How to use misleading statistics in a bid for government funding - the LGA and public health at their finest

Terrible:

Council chiefs have warned of a ‘childhood obesity crisis’ as new figures reveal that the number of young people being treated for Type 2 diabetes has increased by nearly 50% in five years.

Not the statistic but the spectacularly misleading way in which this scary paragraph is framed. It is, I'm afraid, an absolute classic of the public health scare story genre - guaranteed to get media coverage but utterly deceptive.

So let's look at the numbers:

Figures from the Royal College of Paediatrics and Child Health show that 745 children and young people under the age of 25 received care for Type 2 diabetes in Paediatric Diabetes Units in England and Wales in 2017/18.

The first point here is that we're not talking about children here - unless we've begun categorising those aged 18-25 as children? Of the cohort in question (under 25 years old), a third -32% to be more precise - are adults i.e. aged over 18. Some of them may be obese and may have Type-2 diabetes but using these figures to claim an increase in child diabetes is simply wrong.

And that cohort? There are 17.4 million of them meaning that the 745 who have 'received care' for Type-2 diabetes represent a massive 0.004% of the population. There may have been an increase since 2015 of 50% but this is still not in any respect a crisis (except perhaps for the individuals most of whom will be over 18). Even with the more inflated Diabetes Association estimate of 7,000 under 25s who have received support for 'diabetes-related' conditions, the problem still only affects 0.04% of the cohort.

There has been a trend in public health using secondary factors to substantiate proposals for either new regulations, new taxes or more local government funding. Mostly this is because there's not really any evidence that child obesity is rising:





That's from King's College - here's the latest from the NHS itself:



Again no indication that child obesity is rising (indeed it has fallen for children arriving in primary school). So public health look for other statistics to peddle their hysterical fussbucketry, most commonly statistics like these on Type-2 diabetes that, while interesting, suffer from a whole load of flaws (changes in referral practice, greater awareness of symptoms, new centres and facilities to support diabetes) that mean the increase could be entirely unrelated to changes in the number of obese children and relate more closely to better diagnosis and more provision in the NHS system - both good things but no justification for advertising bans or bunging millions for local councils to splurge on useless obesity programmes.

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Evidence-free policy-making is the norm

The main point of Chapman's article is that no adequate process of evaluation has been put in place for this policy.

This quotation, lifted from Chris Snowdon's article about the limiting of stakes on FOBTs (fixed-odds betting terminals) could apply across a huge range of public policies. Worse than this, there is very often no way in which an evaluation can be better than informed opinion or observation.

Take, by way of example, Bradford Council's planning rules on the opening on new hot food takeaways. These rules ban new takeaways within 400m of a school or place that might be widely used by children and young people. To date the latter part of this definition covers parks, playgrounds, halls and community centres. Within the city proper there is almost nowhere (other than the city centre which is exempted from the regulation) where someone can open a hot food takeaway.

I opposed the ban and was told that, despite me pointing out the complete absence of any evidence linking hot food takeaways to child obesity is was (to quote Bradford Council's leader) "common sense" that there is a link. On a later occasion I asked the leader, via a question at full council, how the planning authority intended to measure the effectiveness of the policy. It seemed that they had no plans to do so but, when I pushed the leader, apparently this is part of a "raft" of policies that taken together will be effective in reducing levels of child obesity.

We're told by public policy folk that what they do is "evidence-based" but it seems that, where controlling public behaviour is concerned, there is no need for evidence or a framework for evaluation. When Bradford Council presented its consultation on a new PSPO (public space protection order) across the whole district meant to deal with 'anti-social driving', it was clear that while the things covered by the order - loud music, car cruising, loitering around cars - might be annoying they are not the things that the public consider the real problem: speeding, aggressive driving, road rage. And, just as with the ban on takeaways and the FOBTs stake limit, there is no indication as to how this PSPO will be evaluated so as to assess whether the limiting of civil liberties is justified by a reduction in car-related anti-social behaviour.

We will be having a 'review' but, like other policy reviews, it will feature how many orders were issued, how many people breached the orders and opinion from senior police officers saying how much they value the additional powers.

Finally, by way of example, lots of august bodies and respected individuals have responded positively to the government's consultation on introducing a register of home schooled children.The evidence for there being a need for this? None. But the LGA is keen for local councils to be de facto in charge of your child:

‘A register will help councils to monitor how children are being educated and prevent them from disappearing from the oversight of services designed to keep them safe.’

This is seen as a loophole by local education authorities (which probably should be abolished) and they are using safeguarding as an justification despite the evidence being that homeschooled children are significantly less likely to be abused than children attending regular schools.

It is clear that 'evidence-based policy-making' is almost entirely a myth - public authorities rely instead of expert opinion, referencing themselves and political popularity to justify intervening in private choices and behaviour.

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Deflection (or how to avoid facing up to your nannying fussbucketry)

People who are challenged by journalists, politicians or the public have take to responding by accusing the challenger of a sin against proper language - you're sexists or racist or transphobic or just plain patronising. Such a response shifts the discussion away from the substance of the debate focusing instead on what words are being used in the debate. Here, from nannying fussbucket in chief, Dame Sally Davies:

Dame Sally was questioned about the nannying claims by Mr Robinson.

He asked her: "You always have this question, so I know you are familiar with it - this balance you have to get between nannying on the one hand, or being accused of it at least, and on the other hand banality, stating things that are obvious."

Dame Sally shot back: "I thought you were going to be sexist."

Robinson asked, "What bit of that is sexist?" and Dame Sally replied: "I wonder whether you would say to a male chief medical officer..."

The story becomes Nick Robinson's language rather than whether or not it is "nannying" to issue guidance to parents on limiting screen time (what this has to do with the chief medical officer god alone knows). Dame Sally's question is unanswerable because we only have one chief medical officer and she is (if I'm still allowed to say this) a woman.

Over recent times public health people have become really sensitive about being called 'nannies' - Duncan Selbie, the boss of Public Health England famously denied (despite backing sugar taxes, smoking bans, minimum unit pricing and a host of other interventions into people's choices) being a nanny:

It’s important not to say we are into nannyism. That winds me up because I never had a nanny in my life. It’s too important to leave it to the state. This is about individuals.

It seems to me that saying it's 'nannying' to boss the public around, lecture them about their 'bad' habits and treat them as pariahs is both accurate and guaranteed to wind up public health people. Mostly because they know it's what lots of people think.  Dame Sally, Mr Selbie and all the others really are nannying fussbuckets.

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When misusing the precautionary principle kills - the case of vaping bans

Vaping will be banned in smoke-free areas, although 'this is a precautionary measure' as there is no robust evidence of harm from second-hand vapour.

Welcome to the carefully considered decision of New Zealand's public health gauleiters. Yes folks, they're going to ban something they know isn't harmful because, y'know, precaution. Just let's be clear about this - every single drug introduced onto the market would need banning under this principle. No clinical trial, no epidemiological analysis, no Cochrane Review, no metanalysis and no research appraisal can eliminate the possibility that, in some way, there might be harm.

So what is it with these public health people? Why do they continue to ignore the self-evident reductions of harm from a liberal attitude to vaping and focus instead on something without evidence of harm - sidestream vapour?

For all its problems, the precautionary principle makes some sense. But its purpose is not to ban everything that has even the slightest prospect of causing harm. The problem is that the way risk managers might make use of precaution is very different from the idea of "better safe than sorry" because the latter is a recipe for preventing innovation and invention on the basis of risk.

The purpose of the Precautionary Principle is to create an impetus to take a decision notwithstanding scientific uncertainty about the nature and extent of the risk, i.e. to avoid 'paralysis by analysis' by removing excuses for inaction on the grounds of scientific uncertainty.

That seems clear enough - we act with caution (I'm a conservative why wouldn't I support that idea) but we still act. And we don't let the lack of scientific certainty - proof as us laymen might put it - prevent that action. This is, to the annoyance of some, the driving principle behind many environmental interventions - we're confident that greenhouse gas emissions contribute to changes in climate but we know precious little about the when, why or where of this impact or even how great or small it might be. But because the worst case downside risk - human extinction - is big enough we choose to act on that climate risk.

The problem here is that, while we want action, we don't know what policy choices are effective and what aren't effective resulting in a mish-mash of essentially virtue-driven policies rather than a clear, simple intervention. So, if the reason for climate change is greenhouse gas emission (at least in part), the simple response is a carbon tax but instead we get a bewildering collection of subsidy, sub-optimal investment and bans that don't get to the heart of the problem.

All this is probably fine until we start to apply the idea to areas where the worst case downside risk is not so bad. Obesity is a problem but it's downside risk is a shorter and less comfortable life for the obese and a marginal increase in healthcare costs for society - neither of these are existential. The same goes for most of what passes for public health these days and it results in stupid, "gotta be seen to do something" policies like banning adverts for burgers on bus stops. Worse there's a whole industry of pseudo-science developed to provide succour to these policies - a steady trickle of poorly-framed, badly conducted research studies designed with the ideological purpose of justifying bans, controls and limits in the interests of health.

So focus on the simple - for smoking the two things that worked well to reduce consumption of tobacco, public information and price, have run their course because everyone knows smoking is unhealthy and the price has reached the point where the biggest criminal growth industry is smuggling tobacco. So what's left - especially given further evidence that 'stop smoking service' interventions are expensive and pretty ineffective? We're either got drugs like varencline or vaping. And varencline, for all is effectiveness, carries an actual and demonstrated risk. In contrast vaping really isn't harmful - at least if Public Health England's most recent evidence review is a guide (it would be asking to much, I guess, for PHE to show the same degree of robust review when it comes to alcohol harm or obesity).

So to apply the precautionary principle to policies on vaping in public spaces - "we don't have any evidence it's harmful but, you never know, so we'll ban it" - is to completely misuse that principle. And, in doing this, the idea that vaping is harmful gets set in people's minds - and if a smoker thinks vaping is just as bad and the government bans it in public space then those smokers will carry on with much more harmful smoking. The consequence of precaution isn't safety, it's more harm.


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A combination of fussbucketry, economic illiteracy and the denial of liberty - welcome to Conservative policy-making

Conservative policy-making is in a bit of a pickle. It's not that there isn't any thinking about policy just that the thinking seems rooted in focus groups, the received wisdom of government policy wonks and a seemingly obsessive desire to be liked. The best place to start in explaining this is a set of "principles" set out by centrist Tory think-tank, "Bright Blue". These principles purport to be an encapsulation of something called 'liberal conservatism'. Now, leaving aside the slightly oxymoronic nature of the tag (Americans would probably pop if they were faced with such an apparent contradiction), it seems that the nice folk of Bright Blue have confused having an activist state with 'liberalism' - here's a couple of examples:

We should be open-minded to new thinking, applying solutions to public policy problems on the basis of good ideas rather than tired ideology.

Markets are the best way of allocating resources, but they can be inefficient and inequitable, so government and social institutions can help correct market problems.

Both of these statements doubtless tick the box for bureaucrats and assorted inheritors of Blair's actualist ideal of "what matters is what works" but they are essentially illiberal and, to make matters worse, contradictory. Describing your positioning as 'liberal conservative' is a statement of ideology even if, like Blair did, you adopt a sort of rhetoric that denies ideology while promoting an approach that sees government intervention as central to policy. Bright Blue are ideological in the same way and it is likely that their policy proscriptions will involve the state intervening in the interactions of private individuals - the very antithesis of liberalism.

This illiberal position is underscored by the essentially anti-market stance of Bright Blue's "pro-market, not free-market". If you are a liberal then the free part of free market is the bit that matters - liberals should be making markets more free not believing that government can "correct" market problems. These contradictions and confusions can only result in similarly contradictory and confusing policy proposals. Indeed scrolling though the titles in Bright Blue's library, there is a sense that the environment and climate change, human rights and how capitalism is in some sort of crisis seem to dominate. I may be doing an injustice but I've a feeling that, while these things matter, they are not the basis for a cogent conservative position appealing to the wider electorate.

From this same camp - a sort of slightly squishy centrist world where policy gimmicks dominate - comes Onward, another conservative think tank. It's the brainchild of Neil O'Brien MP (who used to policy wonk for George Osborne when he was Chancellor of the Exchequer) and they are a step ahead of Bright Blue by looking at something that does seem to matter - housing. The problem is that, having identified the problem (there aren't enough houses), Onward sets out proposals that seem designed to make development less likely. After all the cost of land is a big chunk of the reason why we don't building enough houses where people want to live but nowhere in its proposals does Onward set out any way to reduce the cost of land. Instead O'Brien tells us that the high land values are a boon because we can tax them and use the money to build "vital" infrastructure (although it's not so vital that private-funded initiative delivers it).

In truth Onward and O'Brien are trying to square the circle of needing development while pretending this can be done without building on green belt sites. O'Brien also gets confused between landowner and developer (a common problem with the public but one a bright young MP who worked at the treasury shouldn't be making): "(a) thing that drives my constituents mad is the way that developers make a killing when they get planning permission..." says O'Brien when it isn't the developer who cleans up on the land value but the landowner who the housebuilder bought the land from. The only impact of infrastructure contributions, a sort of CIL on steroids, would be to make development more costly, more slow and, in a lot of locations, uneconomic.

Onward has the jump on Bright Blue making proposals that, while they are entirely counter-productive, at least reflect the fears and concerns of likely Conservative voters. The problem, however, is that Bright Blue and Onward assume that the resolution to policy challenges must lie in action by government - tax this, regulate that, control the other - and most commonly by central government. For all Bright Blue's talk of institutions, the only ones they seem to feel matter are the institutions of state - local, private and civil society institutions can be commissioned by the state to deliver policy, there is no sense that those institutions can do the business without requiring the direction of national government.

Policy development in this centrist Tory world seems to consist of manufacturing crisis and then setting out proposals to resolve the crisis, proposals that almost always require significant government intervention, new laws, new taxes and bans. Mark Wallace at Conservative Home, in what amounted to a cry of pain, described the current Conservative obsession with banning things and concluded:

"...meddling in people’s lives might temporarily satisfy some politicians’ itchy need to “do something”, or to paint themselves as go-getters, but the cumulative price is to paint the Government as increasingly dour, gloomy and authoritarian in both tone and policy. Some positivity, some joy, some creation of new opportunity and liberty would not go amiss."

I fear that this pain will be ignored - even attacked - by those developing policy for Conservatives. We are stuck in the world of "something must be done" with the finest example being the new "Obesity Strategy" filled with pettifogging fussbucketry like trying to get Sid's Caff on the A49 to count the calories in his full English breakfast. Even worse there's its pretence that somehow these proposals are based on evidence when they're just another list of nannying gimmicks from astroturf campaign groups like Action on Sugar - ban ads, force manufacturers to reformulate, stop offers like two-for-one, and ban sweets at the checkout. Plus taxes, more taxes and yet more taxes.

Yet, as I noted in criticising the New Puritan Left, the response from ministers when challenged on this is to say that we're doing it to protect the NHS - asked about the obesity strategy's fussbucketry by Phillip Davies, the current public health minister replied:

“This is a publicly funded health service that we all believe in and all love. If we want it to celebrate its 140th birthday, we need to protect it, and that means getting serious about prevention and stopping people coming into the service and getting sick."

The same lie as the left's new puritan nannies - the NHS is under strain and it's your fault because you're too fat, you drink to much and have too many bad habits. All followed up by proposals for bans, controls, taxes and regulations to make you change your bad behaviour. It's a lie - obesity isn't rising and NHS costs are going up because we've got better and better at staying alive. Everyone - even the NHS - knows this, ignores it and proposes a new bunch of nannying, fussbucketing interventions that amount to a nudging us with a baseball bat.

To close the loop here, the same goes for housing. Everyone knows that the problem is that we've spent 30 years or more not building the homes we need resulting in hugely over-valued housing, sky-high rents, homelessness and a resentful young generation. And we also know that the reason we've not built those houses is our planning system, a system that's now wholly-owned by NIMBYs and BANANAs. Yet nobody does anything beyond tinkering for fear of upsetting those (few) constituents who moan to Neil O'Brien about heavy vehicles delivering to development sites or (a loud handful of) campaigners fighting hard to protect a bunch of ugly buildings in a derelict airfield because 70 years ago some brave Americans flew bombers from that field.

There is almost nothing about current Conservative policy-making - whether in think tanks or inside the government - that gives me, as a conservative, any confidence. Our core values of localism, self-reliance, community, enterprise and liberty have been swamped by technocratic solutions based on questionable evidence devised by bright young things with barely the first idea about the communities those policies will affect. It's not just fussbucketry, although that drives me mad, but also the ignorance of basic business economics and the belief that freedom is somehow a 'nice-to-have' rather than something absolutely central to what we believe as conservatives. The next generation of policy will be set by these people and it will be a putrid combination of fussbucketry, economic illiteracy and the denial of liberty. It won't be conservatism.

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The New Puritan Left - fat, poor people must be stopped from eating so many burgers

Ban it! Tax it! For the children! Climate change! Obesity! Cancer! What about the animals!

Hardly a day passes by without the boundaries of fussbucketry being pushed a little further. It began with fags and (I speak as an ex-smoker here) it was hard to argue that smoking wasn't bad for our health. Or rather the heath of those people actually smoking. Now, however, the New Puritan, "ban all the good stuff" has reached into every corner of our lives with its relentless message about "health", "climate change" and "ethics".

In an edition featuring, in huge black type, the words "The Return of Fascism", the New Statesman lives up to its front cover with a spectacular piece of food fascism:

What does need addressing is the excessive consumption of this potentially carcinogenic product, which not only causes cancer and life-threatening illnesses, but is damaging our environment, antibiotic effectiveness, and the NHS.

Indeed, it is the excessive consumption of meat that we should be acting to reduce.

Consuming just 50g of processed meat (a hot dog, for example) a day raises the risk of developing bowel cancer by 18 per cent over a lifetime. With the average UK adult consuming 70g a day and one in four now obese, the burden of meat consumption on the NHS is real. More funding is needed.

In these few short sentences, the left's full embrace of a controlling fascistic agenda is captured - health, environment, government, NHS and obesity stirred together creating a toxic mixture of statist absolutism. And the solution, just as with booze and sugar, is to tax meat. Make it so those chubby working class people can only afford meat on special occasions (like it was in the old days) while telling them it's for their own moral and physical good.

There was a time when I'd engage with what the left laughingly call "the science" of all this but I now realise that this is just a a circle jerk of self-referencing literature produced mainly by sociologists, left-wing journalists and 'public health' organisations astroturfed by big pharma 'philanthropy'. Suffice it to say that telling people eating bacon gives a slightly increased risk of bowel cancer is fine, saying that eating a hot dog a day will doom you is hyberbolic nonsense. No-one denies that cow farts contribute to the world's production of greenhouse gases but it is simply a lie - a huge lie - to claim (on the back of deforestation not bovine flatulence) it's the second biggest source of those bad gases.

But enough of all this - it's not about science, it's about the ideology - nay, the cult - of health. Our collective obsession with how minor variations in diet might just be increasing our mortality risk. We've no real way of telling whether this is true or not since removing confounding factors from epidemiology is nigh on impossible, especially when it comes to diet. The cult, at least in the UK, has an ally in our health system - the cultists tell us it's our fault that the NHS is under pressure. We are too fat, too drunk, smoke too much and generally live such dissolute lives the poor, desperate nurses and doctors can't cope. It's rubbish, of course - it's still our fault but because we're living too damned long not because we're fat drunks with a smoking habit.

You're not going to die because you're eating meat. And neither is eating meat some sort of terrible, irresponsible and unethical idea despite this being what the cultists want you to think. Cows aren't destroying the planet - rice farming alone produces more greenhouse gas than the entirety of the world's livestock farming. And killing and eating other animals is an entirely normal, reasonable and ethical thing for humans to do (as, for that matter, is wearing their skins on our feet and our backs). I know there are some folk who've adopted some sort of self-denying, bunny-hugging philosophy and that's cool (and unhealthy), but they are not better people than us carnivores, they are not more ethical, and they're not saving the planet by doing so.

We - the meat-eaters - need to start challenging the health cultists, the vegans, the swivel-eyed environmentalists and the tin-pot little fascists in government departments churning out policy at the behest of these ghastly fussbuckets. And, in doing so, we need to start pulling apart the offensive idea that it's in any way ethical to use taxes as a sledgehammer to get people to change what they do. Not only are these taxes regressive - it's not well-paid newspaper journalists or academic sociologists who won't be able to afford the meat after you've taxed it, it's the poor. Just like minimum pricing for booze and the sugar tax, what we have is a sneering attack on the ordinary family. It's not grass-fed, wagyu steak that the fussbuckets hate, it's the burger (just look at the picture the New Statesman use), the hot dog and the bacon sarnie from the roadside caff at 5am on the way to lay concrete or clean out sewers.

It has become received wisdom among the great and good (despite all the evidence to the contrary) that the real problem facing our world is that people are living bad lives - we are all, in the eyes of the New Puritan Cult that has captured too much of our government, sinners against the twin gods of heath and the environment. Of course, the great and good don't speak of themselves here but of others, of the great unwashed majority who like cheap food, enjoy a drink and have the audacity to enjoy themselves in an manner not approved by those great and good. Calls for a tax on meat ("we don't want a ban" - the prohibitionists cry of old) represent the endeavour of a minority to impose their bigotry on the majority, the very definition of fascism: fat, poor people must be stopped from eating so may burgers.

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Quote of the day...on the sugar tax

From the lovely People Against the Sugar Tax:

According to data published last week by Nielsen, the number of people saying they will give up sugary drinks has fallen from 11% before the tax started to just 1% now.

And the number of people saying they will continue to buy sugary drinks has actually gone up, from 31% before the tax started to 44% now.

It's not working. This is because people hate the idea (as I witnessed in the Co-op when someone said "how much?" when buying some Coca-Cola Classic - the woman on the check out responded, "it's that stupid tax they've brought in").

And this is before it dawns on the fussbuckets that the tax won't do what they say it'll do - make kids thinner. It is a stupid, illiberal, tax that will fall heaviest on the poorest while not resulting in a single lost pound.

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When life is hard, cheap pleasures hit the mark.

This from Grace Dent is the sum of it (do read the whole article)....

I will never view eating Heinz macaroni cheese cold from the tin as anything less than heavenly. If I had a gun to my head and was asked to choose between 10 courses of Michelin-star fine dining at Claridge’s or lying under a blanket on the sofa eating sour cream and onion Pringles, I would go for the latter. The thing that well-to-do food experts will never truly get is that, for millions of people, life is very hard and, via a million tiny ingrained cerebral signifiers, processed food is very cheering. You know these brands and they know you.

Food, drink, sweet treats, crap telly and fags - cheap pleasures as we used to call them when we were promoting Christmas hampers and researching the potential customers. Not is a bad way but in respecting the fact that when your life is tough, arguments about how your life will be shortened by that pizza, cheap bottle of white wine and 20 Silk Cut really don't wash. Public health folk and foodie wibblers need to start here rather than with trying to ban stuff and wagging stern nannying fingers at stupid poor people.

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Who are these joy-killers who want to ban Tony the Tiger?

Sunny Jim - the original cereal cartoon character here in stuffed toy form

I could launch into a full scale rant at the raft of proposals from the Health Select Committee aimed at combating child obesity - ad bans, mandatory reformulation, restrictions on fast food takeaways and a ghastly, ignorant polemic about the fiction that is "junk food". It is everything we should loathe about modern government, what Chris Snowdon describes as:

...taking a bunch of policies that do not work and piling them on top of another bunch of policies that do not work in the hope that some weird alchemy turns them into more than the sum of their useless parts

Among this "whole systems approach" is the proposal to stop food manufacturers using cartoon characters in their marketing:

Cartoon characters should be banned from promoting junk food to improve childhood obesity rates, a leading group of MPs has suggested.

The Health and Social Care Select Committee has called for a ban on "brand-generated characters or licensed TV and film characters" which are used to promote foods high in fat, sugar or salt on broadcast and non-broadcast media.

It would mark the death of Tony the Tiger and the Honey Monster as represents the worst sort of crass interventionism - annoying fussbucketry that won't make a jot of difference to obesity. I know this because cartoon characters have been used to promote breakfast cereals since Sunny Jim first sprang into life in 1902.

The characters we're familiar with - Coco the Monkey, the Honey Monster, Snap, Crackle and Pop, and the legend that is Tony the Tiger - have all been around for decades or more. Tony first told us Frosties were Grrrrrreat back in 1954, the Rice Krispies kids (originally goblins but, hey, what's the difference) date from 1930 and the Honey Monster began insisting Henry McGee "tell 'em about the honey, mummy" in 1976. Even Coco - a latecomer (succeeding Tusk the Elephant) - arrived on our cereal packets in 1991. None of these wonderful, child-friendly characters has made children fat, all they've done is give children a smile and helped mums' make a brand choice.


Now a bunch of joyless nannying fussbuckets led by the self-appoint Nanny-in-Chief, Sarah Wollaston want to put an end to all this fun because they like banning stuff and want children to have dull lives featuring uplifting, nanny-approved diets that don't involve anything that looks like it might appeal to those children. Yes folks, Sarah and the Fussbuckets want eating to be a boring, unpleasant, state-approved thing rather than any kind of pleasure. And all to deal with an almost entirely fictional obesity crisis.


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Telling stories to public health...

Helped run a story-telling session for public health folk yesterday - my contribution included a direct challenge to their narrative - or rather to the narrative most people see through the media and from government. It's clear that there is still a debate within the public health business as to what we mean by "wider determinants of health" - on one side are those saying this is about economic circumstances, education and housing, while others see it as being factors in the social environment (advertising and marketing, fast food restaurants, capitalism).

Anyway, here's the challenge:

Public health has become an ideology of control rather than a set of policies intended to eliminate, mitigate or reduce environmental impacts on health.

I coined the term nannying fussbucketry to describe this ideology of control - its elements are:

Shooting the messenger - advertising, marketing creates an environment where people are lured into sin. This is despite there being very limited evidence supporting the idea that advertising and marketing act to increase overall consumption (aggregate demand) or consumption of a given product category.

Taxing the poor - taxes on alcohol, cigarettes, sugar and so forth fall most heavily on the least well-off. I can afford to carry on buying bottles of wine because nine or ten quid is not a hardship to me. Poor people - regardless of whether their lifestyle is 'harmful' - may no longer be able to afford

Inflating and conflating statistics - the entire case for minimum unit pricing is built on the idea that elasticity of demand is the same for heavy drinkers as it is for light drinkers (hint - if you think about this for a second, it's clearly nonsense). Every round in the obesity campaign begins with a picture of a very fat person - morbidly obese 40+ BMI - and then talks about how 2/3rds of people are 'obese or overweight'. Overweight - BMI 25-30 - is not a health risk and we shouldn't treat it the same as actual obesity (something that hasn't increased in ten years)

Targeting the whole population - even though most people are not unhealthy, not eating an bad diet, not overweight, not drinking excessively, not smoking. This means we're essentially ignoring the people who really do need help and support - smokers, alcoholics and the morbidly obese. And the whole population approach doesn't work - UK alcohol consumption has fallen by approaching a fifth but there has been no corresponding drop in alcohol-related hospital admissions.

It's for the children - campaigns like the latest 'cover your eyes' stuff from Jamie Oliver present children as agents of their own obesity when children are not, in the main, purchasers of the family's groceries. The attack on fast food restaurants - with its undercurrents of outright snobbery - is another example where there simply isn't any reliable evidence linking eating fast food to obesity. Worse 'it's for the children' is frequently used as cover for limits, price hikes and bans affecting only adults.

All of this is done within a narrative of 'we know better what is good for you'. Despite there being no such thing as an unhealthy food - just unhealthy diets - we demonise sugar, fat and salt as if they are the reason we are fat (consumption of all three sinful ingredients has fallen since the 1970s while average weight has risen and CHD has plummeted). While PHE has been positive about vaping, most public health functions at a local level remain hesitant to promote it as an aid to quitting - we still have vaping bans in public places that have zero health justification, just because it's easier. And public health continues - despite a mountain of evidence - to ignore the fact that moderate drinking, to levels well above current recommended levels, has a positive impact on mortality risk, up to 20% lower than in people who have never consumed alcohol.

You have become, for the people you most want to reach (the remaining smokers, the very fat and the very drunk), the little girl who shouts fire all the time. They've stopped listening to you because all you offer is a wagging finger - a wagging middle-class finger - of judgement about their lifestyle.

Let me give you a couple of little pen portraits - not real people but their circumstance reflect reality:

Mary - lives in a council flat, single mum, two young kids, smokes, drinks and is very overweight. She knows she should quit, should eat less and perhaps not get drunk but her life is shit and doing those things isn't going to make it better.

Stanley - old man, single, lives on state pension. Likes to watch the racing on a Saturday afternoon TV. Buys two or three cans of beer from the shelf with the cheap and damaged goods - all he can afford. That's all he drinks in a week. Minimum unit pricing means he won't be able to afford that any more. You've not made him healthier, you've just made him less happy.

I hope this left something for people to think about.

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You want to make food more expensive? For the children? Give us a break.

It is a rare consensus when all the leaders of Britain's political parties get together to agree on something important:

Among other proposals, they call for the tax system to be “used to make healthy food cheaper and discourage unhealthy choices both at home and on our high streets”.

The leaders also say the levels of sugar, calories, salt and fat in junk food should be lowered overall, while more training should be given to medical staff to help people with nutrition.

In a world where there are a thousand problems ranging from poverty and family breakdown to murders and robberies, all our political leaders can manage to agree on is that food should be made more expensive. And who does this affect - has somebody mentioned to these sanctimonious fussbuckets that it will be the poorest in society who will be hurt most by this policy?

We're told that we need more expensive food because obesity is one of the greatest health challenges of our time. Bigger than AIDs, more challenging than cancer, more cursed than malaria, more frightening than dementia. Yes folks, you need to pay more for your food because, damn it, you're all a bunch of lard buckets and the government needs to force you to eat properly. It's for the children.

Yes. The Children. Those children whose mums and dads won't be able to buy as much food as they did before because a self-righteous bunch of snobbish know-alls marshalled by a fat TV chef have decided this will be good for you. I know they'll tell you it's only "junk food" but this isn't true - it'll be bread and cheese and butter and bacon and cereals and burgers and orange juice and...over half of what you buy to make up a balanced diet for you family is what these tinpot health dictators call HFSS (high in fat, sugar and salt). And these jumped up nannies want it all to be more expensive - so your children (who almost certainly aren't fat) don't turn into obese whales and die before you do.

Worse, the plans aren't just about making the everyday food you feed your family more expensive, they'll make it taste less good by forcing the manufacturers to take out the sugar, salt and fat that gives it the great taste.

There is no obesity crisis. It is a manufactured moral panic based on flimsy (I'm being kind here) evidence that we're all getting fatter and fatter. We aren't - we're on average a bit heavier than we were in the 1980s but this is not unhealthy (it could be argued it's actually healthy). The figures are skewed by an ageing population - middle age spread is, as we all know, a reality - and haven't risen for a decade.

I'm probably shouting into the void here but we really need to tell Jamie Oliver, Hugh Thingy-Wotsit, Channel 4, the BBC, leaders of political parties who'll do anything for a cheap headline in the Guardian (every snobby fussbucket's favourite rag), and the massed hordes of public health campaigners to go take a running jump off a very high cliff. We don't need a load of rules telling food manufacturers what they can and cannot put in what they sell (other than ones to make sure it's safe). We don't need a bunch of prissy middle-class media sorts going around telling ordinary people - on the basis of no knowledge or expertise - what they can and cannot buy to feed their children. And, above all, we don't need a load more new taxes designed specifically to make food - food ffs, the basis of life - more expensive. Just leave us alone will you.

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Quote of the day: taxing the poor till their pips squeak

From Dick Puddlecote:

And lastly, we have the type who knows very well that this is a load of bollocks but just like the fact that sin taxes are regressive. They will leap on any old nonsense to justify a tax which punishes the poor, for the simple fact that they hate people who are not like them. They don't care whether the sugar tax will work, they are simply a modern version of a Victorian aristocrat who would sneer at the choices of the poor. It is now considered shameful to advocate an income tax rate for the low-paid which is higher than that for the rich, but positively encouraged by government to support disproportionately gouging the less well off for products which the rich can afford quite nicely, thank you.

The poor must be punished for making the wrong lifestyle choices (even if those choices are their main source of pleasure in an otherwise dreary life).

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Tax the poor - the nannying fussbucket's favourite policy

From Chris Snowdon comes this:

Is there anything more nauseating than the sight of billionaires buying up newspaper space to lobby for higher taxes on poor people?

This is the final sentence in an article taking apart an advertorial in the Daily Telegraph paid for by Bill and Melissa Gates. The article in question was absolutely shocking - 'brain dead' I called in on Twitter - and, as Chris points out, pulls out all the usual lines from the fussbuckets about evil corporates, advertising and how the answer lies in more controls, more regulations and in making disapproved food more expensive.


We should also, I suspect, be a little bit worried at very rich people buying newspaper space to promote a political ideology and doing so in a way that pretends it is proper news coverages not advertising.

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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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Fast food shop bans - public policy as virtue signalling

Banning new hot food takeaways is a favourite policy of local councils these days. It's driven by a thing they call "wider determinants of health" (tip to aspiring nannying fussbuckets - this phrase should trip from your tongue nearly as often as "cost to the NHS") and, as I was told by Bradford Council's leader in January, the policy is self-evidently "common sense". I'm guess that this is another example of the words 'common sense' simply meaning 'not based in any way on actual evidence' - all I'd done is ask how the council intended to measure the effect of its policy on levels of child obesity (given this was the validation for its introduction). As there is no evidence and no means of measuring the impact of the policy, shouting 'it's common sense' is the only remaining fall back position.

And the evidence? Seems there ain't none:

The evidence that fast food availability causes obesity among children is even weaker. Of the 39 studies that looked specifically at children, only six (15%) found a positive association while twenty-six (67%) found no effect. Seven (18%) produced mixed results. Of the studies that found no association, five (13%) found an inverse relationship between fast food outlets and childhood obesity. Two-thirds of the studies found no evidence for the hypothesis that living near fast food outlets increases the risk of childhood obesity and there are nearly as many studies suggesting that it reduces childhood obesity as there are suggesting the opposite.

And I'm guessing that, since most of these studies merely assess correlation, anyone looking at these findings would have to conclude that the evidence doesn't support the contention that the availability of fast food doesn't relate in any way to levels of obesity in children (or indeed grown ups). All we get is a protected environment for existing fast food businesses and the active prevention of new businesses in this market. In the end we have a smaller economy and just as many fat kids. Evidence-based public policy? What we have is just public policy as virtue signalling.

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Obesity policy - snobbery dressed up as healthcare

So, yet again, the Guardian lays into the choices of normal people:

A ban on junk food advertising before the 9pm watershed is long overdue. It should be supplemented by a ban on promotions and price cuts for “sharing” bags of chocolates, as Action on Sugar urged last month. And the sugar tax on drinks could be extended to food products, with the revenue channelled into initiatives making fruit and vegetables more affordable and attractive to consumers. The government’s failure to force change means that the rest of us will pay the price – in ill health and higher taxes – as big food rakes in the profits.

I've given up pointing out that obesity hasn't risen for over a decade, that how we define obesity (BMI of 30+) has no scientific basis, or that individual ingredients - sugar, fat, salt - are not the reason why folk today are fatter than they were in the 1970s (when they ate a lot more sugar, fat and salt).

Now I'm just cross and irritated by the snobby, self-righteous people who write editorials in the Guardian, pontificate on daytime telly, and fill the minds of young doctors with utter tripe about diet and health. It really is the case that what these fussbuckets believe is that your choices - especially if you're one of McDonalds' 3.5 million daily customers in Britain - are wrong. Worse these snobby judgemental nannies want to slap on taxes, bans and enforced 'reformulation' - to take away your pleasure in food - simply because what you like doesn't match what they like (assuming they get any pleasure at all from their sad diets of spiralised vegetables, quinoa and bean sprouts).

It really is time that the vast majority of people who eat a decent diet - including sugary snacks, fizzy drinks, pizza and burgers - tell snobby Guardian writers and public health officialdom to take a hike. Obesity really isn't the number one health problem facing the UK and slapping on controls, bans and taxes that might (but probably won't) result in all of us losing a handful of pounds will not improve the overall health of the nation one iota. Most people - 95 to 97 out of 100 - are not unhealthily overweight and, if we want to do something about obesity, we need to direct the resources towards the relatively few for whom it is a serious issue. Right now we're squandering millions on a fool's errand of reducing the whole population's weight when, quite frankly, the whole population doesn't have a weight problem.

The truth, of course, is that grand public health fussbuckets have decided that, because they disapprove of the eating habits (and drinking habits for that matter) of less well off people, those people should be forced to pay more for their food. It's just snobbery dressed up as health care.

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Trust the people (but only the smart, well-educated, urbane ones)

Some of you will have had the dubious pleasure of seeing broadcaster Terry Christian on the BBC's Question Time programme. Mr Christian is an ardent enthusiast for the UK remaining a member of the European Union and, in broad summary, considers everyone who doesn't agree with him to be imbeciles. One of our intrepid broadcaster's shticks is to chatter about how the Brexit vote was cooked up by (anonymous) very rich people who then conned the working class. In simple terms, Mr Christian believes that the working class are too stupid to be allowed out in public with something as explosive as a vote.

This belief that ordinary people do not have agency - can't be trusted to make decisions about their lives - is widespread. Here's a chunk from a post at Tom Paine's blog talking about an academic psychologist from UCL's Centre for Behaviour Change:

He doesn’t mean to be a monster and I don’t want to see him as one, but in his presence my blood ran cold. I was afraid of him. I was even more afraid of the way the earnest folk in the room laughed as he joked about the unintended consequences of various programmes to clean up the act of the idiotic, self-destructive great unwashed, I realised that I might be the only one there who included himself in the category of “the people” to be shaped as opposed to the smug elite doing the shaping.

What we have here is an entire research centre - indeed something close to a whole academic discipline - dedicated to the idea that people should be stopped from making (what the academics consider to be) bad choices. These are, as Tom Paine observed, nice people - smart, well-educated, urbane, the very sorts you'd want your son or daughter to marry. The problem is that they believe they know better than you do and, they argue, have the research to prove this. They also believe that, because they know better than you do, you should be prevented from making a choice that the smart, well-educated and urbane don't approve.

It is odd that, at a time when we celebrate the widening of the franchise in 1918, a whole bunch of people are putting serious effort into removing choice, freedom and agency from people. The Brexit vote, for many of the smart, well-educated and urbane, has been the tipping point as they rush headlong away from the idea of democracy (while bizarrely trying to pretend that a polity where voting can't change the people in charge is a democracy) or at least from the thought that ruddy-faced older folk - gammon is the term our smart folk use - from slightly tatty northern towns should have a say in what happens.

The result is illustrated by the BBC - home to lots of those smart, well-educated and urbane folk - 'debating' the proposal from one of their number that old people shouldn't be allowed to vote:




How dare people say they won't vote for politicians who ignore their interests!

There are two things going on here but both of them reflect a new version of Plato's philosopher kings - a superior cadre of leaders who are intelligent enough to direct society. In the case of behaviour - poor lifestyle choices, for example - these overlords want, in the manner of Brave New World, to make you have a (long) life of unstressed, bovine contentment and this requires them to direct the choices of the idiotic, self-destructive great unwashed.

With democracy - whether you're Terry Christian saying working class folk were conned or Jeremy Paxman suggesting old folk hold politicians to ransom - the problem is that people have started making electoral choices that our Philosopher Kings don't agree with. The only way out of this is to either have less democracy or else to limit the way in which democracy operates most obviously by limiting the franchise. Following the referendum there was a great deal of chatter (from those who didn't like the result mainly) about how this shows how referendums are a really awful idea and we should stop having them. We elect politicians (nearly all smart, well-educated and urbane Philosopher Kings) and they should make all the important decisions so as not to cause upset or headaches among the masses.

Part of the problem is that the smart, well-educated and urbane simply don't ever get near to the lives of most people - they live in a snobby world where no-one goes to McDonalds (junk food is bad and unhealthy) except, it seems, by accident:

I was at a workshop on Friday, and whilst driving back home, I stopped off at one of their restaurants in a service station. I'll put this comment upfront, especially given that I work in Public Health; I am not advocating fast food consumption. The options available in service stations are rather poor, especially when looking for hot food (I have found a way around this which I'll mention at the end!). What caught my attention though was the way in which McDonald's understand how to influence behaviour, strategies that we could look at when working in Public Health...But they also understand - in very fine detail - how their systems work, how each component part operates, and how these parts can be refined to maximise efficiency.

For the smart, well-educated and urbane, McDonalds is the enemy - despite (or maybe because) the ubiquitous hamburger chain serves about 3.5 million customers every day in the UK. McDonalds and its franchisees know far more about the ordinary folk of Britain than most academics - this is because it really matters to them as a business, getting the detail right means happy customers. The problem is that our visiting academic doesn't see a great business delivering good food to happy customers. Like Terry Christian with Brexit voters, our academic sees wrongness, exploitation, manipulation - a con. How dare ordinary people make such bad choices and, worse, be happy doing so.

What the Brexit vote uncovered and Corbyn's surge confirmed is that the smart, well-educated and urbane people aren't really all that keen on democracy. They're very keen on votes but these orchestrated events should be like electing the supreme soviet - everyone gets a vote, we're really excited about voting, there are campaigns, speeches, debates but in the end nothing much changes. Democracy should entail the possibility of - people should be able to hope for - a change in the rulers but this doesn't suit the courtiers.

At the core of this is this belief that people (other people who aren't part of your smart, well-educated and urbane circle) don't know what's good for them. These folk are the living embodiment of Douglas Jay's unintentionally honest comment back in 1937:

"...in the case of nutrition and health, just as in the case of education, the gentleman in Whitehall really does know better what is good for people than the people know themselves".

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Minimum pricing for alcohol - stupid and immoral in equal measure

The Welsh government has (having tiptoed back from banning e-cigs) decided that it's keen on introducing a minimum unit price for alcohol:

A law to set a minimum price for selling alcohol in Wales has been unveiled.

Ministers believe tackling excessive drinking could save a life a week and mean 1,400 fewer hospital admissions a year.

Pricing is seen as a "missing link" in public health efforts, alongside better awareness and treatment.

Under a 50p-a-unit formula, a typical can of cider would be at least £1 and a bottle of wine at least £4.69.

A typical litre of vodka, for example, would have to cost more than £20.

The Welsh Government has not yet decided what the price will be, however.

This policy is popular with the New Puritans and temperance campaigners who populate public health departments these days. And, sadly, politicians who should know better cluster around these officious fussbuckets thinking that 'clamping down on drinking' is, in some way, a good idea and popular.

But minimum unit pricing is, in equal measure, stupid and immoral. Here's why stupid:

Alex Loveland, a recovering alcoholic who supports people with dependency, is worried that it will not help them.

"They're going to try to get alcohol by any means necessary and I think it will put more strain on very underprivileged people," he said.

So here's a fellow who, I guess, knows a little bit about problem drinking. Imagine the typical alcoholic - faced with more expensive booze, what are they going to do? The idiot fussbuckets who are proposing a minimum unit price think this:

"The most substantial effects will be experienced by harmful and hazardous drinkers, who are more likely to consume cheaper and higher-strength alcohol products." 

Yes folks, these people think an alcoholic is going to drink less because the price goes up. You know, I've a feeling that addictive demand is pretty inelastic - just a guess but if I've a compulsive need for booze, I'm going to fail to feed the kids before I don't get that booze. The policy is stupid.

It doesn't make any difference how you look at this outcome, it is also immoral to propose a policy that has such an effect. To introduce any public policy that, by design, results in more risk and more harm for vulnerable people cannot be justified. Plenty of public policy (any examination of our benefits system over time shows this) has unintended and harmful negative affects but most of it is not harmful by design. Minimum unit pricing is intended to increase risk and harm among problem drinkers - it is its sole purpose. Or rather among those problem drinkers who can't afford £20 for a bottle of vodka, which I suspect is a minority of such drinkers.

Others will point out that this policy of targeting only cheaper drink is an attack on the less well off. On the poor old man who buys a couple of the cheapest cans to drink on Sunday afternoon while he watches the racing on the telly. Or the single mum on benefits with two kids who gets respite from them on a Thursday and celebrates with a bottle of Lambrini, some cheap snacks and reality TV.

Us better off folk will be fine. We'll still be able to afford malt whisky and craft beer. And we'll feel better - or so the public health nannies think - knowing we've dealt with the problem by making poor people pay more for their moderate drinking. As I said - stupid and immoral.

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Obesity strategies ignore obese people

Some time around 1990 I was involved in some work for Bradford Health Authority that touched on the use of data to improve the impact of public health messaging - we were looking mostly at HIV/AIDS and diabetes. The difficulty for the health authorities came when we pointed out that AIDS really wasn't an 'all population' risk except in the very broadest of definitions. There were some groups in Bradford - gay men, intravenous drug users, African immigrants - where the risks were far higher. We suggested profiling and targeting so as to get the best value from the limited pubic health funding available (especially since there were extensive national media information campaigns about AIDS at the time). This was rejected because of 'stigma' or a risk of being perceived as racist or homophobic.

The consequence of this refusal to use profiling is a belief that, not only are the risks equal across society, but that public health strategies should be directed to the whole population regardless of the truth about those risks. This 'whole population' approach has been widely debunked with alcohol consumption (although its advocates continue to use models to pretend that the merest sip of the demon drink lead inevitably to ill health) and we see it also with obesity where the public health focus is on what they call Tier One Intervention - stressing the 'social determinants of health'.

With obesity, the result is that health funding is directed primarily to seeking behavioural change in the whole population - weighing children, getting shouty chefs to bang on about school dinners, browbeating restaurants to make portions smaller or offer salad, banning kebab shops anywhere near children and getting Lucozade to make their core product taste awful. This is despite the fact that 95% of the population isn't facing any serious health risk from our weight. We use 'scare statistics' about how two-thirds are 'obese or overweight' and then illustrate this with images of a 25 stone person rather than the reality that 'overweight' (BMI 26-30) really isn't anything that 'a little more exercise and fewer puddings' wouldn't sort out and probably isn't unhealthy either.

At this point the Guardian notices that the UK, compared to other places, doesn't do much bariatric surgery on obese people:

What’s going on? The procedure is the most effective way of helping people who are obese to lose weight and can have a radical impact on their quality of life. At approximately £6,000 per operation, it’s relatively cheap and saves the NHS significant amounts of money on more expensive procedures such as hip and knee replacements further down the line. But here in Britain, it is being reserved only for the most extreme cases.

This situation is entirely a consequence of stressing Tier One rather than looking at higher tiers. You could call this 'fat shaming' but I prefer to call it massively stupid public policy. There are around 5% of the population with a serious, health-threatening weight problem but public health is too busy making out that obesity is the biggest health problem in society (and getting schools to write unpleasant letters to parents about their children's weight) to do its job of helping those people who really do have a problem with their weight.

None of this Tier One effort makes a blind bit of difference to levels of morbid obesity. If you take the sugar out of fizzy pop, obese people just switch to another calorie-loaded drink or food. Campaigns about fizzy pop, pizza or burgers result in thin people changing their diets (and talking endless rubbish about 'low carb' or 'clean diet') but do not look at the reasons why some people - maybe one in 20 - are very fat. And the same goes for exercise - it's probably a good thing that active living promotions have helped shift a further 3-4% of the population into regular (the approved 30 minutes a day) physical activity but it isn't working for the 50% of folk who do next to no exercise.

For all that the NHS bosses say obesity is their number one priority, we see that actually doing something to help people who really are obese isn't included within that prioritisation. Instead we get an increasing pile of pointless and intrusive fussbucketry masquerading as an 'obesity strategy'. While all this righteous lecturing about food (and attempts to make out that it's not fat people's fault that they're fat by blaming the food industry) is going on, the option of targeting efforts on the very obese is ignored. Public health wants to change the behaviour of the whole society - despite most folk's behaviour not seriously risking their health - rather than help the people who, for whatever reason, are riskily overweight. It's perhaps time we started talking about the problem - and helping those with it - rather than making up a sort of moral panic about lots of people being a few pounds heavier than they used to be.

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Friday Fungus: Is work making you ill? Blame it on the wallpaper

Killer wallpaper

We've know for a long time that wallpaper can be dangerous:

Scheele's Green was a colouring pigment that had been used in fabrics and wallpapers from around 1770. It was named after the Swedish chemist Scheele who invented it. The pigment was easy to make, and was a bright green colour. But Scheele's Green was copper arsenite. And under certain circumstances it could be deadly. Gosio discovered that if wallpaper containing Scheele's Green became damp, and then became mouldy (this was in the days of animal glues) the mould could carry out a neat chemical trick to get rid of the copper arsenite. It converted it to a vapour form of arsenic. Normally a mixture of arsine, dimethyl and trimethyl arsine. This vapour was very poisonous indeed. Breathe in enough of the vapour, and you would go down with a nasty case of arsenic poisoning.

This, some say, was what killed Napoleon.

Anyway - and you'll note the role of mould in making this nasty wallpaper effect happen - to bring the story up to date:

In laboratory tests, "we demonstrated that mycotoxins could be transferred from a mouldy material to air, under conditions that may be encountered in buildings," said study corresponding author Dr Jean-Denis Bailly.

"Thus, mycotoxins can be inhaled and should be investigated as parameters of indoor air quality, especially in homes with visible fungal contamination," added Bailly, a professor of food hygiene at the National Veterinary School of Toulouse, France.

'Sick building syndrome' has been blamed on lots of things but it does seem there's some mileage in blaming the wallpaper (or indeed any mouldy material knocking about). More worrying is the associated evidence that our enthusiasm for energy-efficiency and hermetically sealed environments makes matters worse;

The study was published in Applied and Environmental Microbiology, a journal of the American Society for Microbiology. Creating an increasingly energy-efficient home may aggravate the problem, Bailly and his colleagues said.

Such homes "are strongly isolated from the outside to save energy", but various water-using appliances such as coffee makers "could lead to favourable conditions for fungal growth", Bailly explained in a society news release.

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