Being poor is bad for your health and being ill is bad for your wealth

Babbling on about health inequality has become the latest obsession of the sort of Labour politician who rises to being a council leader or perhaps the shouty sort of backbench MP. This obsession leads to this sort of nonsense:

‘Shocking’ health inequality and poverty go hand-in-hand, meeting told

So says Susan Hinchcliffe, leader of Bradford Council as she comments on a report showing that people living in Ilkley - one of the wealthiest places in the North of England - live 21 years longer than people in Tong, one of the UK's most deprived communities. That both these places are in the Bradford metropolitan district is a quirk of political geography.

What's nonsense here is, of course, the idea that we should be shocked that poor people have less good health outcomes than rich people. This fact has been pretty much common knowledge since people first started thinking about health. So the solution isn't to, in some way, redirect resources from Ilkley to Tong (at a guess the per capita spending on healthcare in Tong is significantly higher already) but rather to reduce the poverty.

The second common misunderstanding here is that there is something about the place that means people are healthier - or for that matter richer. While place has some impact on health (air quality, for example) most health outcomes are entirely unrelated to where people are born or where they live. People in Tong are less healthy because they are poorer. And they live in these places because they have the affordable housing that poor people need.

And for some of the people in Tong, the reason they are poor is because they have poor health. Illness and disability can and does lead directly to reduced income. We can probably all think of someone we know who, because of their health, dropped out of a career or because of their disability never embarked on one. It's probably true that we could do more to reduce this effect but it's also true that we can only really resolve the poverty not the inequality.

So Bradford's "shocking" health inequality is entirely a consequence of Bradford's income inequality. And we don't fix this by making people in Ilkley poorer (or less healthy) but rather by making people in Tong richer. Indeed, we should stop using geography as a measure - especially given the degree to which otherwise intelligent people completely fail to grasp what local area statistics tell us - and should focus on people who are poor wherever they live.

Nationally we spend something like £6 billion on public health and a further £6 billion on various activities dubbed 'prevention'. If we were serious about improving health outcomes - and reducing that health inequality contingent on geographical concentrations of wealth or poverty - then we would shift most of this spending away from nannying people about booze, fags and burgers and spend it instead on programmes to reduce poverty. But I guess that doesn't fit the script.

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Vegan diets are unhealthy, don't help the environment and lots of animals still die. We should stop indulging their propaganda.

It has become terribly faddish to be a vegan. Hardly a day passes without another TV show featuring some sort of vegan promotion. We're told that being vegan is healthy, environmentally responsible and, of course, morally superior to the old-fashioned human diet filled with animal products. The latest in this stream of propaganda come the other day with the supposedly planet saving 'healthy reference diet' proposed by the EAT-Lancet Commission:

The Commission quantitively describes a universal healthy reference diet, based on an increase in consumption of healthy foods (such as vegetables, fruits, whole grains, legumes, and nuts), and a decrease in consumption of unhealthy foods (such as red meat, sugar, and refined grains) that would provide major health benefits, and also increase the likelihood of attainment of the Sustainable Development Goals.

It's true that these folk aren't proposing that we should all be forced into eating a vegan diet (although they do suggest lots of draconian choice-reduction enforced by government) but the arguments are familiar and move on from the traditional "don't kill animals" position of vegans to a more nuanced morality tale about saving the planet and eating healthily. It is still, however, vegetarian propaganda wrapped up as science. EAT is funded by a couple of Norwegian billionaires (they paid Bill Clinton 3.5m Norwegian Krone to speak at one of their conferences) and funds a familiar collection of researchers:

Take Christiana Figueres, former Executive Secretary of the United Nations’ Framework Convention on Climate Change (UNFCCC). She has compared meat eaters to smokers - who likewise were once role models but later became pariahs - and believes that they should be having their meal outside of the restaurant. Or Harvard's professor Walter Willett, who has claimed that one in three early deaths could be saved if we all gave up meat, and Oxford's vegan researcher Marco Springmann who has called for a meat tax to prevent over “220,000 deaths” and save billions in healthcare costs.

This comes from a review of the EAT-Lancet Commission proposals published in the newsletter of the European Food Agency. The review by food scientist Frédéric Leroy and sociologist Martin Cohen concludes:

The initial effect of the EAT-Lancet campaign seems to be not so much to promote animal welfare as to open up for “Big Ag” lucrative new markets and feed the hunger of governments for new tax bases. What start as academic and scientific debates become political arguments that are dangerously simplistic and may have several detrimental consequences for both health and the environment.

This points us to the core issue with vegan and near-vegan diets - they are unhealthy, probably do little for the environment and almost certainly are bad for the planet's animals. It has always struck me as ridiculous to pretend that we can inhabit the planet without, at some point, killing animals. Moreover, vegans seem to make an almost arbitrary distinction between types of animals - keeping livestock is wrong but it's all fine to drive at 70 mph along the M6 while slaughtering hundreds of innocent flies. And how many little beasts are killed by the arable farmer in growing, harvesting and preparing that quinoa, soy or rice?

Humans have had a close relationship with livestock for thousands of years and cows, sheep, pigs and poultry shared our lives from prehistoric times. Indeed keeping animals makes sense as crop scientist, Dr Sarah Taber points out in a tweet - "when produce is too far gone to sell & there's no processing market (say, melons), it often gets fed to livestock. That's…actually a lot of the point of livestock, historically. They eat stuff we can't & turn it into meat, milk, & eggs that we can."

The idea of a balanced diet means perhaps eating more vegetables and less meat but vegan foods are commonly highly processed and require the addition of supplements to replace the nutrition lost from not eating meat or dairy. And, as Joanna Blythman points out, most of the pastureland in places like the UK simply isn't suitable for growing anything but grass:

But wet, green Britain lends itself to livestock production. Huge upland swathes of the country are quite incapable of growing food crops, but this otherwise agriculturally useless land can be grazed by cattle, sheep, goat, deer and other game. When meat and milk comes from predominantly free-ranging, grass-fed animals, this isn't stealing mountains of grain out the mouths of people, but harnessing natural resources to produce quality, healthy food.

Despite this the vegan propagandists are given a free ride but the media - nobody challenges Marco Springmann when he makes sweeping claims about the health benefits or a vegan diet (or rather the disbenefits of eating meat) or extravagent claims about the impact of livestock on climate change. And we're expected to change our choices and habits because a few people have adopted this pretty stupid dietary choice while their propagandists tell us meat-eaters that we're morally reprehensible humans.

The EAT-Lancet report has been beautifully ridiculed by Chris Snowdon but everywhere else - the BBC, ITV, radio and broadsheet newspapers - has treated it as a genuine contribution to science rather than as a piece of propaganda produced by vegan extremists.

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Public health is a faith-based ideology not a science

And I accept that you may be happy with your faith in the tenets of the public health folk. To explain, we'll start with this from the Director of Public Health in Sheffield, GregFell:

"The fundamental point is that obesity is a complex systems problem, and the location of fast food outlets can’t be causally disaggregated from all the other factors."

This is a statement of faith, in a belief that the reasons for the increase in obesity from, say, 1980 to 2000 was a consequence of something called an "obesogenic environment" rather than by, for example, changes in human behaviour consequential on increased wealth and improved technology.

The public health position - as captured by Fell in another blog posting can be summarised:

"spot on – stop asking ‘does it work?’ and instead ask ‘how does it contribute?’”

"Complex systems adapt in response to interventions so we shouldn’t necessarily expect changes to distal outcomes."

The premise here is that the 'system' is too complicated for us to understand it - we must act on faith rather than evidence in deciding what is the right thing to do. And individual elements of the system can't be seen as in any way discrete because to do this denies the interconnectedness that is central to the public health faith.

So we persist with ineffective smoking cessation interventions because it is the "right thing to do" and because such interventions "contribute" (and in doing so ignore successful market-based development of effective substitutes). We continue "Tier One" activities despite the almost complete absence of evidence of their effectiveness because using the "wrong evidence paradigm might lead us to do the wrong thing". Now forgive me if I don't fully understand what Fell means by an "evidence paradigm" - the term is used to distinguish between RCT (randomised control trials) evidence and the process of trial and error as well as a welcome shift from the old model of medical imperialism where the doctors diagnosis and conclusion was all the patient received to a model where the evidence on which those decisions are based being shared with the patient. None of this is about doing something you think is "right" despite there being no evidence to support this belief (or worse, as Chris Snowdon observes, actual evidence to say that it doesn't work).

The pragmatic evidence about public health leads us to reject the main thrust of this faith's adherents:

The evidence on smoking cessation tells us that reductions in smoking rates are consequential on three things - public education, price and substitutes. Advertising bans, cessation programmes, bans in public places, standardised packaging - all the rigmarole of modern anti-smoking - simply aren't making a difference

Alcohol consumption is for 90% of drinkers almost entirely benign (and arguably health positive) so reducing the whole population's consumption does not reduce harm. Again public education, price and substitutes matter more that warnings, packaging, advertising restrictions and intrusive licensing

The rise in obesity is not a consequence of that "obesogenic environment" (or, if you prefer, "complex system") but rather the result of reduced levels of every day physical activity resulting from the largely beneficial introduction of new technologies (there's a clue in the term 'labour-saving device'). Average calorie intake has fallen while average weight (and weight/height ratio) has risen - this change is not the result of a social shift from cooking and eating our own food to getting someone else to do the cooking for us

You are, of course, welcome to disagree with what I say here but I'm confident there is evidence supporting my position. This means that, if I'm to change my view, you need to produce evidence that falsifies my argument that much of what we're doing in public health is purposeless fussbucketry based on blind faith in the view that public health problems (drinking, smoking, burgers) are caused by problems in the social environment. And therefore that any intervention in that social environment must 'contribute' to reducing its negative impact even if we can find no evidence to support this belief.

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How public health and temperance campaigners exploit children

Prohibition and temperance aren't the children of health concerns but rather the offspring of a certain type of christian judgmentalism. But perhaps it shouldn't be a surprise that today's dominant religious faith - heath and wellbeing - has adopted the moralism of a previous age in its desire to have us all live a dull but righteous life so we can live forever. How could you indulge in pleasures that may, as a side effect, shorten your life?

And just as with all good religions, our Church of Public Health creates its myths and legends as convenient fairy tales designed to sway the gullible to the cause of living forever. Here's a classic:

Alcohol is being sold at "pocket money" prices across the UK, with products commonly bought by underage drinkers among the cheapest, research by a campaign group suggests.

The Alcohol Health Alliance said white cider - sold for as little as 16p per unit of alcohol - is favoured by teens.

The story in question combines two entirely separate and essentially unrelated pieces of information into a scary story about how young girls are being sucked into a terrible world of self-destruction, harm and death by the purveyors of booze at those 'pocket money prices'.

The first piece of information tells us that:

The Organisation for Economic Co-operation and Development (OECD) study of its 35 member countries found that 31% of 15-year-old girls reported having been drunk at least twice, compared with 26% of boys (which is in line with the OECD average).

Note the wording - 'drunk at least twice'. What the research tells us is that some girls self report that they have been drunk on two or more occasions. And that seven out of ten girls say they haven't been drunk on even two occasions. The rest are the rebels who maybe drank a few glasses at Christmas or shared a half bottle of vodka at a sleepover. There really isn't anything to get worried about in these statistics. And let's be clear that they've absolutely nothing at all to do with the other information in the story - the bit about 'pocket money prices':

The Alcohol Health Alliance (AHA), a grouping of more than 40 organisations including medical colleges and health charities, surveyed the cost of 480 products on sale in major supermarkets and off-licences in London, north-east England, north-west-England and Scotland.

Its research found both Asda and Tesco to be selling perry at 19p per unit, while the same drink was available at Sainsbury's for 22p per unit. Morrisons was selling cider at 20p per unit.

Now let's set these temperance folk a challenge. Take a 15 year old girl, give her some pocket money and tell her to go and buy some of that 19p per unit perry in ASDA. It's not going to happen, there is no way they'll be able to blag their way through this one. The girl will not succeed in buying any sort of booze, not even cheap white cider at 'pocket money prices' in any supermarket (or for that matter off license). If the 15 year old girls are drinking it's because they've bought in illegally from a smuggler, stolen it or most like been bought it by someone old enough to make the purchase. And, as the distinct lack of drunk 15 year old girls staggering round our streets tells us, this really isn't common or much of a problem.

So, given that the evidence is that booze at 'pocket money prices' isn't driving high levels of teenaged bozziness, why are the Alcohol Health Alliance and other fussbuckets so keen to make out that it is? Here's a clue:

The chairman of the AHA, Prof Sir Ian Gilmore, the former president of the Royal College of Physicians, said: "In spite of a government commitment to tackle cheap, high-strength alcohol, these products are still available at pocket money prices."

Calling for an increase in duty on cider, Prof Gilmore said: "In addition, we need minimum unit pricing. This would target the cheap, high strength products drunk by harmful drinkers whilst barely affecting moderate drinkers, and it would leave pub prices untouched."

This isn't about those girls at all, it's about 'high strength products drunk by harmful drinkers' who the AHA, as good temperance folk, heartily disapprove of. Now some of these people are pretty unsavoury and can cause problems with their behaviour but they're still adults with choice and agency. And making the booze more expensive won't change much - except they'll eat less, skip the rent (and get evicted) and spend more time panhandling other folk for the wherewithal to buy the newly expensive white cider. The more creative ones might make their own - it's really easy.

What the AHA are doing here is playing the 'for the children' card by hinting that children are the ones supping the white cider and therefore we should do something to stop them. Hence the reference to 'pocket money' and the talk about girls - we're having our emotional strings played here by organisations with over 100 years spent perfecting the demonisation of drinking. Prof. Gilmore and his fellow fussbuckets don't just want to stop 'harmful drinking', what they want is to denormalise drinking, to make it something banned, controlled, taxed, price-fixed and confiscated. They want to take you pleasure away simply because they disapprove of that pleasure.

And to achieve this end, the Church of Public Health will conflate unrelated data, will exaggerate research results, will speak of exceptional cases as if they were commonplace, and - when all this fails - they'll just straight up lie.

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Scribblings VI: Old lags, metaphysics, arts funding, pubs and public health

Trying to keep up with assorted Scribblers is challenging and this is a selection that tries to avoid stuff about the US Presidential Elections, Brexit and the leadership of the Labour Party. Not that these things are unimportant but that they've a tendency to crowd out other stuff that's just as interesting (and maybe important).

On the latter point, this post from Anna Raccoon is definitely important - what do we do with elderly and ill (even terminally ill) prisoners?

The number of older prisoners in the UK has more than doubled in the last decade, with the greatest increases amongst those over 70. Around 40% of older prisoners are sex offenders, many of whom are in prison for the first time due to historic abuse. Longer sentences and more stringent release criteria mean that increasing numbers of ‘anticipated deaths’ in prison are predicted.

Fascinating - especially the issues with painkilling drugs (most of which are, from a different angle, narcotics).

Meanwhile the Flaxen Saxon is getting all metaphysical:

Philosophers as far back as Plato (see the allegory of the cave) have reasoned that what we perceive is not reality. With the advent of computers and especially the stupendous increase in computing power, we have to ask ourselves- are we part of a huge computer simulation? Sounds ludicrous, doesn't it? Perhaps, but there are serious professional physicists and philosophers out there who consider the concept not only plausible, but likely. And no, these folk are not inmates of a secure mental health facility, they are, in the main, tenured academics.

As I commented on the blog - all reminds me of Brian Aldiss's 'Report on Probability A'. Which rather takes us to that age old question as to whether we can, in the manner of Azimov's 'psychohistory' break everything down into equations, algorithms and metrics. As Demetrius asks in talking about arts funding:

So many of us ask for the arts to have some funding and support to ensure their survival and continuance in a difficult world. Now it seems that this can only be if extensive management is applied to the distribution and assessment of those which are being assisted.

Having just re-read Yevgeny Zamyatin's 'We' (written in 1921 as a critique of Taylorism but banned by the Soviets as it applies as well to Scientific Marxism) it's clear that this breaking down of everything into numbers and measurements remains a challenge to civilisation.

Indeed there's a part of this problem displayed in the endeavours of public health to use science to promote their rather joyless ideology of wellbeing. And both Frank Davis and Paul Barnes pick up on this. First Paul on Stop Smoking Services (SSS) and e-cigs:

This is where I begin to have a niggly problem with SSS. I don’t knock the work they do, but nine times out of ten when a positive article appears in the press there is always this cessation approach – the “they can help you quit smoking” – type line. Broadly speaking that statement is true, but e-cigarettes are substantially more than just a bloody quit aid.

And Frank on 'junk food':

My conclusion is that “junk food” is perfectly good food, but “disapproved food”. It’s food that’s been labelled as “junk”, and most likely libelled as “junk”. And there is no rhyme or reason for this disapproval, much like there is no rhyme or reason for the disapproval of everything else the disapprovers disapprove.

Only approved pleasures are allowed, citizen!

But we like pubs, of course. Pubs are about community - wholesome, clean, caring community. And we should save them. Old Mudgie takes issue with this simple mantra as promoted by Greg Mulholland MP:

Now, I recognise that pubs can have a value as community resources that transcends narrow financial considerations, and that ACV listings, if properly applied, can give them a valuable stay of execution if they are threatened. I’d also support pubs being given protection from being turned into shops or offices without needing planning permission, subject to a reasonable minimum time limit of trading as pub.

But it has to be accepted that society changes and moves on over time, and that most of the current issues around planning and redevelopment are symptoms of the general decline in the demand for pubs, not its cause.

The idea - as Mulholland has promoted in Otley - that every single pub (there are over 20 in Otley) merits protection is hard to defend. Helping locals save the only village pub is a great idea but using planning and regulation as a stick to beat PubCos really won't work if the pub isn't viable in the first place.

Perhaps, if we're concerned about community, we need to ask about how councils, police and fire services are stopping local events unless they pay up or provide their own security (at great cost). Here's Julia:

So....what's happened here is the council get to shrug their shoulders and say 'Toree cutz, mate, innit?' Because that's easier than changing the event into something more manageable.

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Interesting stuff I found down the back of the sofa (plus a comment on grammar schools)

Trade is good.

Clearing out my pockets - here's a few things (other than lint and misformed paperclips) I found:

Big cities are bad for health (this sort of reminds us what public health really is about):

Dr. Seth Berkley, CEO of the vaccine alliance Gavi, points to the recent increase in the scale of densely populated urban areas, many without adequate sanitation, as turning containable illnesses like Zika and Ebola into pandemics. Dense urbanization may not have created Zika, which causes newborns to have unusually small heads, he notes, but it has accelerated its spread from a mere handful to a current tally of 1.5 million cases this year.

Tokyo doesn't have a housing crisis - because it has sensible (aka laissez faire) planning rules:

Here is a startling fact: in 2014 there were 142,417 housing starts in the city of Tokyo (population 13.3m, no empty land), more than the 83,657 housing permits issued in the state of California (population 38.7m), or the 137,010 houses started in the entire country of England (population 54.3m).

Ideology presented as fact - the curse of economics (here's a good example of the genre):

Is there a good economic reason why Brexit in particular should require abandoning austerity economics? I would argue that the Tory obsession with the budget deficit has had very little to do with economics for the past four or five years. Instead, it has been a political ruse with two intentions: to help win elections and to reduce the size of the state. That Britain’s macroeconomic policy was dictated by politics rather than economics was a precursor for the Brexit vote. However, austerity had already begun to reach its political sell-by date, and Brexit marks its end.

And globalisation (meaning free trade and immigration since you asked) is good for the working class:

There isn't an economy in the world — now or ever — that could have endured such massive blows without a major hit to its people. But the worst that has happened in America is stagnant wages. Remarkably, our quality of life has continued to improve.

They never tell you how fast Africa is growing (or that it's down to capitalism - also socialism was what made Africa poor):

Some of Africa’s growth was driven by high commodity prices, but much of it, a McKinsey study found in 2010, was driven by economic reforms. To appreciate the latter, it is important to recall that for much of their post-colonial history, African governments have imposed central control over their economies. Inflationary monetary policies, price, wage and exchange rate controls, marketing boards that kept the prices of agricultural products artificially low and impoverished African farmers, and state-owned enterprises and monopolies were commonplace.

The rise of the far-right is down to the EU (prize for spotting the huge factual error in the article):

All “civilised” politicians in the founding EEC nations agreed nationalism must be overcome. Christian Democrats, Social Democrats, Socialists, Euro communists, all the mainstream Continental political groups agreed that old-style patriotism was at best embarrassing, at worst dangerous and wicked. This meant that ordinary Frenchmen, Germans, Dutchmen, Belgians who wanted to stay French, German, etc had no-one else to vote for but extreme nationalists. Anyone wishing to oppose ever-closer union had no other home than among the xenophobic fringe parties.

It's not just technology but finance that's changing car ownership:

With the rise of companies like Uber and Lyft, it’s clear that we will need to see advances in new ownership models to support tomorrow’s transportation landscape. In fact, Uber recently received a $1 billion credit facility led by Goldman Sachs to fund new car leases. Uber (and Wall Street) are also recognizing the need for more flexibility with this deal — especially at a time when Americans are making larger monthly payments than ever on their cars and taking out record-size auto loans.

The impact of Brexit on projections for housing requirements (sexy stuff I know):

In summary, the current basis for UK estimates of housing need are already predicated on a 45% drop to total net-in-migration by 2021, so for Brexit to have any downward pressure on planned housing targets in Local Plans, it would need to be assumed that Brexit resulted in European net-migration to the UK falling to virtually zero over the medium to long term. This seems unlikely.

A brilliant article - essentially a film review - on small town poverty and decline in the US mid-west (and a glimpse of why Trump):

In Medora we see not only poverty, but nearly complete social breakdown. I don’t recall a single player on the team raised in an intact family. Many of them lived in trailer parks. One kid had never even met his father. Others had mothers who themselves were alcoholics or barely functional individuals. They sometimes bounced around from home to home (grandmother, etc.) or dropped out of school to take care of a problematic mother.

Finally I can't resist a comment on grammar schools. They really aren't the answer to educational challenges but at least the Conservatives are looking at system reform rather than saying the solution is putting more money into institutions - big urban comprehensives - that are failing children.

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Quote of the day - on mortality

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Sage advice - we should live just for the sake of living, we should live for fun:

It is time to turn the clock back to a more dangerous era, but only we crumblies have the authority to advocate it. I am not obviously proposing a life of foolhardiness and debauch; but I am uncomfortably aware that as I look back, it is those moments when I went too fast, dared too much, fell too far, drank too deep which bring a smile to my lips, an ache to my heart.

My advice to young people is simple. Eat, drink, even smoke, and be generally merry, because that way you might be spared too many days of misery for yourself and your friends and family. Live short and prosper.

Public health people, fussbuckets, nannies and health facists - stick this in your pipe and smoke it!

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Too old to rock and roll? Forget it! Welcome to 21st century ageing.

The so-called WASPI campaign for women affected by the change in their retirement age from 60 to 66 has been a feature of news and comment for a while now. It is one of those odd quirks - not always a good one - of policy changes that some people are caught in the change meaning that, while nearly everyone accepts that the new policy is a good one, they also want it not to affect those caught in the change. In a society where women are not excluded from the workforce and where efforts are made to treat those women equally, there is no justification for having a different retirement age for men and women. Nor, given average life expectance pushing 80 years, is there much sense in younger people being taxed to provide twenty years or more of living for those older people.

But I don't want to discuss this issue but rather for it to provide a little context for a look at age discrimination in the UK. This has interested me for a while but was prompted by someone tweeting a rather unfunny quip about all of UKIP members being old dodderers. It wasn't that UKIP's members aren't disproportionately older but that it was fine to criticise - with references to Stannah and Saga - a group of people purely on the basis of their age. My concern though isn't that some people are unpleasant but whether this disparaging of older people is reflected in a wider set of prejudices that result, not in rude words on Twitter, but in significantly different treatment.

One of the WASPI arguments (albeit not their strongest) is about work. Or rather that women in their 50s and 60s find it difficult to find work:

Living longer inevitably means working longer too. But that’s no help to older women who can’t just grit their teeth and work longer as a result of Osborne’s measure, because they’re not even working now: women made redundant late in their fifties, who can’t persuade employers that they’re not past it;

Now I'm happy to believe Gabby Hinsliff here. I want to believe her. But I find it difficult to find much real evidence that older people can't find work. The number of people over 65 working in the UK has nearly doubled since 2008 hardly an indication that the people made redundant in their 50s will fail to get a job. What I do suspect is that men and women who leave management or professional positions in their 50s find it hard to get a similar job on a similar wage - I've known people who had very senior jobs really struggle to get new employment. For a few there's also the issue of declining health. But there remains something of a cult of youth reflected in the attitudes of the, mostly younger, recruiters.

In short, faced with two equally qualified candidates the recruiter will pick the younger one - "they'll fit in better", "more scope for development", "planning for the future". All quite understandable until you think about the actual facts. The average time people stay in a given job has been falling for years - Forbes reported that 'millennials' (can I say how much I hate that unhelpful term) are switching jobs every 4.4 years. So if you've a well-qualified 59 year old woman in front of you, don't think 'she'll be retiring soon', think 'up to eight years contribution from a really experienced person - more if she wants to stay longer'.

Another, more subtle piece of ageism, is a political act - typified by former MP, David Willetts in his book 'The Pinch':

David Willetts shows how the baby boomer generation has attained this position at the expense of their children.Social, cultural and economic provision has been made for the reigning section of society, whilst the needs of the next generation have taken a back seat. Willetts argues that if our political, economic and cultural leaders do not begin to discharge their obligations to the future, the young people of today will be taxed more, work longer hours for less money, have lower social mobility and live in a degraded environment in order to pay for their parents' quality of life.

It's hard to see how we reconcile this polemical view of my generation - selfish, greedy and so forth - with the WASPI victimhood or the anecdotes of declining income as older people take the only jobs they can get, well below their skills and experience. Yet that is what's happening - we're told (with good reason) that more and more of the government's spending is directed towards the old and we're supposed to get agitated because some how this is an imposition on the young while at the same time the established image of the poor old folk struggling away on a pittance sticks in the public's mind.

And yes it's true that we should stop with this emotive nonsense about 'the family home' or 'life savings' and expect older people to use that money to look after themselves. It really is an imposition on younger people to expect them to provide for older people just so they can pass on loads of expensive assets to their children and grandchildren. Indeed this is the only proper response to the issue starkly described by James Delingpole writing about the NHS:

That’s the good side. Now the bad — and it’s so bad I’m surprised it isn’t more of a national scandal. We read a lot about a service stretched to breaking point but what few of us grasp — I didn’t until I saw it myself — is perhaps the main contributory factor to this: bed after bed occupied by elderly, often Alzheimer’s-afflicted patients who simply don’t belong in wards designed to treat acute, short-term conditions.

Round about 75% of all the money spent by the NHS is spent in one way or another on the elderly. It's not just the 'bed-blocking' Delingpole describes but the industrial quantities of medication that the average pensioner chuffs down everyday, the repeated visits to the GP and the collection of special tests, injections and clinics directed to pensioners. All of this - except the de facto role of hospitals as old folks' homes - is entirely justified since it means more and more people living happy, healthy and active lives into their dotage.

Not only are those old people expensive but there are also more and more of them selfishly and greedily staying alive longer and longer. And this will carry on (perhaps with the exception of rock stars whose lifestyles perhaps preclude longevity) as our contemporaries - I speak as one of those 'boomers' - dash about filling up theatre seats, cruise ships and tea shops while driving carefully within the speed limit in front of the next generation of future selfish old folk.

Now I know a lot of young people will go 'ewww' at this but they've to get used a world quite unlike the one I was brought up in - a world where fashion, music, food and drink, art and travel markets are dominated by the middle aged and upwards and where 'youth culture' is a minority sport in every sense of the word. And this isn't because we've sucked up all the cash but because there are loads of us, we've earned a load of money during our lives and the bit of that cash we've got left we're planning on spending living well.

The ageism that Gaby Hinsliff alluded to in her article about the WASPIs may indeed be the case (although it's hard to find solid evidence for it) but it's a fact that's days are numbered. Not because of some sort of national campaign or shouty MPs but because the market tells us you'd better start respecting older people if you want to stay in business.

There's a bar in Harrogate called (creatively) The Blues Bar and it does more or less what it says on the tin. We're there listening to some good blues rock and, looking around, the whole audience is our age or older - no plaid, no slippers and no comfortable stretch slacks but rather jeans, casual shirts and even the occasional band t-shirt. This is the reality of 21st century ageing.

So however po-faced David Willetts gets, I'm convinced that he's wrong. Us 'boomers' do have a duty - it's not to subsidise the next generation or to get trapped in an inter-generational version of the lump of labour fallacy but rather to have as good a time as possible in the two or three decades left to us on this earth. To travel, to party, to eat, drink and enjoy the bounty of the great world we've helped create - we are the richest generation there has ever been and we should enjoy that wealth rather than find reasons to say 'it's not fair'. The next generation, without a shadow of doubt will be even richer than us, will live even longer and - I hope - will have an even better time with their last couple of decades.

We've a long way to go yet. Organisations like Age UK (and the WASPIs for that matter) are still stuck playing the 'poor old folk' card when in large measure that simply isn't the case at all. For sure, there's age discrimination - from nasty little quips on Twitter through to the difficulties redundant managers have in getting jobs - but in the place that really matters, in the consumer markets, older people are the kings and queens. Let's enjoy it!

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Much public health campaigning is about snobbery not concern for people's wellbeing

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Whenever you read a piece - most typically in The Guardian or Independent although sometimes these days in any media going - that talks about some or other 'public health crisis', the focus is always on things that people other than the writer is consuming. The problem with lager, fags and junk food isn't merely their supposed unhealthiness but that the sort of person who reads a broadsheet newspaper and goes to dinner parties with doctors doesn't consume these things. Indeed many of these writers only see these bad and unhealthy things being used - I'm guessing 'used' is the right word here since the stigma is akin to the taking of drugs - in the parts of society they only frequent vicariously via TV and magazines.

I'm reminded that this casual distaste for other people's choices makes little sense with food - there's no real calorific difference between a Big Mac and the sort of hand-formed, artisan burgers our Guardian reader enjoys on his night out. And let's not poke too closely into the sugar question - suffice it to note that uber-hypocrite Jamie Oliver peddles sugar-laden cakes and puddings in his books, newspaper columns and TV shows while ranting and raving about how much sugar there is in a can of coke.

All of which brings me to the matter of vaping, a practice that is, compared to the other snobbishly rejected bad habits, pretty benign and harmless - at least if we are to take the advice of Public Health England and the National Centre for Smoking Cessation and Training (NCSCT):

We begin by acknowledging that e-cigarettes are considerably safer than smoking cigarettes, are popular with smokers and that they have a role to play in reducing smoking rates

By considerably safer we mean at least 95% less harmful than smoking cigarettes - at least according to PHE. So what's the problem with vaping? Why are those public health officials in every town not rushing to support people switching from fags to vaping? And why aren't places becoming vape friendly, welcoming former smokers back into the warmth of indoors?

Partly the answer lies in a long puritanical campaign conducted - without any evidence - by a handful of well-connected academics and lobbyists. Partly, it's a classic case of 'not invented here syndrome' as public health campaigners and their friends in the pharmaceuticals business fail in believing that a consumer market can resolve the smoking'problem' that they've tried and failed to deal with over decades. But mostly it's just rank snobbery - vaping is something that fat, ugly working class people do. Even when the user is anything but:

It jarred against his crisp tux and stylish stubble, but there was no mistaking the object in Leonardo DiCaprio’s hand at the SAG Awards in January. That was a vape pen, which turns liquid nicotine into vapour.

When photos of the incongruous image began to emerge, the mockery was swift and slightly delirious. “That photo of Leonardo DiCaprio vaping at the awards dinner makes it easier to watch him die at the end of Titanic. #DoucheFlute,” one Twitter user wrote.

The scorn seemed baffling. Why would something designed to help smokers quit incur the snarky wrath of the Internet hordes? But while public-health experts continue to debate the risks and benefits of such smoking-cessation aids – e-cigarettes, as most people know them – cultural critics have reached a decisive verdict: Vaping is incredibly uncool.

The article in question goes on to describe the vaping community as "united in its tackiness" throwing out negative descriptions like this:

It is “vaped” with a gesture that looks disarmingly like a baby drinking its bottle: clutched with the full hand and suckled with pursed lips from a kind of nib.

The journalist in question then runs a quick canter round the usual lies and misinformation about vaping - noting the PHE research but then gleefully celebrating the fact that politicians are ignoring all this, buying the myth of a gateway effect and banning vaping indoors. What's driving this isn't that any of these politicians know whether vaping is dangerous but rather that it's simpler to whack on a ban knowing that those vaping - Leonardo Di Caprio aside - are a bunch of low life losers who are better kept outside.

Vaping is lumped in the same box as cheap kebabs, cans of premium strength lager, fizzy pop and salty corn snacks plus the evilest of evils itself, smoking. Instead of celebrating that Di Caprio has joined millions of others in taking up vaping to reduce harm and quit smoking our health reporters, so-called public health experts put on their finest sneer, peer down their upturned noses and wave away the vape as another distasteful lower class habit to be despised.

Public health campaigns remain unrelentingly snobbish - from forcing children to eat undernourishing salads rather than pies and puddings to clipboard wielding officials lecturing fried chicken shops on reducing salt and sugar, the whole sorry mess is about promoting an approved set of behaviours onto everybody. With the result being a passionless diet of tasteless low salt and sugar free food, an almost total abstinence from booze, the complete rejection of smoking and a preference for giving people dangerous mood altering drugs rather than supporting vaping.

If public health campaigners really cared about people's wellbeing they'd ask why it is that poor people die younger. They'd wonder why the single mum overeats, the unemployed twenty-something smokes and the old soldier drinks rather than simply trying to nudge them out of these habits with the policy equivalent of a baseball bat. But these public health fanatics don't ask these questions, they just ban stuff, control stuff, lecture, nanny and fuss. Public health campaigning isn't about health, it's about the snobbish promotion of a lifestyle set by passionless middle-class puritans.

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In which we are reminded that the NHS management don't understand economics

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It starts with this:

‘Collectively and cumulatively [these actions] and others like them will help shift power to patients and citizens, strengthen communities, improve health and wellbeing, and – as a by-product – help moderate rising demands on the NHS’

This is the rather ghastly sounding 'Health as a Social Movement' line in the NHS's vain attempts to pretend that preventative medicine will 'moderate rising demands'. What is most striking here is that, yet again, the basic economics of all this are overlooked (although given they've appointed the risible joke of a think tank, New Economics Foundation, it's pretty clear they're not remotely interested in actual real economics).

Unless the project is about improving productivity through these community-focused actions then the only impact - assuming they do improve health and wellbeing - will be to increase the long-term demands (and hence costs) on the NHS.

The report ...projected that people with Type 2 diabetes who participated in a disease management program to prevent serious complications would cost the federal government slightly more money over 25 years than they would have without any intervention.

If you stop and think about this for a second, the reason for a healthy community being more expensive is pretty obvious - most of the costs in the health system (and the care system too) are directed towards older people so if more people live to a ripe old age there are more of those 'end of life' costs.

To use a big example, we've seen a massive decline in the numbers of and in survival rates from heart attacks - since 2002 the mortality rate has more than halved. In simple terms this means there are double the number of long-term heart 'patients' compared to the old days when they all died of a heart attack. This absolutely brilliant and a credit to doctors, pharmacists and the health benefits of a bigger, richer economy. But it's costing the NHS a fortune.

And it's not just heart attacks but every sort of disease, from childhood infectious diseases through to cancers, that has seen declining mortality rates. And this means it's pretty normal to live into your 80s, not unusual to make it to 90 and increasingly common for folk to make it to 100. So when we act - quite rightly - to prevent disease and reduce mortality rates the result is more and more old people and more and more demand for the NHS services that are under so much strain.

The challenge for healthcare is to improve productivity - to reduce unit costs for operations, for providing care, for dispensing medicines, for all the vast array of stuff health care does. And spending money on "health as a social movement" only does this if it means that the allocation of NHS resources to these communities is thereby reduced. So long as we focus on simple prevention as a demand management tool, we will find no benefit in higher productivity and a pile more demand-led costs for the system.

This is, of course, what you get if you believe that NESTA, the RSA and New Economics Foundation are the sorts of organisations that are able to guide the NHS towards greater efficiency and higher productivity. A load of left-wing cant and absolutely no moderation of rising demand.

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Quote of the day: Why doctors shouldn't strike

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Nothing to add to this:

When a country operates under a healthcare monopoly, its citizens are fundamentally at the mercy of the provider. That provider has an ethical responsibility to show up to work every day and look after its patients; if they don’t, no one else will.

Absolutely spot on. It's unethical for doctors to strike.

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The real story is health spending not spending on the elderly.

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This graph is doing the rounds, usually attached to arguments about how favoured the old are under the present government.

Right now spending on 'older people' (which I assume means the state pension and assorted other welfare payments directed to retired folk) has got back to the position it was relative to other spending back in 1997. We can also note that, despite falling unemployment and endless stories about the evil DWP, the rest of welfare spending has barely budged as a proportion of total spending. And there's a reason perhaps for old people getting more of the budget - there's a whole lot more of them than there used to be:

I'm not defending the 'triple lock' or other decisions made by government over the past several years merely observing that the increased number of older people inevitably means a bigger bill for old age pensions.

To return to that graph from the Resolution Foundation again, the real change that shows isn't the up and down in terms of funding for old or young but the acceleration in health spending as a proportion of total spending. Now this is, in part, another consequence of those older people - something like three-quarters of NHS spending is on the over 65s (for the simple fact that they need the health care while younger folk mostly don't) - but it is also shows that health spending is the real priority of government. And reminds us that the efficient and effective use of that growing resource represents the dominant challenge for any UK government. Shouting about how old folk are getting a better deal isn't the issue here - getting to grips with the health budget is.

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Burgers, bookies, borrowing and the holiday tan - nannying fussbucketry reaches the High Street

A healthy high street - complete with 'unhealthy' sugar!

The 'Health on the High Street' report from the Royal Society of Public Health starts off well with a statement that, for once, actually has some connection to actual public health rather than the regular nannying fussbucketry we associated with the profession:

A healthy high street environment is one in which there is clean air, less noise, more connected neighbourhoods, things to see and do, and a place where people feel relaxed. The architecture of the high street would be such that it fosters active urban design principles including pavements, seating, shade and shelter. Above all the high street would provide a safe environment where the public don’t live in fear of crime,violence, harassment, or accidents. 

It's hard to take issue with this as an argument. Firstly it's absolutely about the public realm, the environment in which people go about our everyday tasks and in which we celebrate the good things of life. And this is the concern - if there is one - of public health. But just as importantly these things - less pollution, places to sit, low crime and a mix of indoor and outdoor - are what make for successful town centres.

Sadly though the Royal Society of Public Health doesn't stop with saying high streets should be clean, green and safe. Turn the page and that nannying fussbucketry hits you in the face. We are presented with yet another judgemental dismissal of things other people (mostly other people from lower social classes) enjoy.

The businesses on a healthy high street would not only enable basic needs, including access to affordable healthy food and affordable financial services to be met, but would actively promote healthy choices. There would be access to essential services whether that is health services, cultural amenities, places to be active, leisure centres or green spaces, for example. A healthy high street would also create opportunities to minimise harm whether that is ensuring that health is included as a condition for licensing and a consideration for planning consent. 

We have arrived at the crunch. The health high street isn't about a clean, green, safe space at all but is rather about public authorities - through licensing or planning controls - deciding what sort of business is fit to grace our town centres. To justify this particular branch of health fascism the Royal Society of Public Health has cooked up some of its own pseudo-science - what they call 'the Richter scale of health'. This scale (unlike the actual Richter Scale) is an entirely subjective, opinion-based scale. A business can score somewhere between -8 and +8 on the basis of researchers allocating a score from -2 to +2 against four 'areas of health': encourages healthy lifestyle choices; promotes social interaction; allows greater access to health care services and/or health advice; and promotes mental well-being.

Now you'll have noticed that most high street retailers will score zero (since this, our researchers tell us, is what is given where 'the category is not relevent to the outlet'). Your typical shoe shop, assuming we're not running a campaign on the health impact of high heels, is entirely neutral on matters relating to health. Mostly because it's a place where you go to buy shoes.  And the same goes for building societies, charity shops, clothing shops, hairdressers and hardware stores.

As a measure then this is worse than useless. Unless of course your objective is to use your status and authority (this is a 'Royal Society' after all) to promote a given political agenda around your intrusive and judgemental definition of public health. It will come as no surprise to discover that the 'research' identifies betting shops, tanning shops, payday lenders and fast food takeaways as the dark evil on the high street, the causes of unhealthy high streets. And the healthy stuff - leisure centres, health centres, pharmacists, health clubs, museums and pubs (the inclusion of which will be giving various in the Church of Public Health palpitations - in the authors defence they did manage to find a picture from inside a pub that didn't show anyone actually drinking*).

The authors then go on to set out in lurid detail the evils of gambling, burgers, fake tans and high interest borrowing before settling down to create a little ranking of the most and least 'healthy' high streets in England. Unsurprisingly the resulting ranking show that high streets in northern towns where people like a flutter and eat take-away kebabs are much more unhealthy than high streets in the nice, comfortable market towns where the researchers and their friends are likely to live. This time it's Preston that gets the devil's mark resulting in the usual slew of sneering broadsheet articles and this from the local paper:

OFFICIAL: Preston has unhealthiest city centre in the UK

Followed by people from Preston agreeing:

Coun John Swindells, deputy leader of Preston City Council, said: “The results of this survey mirror our own concerns. Indeed the Royal Society for Public Health is campaigning to allow local authorities greater planning powers to deal with this issue. It is something the council, along with 92 other local authorities, has and will continue to lobby the Government for."

This is the saddest thing about the report - not that a bunch of London-based nannying fussbuckets has produced 'research' designed to show the awfulness of northern cities and towns but that the leaders of those places fall over eachother to say just how much they're doing to make Preston more like Salisbury (as if that was either achievable or desirable). If places like Preston and Middlesbrough - number two in this particular ranking of evilness - are doing badly it's got more to do with the relative poverty of the place than it has to to with whether the council has powers to ban betting shops or fast food takeaways.

Finally the report goes into full 'something must be done' mode listing a veritable cornucopia of fussbucketry. This opens with planning and licensing controls including specific powers around health as a reason for refusing a licence (having been nice about pubs earlier in the report they include alcohol licensing in this demand) as well as a general power to stop 'clustering' - presumably that wouldn't apply to Bond Street or Saville Row.

We then get assorted nudges and bans (including the entirely stupid proposal for a ban on displays of vaping products) before the entirely predictable for differential business rates, mandatory health warnings and limits on stakes all while repeating the familiar litany of lies about these products and services ('crack cocaine of gambling'). All of this is deeply depressing and reminds us that too many - the leader of Preston City Council for one - are taken in by this New Puritan agenda of public health.

This research (truly awful and unscientific research) will be rolled out again and again - by the LGA, by the BBC, by assorted groups of fussbuckets - to support the argument for ever more restrictions on who can do what and where. It will be accompanied by the continuing sound of moaning as high streets continue to decline - with the sort of outlets derided here forming the last vestiges of a town centre economy. And rather than look for a completely different approach, we'll trog along behind the health fascists and control freaks as they nail the last few nails into what's left of our high streets.


*Although the eagle-eyed will note that it's a very old photograph as it contains images of smoking!

In which our friend Leg Iron explains stuff to the Daily Mail's health experts...

As it’s payday on Friday and I have a little to spare, what took my fancy tonight was a lump of rump steak with a bottle of cut-price Aberlour for dessert.

And so on - quite wonderful. Do read and act on the advice therein.

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It's really time our debate about health grew up.

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Our national debate about health is a shambles. Indeed, 'disgrace' is probably the best way to describe how politics debates the issue that remains with economic well-being the single most important issue for most people. I am grateful to Jackart for 'Bracken's Law of NHS Debate':

"The longer any discussion about the NHS goes on, the closer the probability a spurious invocation of the US system of healthcare gets to one, and whoever does so has lost the argument"

The minute anyone uses the word 'competition', 'market' or 'reform' those with a vested interest respond with reference to the US system (which somehow manages to be both very expensive and wholly captured by producer interests).

The other, and closely related, aspect of the debate is to invoke the caring nature of nurses, doctors and others who work in the NHS. And to imply that, without the NHS, none of this would be there. You'll have heard people exclaim: "my mother (or child or spouse or sibling) is alive today because of the NHS".

To which my response is to ask whether that person would be dead had they lived in France, Holland or Sweden - none of which have a centralised, bureaucratic, national health system. But you can't win with this argument because the shameless and disgraceful debate kicks in with shouty stuff about "selling off the NHS" or even "you don't care about Our NHS".

We have a huge challenge in our health service that isn't being discussed. Or rather it's not being discussed by the national political leaderships, by the representatives of health care producers or by the media. At the very local level people are prepared to discuss how we deal with an ageing population, how we strike the balance between social and health care, and whether our spending priorities are entirely geared to meeting the real health challenges we face.

Yesterday - as the motion's proposer made very clear - Bradford Council didn't debate a motion about public health. We went straight to the vote. Now, to be honest, the motion was a good example of us not facing up to the truth about health spending - instead of asking what Bradford Council was doing with the £30m or so it gets in public health funding, all the motion's proposers wanted was a line in every report asking "what are the implications for public health". This would join similar lines on "sustainability" and "trade unions".

The thing we should have asked was whether the way we're spending that money right now is the best way to help get better health for Bradford's population. And maybe suggesting to the government that they trust local councils and lift the ringfence on public health money would be a start. However valuable smoking cessation clinics might be (and the answer is actually 'not very effective') would the money - three-quarters of a million - we spend there not be better directed to helping keep the wheels from falling off our social care system and keeping old people out of hospital?

If we want a better health service (and right now ours really isn't good enough) then we need to discuss how to get such a service. Instead we refuse to discuss the choices facing us because we fear 'Bracken's Law' and the shouty ignorance of those most interested in keeping the status quo. It really is time our health debate grew up.

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Hot food takeaways, obesity and planning - an expected result but an unexpected comment

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I toddled along to Bradford Council's Executive this morning to make a representation about the proposed Supplementary Planning Document (SPD) for Hot Food Takeaways. Among other factors (litter, noise, smell, traffic and so forth) the Council intended to restrict the opening of such establishments within 400m of schools, parks and playgrounds. This is in response to concerns about obesity among children.

My presentation made the point that there really isn't any evidence at all to support such policies - the grounds for Bradford's proposal (and the support from Public Health England and the Local Government Association) is one study that found some link between 'body mass index' and the clustering of fast food takeaways among adult commuters. This apparently is "generalisable to children".

The Labour Councillor who leads on these matters took the brazen approach - there's lots of support from the 'health community' so we don't have to discuss the evidence. She went on to tell me that I should agree with her because "Boris Johnson supports these planning policies". As if I should ignore the evidence just because Boris ignores the evidence. So it's clear that (as I expected) the Executive simply rubber-stamped the proposals from planning regardless of the evidence.

However, the unexpected comment came from Bradford's Director of Public Health when she was asked to comment on the evidence. Cllr Cooke is right, she said, there isn't much evidence to support the policy. We need to be looking at poverty not planning regulations.

I guess there is a glimmer of hope!

And to remind you - this is the evidence:

 ...there was no significant association between increasing takeaway and fast food consumption and obesity as measured by BMI corrected for age and gender. This is not a new finding. For example, French and colleagues found no significant relationship between frequent consumption of fast food and being overweight in their analysis of a cohort of 11-18-year-old boys and girls. Similarly, Simmons et al found no correlation between increasing takeaway consumption and obesity measured by either BMI or waist circumference.

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Food heroes of the day - Ninewells Hospital, Dundee...

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Assorted health fascists and nannying fussbuckets are frothing at the wonderful dish served up at Dundee's Ninewells Hospital:

The pie is crammed with sausage, bacon, black pudding and beans and is topped with a fried egg. It is available from a takeaway counter at the Dundee hospital.

This is a hospital, people are gloomy, ill, depressed and in need of some decent nosh - hence such a fantastic pie. But the nannies  hate it:

Professor Mike Lean, a former government advisor and chair of human nutrition at Glasgow University said it was a "shocking" example of a meal.

"It should never be anywhere near a hospital," he said. "It is laden with fat, salt and without a vegetable in sight. There should be strict guidelines for all food sold in hospitals."

And Tam Fry, the self-appointed obesity expert shouts:

"What we have here is a heart attack on a plate. It should be absolute obligatory for the NHS to have wholesome food whether it is from a takeaway shop within hospitals or on menus."

I don't get it at all - what could be more wholesome that a fry-up in a pie. At least it's not deep fried (yet).

A good view of the pie (and a fine sight it is, if not for the faint-hearted) can be seen here.
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Schools, hospitals and money...give me just a little more choice!

We live in a world of choice. Think for a brief moment about how many different types of cheese you can buy in your local supermarket. Consider the aisle filled with varied and exciting bread. And ponder on a world where one relatively small space can contain over 45,000 different products from, it seems, everywhere in the world. Still further, if you live in Bradford at least, a different journey can also take you to market stalls and shops selling great locally sourced fresh vegetables, fantastic hand-crafted sausages and super fresh caught fish.

Note as well that, when it comes to that convenient portable communications device we all love, there's a still more bewildering choice of handset, of contract and of places where we'll get some informed help making our decision. It truly is a wonderful world, a world created by that simplest of simple ideas - one that's been around since the dawn of time - free exchange for mutual benefit. Or if you want it put a different way - the market.

Yet when it comes to three things that are pretty fundamental to everyone's lives - education, health care and money - we're told that free choice is a bad thing and instead government must decide on the nature, quantity and distribution of these essential requirements. What makes this so very odd is that we can see how free choice in free markets improves the lives of everyone, yet we continue to tell ourselves that somehow markets would be a bad thing in these three vital areas.

Instead of the liberty of markets, what we choose instead for the provision of schools, hospitals and cash is a thing called 'government'. And what a thing that is - confused, secretive, lying, deceiving and troublesome. I was talking the other day with some public health folk and (I forget the precise details) the matter of 'who runs the NHS' arose. Scales fell from my eyes as I appreciated that no-one actually runs the NHS. For sure there's a chap called Simon who has the title 'Head of the NHS' or similar but he doesn't really run this vast many-headed hydra except that, because there is no consumer sovereignty in health care, there has to be a process for allocating the money set aside by government to pay for said health care. And Simon is in charge of that process.  He doesn't run hospitals, he has no say over primary care, he doesn't train doctors or nurses - he sits atop a pile of other people's money and uses it as a bully pulpit.

The same goes for schools - there's no-one in charge and no market either (although there is a chimera of choice in the ability of parents to 'express a preference'). We have Michael who is in charge of Ofsted, we have a collection of 'Directors of Children's Services' in 'Local Education Authorities' and we have the management of individual schools (governors and school 'leadership teams'). As with the NHS these people aren't 'in charge' of the system and there is no fair or efficient system - nor can there be outside of a choice mechanism - for the distribution of either funds or for the making of 'allocation' decisions.

For both health and education we use bureaucracy moderated by the unseemly rabblerousing that is political debate as a proxy for the market. But the systems are too large for effective central direction so some things are 'devolved' to different parts of the system. Except that two things remains - one is what we might call the Widdecombe Principle and the other is our expressed preference for consistency.

The first of these two things refers to Anne Widdecombe who explained that central direction would never change so long as the Minister was dragged kicking and screaming into the Newsnight studio to explain. Even though ministers - like the Head of the NHS and the Head of Ofsted - are not really 'in charge' of the system, they are the ones who get verbally berated when stuff goes wrong.

The second factor is what we say to opinion pollsters - essentially that we don't like 'postcode lotteries' and therefore we don't like difference and variation within national systems. Our slightly warped idea of 'fairness' tells us that everybody should get the same, even if that 'same' is mediocre because the avoiding of difference destroys innovation, initiative and creativity.

All this brings me to the third thing government won't let choice and markets play with - money. It seems to me that what we might called 'modern applied macroeconomics' is predicated on the continued 'control' of money by government. But, just as with health and education, there's only an illusion that someone is in charge of the system. There's Mark who is the boss at the Bank of England - he gets to set interest rates (and, were I a cynic, keeps his job if he doesn't stray too far from what HM Treasury wants to do) but it doesn't seem to me that he's really in charge.

There may be very good reasons for all this lack of choice - that idea of fairness, the convenience for all of a defined and guaranteed currency. Plus, of course, the big important thing for government - collecting taxes. Indeed the scared rabbit reaction of banking regulators to 'cybermoney' like Bitcoin is rather revealing of this fact!

It seems to me that the next few years - perhaps a couple of decades - will see a huge tug-of-war between these big three government monopolies and a set of technology-driven innovators. Some of these innovators will be looking for a fast buck through exercising some sort of arbitrage while others will be seeking to develop choice models within the systems themselves - building on the availability of data to disrupt that desire for sameness I described earlier.

I don't know how this contest will play out but I hope that, whatever the long term role for government systems, it results in more choice. Or rather in systems where consumer sovereignty is allowed to operate. I hope for this result because it will deliver the greatest rate of improvement for the least effort (and probably least money). There's a big debate in the NHS about a future funding gap - it seems to me that the solution to this challenge isn't running the good old centralised NHS and trimming a bit here or rationing a bit there. Rather the funding gap is closed by allowing innovators to innovate and the best way to do this is by the development of real choice systems rather than the current 'plan and provide' approach.

The same goes for education. And for money. Choice is the best driver of improvement both through consumers exercising that choice and through providers responding to consumers is developing new, different and better way to serve their needs. And what works for bread and cheese, what delivers for mobile phones, TVs and insurance, will given a chance deliver for schools and hospitals and will provide a more stable economy less open to the abuse of politicians buying their way into power or bankers manipulating their way into wealth.

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Merit, opportunity and the reduction of poverty in Bradford

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Yesterday I was at a 'development session' for Bradford's Health and Well-being Board and getting a bit irritated by the interminable mission creep (not to mention bucketloads of nannying fussbucketry). I appreciate that we have to 'tick everyone's box' in drawing up a five year strategy but there seems an almost wilful blindness to the big challenges facing Bradford's health economy. The first of these is a challenge everywhere - the rising cost of healthcare is outstripping society's ability to pay - but the second, while not unique to Bradford, is more specific. It is poverty.

And I say this in capital letters with flourishes and knobs on - the main reason for Bradford's poor health outcomes is poverty. It's not drinking. It's not smoking. It's not a big south Asian population. It's not obesity. It not illegal drug use. It's not road safety. It's not air quality. It is quite simply that being poor, always and everywhere, leads to a shorter and less healthy life.

Then I was corrected. Oh no, it's not poverty but something called "health inequality". Mostly, it seems because we have a strategy on combating "health inequality" but no strategy for reducing poverty. And this raises a very important issue by exposing again the conflation of poverty and inequality. With the result that we attend too much to enviously looking at how much richer, happier and healthier the residents of Burley-in-Wharfedale are compared with their counterparts in Barkerend.

What we should be doing is attending to the fact that people in Barkerend are poor not to the gap between their circumstances and the circumstances in Ilkley. But the conceit of the left (and of too many public services planners and managers) is the view that inequality and poverty are either inextricably linked or essentially the same thing. With the consequence that policy becomes about withdrawing from universal services in wealthy areas rather than the intelligent direction of resources to the alleviation of - with the end of eliminating - poverty.

This conceit - and its associated false dichotomy - is exemplified by this profile of Simon Willis who runs the Labour-supporting think tank, The Young Foundation:

"Let's say that we had a vigorous debate," he says. "The most important point Young made is that the opposite of inequality is not equality, it's fraternity … it's community and cooperation."

There we have our essential error about inequality. To say that the opposite of inequality is something other than equality is a deceit. It may be that fraternity, community and cooperation are more prevalent in a more equal society but it does not follow that equality leads to these things - nor do I see any supporting evidence. It also repeats the myth - a myth exposed time and time again only to be warmed over and reissued - that your riches are the cause of my poverty. But this time it is worse - Willis argues that the problem is 'meritocrats' because:

"They mistakenly think all their power and money and success is down to their own individual brilliance and hard work."

Again a familiar argument. Except that I've never met a successful person who didn't credit his or her success to a whole host of exogenous factors - from schools and parents through great colleagues to sheer good fortune.  Moreover we should consider what the alternative to meritocracy might be - presumably this is the 'fraternity' Willis alludes to as the opposite of equality. But isn't that a pretty stagnant society, a sort of land of 'meh'.

So I return to my earlier point. It is poverty that should challenge us not inequality. In the short-term part of the response to poverty is redistribution but over a longer period we need to alter the opportunities available to poor people, to allow them to play the meritocratic game along with everyone else. And these solutions are educational and economic - put bluntly better schools and better jobs. To say, as Willis is saying, that meritocracy is a problem is to deny the poor opportunity. Or rather to replace the chance to be independent, self-reliant and achieving with a sort of commune-like fraternal society.

This is just the intelligent articulation of the problem with community development - the idea that we can 'work with' communities from outside and that growing vegetables on roundabouts is somehow a substitute for education, skills and jobs. This is the world of the cuddly left where hugging the poor and saying 'there, there' is seen as a satisfactory response to the fact that they failed at school and haven't got a job. Or worse still giving them a hug and saying their problems are all the fault of those rich people in Ilkley (or bankers, or big business).

So back to Bradford and its health challenges. To make a difference we have to do a couple of things well - target interventions where they work best and recognise that improving the economic lot of people in Holme Wood or Barkerend is the best way to improve their health. For the targeting it's not about nannying because we know nannying doesn't work. Instead it's about real improvements - warmer homes, fewer chances to trip and fall, more pedestrianised areas, support for self-employment, training in today's skills and better outcomes at school. But this wouldn't suit The Young Foundation because what we're saying to those people is that they have skill, talent - genius even - and that we're going to release it, to allow them to achieve. Not from entitlement but from merit.

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Note on the causes of health inequality...

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This is from the ONS statistical bulletin entitled "Life Expectancy at Birth and at Age 65 by Local Areas in the United Kingdom, 2006-08 to 2010-12". It talks about possible reasons for health inequality - including this one:

One factor that has received less attention is the selective migration of healthy individuals from poorer health areas into better health areas or vice-versa. This type of migration has been shown to play a significant role in increasing or decreasing location-specific illness and mortality rates, which then consequently impact on life expectancy figures. Norman, Boyle and Rees (2005) demonstrated that the largest absolute flow within England and Wales between 1971 and 1991 was of relatively healthy people moving from more deprived into less deprived areas. The impact of this migration was to raise ill-health and mortality rates where these people originated from and lower them in the destination areas. The authors also noted that the benefit to less deprived areas was reinforced by a significant group of people in poor health who moved from less to more deprived locations.

Migration explains a lot of the variation it seems. So area-based approaches to reducing 'health inequality' may be addressing entirely the wrong target problem.

H/T Tim W