undertake their work. Nonetheless, this human priority cannot stand alone.

Medical scientists have not always covered themselves in glory when it comes to collaborating within the Big Science framework - the Daresbury crisis of a few years ago comes to mind - and for some of medical researchers the universe probably finishes at the point where abstract research translates (to use the new term) into pharmaceuticals. This is why, when public money is involved, others must take a wider view.

Science policy and public policy
Policy in government-sponsored science is not, contrary to much of the discussion, a singular issue. For a start, there is policy about science; and then there is policy relating science and the general public interest. These two are inter-connected, but not always the same.

Science policy variously (as examples, and in no order of priority) might be about:
* 'translating' or bringing blue sky research to the market;
* meeting a specific human or technical need;
* continuing promising lines of investigation which may or may not eventually go anywhere;
* establishing or maintaining national reputation, or that of an institution and / or individual/s.

Public policy relating to science might, e.g., concern:
* developing local science-based businesses;
* linking scientific and technical / medical research outcomes to the wider economy;
* developing programmes or projects in geographical or otherwise specifically identified areas, to progress regeneration or other ambitions for general benefit;
* seeking answers to particular policy conundrums or challenges, by way of developing the evidence-base available to decision-makers.

Contextual perspectives on science
To make sense of these difficult and often conflicting priorities between science and public policy requires seeing the wider contexts in which science and technology operate.

Social, economic and political backdrops are not secondary matters when government is paying directly for science to be done. They are central and critical, right from the beginning.

'Translating' science is ultimately about taking blue sky research to market, but it is also in another sense about making sure that stakeholders - the general public - know and are comfortable with what, through their taxes, they are paying for.

Consensus on taking science forward
From this point of view scientists need to accept that, if government pays directly, it wants to know how the research will take public policy forward.

Politicians are not usually keen to write open cheques for unknown outcomes, nor should they be.

Scientists paid by government are usually there to do their part within a policy framework geared to fairly tight timescales, to make the evidence-base available or to develop a required product. As such they rarely have the luxury of following their noses in research, just because it looks interesting.

Government funding
Sometimes there is a case for blue sky research directly funded by government, but probably, given budgetary constraints and the constant need to be immediately answerable to the electorate, not often.

The right way to support (most) blue-sky research is through the universities' wider funding and large science-led corporations.

Such investment will, if directed wisely, bring reward in the longer term, when investors can as a result make the evidence-based case for government to invest in developing the applications of their new-found knowledge.

Dusk in town (small) 80x91.jpg British Summer Time begins at 2 a.m. on Sunday 25th March this year (2007). Surveys suggest that both safety and energy saving would ensue from BST year-round, and a large majority of people will welcome the lighter evenings. But why have we just had to endure five months of days which end before the afternoon teabreak?

The evidence becomes ever more compelling.... As the Transport Research Laboratory has demonstrated over many years, British Summer Time is indeed best for almost all of us.

There are inevitably risks in any change, but sometimes the biggest risk lies in Doing Nothing. That's what applies to the odd practice of reducing afternoon daylight (in favour of 'lighter mornings') at the very point in the year when there is already least of it.

The 1968 - 71 'experiment'
The oft-recycled stories about children 'hating' having to wear fluorescent jackets because of the super-dangerous mornings during the 'experiment' of 1968 - 71 are selective recall, I'd suggest. I don't think I ever saw one child so clad.

But the debate goes on. And recently, as the TheyWorkForYou.com website admirably demonstrates, Tim Yeo MP has been proposing Single / Double Summer Time, which has incensed some even more.

The Scottish dimension
We know of course that there are people in Scotland who would prefer to keep the status quo, regardless of the proven greater overall risks of accidents, depression and poor health, but with devolved government, as Tim Yeo and before him Lord Tanlaw acknowledged, these can surely be addressed by those most involved.

But even in Scotland opinion is divided and the evidence for the status quo doesn't fully stack up (unless Scottish cows have learnt to tell the time and will rumble their herdsman adjusting the alarm clock to keep their bovine stock's milking hours stable...).

The evidence
As Tim Yeo and Lord Tanlaw have emphasised, even in Scotland there are plenty of people who would prefer the lighter evenings, whilst YouGov have found (December 2006) that 51% of workers feel less safe travelling home in the dark, with 71% of women saying the dark makes them feel uncertain and worried.

Likewise, when Victor Keegan ran a campaign a few months ago, he easily achieved his objective of 50 people asking their MPs to support Tim Yeo's bill. On energy saving grounds alone there are compelling reasons to suppose we should abandon British Mean Time. A majority of those voting supported it, but Tim Yeo's non-party Bill fell on 26 January 2007 because it did not gain more than one hundred votes.

Another way forward?
So what's holding things up? There are rather feeble claims (see TheyWorkForYou.com, as above) that an experiment in Portugal was not successful, but perhaps political nervousness about Scottish issues is, short-term, at the heart of the matter.

There is, however, a very simple and easy way to resolve things once and for all. Why not actually undertake a serious Government-led enquiry into all the evidence available, on energy, accidents, health, business and other impacts, examining England (and Wales and Northern Ireland) separately from Scotland?

And let's ask for the report to be produced by Sunday 28 October 2007, before the next grim return to Winter darkness, when British Summer Time is due to end. This, it seems to me, is a genuinely good example of when policy can indeed be informed by best practice in natural and social scientific research.
It really does need to be done, and soon.


The full debate about BST is in the section of this website entitled BST: British Summer Time & 'Daylight Saving' (The Clocks Go Back & Forward).....
See also:
Save Our Daylight: Victor Keegan's Pledge Petition
The Clocks Go Forward...And Back... And Forward...
British Summer Time Draws To A Close
Time Is Energy (And 'Clocks Forward' Daylight Uses Less)
The Clocks Go Forward ... But Why, Back Again?

Read the discussion of this article which follows the book E-store...

Innovation (small) 80x101.jpg England's Northern Universities are upset that the Biomedical Research Centres (BRCs) of excellence are all in the 'Golden Triangle' of Oxford, Cambridge and London. 'Added value' economic impact has been sidelined. With intimations of southern advantage and selective assessment perspectives, is this a re-run of the 4GLS synchrotron debate on location in the 'north' or 'south'?

Prof Alan Gilbert, Vice-Chancellor of Manchester University, is championing medical science in England's northern universities, after his institution was not selected as a comprehensive biomedical research centre of excellence (BRC). This accolade, worth 8-figure sums to each institution, has been awarded only to universities in Oxford, Cambridge and London.

Once again, the Golden Triangle has triumphed over everywhere else in England.

And once again the southern economy hots up as northern sensitivities are similarly inflamed.

Who decides?
The decision to support only Golden Triangle universities was made by the Department of Health / NHS National Institute for Health Research (NIRH) high command, on the basis of assessment by a panel of experts working outside England of the international excellence of medical science in the competing universities.

This panel does not seem to have laid much emphasis on the impact of macro-investment in the knowledge economy on regional economies as such.

History repeats itself
So here we go again.

More science money is being invested where money has already gone. Comparatively less is made available where investment has historically been more difficult to obtain.

When the big debates about synchrotron investment in the North of England were conducted, the medical science people were hardly to be seen. The Wellcome Trust, a major player in bio-medical research, was widely regarded as unhelpful to those making the northern case, and even some northern university medical scientists did not support it.

Yet investment (usually of government money) in scientific institutions with capacity and established further potential is critical to wider long-term prospects for the UK economy.

Biggest impact, greatest added-value
Prof Gilbert says that universities must not 'ask favours because we have been disadvantaged historically'. But in fighting his case he could look at the Daresbury (4GLS) - Rutherford Appleton (Diamond) synchrotron debates to see that the issues may be slightly different.

It is not 'asking favours' if those of us, the public whose money is being spent, demand equity in terms of investment opportunities for top-level science.

Wider perspectives
The NHS is a very closed institution which has not, historically, been good at acknowledging it is now an important part of the wider knowledge economy.

Patient care is the aspect of this huge organisation which most members of the public experience, but that should be a fundamental 'given'. It cannot provide refuge from the fact that, medically or otherwise, international science knows no silos.

Excellence in context
Nor can a rightful emphasis on patient experience permit us to forget, as collectively holders of the public purse, that any public investment needs to work in as many different ways as possible.

As the growing success of the U.K.'s 'northern' Darebury Laboratories has shown, internationally excellent science, public benefit across the nation and added-value regional development can evolve hand in hand, if enough decision-makers have the vision and courage to ensure that this will happen.



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