Sunday, August 29, 2010

swapping health care for death threats

NHS Direct is the latest victim of the Tory cuts. The phone line was, itself, set up as a money-saver. People can ring up with minor ailments and speak to qualified nursing professionals so they don't use the more expensive 999 calls or A&E admissions. The plan is to replace it with a line staffed by people who've had 60 hours training. The opportunities for misdiagnosis - costing more money as well as misery - are vastly multiplied.

This is not like John Major's Cones Hotline that was trumpeted by government yet only handled a dozen calls a day (including pranks). NHS Direct receives nearly a million calls a month. Its abolition is just a further gratuitous dismantling of the NHS. The replacement system is still being piloted, yet they've decided to decided to roll it out nationally and permanently. Andrew Lansley has a novel definition of 'piloting'.

The new government's continual excuse for the cuts as essential cost-cuting is an outrageous decoy. Just as they're axing the Sustainable Development Commission even though it saves tens of times its cost, so they're claiming their NHS cuts all save money and improve efficiency.

They tell us they're cutting layers of NHS bureaucracy, such as abolishing Primary Care Trusts. Leaving aside the fact that the Tories invented the internal market of the NHS and fertilised the culture of outsourcing, the new government is actually bringing in a new layer of NHS bureaucracy in GP's fundholding. Indeed, it seems likely that the bureaucrats we sack from PCTs will be rehired by GPs (doctors are hardly going to do all their own accounting), but with all the added waste of bringing in a new system.

Beyond all these giant cogs and gears of Tory spending cuts, there is a simple test to apply to claims of necessary cuts. They cannot credibly talk of saving money by cutting waste and things that don't get used whilst they're planning to replace Trident.

These WMDs are so terrible that they cannot be used. Their effects would decimate populations and poison land far beyond the target, quite possibly affecting the UK.

Here's the deal; if your enemy knows you won't use a weapon, it is not any kind of a deterrent. Every penny of the tens of billions of pounds spent on them is a pointless waste. The cost of Trident replacement is commonly cited as £20bn - coincidentally the same amount the NHS has been ordered to cut between now and 2014 - though a Greenpeace report estimates £97bn over its 30 year lifespan.

You expect Tory papers like the Mail and Telegraph to toe the government line, but the supposedly impartial BBC and the lefty Guardian use the phrase 'nuclear deterrent' too. That is not neutral descriptive language, it is the militaristic opinion that nucelar weapons deter. Trident is not a nuclear deterrent, it is a nuclear weapons system.

Frankly, I can't see any defensive element to the British military. If we abolished our armed forces, who exactly would invade us? But certainly, long before we reach such issues, there is no credible argument for nuclear weapons. Those who say we should keep them talk of being 'left defenceless'. Take a look at what we've done in Serbia, Iraq and Afghanistan lately, all without nukes. See how many mighty non-nuclear states around the world go about their business unattacked.

Farting around making what are, financially speaking, comparatively tiny cuts to services people actually use and rely on in order to have the cash to spend on something that will never be used would be laughable if it were just an idea. It means we take away quality of life for our citizens in order to pretend to threaten ugly death to citizens of other places.

The fact that such ideas are at the forefront of the minds of the people running the country is frankly terrifying, and makes you wonder with dread what they'll do next.

Friday, August 20, 2010

sharks, ice cream, methane and hot water bottles

Analogy of the week has to go to Gary Younge in his piece about immigration and job losses.

Because two things are correlated does not mean one causes the other. Shark attacks and ice-cream sales both rise in the summer. They're linked by the season. But that doesn't mean ice-cream attracts sharks or people react to fear about shark attacks by eating more ice-cream.

This image outstrips another analogy that I found in the new issue of The Land. It's an obscure yet vital magazine. Produced by The Land Is Ours crew, it always gets into the fundamental cogs and gears of land ownership and use. Intelligent, thoughtful and informative, every issue has a number of things that make you want to read them out loud to people. I lifted their article Can Britain Feed Itself? for U-Know.

In the run-up to the Copenhagen Climate Blahblahblah, I pointed out that the Chinese and Indian use of measuring 'carbon intensity' rather than carbon emissions was a way of wriggling out of reducing emissions. The current issue of The Land has chewed the pencil and crunched the numbers. Check out these graphs.

Elsewhere there's a discussion about the climate impact of methane. It's a far more potent greenhouse gas than CO2, but it breaks down quicker. The convention is to measure a gas' potency over 100 years. At that level, methane is about 25 times stronger than CO2 [IPCC Fourth Assessment Report, Chap 2, table 2.14]. Some people are arguing that we should pick a shorter term (over 20 years, it's 72 times stronger), as cuts in methane mean greater cuts in the immediate greenhouse effect.

Anyway, the silver medal analogy of the week comes in a piece about this. The Land's Simon Fairlie argues that the longer-term impact of CO2 is what actually makes it more important than methane, not less. He quotes a piece by Geoff Russell:

a tonne of methane contributes 100 times more warming during the first five years of its lifetime as a tonne of CO2, yet under current Kyoto rules, its comparative potency is set at 21. This is because the relative impacts of ALL greenhouse gases are averaged over the same period 100 years, regardless of their atmospheric lifetimes.

This is like applying a blow torch to your leg for 10 seconds but calculating its average temperature as just 48 degrees because that’s what it is when averaged over 20 minutes, with 20 minutes being used because that happens to be some agreed international standard when measuring heat sources applied to legs. The implication being, of course, that a blow torch for 10 seconds and a 48 degree hot water bottle for 20 minutes have the same effect.

Fairlie then runs with it.

The analogy is potentially illuminating, but it is misleading because the methane blowtorches and the CO2 hot water bottles aren't being applied to anything as sensitive as a leg, but are heating up the atmosphere, as in a room.

Also, it is incomplete because there isn't just one blowtorch and one hot water bottle, there are hundreds of them being brought into the room continuously. Although the blowtorches are individually intensely hot, they go out within a matter of seconds, whereas the hot water bottles keep piling up until their collective heat far outstrips that of the relatively few blowtorches that remain ignited at any one time.

At the point where the heat becomes unbearable, the obvious first course is to reduce the flow of blowtorches into the room. That will be the quickest way of reducing the temperature back to the level it was just before it became unbearable. Reducing the flow of hot water bottles will have comparatively little immediate effect.

But removing the blowtorches won't prevent the hot water bottles continuing to pile up until the heat becomes unbearable again; that will eventually happen even if the flow of blowtorches is completely stopped, and when it does happen it will be much harder to lower the temperature again.

In fact, the shorter lifetime of methane also speaks in its defence. In order to maintain the blowtorch heat, the blowtorches have to come into the room thick and fast. In other words, in order to maintain a given level of methane in the atmosphere we have to keep pumping out regularly otherwise the number of parts per million will fall away rapidly...

On the other hand, if humans stopped burning fossil fuels tomorrow, the burden of CO2 emitted in the 20th century would linger on for several generations.

This means that if the world decided to stabilise greenhouse gases at their current level, we would only need to reduce global methane output by 6.1 percent, but CO2 emissions by anything from 50 to 85 percent.

Any 'targeting' of methane to compensate for the manifest failure to reduce CO2 emissions... would be scapegoating methane to bale out CO2; or put another way, it would be extracting a subsidy from methane emitters for the benefit of fossil fuel users...

Whereas UK and US methane emissions comprise 8 and 9 percent of the greenhouse gas emissions respectively, India's methane emissions, two-thirds of which come from cows and rice, are reported to comprise 35 percent of her total. India, like most poor countries, burns far less fossil fuels per head than the USA or UK, and for many of her poor, a goat or a cow may represent almost the entirety of their greenhouse gas emissions.

Targeting methane emissions such as these to compensate for a failure to reduce CO2 emissions is another facet of the neo-colonialism that has pervaded international climate negotiations.

The Land. Go buy it.

Wednesday, August 18, 2010

kingsnorth: back from the dead?

The latest in the line of anti-environmental actions from the ConDems is a spectacular U-turn on a central policy promise that, in opposition, they beat Labour round the head with.

David Cameron, 16 June 2008:

We’ll only get the big benefits of going green if we’re really ambitious and really change the way we do things. What I’m talking about is one of the most radical technological and social shifts for generations. I’m talking about reconfiguring our whole economy and overturning our whole hydrocarbon dependency...

So that’s why I can announce today that a Conservative Government will follow the Californian model, and implement an Emissions Performance Standard. This would mean the carbon emissions rate of all electricity generated in our country cannot be any higher than that generated in a modern gas plant. Such a standard would mean that a new generation of unabated coal power plants could not be built in this country.

That's clear, specific and unambiguous.

So, once elected, it was no surprise to see it in the main policy document The Coalition: Our Programme for Government, May 2010:

We will establish an emissions performance standard that will prevent coal-fired power stations being built unless they are equipped with sufficient carbon capture and storage to meet the emissions performance standard.

Again, that's clear, definite and unequivocal.

But three months on when it's time for action, we find out it's actually time to jettison the policy promise, 15 August 2010:

Now government sources confirm they will not be bringing forward legislation in the autumn and will instead spend the summer working on "the larger picture". They will open a consultation on the [Emissions Performance Standard] idea in the autumn with the results being presented to parliament as a white paper in the new year.

You can hear the beast of unabated coal stirring in its lair. See you in front of the bulldozers at Kingsnorth.

Friday, August 06, 2010

on this deity (slight return)

Dorian Cope has relaunched her On This Deity site! I say now what I said when she did the beta version:

This is what I find most encouraging about the writing trades: they allow mediocre people who are patient and industrious to revise their stupidity, to edit themselves into something like intelligence.
- Kurt Vonnegut

Vonnegut observed a truth there that all of us who write recognise.

Dorian Cope, however, is one of those people who can do it without so much of the revision and editing, she can just lay it out off the top of her head. Look what happens when she's interrupted on her way somewhere by a randomer who asks her about the MC5.

Dorian is the wife of the indefatigable Julian Cope. As he releases an album more than once a year and has written a swathe of effervescent groundbreaking scholarly books on history and music, it must take a mighty intellect and a bold character to keep up with him at close quarters, let alone to encourage, inspire and criticise as he creates. Dorian does all that and more, so it's long past time that she started publishing stuff herself.

Her On This Deity site marks anniversaries of events in history. And not the history of kings and presidents but the other history, the history of dissent and rebellion. It's got the classic Cope mix of vision, fresh interpretation and an understanding of music as central cultural force and key part of radical history.

Each post is an illuminating piece, but there's a powerful composite message too. As we see that these events have gone on - every day, all around the world, year in year out for centuries - so we realise that the daring, imaginative, revolutionary perspective isn't a wacky sideshow or something reserved for mighty superheroes like Mandela, but that it's something that binds us in the millions and, most importantly, is as real and possible a force for change now as any time in the past.

Tuesday, August 03, 2010

poor people, poor health

As the new government continues to shift the blame for poor health on to the unhealthy people - arguing that we should further stigmatise obese people as a matter of policy -  a new report in the British Medical Journal studies the disparity in life expectancy between rich and poor.

By the year 2007 for every 100 people under the age of 65 dying in the best-off areas, 199 were dying in the poorest tenth of areas. This is the highest relative inequality recorded since at least 1921.

Elsewhere, Ben Goldacre says male life expectancy in Kentish Town is 70, whereas two miles away in rich Hampstead it's 80.

I know this because I have the Annual Public Health Report for Camden open on the table right now.

This phenomenal disparity in life expectancy – the difference between a lengthy and rich retirement, and a very truncated one indeed – is not because the people in Hampstead are careful to eat a handful of Brazil nuts every day, to make sure they’re not deficient in selenium, as per nutritionists’ advice.

And that’s the most sinister feature of the whole nutritionist project, graphically exemplified by [Gillian] McKeith: it’s a manifesto of rightwing individualism – you are what you eat, and people die young because they deserve it. They choose death, through ignorance and laziness, but you choose life, fresh fish, olive oil, and that’s why you’re healthy. You’re going to see 78. You deserve it. Not like them.

How can I be sure that this phenomenal difference in life expectancy between rich and poor isn’t due to the difference in diet? Because I’ve read the dietary intervention studies: when you intervene and make a huge effort to change people’s diets, and get them eating more fruit and veg, you find the benefits, where they are positive at all, are actually very modest. Nothing like 10 years.

It's worth pointing out that life expectancy is a good tool for measuring public health, but also something of a blunt one. The poor don't just die younger, they fall into ongoing disability much younger.

Fair Society, Healthy Lives was a government report into this issue, published in February.

people in England living in the poorest neighbourhoods will, on average, die seven years earlier than others living in the richest parts of Britain, the study finds.

Not only is life expectancy linked to social standing, but so is the time spent in good health: the average difference in "disability-free life expectancy" is now 17 years between those at the top and those at the bottom of the economic ladder, the report says.

Goldacre continues, attacking the unqualified media nutritionists like Gillian McKeith for focusing on freakshows rather than confronting the underlying causes of poor diet and poor health.

What prime-time TV series looks at food deserts created by giant supermarket chains, the very companies with which stellar media nutritionists so often have lucrative commercial contracts?

What show deals with social inequality driving health inequality? Where’s the human interest in prohibiting the promotion of bad foods; facilitating access to nutrient-rich foods with taxation; or maintaining a clear labelling system?

Where is the spectacle in “enabling environments” that naturally promote exercise, or urban planning that prioritises cyclists, pedestrians and public transport over the car? Or reducing the ever-increasing inequality between senior executive and shop-floor pay?

However, whilst he says it's a matter of asking 'where's the TV audience ratings?', we can also see Health Secretary Andrew Lansley sweeping free health care and food labelling aside as he and the other Tory ministers ask 'where's the shareholder dividends?'