I have always been drawn to a good analogy. Recently, a very simple analogy was related to me which can be adapted to just about every walk of life. The analogy tells of a man standing on the banks of a river fishing dead bodies out as they float downstream. Another man comes along and instead walks upstream to try and find where they are coming from. Like all truly great analogies it is beautiful in its simplicity and easy to follow.
I applied it in several contexts as I am sure you will already have done. In their wisdom (and if I was inclined to a mere slither of cynicism), the Welsh Government have once again sought to emulate their Scottish cousins by proposing a minimum pricing on alcohol. They claim that a minimum price of 50p per unit of alcohol might save the Welsh economy £1 billion annually. That is quite a claim. This is apparently based on research assessing crime, illness and workplace absence over the last 20 years. So why not just introduce this measure (no pun intended) and have done with it? Putting aside the usual "political obstacles" which will impede such a proposal, is it possible that the current problem drinkers either continue to do so or just seek an alternative "high" or "escape". And that gets to the heart of the matter; why seek to address the consequences of the problem when it is more fruitful to address the route causes upstream.
In an excellent Ted Talk in 2010, the Argentinian psychologist Isaac Prilleltinsky delivered an insightful, amusing appraisal of the concept of Community Well Being. One of the many points made worthy of repetition was this one; for every £1 spent on health promotion and disease prevention, the economy will get back £17 in return. The average economy in the "developed world" spends about 3% of its entire healthcare budget on health promotion and disease prevention. But so far, I have just used the example of alcohol. Culturally, Wales has a huge problem with alcohol although I'd be the first to concede that Wales is also in good company.
Put simply, poor health and poverty are, and always have been, natural bedfellows. Therein lies the challenge. How to prevent progression to excess alcohol consumption in the first place? Logically, using the analogy of the dead bodies in the river, wouldn't it be more fruitful to target children from primary school onward? The statistics now point strongly to increased levels of drinking at home. This would seem to suggest that parents might need a little assistance. Whatever the solution, I would sooner see the resources being allocated upstream as opposed to the current insane firefighting.
But there are more evils in life than alcohol. A common sequel of alcohol excess is mental illness although the latter has many causes. Mental illness is estimated to cause the Welsh economy £7.2 billion annually. So what are the other key causes of mental illness? The answer is complex. The causes range from the genetic to the biological to the psychological to environmental factors. See what I mean? Go upstream to find the causes of mental illness and you will find a challenging conundrum. The World Health Organisation urges Governments to promote mental health so that both individuals and communities can better cope with the stressors and conflicts which are a part of everyday life. Globally, 1 million people commit suicide every year. That is arguably one of the greatest tragedies of our times.
The solutions to such challenges tend to be far more simple than our decision makers sometimes think. The food we eat, the past-times we enjoy, our education and our resulting income are all of huge importance. But there is arguably one factor which is of greater importance than all of these. When it is normal, it sustains our sense of well-being. But when it is disturbed, the knock on effect on our sense of well-being and mental health can be devastating. I refer of course to the activity which we should spend about a third of our life on - sleeping. Sleep health is attracting greater attention as researchers attempt to identify the key drivers of mental health.
As adults, we should be aiming for between 7 and 9 hours every night in order to achieve full, restorative sleep. Insomnia, apnoea and mental illness are the main obstacles to achieving this. In short, sleep is one of the easiest things we can address to exert a positive health outcome in our lives. But what if we have just lost our job or separated from our spouse or had our benefits stopped or just been told of the death of a very close friend or family member? All of a sudden, its easy to see how sleep can become a challenge rather than the pleasure it ought to be. Of course we can get nine hours of sleep after a skin full of alcohol but this is not restorative sleep. We can also sleep for hours if certain drugs are taken but once again, this form of sleep falls well short of the ideal. And sleep has a massive bearing on our functioning during the day.
But how does our diet impact on our sleep? To seek the best possible sleep, research now suggests a diet rich in fruit and vegetables with low-fat protein and whole grains. This serves to reinforce Government advice from 2003 asked us all to aim for five portions per day of fruit and vegetables. But even this has its challenges. The current leader of the RCGP (Royal College of General Practitioners) has just suggested that this advice is unfair for those on lower incomes because such a diet is much more expensive. She has also expressed doubts about the wisdom of always trying to persuade smokers to give up. And yet, the research has shown clearly that a one minute discussion on smoking has the long term effect of saving the NHS millions.
It is well known that the health systems with the greatest focus on Primary Care deliver the best health outcomes (greater life expectancy, earlier detection of cancer and less deaths from cardiovascular disease). This leads to fewer hospital admissions, lower cost and less health inequality. In recent years, the Department of Health has been spending less on Primary Care. Given that the research assures us of improved outcomes when Primary Care becomes the main point of focus, this is counter-intuitive. To put this in to context, 11% of the NHS budget was being spent on Primary Care just 10 years ago. The current 8% level represents a £3.8 billion annual deficit. To try and put that in to context, the cost of the HS2 project (which will inevitably make access to London more viable for more people) is estimated to be £55.7 billion. In the end, it all comes down to priorities.
One of the keys to improved mental health in our society is a greater sense of community. Consider this then; in neighbouring Flintshire, elected county councillors have cut public services to the extent that the county now boasts just four public toilets for a population of 150,000. I use this example because most sane people would recognise that the provision of adequate toilet facilities for the public is just a basic sign of a progressive society. We are too often labelled as the developed world despite so much evidence to the contrary. In my own county, the situation is hardly any better. So why are decisions being made which will so obviously cost society so much more in both the short and long term? For one thing, our society is now being governed more by the "bottom line" of grey accountants than by simple logic and reasoning. If every decision made had to pass a "humanity test", I have little doubt that the current levels of mental illness would be far more manageable.
Could it be that the wrong people are making the decisions? I don't mean county councillors as such. I refer instead to a theme about which I have written before; subsidiarity. This means the devolution of decision making to the lowest possible level. So, for example, instead of asking a few dozen elected county councillors to vote on whether to get rid of public toilets, why not instead lay out the financial challenge to individual local towns and villages and ask people what is most important to them? This would at least arrive at the most sensible and least painful decisions. Although we are frequently referred to as a democracy in the UK, it is often difficult to find good evidence.
Abram Maslow was the famous psychologist who espoused a hierarchy of human needs. At the bottom of his pyramid are the basic physiological needs of food, water, fresh air, warmth and rest. As the pyramid goes up, it recognises the need for safety, love and esteem before people are properly equipped to be able to reach their true potential. It is as valid today as when he first proposed it in 1943. Given its obvious logic, it really is hard to understand why a succession of governments have failed to take note. But government is all too often part of the problem rather than the solution. In a truly altruistic setting, governments would first consider only the essential basic needs of a society before aspiring to grander ideas such as the HS2 project. Were it not for vested interests and corporate greed driven by hungry shareholders, I doubt whether HS2 would even be on the table.
But it is not only governments (national and local) who abuse their power. The power of the food industry in the UK (and elsewhere) is truly frightening. Thus, the seemingly exponential desire for the foods most detrimental to our health continues unabated. Think about the last time you ventured in to your local supermarket. If I asked you to remember what was stacked closest to the entrance to attract your attention, you probably wouldn't even remember. But I would expect that it was either something with a high content of sugar or alcohol. I'm guessing it wasn't radishes or carrots. And the supermarket sector has been allowed to flourish alarmingly by a succession of governments cap in hand to the all powerful food lobby. It is a serious problem and the health impacts are only now beginning to be felt.
Only last week, we learned that for the first time, heart disease had been pushed in to second place as the leading cause of death in the UK. The new top dog is dementia. It is a massive problem on so many levels. Families have to watch as the person they once knew so well becomes a shadow of their former self. The cost of care for dementia is a great but necessary burden on the public purse. Who among us would not want to be cared for with dignity if we ever lost capacity to make decisions for ourselves? Dementia costs the UK £26.3 billion annually. Two-thirds of that cost is picked up by families either by providing unpaid care or by paying for expensive private care. Just imagine if the NHS had to start paying these families for the care they currently deliver gratis! The entire system would go in to meltdown overnight and that, as they say, would be that. Yet how often do we hear appreciation being expressed for this silent army? How much support do they get to relieve them of the daily grind of a full time job with no financial reward? The blessing for the nation is that families will go to the ends of the world and back for a loved one. The truth is that not so long ago, this was what everyone had to do as there was no alternative.
By comparison, diabetes (another great illness of our age) now costs £14 billion annually and, by 2025, it is estimated that this condition will affect 4 million people in the UK. Those high sugar snacks for children can be the fore-runner of this illness and yet while tobacco advertising has long since been banned, adverts for both high sugar foods and alcohol are seemingly ok. The fact is that all of the above impact detrimentally on the health of the nation. But, by inference, the physical health problems all too often impact on mental health. It is a damning cycle which needs desperately to be nipped in the bud. It is not just the future of the NHS which is at stake here. A nation weighed down with so much illness will struggle to remain productive.
As much as anything, it is the language which needs to change. We often hear about hard drugs but we also often hear about soft drinks. But which exerts the greater cost to the economy and the health service in particular? Just this week, a report has found that the average teenager in the UK is consuming sugary, fizzy "soft" drinks to the tune of a full bath every year. That is quite an indictment of the way in which we sanction one behaviour and chastise another. Until we change the language, we will struggle to change the mindset and it is the national psyche that this battle will be won and lost.
Diet is one part of the equation. The other part, if anything, is an even greater challenge. Sedentary lifestyles lacking in meaningful exercise have predominated in recent years. So while fewer smokers is to be welcomed, that excess alcohol and sugar needs two things to happen. The levels of consumption need to be drastically reduced and the levels of exercise need be cranked up considerably. Just recently, my home town saw roadworks for a new roundabout which saw ridiculous traffic queues as parents from one side of the town attempted the school run in their cars to the other side of the town. It makes me feel old to say this but my childhood started with a very long walk down country lanes to get my lift to primary school and I used to enjoy it. When I went to boarding school, junior boarders like myself cycled three miles to school every day and back again after lessons. It was enjoyable and set me up for the day. Exercise can sometimes conjour up feelings of dread and that is a great pity because it is invigorating and massively beneficial. The recipient of regular exercise invariably feels so much better for it. It would have been great to see a human line of parents and children walking to school together liberated from the insularity of their precious cars. Lord For has recently highlighted the dangerous trend in which half of children aged 8 to 14 are experiencing a 50% drop in their levels of physical exercise. We all need to sit up and take note of that.
So, whatever the solution to these problems which exert such a huge knock on effect both locally and nationally, it would be wise to follow the strategy of the man walking upstream to find the cause. To carry on emulating the man standing on the river bank is madness and time is running out.
I applied it in several contexts as I am sure you will already have done. In their wisdom (and if I was inclined to a mere slither of cynicism), the Welsh Government have once again sought to emulate their Scottish cousins by proposing a minimum pricing on alcohol. They claim that a minimum price of 50p per unit of alcohol might save the Welsh economy £1 billion annually. That is quite a claim. This is apparently based on research assessing crime, illness and workplace absence over the last 20 years. So why not just introduce this measure (no pun intended) and have done with it? Putting aside the usual "political obstacles" which will impede such a proposal, is it possible that the current problem drinkers either continue to do so or just seek an alternative "high" or "escape". And that gets to the heart of the matter; why seek to address the consequences of the problem when it is more fruitful to address the route causes upstream.
In an excellent Ted Talk in 2010, the Argentinian psychologist Isaac Prilleltinsky delivered an insightful, amusing appraisal of the concept of Community Well Being. One of the many points made worthy of repetition was this one; for every £1 spent on health promotion and disease prevention, the economy will get back £17 in return. The average economy in the "developed world" spends about 3% of its entire healthcare budget on health promotion and disease prevention. But so far, I have just used the example of alcohol. Culturally, Wales has a huge problem with alcohol although I'd be the first to concede that Wales is also in good company.
Put simply, poor health and poverty are, and always have been, natural bedfellows. Therein lies the challenge. How to prevent progression to excess alcohol consumption in the first place? Logically, using the analogy of the dead bodies in the river, wouldn't it be more fruitful to target children from primary school onward? The statistics now point strongly to increased levels of drinking at home. This would seem to suggest that parents might need a little assistance. Whatever the solution, I would sooner see the resources being allocated upstream as opposed to the current insane firefighting.
But there are more evils in life than alcohol. A common sequel of alcohol excess is mental illness although the latter has many causes. Mental illness is estimated to cause the Welsh economy £7.2 billion annually. So what are the other key causes of mental illness? The answer is complex. The causes range from the genetic to the biological to the psychological to environmental factors. See what I mean? Go upstream to find the causes of mental illness and you will find a challenging conundrum. The World Health Organisation urges Governments to promote mental health so that both individuals and communities can better cope with the stressors and conflicts which are a part of everyday life. Globally, 1 million people commit suicide every year. That is arguably one of the greatest tragedies of our times.
The solutions to such challenges tend to be far more simple than our decision makers sometimes think. The food we eat, the past-times we enjoy, our education and our resulting income are all of huge importance. But there is arguably one factor which is of greater importance than all of these. When it is normal, it sustains our sense of well-being. But when it is disturbed, the knock on effect on our sense of well-being and mental health can be devastating. I refer of course to the activity which we should spend about a third of our life on - sleeping. Sleep health is attracting greater attention as researchers attempt to identify the key drivers of mental health.
As adults, we should be aiming for between 7 and 9 hours every night in order to achieve full, restorative sleep. Insomnia, apnoea and mental illness are the main obstacles to achieving this. In short, sleep is one of the easiest things we can address to exert a positive health outcome in our lives. But what if we have just lost our job or separated from our spouse or had our benefits stopped or just been told of the death of a very close friend or family member? All of a sudden, its easy to see how sleep can become a challenge rather than the pleasure it ought to be. Of course we can get nine hours of sleep after a skin full of alcohol but this is not restorative sleep. We can also sleep for hours if certain drugs are taken but once again, this form of sleep falls well short of the ideal. And sleep has a massive bearing on our functioning during the day.
But how does our diet impact on our sleep? To seek the best possible sleep, research now suggests a diet rich in fruit and vegetables with low-fat protein and whole grains. This serves to reinforce Government advice from 2003 asked us all to aim for five portions per day of fruit and vegetables. But even this has its challenges. The current leader of the RCGP (Royal College of General Practitioners) has just suggested that this advice is unfair for those on lower incomes because such a diet is much more expensive. She has also expressed doubts about the wisdom of always trying to persuade smokers to give up. And yet, the research has shown clearly that a one minute discussion on smoking has the long term effect of saving the NHS millions.
It is well known that the health systems with the greatest focus on Primary Care deliver the best health outcomes (greater life expectancy, earlier detection of cancer and less deaths from cardiovascular disease). This leads to fewer hospital admissions, lower cost and less health inequality. In recent years, the Department of Health has been spending less on Primary Care. Given that the research assures us of improved outcomes when Primary Care becomes the main point of focus, this is counter-intuitive. To put this in to context, 11% of the NHS budget was being spent on Primary Care just 10 years ago. The current 8% level represents a £3.8 billion annual deficit. To try and put that in to context, the cost of the HS2 project (which will inevitably make access to London more viable for more people) is estimated to be £55.7 billion. In the end, it all comes down to priorities.
One of the keys to improved mental health in our society is a greater sense of community. Consider this then; in neighbouring Flintshire, elected county councillors have cut public services to the extent that the county now boasts just four public toilets for a population of 150,000. I use this example because most sane people would recognise that the provision of adequate toilet facilities for the public is just a basic sign of a progressive society. We are too often labelled as the developed world despite so much evidence to the contrary. In my own county, the situation is hardly any better. So why are decisions being made which will so obviously cost society so much more in both the short and long term? For one thing, our society is now being governed more by the "bottom line" of grey accountants than by simple logic and reasoning. If every decision made had to pass a "humanity test", I have little doubt that the current levels of mental illness would be far more manageable.
Could it be that the wrong people are making the decisions? I don't mean county councillors as such. I refer instead to a theme about which I have written before; subsidiarity. This means the devolution of decision making to the lowest possible level. So, for example, instead of asking a few dozen elected county councillors to vote on whether to get rid of public toilets, why not instead lay out the financial challenge to individual local towns and villages and ask people what is most important to them? This would at least arrive at the most sensible and least painful decisions. Although we are frequently referred to as a democracy in the UK, it is often difficult to find good evidence.
Abram Maslow was the famous psychologist who espoused a hierarchy of human needs. At the bottom of his pyramid are the basic physiological needs of food, water, fresh air, warmth and rest. As the pyramid goes up, it recognises the need for safety, love and esteem before people are properly equipped to be able to reach their true potential. It is as valid today as when he first proposed it in 1943. Given its obvious logic, it really is hard to understand why a succession of governments have failed to take note. But government is all too often part of the problem rather than the solution. In a truly altruistic setting, governments would first consider only the essential basic needs of a society before aspiring to grander ideas such as the HS2 project. Were it not for vested interests and corporate greed driven by hungry shareholders, I doubt whether HS2 would even be on the table.
But it is not only governments (national and local) who abuse their power. The power of the food industry in the UK (and elsewhere) is truly frightening. Thus, the seemingly exponential desire for the foods most detrimental to our health continues unabated. Think about the last time you ventured in to your local supermarket. If I asked you to remember what was stacked closest to the entrance to attract your attention, you probably wouldn't even remember. But I would expect that it was either something with a high content of sugar or alcohol. I'm guessing it wasn't radishes or carrots. And the supermarket sector has been allowed to flourish alarmingly by a succession of governments cap in hand to the all powerful food lobby. It is a serious problem and the health impacts are only now beginning to be felt.
Only last week, we learned that for the first time, heart disease had been pushed in to second place as the leading cause of death in the UK. The new top dog is dementia. It is a massive problem on so many levels. Families have to watch as the person they once knew so well becomes a shadow of their former self. The cost of care for dementia is a great but necessary burden on the public purse. Who among us would not want to be cared for with dignity if we ever lost capacity to make decisions for ourselves? Dementia costs the UK £26.3 billion annually. Two-thirds of that cost is picked up by families either by providing unpaid care or by paying for expensive private care. Just imagine if the NHS had to start paying these families for the care they currently deliver gratis! The entire system would go in to meltdown overnight and that, as they say, would be that. Yet how often do we hear appreciation being expressed for this silent army? How much support do they get to relieve them of the daily grind of a full time job with no financial reward? The blessing for the nation is that families will go to the ends of the world and back for a loved one. The truth is that not so long ago, this was what everyone had to do as there was no alternative.
By comparison, diabetes (another great illness of our age) now costs £14 billion annually and, by 2025, it is estimated that this condition will affect 4 million people in the UK. Those high sugar snacks for children can be the fore-runner of this illness and yet while tobacco advertising has long since been banned, adverts for both high sugar foods and alcohol are seemingly ok. The fact is that all of the above impact detrimentally on the health of the nation. But, by inference, the physical health problems all too often impact on mental health. It is a damning cycle which needs desperately to be nipped in the bud. It is not just the future of the NHS which is at stake here. A nation weighed down with so much illness will struggle to remain productive.
As much as anything, it is the language which needs to change. We often hear about hard drugs but we also often hear about soft drinks. But which exerts the greater cost to the economy and the health service in particular? Just this week, a report has found that the average teenager in the UK is consuming sugary, fizzy "soft" drinks to the tune of a full bath every year. That is quite an indictment of the way in which we sanction one behaviour and chastise another. Until we change the language, we will struggle to change the mindset and it is the national psyche that this battle will be won and lost.
Diet is one part of the equation. The other part, if anything, is an even greater challenge. Sedentary lifestyles lacking in meaningful exercise have predominated in recent years. So while fewer smokers is to be welcomed, that excess alcohol and sugar needs two things to happen. The levels of consumption need to be drastically reduced and the levels of exercise need be cranked up considerably. Just recently, my home town saw roadworks for a new roundabout which saw ridiculous traffic queues as parents from one side of the town attempted the school run in their cars to the other side of the town. It makes me feel old to say this but my childhood started with a very long walk down country lanes to get my lift to primary school and I used to enjoy it. When I went to boarding school, junior boarders like myself cycled three miles to school every day and back again after lessons. It was enjoyable and set me up for the day. Exercise can sometimes conjour up feelings of dread and that is a great pity because it is invigorating and massively beneficial. The recipient of regular exercise invariably feels so much better for it. It would have been great to see a human line of parents and children walking to school together liberated from the insularity of their precious cars. Lord For has recently highlighted the dangerous trend in which half of children aged 8 to 14 are experiencing a 50% drop in their levels of physical exercise. We all need to sit up and take note of that.
So, whatever the solution to these problems which exert such a huge knock on effect both locally and nationally, it would be wise to follow the strategy of the man walking upstream to find the cause. To carry on emulating the man standing on the river bank is madness and time is running out.
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