All posts by aldomussi

70 Years of the NHS: A very British way of not queue-jumping.

save our NHS

Our team member Aldo Mussi argues that “Perhaps the most inconsistent thing about privatised healthcare is that it’s, well… not very British!”

I held the shiny new 50p in my hand. It was 1998, and this was a special commemorative coin minted for the 50th anniversary of the founding of the NHS – and given one each to (I’m not sure how many) staff for free! I was a team leader in the NHS, and proud to be part of the best healthcare system in the world.
Some might take that 50p to be symbolic of the waste that pervaded the NHS in the past – but the danger would be to overlook the bigger threats that have plagued it throughout its existence. In the early days it was noticeably the medical profession that resisted Aneurin Bevan’s setting up of a nationalised healthcare service – so much so that he complained of having to bribe them by ‘filling their mouths with gold’. Today it is the filling of the pockets of businesspeople and lawyers that we must be wary of.

These days I teach Health Promotion/Public Health, and my students get to see how most of the health of a population is actually determined by factors outside of healthcare (ie our environments and behaviours). That said, while healthcare’s contribution to health is limited, it is nonetheless an essential one, and especially with basic community & family care (Midwifery, immunisations, screening etc). Big, expensive hospitals are great for individuals who are acutely ill, but overall don’t make such a big impact on our average life expectancy, or happiness.

The NHS continues to be treasured by Britons – so, for a country where ‘socialism’ has been treated as a rude word by the establishment, my students are often surprised to consider how socialist an idea the NHS is (we pay via taxation according to our ability, receiving care according to our need). It seems that Britons are more socialist than they realise.

Of course, even at the outset there were capitalist strands to the new system (charges remained for dentists, opticians and prescriptions), but it took the Thatcherite introduction of a contract culture to really start undermining things: It could be claimed that a genuinely national health service ceased to exist when local ‘NHS Trusts’ were set up in 1992, with a ‘purchaser-provider split’.

My students can be puzzled by how many of their healthcare colleagues adhere to the idea that privatised healthcare is the best, for those who can afford it. But even setting aside the now-clear realisation that unequal societies make health worse for everyone at a population level, privatisation doesn’t deliver for us: the same staff could provide care for us in a better-supported NHS (which already has better facilities)… and of course when things go wrong in a private clinic, it is NHS emergency care which rescues people, at the public expense. Another example of ‘socialism for the rich, capitalism for the poor’?

Privateers in the USA point to the few areas where expensive insurance can open doors to fast & high-tech treatments for the few. People paying $100 to get a splinter removed, or selling their house to pay for cancer care, are less impressed. In fact the USA has the most expensive healthcare in the world, but with downright unimpressive outcomes (other than big profits for insurance companies and lawyers).

“We are renowned for waiting our turn in orderly queues, in the interests of fair play and order. Yet privatised healthcare is queue-jumping at best, and damaging to the public’s overall health. So it’s odd that people who wouldn’t dream of pushing in to a queue at something more trivial like the cinema, will in some cases be persuaded that it’s ok to pay for getting treated ahead of someone else.”

That might seem ok if healthcare was supposed to be in a ‘marketplace’, as a commodity to be bought and sold. But that would be forgetting that access to essential healthcare is a human right, and that (as with schooling) attempts to privatise it are a breach of that right.
But perhaps the most inconsistent thing about privatised healthcare is that it’s, well… not very British. We are renowned for waiting our turn in orderly queues, in the interests of fair play and order. Yet privatised healthcare is queue-jumping at best, and damaging to the public’s overall health. So it’s odd that people who wouldn’t dream of pushing in to a queue at something more trivial like the cinema, will in some cases be persuaded that it’s ok to pay for getting treated ahead of someone else. So far, paying for organs is illegal in Britain – but for how long will this be the case, in the event that we have another 40 years of uninterrupted Thatcherite healthcare policy?

Safeguarding the NHS, a collectivist system, will require us to maintain our collective commitment as a nation. As individual citizens, we could also take actions such as

– Decreasing our reliance on privatised healthcare. With the constraints currently being imposed on the NHS, an individual can’t necessarily be blamed for trying to get the quickest care for their loved ones… but we could opt out of, eg workplace healthcare schemes.

– Joining the political effort, such as the upcoming ‘Save Our NHS’ demonstrations led by organisations such as https://keepournhspublic.com/

– And of course, we must also look beyond treating illnesses when they arise, and get more serious about preventing those illnesses, and promoting wellness, in society as a whole.

A happy, healthy 70th anniversary!

Aldo NHS not Trident

Aldo Mussi
Tutor in Health Promotion / Public Health.

Universities divesting from fossil fuels – & how BCU has narrowly missed getting a ‘1st’!

Climate change is not only a pressing public health, ecological and justice concern – it’s increasingly a financial worry. With fossils fuels increasingly seen as a liability, the shift by investors away from this old technology is growing (1).

In keeping with that trend, in November 2015 I welcomed reports that BCU was in the top 16 of British universities which had started ‘divesting’ from fossil fuels. (The top 10 were divesting completely, while the fund managers for BCU and others were merely fleeing tar sands & coal (the dirtiest fuels) (2). Others have joined the trend since then, but BCU is still in the top 25% of universities who have made the move (3).

emmissions stacks
(photo: Getty Images)

People & Planet (a national network of student eco-societies) publish a ‘green league table’ of British universities, and in the 2016 results, it’s good to see BCU placed 31 out of 150 institutions (top of the list of those awarded a ‘2.1’, but frustratingly just missing out on a ‘First’) (4).

A quick look at BCU’s scorecard (below) raises an obvious question: If we are at the forefront of divestment, why did we score a zero for ‘Ethical Investment’? It turns out that People & Planet’s criteria depend largely on being able to audit an institution’s published policies, including an Ethical Investment policy. BCU had not yet published one, so that counted against us. Interestingly, had it been published, our partial divestment would have counted for a score of 5% – possibly enough to push us up into a ‘First’ next time?

It seems that BCU management may be addressing this in the near future, so I’m hoping I’ll be able to report even better news soon…

BCU 2.1 green league 2016
Birmingham City University People & Planet University League 2016 Scorecard :
1. Environmental Sustainability; Policy and Strategy 100
2. Human Resources for Sustainability 40
3. Environmental Auditing & Management Systems 100
4. Ethical Investment 0
5. Carbon Management 35
6. Workers Rights 15
7. Sustainable Food 60
8. Staff and Student Engagement 20
9. Education for Sustainable Development 35
10. Energy Sources 31
11. Waste and Recycling 76
12. Carbon Reduction 78
13. Water Reduction 50

Sources
1) http://www.huffingtonpost.com/entry/fossil-fuel-divestment_us_584ee51de4b0bd9c3dfdbce8
2) https://www.theguardian.com/environment/2015/nov/10/ten-uk-universities-divest-from-fossil-fuels
3) https://www.theguardian.com/environment/2016/nov/22/fossil-fuel-divestment-soars-in-uk-universities
4) https://peopleandplanet.org/university-league-2016-tables

Aldo Mussi is a Tutor & Activist in Health Promotion/Public Health at Birmingham City University
and Environment Rep for the Universities and Colleges Union branch at BCU.
aldo.mussi@bcu.ac.uk

Sustainability In Public Health: A response to PHE’s 2016 report.

We can’t maximise our health if our environments are unsustainable.

Public Health England accept this in their Sustainability In Public Health Report 2016.

I was asked to comment on the report, partly due to my role as Sustainability Rep for BCU’s branch of the Universities & Colleges Union – so here goes:

The first thing that must be said is that if all employers shared Public Health England’s apparent willingness to consider their impact on sustainability, the world would be a healthier place. Also, while I have concerns about PHE’s position, I was to some extent reassured by a conversation recently with PHE’s Paul Cosford, that at least individuals like him were right on the ball.

On the document itself : As so often happens, the focus is on immediate impacts on the physical environment. Important as that is, for true Sustainability/ Sustainable Development, attention must also be paid to the social and economic environment (see my comments at end).

Sustainability1

Buildings

PHE’s buildings use is rightly considered, and some care is being taken with their environmental impact. More information is needed on the impact PHE is having with any office moves, refurbishments and new constructions.

Greenhouse gas emissions

It’s good that there have been some reductions, and wise to have invested in photovoltaics – but any lead organisation like PHE must achieve more than 2.6% reduction per year, if it is to lead the way for Britain to achieve its climate change obligations.
Clearly, the government must reconsider the need for & operation of the facility at Porton, given its huge impact… & what is going on with refrigerant loss at Colindale?

Travel

It’s good that staff train use is up and car use is down (although we must hear why it is that the Chief Operating Officer’s department spends so much on car use). More data would also be welcome on how these cars are powered.
An increase in 73% on international flights is unacceptable (we need to hear how much of this is really due to crises like ebola) – and even worse, that domestic flights within a small country like Britain have also increased by 73%.
It’s welcome that more videoconferencing is being encouraged, but it is insufficient to say “It is hoped that this new technology, which is available for all staff, will help reduce our need to travel for face-to-face meetings,” or, “we will use public transport wherever possible, rather than our own cars”. Clearer intentions and actions are required. Further calculations would also be useful, such as whether the organisation is successfully increasing the proportion of commuting miles cycled/walked/run, compared with car use.

Sustainability training

The staff training on sustainability is welcome, and there are some good, if limited actions on biodiversity. Perhaps more could be said about, eg avoiding the use of pesticides such as glyphosate, and avoiding genetically-modified organisms.
I’m glad that the need for responsible procurement gets a mention – and more detail is needed on how successfully PHE manages to increase the proportion of its purchases which are organic, fairtrade, and locally- or co-operatively- produced, and how much of the electricity used is from renewable sources (not just ‘green tariffs’).

Waste

I’m glad that PHE has reduced its ‘waste’ materials, and especially that landfill has reduced (though we should hear more about what was actually done with its used materials). It’s good that there is a disposal plan for IT equipment – but more must be said about how the need for new IT equipment can be reduced. Indeed, it would be very instructive to have reporting of what goods/materials were acquired during the year, to see if the consumption could be reduced at the outset.

Cold homes

There is brief mention of cold homes (an essential consideration, given that colder countries such as Sweden do not tolerate the excess winter deaths of British citizens condemned to fuel poverty and inadequate housing). I doubt that “Providing local authorities with data on how to improve their housing stock” will have much effect – Councils already know what’s needed, but have had their funding cut. Stronger advice is needed to national government, which could do much more to reinstate the welfare safety net, as well as increasing housing standards (especially in the private rented sector).

Social & economic environment

More could be said on how well PHE is, for example, promoting equality, reflecting the population it serves, and avoiding use of ‘first class/business class’ travel.
On the ‘economic environment’, it would be good to see PHE’s pay ratios within the organisation (including externally-contracted staff), and whether PHE ensures its investments are free from arms, torture, tobacco, and fossil fuels.
So, overall, I would say this document shows a better picture than I would expect (unfortunately) from most employers – but given that PHE is a lead player on sustainable development, even more is needed, if Britain is to reach its sustainable development responsibilities.
I wish Paul Cosford and colleagues all the best for their future actions.

27 Jan 2017
Aldo Mussi
Tutor in Health Promotion/Public Health at Birmingham City University (BCU)
Sustainability Rep for University & Colleges Union at BCU.
aldo.mussi@bcu.ac.uk

Air Pollution : 8 ways to stop killing people

by Aldo Mussi, Tutor in Health Promotion/Public Health.

The time has now arrived to take air pollution, as currently encountered in the UK, much more seriously. It should be considered a major public health problem”, according to a new report featured in The Lancet.chest xray

60 years on from the first Clean Air Act, this is the latest ‘inconvenient truth’ about our lethally sub-standard air quality, which the UK government will find ever harder to ignore. It’s been known for some time (but little discussed) that 29,000 per year die early due to inhaling particulates (invisibly-small specs of soot), mainly from diesel engines. The report now shows that the total increases to 40,000 when we add in the early deaths due to nitrogen oxide poisoning from exhausts. The effect of these toxins on the human body is mainly seen as heart and respiratory disease, stroke and lung cancer.

 

 

Motorists have some cause to feel confused: The ‘switch to diesel’ encouraged by governments over the last decade or so was based on the still-sound evidence that diesel engines produce less greenhouse gas pollution than petrol. That’s still important – but what wasn’t known then, is the level of disease caused by diesels, especially in towns. Both types of engine are harming us, in slightly different ways.

The report goes on to look at the additional early deaths from indoor air pollution. While second-hand smoke, faulty gas heaters and radon have long been recognised, the authors call for more attention to be given to the less-discussed threats from sources such as air ‘fresheners’ or other chemicals such as in deodorants and hairsprays, or from faulty log burners. It seems that more action is needed to enable people, and especially children, to enjoy clean air indoors.

 

So, some actions we could take as a country could include :

  1. For the government to stop acting illegally (costing us in fines as well as deaths), and comply with legally-safe levels of air quality.
  2. For ministers to stop costing our economy £20 billion per year from their failure to create a safe, accessible and interconnected transport system.
  3. Where private vehicles are seen as necessary, encourage diesel vehicles for long-haul journeys only, and in towns move to more low-emission options such as no cars, electric (renewable) cars or at the very least, high-efficiency petrol cars. Diesel buses, trains and taxis will become a thing of the past.
  4. For more councils to follow the example of Solihull, as the first authority in England to start restricting traffic volumes around schools – and on air quality grounds, not just to limit crashes.
  5. Make it easier for people to wean themselves off their car habits, and make our roads less hostile to non-drivers. As my students know, ‘making the healthy choice the easy choice’ has long been a mainstay of individual behaviour change.
  6. Do more research into the effects of household and ‘personal care’ chemicals, and fumes from heaters. A social marketing campaign to raise awareness of this may be necessary.
  7. For the Public Health community to give as much attention to ‘unfashionable’ hazards such as vehicle emission poisoning, as they do to comparable hazards such as tobacco and alcohol. Our BSc and MSc students here at BCU already do this, so it’s one reassurance that they’ll be part of the future workforce.
  8. For all of us to ensure the authorities are held accountable for protecting our health from avoidable hazards. (Who will you let in at the next election?)

Details of BCU’s BSc and MSc courses in Public Health can be found at : www.bcu.ac.uk