Hairdressing is not an obviously dangerous occupation. Yet working in a hair salon or a barber’s shop can provoke skin conditions, musculoskeletal diseases such as arthritis and tendonitis and work-related asthma.
Now Usdaw, the shopworkers’ union which represents many of Britain’s estimated 140,000 hairdressers, is calling for a “new deal” to protect them. Paddy Lillis, the union’s deputy general secretary, said the government needed to give “proper protection” to barbers and hairdressers, the majority of whom are female and younger than 40.
A Europe-wide agreement on health and safety standards for the industry has been blocked by the European commission, under pressure from successive British governments. “It’s time we had a new deal for hairdressers,” Lillis said. “All too often the safety of shopworkers is overlooked in the mistaken belief they work in low-risk environments.
“This is a mistake the UK government made when they scaled back Health and Safety Executive inspections and slashed inspections by local authorities who enforce safety in shops, warehouses and offices. It is time that the government and the European commission took these risks to the health and safety of hairdressers seriously and gave them proper protection.”
Research indicates that hairdressers are at risk from seemingly innocuous activities such as washing hair, cutting hair and using hairspray. Repeatedly washing hands can lead to dermatitis, a non-contagious sensitivity to chemicals that causes painful cracked skin and bleeding, and research has shown that 70% of hairdressers have suffered from skin conditions.
Breathing in hairspray and other chemicals may be linked to asthma, according to some studies. Using scissors day in, day out can provoke arthritis and tendonitis in the hands and thumb, through loss of cartilage.
And hair dye has been blamed for a link between hairdressing and bladder cancer, although Cancer Research UK believes this is more likely to be the result of older hair dye ingredients which have been discontinued. Most of these issues could be solved by wearing appropriate gloves and taking regular breaks.
Rebecca Walker had been a hairdresser for nearly 10 years when she developed arthritis. The first signs were a “really stiff shoulder”. “I thought that maybe I’d been overworking it, but it didn’t go away and the pain moved to my elbow,” she said.
Within two months she had resigned because she was taking too much time off because of the pain in her wrists and hands. “I suppose I’m quite a determined person so I didn’t want to give up,” she said. So in 2011 Walker opened her own salon, quirkydo in Macclesfield, and now employs several other people.
“There have been times I’m not sure how I’m going to get through the day, but if I give myself a break for half an hour between clients, it’s OK,” she said.
The picture is different on the continent where hairdressers are more likely to be employees. Regina Richter has been a hairdresser in Leipzig for 51 years, but for the last 30 years she has suffered major back problems due to standing up for eight hours a day. “It seems to be affecting my younger colleagues more now,” she said. “After four or five years they are starting to experience pain. I think it is because the pressure has increased – now everyone has to cut hair as quickly as possible to get as many clients as possible.”
She believes that sometimes being able to sit down while cutting hair, and using ergonomic scissors and lighter hair dryers, would have prevented or delayed her condition.
In 2012, the union that represents about one million hairdressers across the EU, Uni Europa, was involved in drawing up an agreement for EU member states to sign up to shared health and safety standards for hairdressers. But since Jean-Claude Juncker became president of the European commission, the agreement has been blocked, under pressure led by Britain and some other parts of the EU, according to Oliver Roethig, regional secretary of Uni Europa.
“When we look at hairdressing, it’s the tip of the iceberg,” he said. “Social legislation by the EU has been completely taken off the agenda by the Juncker commission. He said the EU must not be big on the smaller things. But we don’t think that hairdressers having to give up work is a small thing.”
In the UK, where nearly half of all hairdressers are self-employed, it can be difficult for individual stylists to raise health and safety issues in their salon, and given the role of Britain in obstructing progress at a European level, life after Brexit is unlikely to get any easier.
In 2009, the Health and Safety Executive handed over responsibility for its campaign on dermatitis to the Hairdressing and Beauty Industry Authority (Habia) and the National Hairdressers’ Federation.
However, Habia’s website refers to health and safety only from an employers’ perspective and does not offer guidance to hairdressers.
Hilary Hall, chief executive of the National Hairdressers’ Federation, said it did offer guidance to employers on contracting dermatitis and advised staff to wear vinyl gloves when washing hair.
“The directive pretty well captures what is available in the UK,” she said. “The difference is enforcement. The individual is responsible and they could be subject to inspections. We feel it is better to let people choose.”
THE DANGERS
Dermatitis
A study in 2004 revealed that 70% of hairdressers in Britain had suffered from work-related dermatitis, in the form of red, sore and sometimes itchy skin, mainly to the hands and fingers but also to the arms, face and neck.
Asthma
In France, a paper published in 2003 showed that 20% of women affected by work-related asthma were hairdressers, compared with 1% for the general population.
Arthritis
According to the European Agency for Safety and Health at Work, musculoskeletal disorders are five times more prevalent among hairdressers than in the general population. Research published in the journal Work in 2009 showed that in a study of 145 hairdressers, 41% experienced ‘work-related upper limb disorders’.
Cancer
An analysis of 42 bladder cancer studies in 2010 showed that hairdressers faced a risk 30 to 35% higher than the general public. However, Cancer Research UK says that because cancer can take many years to develop, this may be due to exposure to older chemicals that are no longer used.
On the morning of 4 February, Harish Tikedar, Ganesh Soni, and Mohammed Isafil Ansari waited in a queue to use the community toilet in the Indira Nagar slum in eastern Mumbai. All of a sudden the floor collapsed, plunging Tikedar, Soni and Ansari into the septic tank 15-feet below.
Two others who also fell – Sirajjudin Turat and Ramakant Kanojia – managed to hold on to the sides until they were rescued.
“I was submerged up to my shoulders in the slush,” says Turat. “I could feel it pulling me down but somehow held on to a slab. Then some people pulled me up and I passed out.”
The five men who were pulled out were unrecognisable, covered in faeces. They were all taken to a nearby hospital but Tikedar, Soni and Ansari did not survive.
In Mumbai’s slums, the simple act of relieving oneself is fraught with danger, especially in the slums of M-East ward where population density is high, and the few public amenities are crumbling.
M-East is the poorest and most deficient in civic services of Mumbai’s 24 administrative wards. It has expanded over the last 15 years but has remained on the periphery of the city’s consciousness and governance systems. The differences between the civic amenities available in the smattering of middle-class apartment blocks and the slums, which dominate M-East, are stark.
The majority of slum residents are forced to depend on the thriving informal market for water, operated by a network of local strongmen. Photograph: Rajanish Kakade/AP
Most of the 100 square feet slum houses do not have sanitation and water facilities, either because applications for individual toilets and taps are pending approval or because the slum is on encroached land, which means that the civic body will not provide any services there.
For sanitation, people in Mumbai pay two to three rupees (£0.02-0.04) to use a community toilet, which generate revenues of 3.6bn rupees (£47m) a year, according to a recent report by the Observer Research Foundation. The poorest of the poor pay more than 10m rupees (£120,000) per day for the most basic necessity, yet the facilities are rarely maintained despite complaints.
If it wants, the Brihanmumbai Municipal Corporation can find a way to provide basic rights
Some 78% of community toilets in Mumbai’s slums lack water supply, 58% have no electricity, and many don’t have proper doors or facilities for women to dispose of sanitary napkins. The statistics are worse in M-East.
“The chief minister [of Maharashtra] should order a structural audit of all community and public toilets. All those found deficient must be demolished and reconstructed,” says Dhaval Desai, author of the Observer Research Foundation report. “The long-term solution is to allow slum dwellers to construct individual toilets inside their houses. About 83% of the people we interviewed said they would spend the money, but the BMC [Brihanmumbai Municipal Corporation] denies permission on technical grounds.” Most of the slums appeared after 2005, which makes them illegal.
“That slums post-2005 are not given water is a sham,” says Rais Shaikh an elected representative to the BMC from M-East, and leader of the Samajwadi party. “All of them get water; by what means is an open secret. If it wants, the BMC can find a way to provide basic rights.”
The majority of slum residents are forced to depend on the thriving informal market, operated by a network of local strongmen that supplies water through tankers and via the unfinished pipe system laid by the civic body. The cost depends on demand and supply, from as high as 40 rupees (£0.48) to as low as five rupees (£0.06 ) for a 40-litre can. When the municipal corporation imposes water cuts in the summer, the cost rises considerably.
Where there is a gap in sanitation services, NGOs step in to construct community toilets, or local MLAs (member of legislative assembly) and MPs contribute money from area development funds. A coterie of contractors usually takes up the construction and management of these community toilets. But they have no accountability to either the BMC or residents, and repeated complaints about sinking floors and full septic tanks go unheeded.
After an incident, the MLA or MP comes visiting, often with a cheque. We know life is cheap in Mumbai, but so cheap?
The community toilet that collapsed in the Indira Nagar slum was only 10 years old and was built using the local MLA’s area development fund. The contractor was arrested and booked under the Indian Penal Code on charges including culpable homicide not amounting to murder, but he was eventually set free. He was not available for comment.
The accident is not an isolated one. Across Mumbai, seven people have died and one was left disabled in similar incidents in the last three months.
“There must be guidelines that the BMC enforces for construction, otherwise this kind of death will become routine,” says Razzaq Shaikh, who helped rescue the two survivors. “After an incident, the MLA or MP comes visiting, often with a cheque. But what’s the point? We know life is cheap in Mumbai, but so cheap?”
The benchmark for toilets, adopted as part of India’s Swachh Bharat Abhiyaan [Clean India Mission], is one toilet for 25 women or 30 men. In M-East, however, the average is one toilet per 190 people, according to surveys by the Tata Institute of Social Sciences.
“The availability of toilets and tap water is so abysmal that the Swachh Bharat Abhiyaan is laughable,” says Amita Bhide, dean of the institute’s School of Habitat Studies and head of its M-East ward project. “The state and the BMC has to intervene and be innovative, not sit on applications for individual toilets because there aren’t sewer lines to link to.”
Regular water supply is also a perennial election promise, but despite politician’s campaigning, nothing seems to change in Mumbai’s poorest slums.
“All political parties come here using the water issue as their trump card,” says Syed Lateef. “All of them say that when they come to power, water issues will be resolved. Water pipes have been installed and reinstalled, but we don’t get water. We buy it.”
Additional reporting by Suryasarathi Bhattacharya and Jovita Aranha.
A version of this article first appeared on scroll.in and has been republished with permission. Follow the author @urjourno and @scroll_in on Twitter.
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The current debate about the ever-growing pressure on social care services is by no means the first, and certainly won’t be the last. But it is always predicated around the same central assumption: with increasing numbers of older people, the costs can only go up. This is to miss an important point, one well known to public health experts but strangely ignored by most politicians. The problem isn’t just about an ageing population, it’s also about an increasingly sedentary one.
That far too many Britons are not physically active is well documented, even if the sheer extent can sometimes be surprising. For example, a fifth of Scottish people say they have not walked for more than 20 minutes even once over the past year. Not once. Also well known, if less discussed, is the toll this takes on the public health. The usual estimate is that about 85,000 people die early each year in England and Wales due to illnesses caused by sedentary living, mainly heart disease, type 2 diabetes and various cancers.
But callous as it sounds, what really keep senior civil servants awake at night isn’t the mortality rate; it’s the parallel issue known as morbidity: the quality of life people can expect as they age, and thus how independent they remain. Here, the near-magical effects of keeping up even a fairly minimal regime of exercise are also well documented.
Physical activity keeps people stronger and more supple as they age. It also improves balance, gives better bone density and makes them less likely to be depressed or develop Alzheimer’s. These are all things associated with needing less social care.
Cyclists in Amsterdam: ‘The Netherlands and Denmark have spent decades deliberately re-shaping their road environments away from the car culture of the 1960s and 70s towards mass cycling.’ Photograph: Alamy Stock Photo
The earlier people start such a regime, the better the effect into older age. One public health expert once told me he encourages people this way: “I tell them, ‘being active throughout your life is about being able to get to the loo on time in your old age’. They can get their heads around that.”
If it’s so conclusive, why is the government not pushing this as part of the solution? Here we get into the more tricky area of what is politically acceptable, and whether ministers want to embark on what is, in effect, low-scale social engineering. Decades of experience has shown that just encouraging people to exercise has limited impact. Urging people to go to a gym or walk briskly round their local park eats into what is known to experts as “discretionary time” – when they could be doing something else. Thus they tend to give up pretty soon.
One of the few exercise regimes proved to stick is active travel, more specifically making walking or cycling to work, school or the shops sufficiently safe and convenient that it becomes easier for people to do it than not. Cycling is arguably the mode that should be encouraged the most. Aside from the fact people can cover greater distances on a bike than on foot, studies have shown that the slightly greater exertion it involves brings even more miraculous health benefits.
The mechanics of how you nudge people away from cars and on to bikes is another discussion, but there is little doubt it can be done if the political will is there. The Netherlands and Denmark, for example, have spent decades very deliberately re-shaping their road environments away from the car culture of the 1960s and 70s towards mass cycling. It’s not an accident.
‘In his first interview as transport secretary, Chris Grayling spoke of cyclists only to complain about those who jump red lights and to say bike lanes cause problems for “road users”, a group that apparently doesn’t include people on bikes.’ Photograph: Alamy Stock Photo
Yes, it would take the UK a decade or so to make similar changes. But given the vast and unquestioned public health benefits on offer, with the huge savings this would bring on social care (not to mention the NHS, which some experts predict will soon become bankrupt due to the costs of ailments linked to sedentary lives), it’s a bit depressing that we haven’t even begun the debate.
For all the occasionally hysterical media narrative on cycling, it barely exists as an issue at the top of government. In his first interview as transport secretary last week, Chris Grayling spoke of cyclists only to complain about those who jumped red lights and to suggest that bike lanes caused problems for “road users”, a group that apparently doesn’t include people on bikes.
Grayling’s predecessor in the job, Philip Hammond, now the chancellor, was reported last month to have urged London’s mayor, Sadiq Khan, to rip out one of the few properly designed and safe bike lanes in the entire country. This is not to castigate the pair personally. Barring a handful of exceptions, almost all Britain’s top politicians think much the same about cycling as everyday transport.
The debate on social care shows how blinkered this is. As part of a book I’ve been writing about the beneficial effects of more cycling, I spoke to a number of public health experts about the problem of sedentary living. Several of them used the same analogy: getting people active in their everyday lives is, they said, like “a miracle pill” in the way it wards off disease and decrepitude. That miracle pill is well known. We’re just waiting for someone with the political vision to administer it.
• Bike Nation: How Cycling Can Save the World, by Peter Walker is published in April
With the results of the most recent presidential election, Americans are faced with all sorts of uncertainty in regards to their health. But there are some consumer choices that individuals can make to protect against future illness: cutting down on sugar, for example; exercising daily; and, surprisingly, being careful about how you clean your delicates.
You may not know it, but most dry cleaning isn’t dry at all – and it isn’t clean. Instead of water, professional cleaning processes use a liquid solvent to dissolve stains on garments. This typically involves a chemical known as perc that, while highly effective at getting scuff marks out of clothing, is also a known health and environmental hazard.
Health organizations, including the Environment Protection Agency (EPA) and the International Agency for Research on Cancer (IARC), have classified perc as a toxin, but it’s still widely used across the industry. In 2012, the EPA classified perc as a “likely human carcinogen”, meaning that prolonged exposure to the chemical has been linked to an increased risk of cancer.
Perchloroethylene, also known as tetrachloroethylene, PCE or perc for short, is a chlorinated hydrocarbon used primarily by the dry cleaning industry, but it’s also used as a metal degreaser in industrial cleaning.
In the EPA’s 2012 press release on the subject, the agency warned: “Studies of dry cleaning workers exposed to tetrachloroethylene have shown associations between exposure and several types of cancer, specifically bladder cancer, non-Hodgkin lymphoma and multiple myeloma.”
In the same year the IARC, found perc to be “probably carcinogenic to humans” based on evidence from epidemiological data and animal studies.
According to the most recent data, the EPA estimates that 28,000 dry cleaners in the US use perc. In 2006, the agency significantly tightened its requirements for the use of air toxins in dry cleaning. A spokesperson for the agency said: “The rule includes a phase-out of perc use at dry cleaners located in residential buildings, along with requirements that will reduce perc emissions at other dry cleaners.”
The requirement includes the complete phase-out of perc machines in dry cleaners located in residential buildings by 2020. New York, Illinois and New Jersey are among some of the states to have passed recent legislation clamping down on the use of perc. But a decade after the EPA ruling, the only state to pass legislation outright banning perc has been California.
The main health risk with perc is not through wearing clothes that have been cleaned with it, but rather, exposure through air or soil. The effects of short term exposure (breathing in high amounts over a short span of time) include dizziness, headaches and loss of consciousness, according to the EPA.
It is long term exposure that can increase the risk of cancer, putting dry cleaning workers and people who live in close proximity to shops at the highest risk.
A 2009 study in the Journal of Environmental and Public Health found that living near a dry cleaner that uses perc increases the risk of developing kidney cancer. Proximity to a dry cleaner does not mean that exposure to perc is a given. Not all dry cleaners use perc, and many that do send the clothing off-site to an industrial complex away from residential buildings.
Additionally, with correct ventilation and maintenance, the amount that leaks into the air can be minimized.
The National Association for Cleaners (NCA), a trade group that looks after the business interests of dry cleaners, does not view perc as dangerous. In an interview with the Wall Street Journal, director of technical services Alan Spielvogel said the latest perc machines are much safer, and that alternatives to perc don’t clean as well. The NCA did not return the Guardian’s request for comment.
As a chlorinated hydrocarbon, perc breaks down very slowly in the air so it can travel long distances, meaning that in urban areas there are trace amounts of it in the air even if there is no dry cleaner nearby. According to air samples of urban areas in different parts of the US, the typical background level of perc is roughly a couple of micrograms per cubic meter.
The New York Health Department recommendations for a safe level of perc in the air is no more than 30 micrograms per cubic meter. The guidelines, however, state that “reasonable and practical actions should be taken to reduce perc exposure whenever air levels are above background”.
The agency has a particular concern that indoor levels of perc in the air are kept as close to background levels as possible.
Measuring the levels of perc in the air, however, isn’t all that straightforward. In New York, the authorities do not regularly monitor dry cleaning emissions and generally, environmental agencies in other parts of the country only do so when there has been a complaint or reason to suspect a contamination.
Earlier this year, a Crains investigation into the use of perc in the city found that since 2011 the health department received 250 complaints from dry cleaners and residential laundry rooms about their emissions.
Consumers are becoming increasingly aware of the health hazards of perc, as well as its environment impact, and are questioning why it’s taking so long for the chemical to be phased.
Dr Ivan Rusyn, a committee member for the National Academies of Sciences, Engineering and Medicine, who reviewed the EPA’s risk assessment of perc, said that in the grand scheme of how federal agencies work, it’s not been that bad. “It’s a very long process to create these human health assessments,” Rusyn said.
The California air board spokesperson said the biggest challenge in phasing out perc has been a resistance on the part of dry cleaners who think it’s the most effective way to clean clothes.
Tim Maxwell, the president of GreenEarth, a widely used silicone-based alternative to perc, echoed that challenge. He also said that the unstructured nature of the dry cleaning business, which has been in decline for the last ten years, makes implementing drastic changes difficult.
“Most dry cleaners are mainly small mom-and-pop businesses,” he said. “The hardship of replacing that perc machine is anywhere from $ 40,000 to $ 100,000 and that’s very economically challenging.”
GreenEarth is among many of the alternatives to perc, which also include water-based cleaning technologies known as wet cleaning, carbon dioxide technology and a host of other chemical cleaning systems. While the alternatives are thought to be preferable both from a health and environmental standpoint, research into these other systems is still in its nascent stages.
Other options for consumers looking to avoid the potential risks associated with dry cleaning is to launder clothes at home or in a regular laundromat. Despite clothing labels saying otherwise, consumers often find that clothes marked as “dry-clean-only” will come out of a regular wash unscathed (for the most part).
It had been three years since I’d met up with my first boyfriend – let’s call him Steven. When he walked into a Brixton pub in June, it was a shock. I’d first met him well over a decade ago, and back then he was sporty, a bit of a health freak: other than the usual occasional student alcohol binge, relatively strait-laced. This Steven had dilated pupils, red marks on his arms, and his head jerked erratically as he spoke manically. He was addicted to crystal meth, and had an abusive relationship with other drugs and alcohol.
Steven’s story is all too revealing about a silent health crisis afflicting gay men. The words “health crisis” in conjunction with “gay men” normally conjures up the HIV catastrophe that decimated the gay and bisexual community in the 1980s. In the developed world, HIV is no longer the death sentence it once was, although the treatment can cause health complications, and in the UK an estimated 6,500 men who have sex with men live with undiagnosed infections. A far greater menace is mental distress – impossible to disentangle from a society riddled with homophobia – and the drug and alcohol abuse that can follow.
Steven has been clean for 66 days, has enthusiastically taken to treatment and volunteers at his local support group. But why – like so many gay men – did he succumb to addiction? When Steven came out, at the age of 15 years old, his parents drove him to a pseudo-clinic run by fundamentalist Christians to be cured of his homosexuality. But he doesn’t speak with bitterness. “I know they love me and they were doing the best they could,” he says. “They didn’t know what I needed, so they looked to their own experience, a culture that taught that if you were gay it was a disaster. You’d be lonely, you’d get Aids, you’d find life difficult. They felt they were trying to support me.”
The problem was far broader than his family, though. Coming out as a teenager in the early 00s meant almost inevitable bullying at school, a lack of awareness of where to find positive role models, and homophobic voices amplified by the media. “Taken together, it meant I was isolated and thought that I was the problem.” Internalising that shame at such a young age inflicts long-term damage – and explains much of his current turmoil.
It’s an issue covered by the former Attitude editor Matthew Todd in his utterly brilliant – and disturbing – recent book Straight Jacket. He identifies a number of problems that most gay men, if they were honest, would at least recognise: “Disproportionately high levels of depression, self-harm and suicide; not uncommon problems with emotional intimacy … and now a small but significant subculture of men who are using, some injecting, seriously dangerous drugs, which despite accusations of hysteria from the gatekeepers of the gay PR machine, are killing too many people.” He lists a disturbing number of gay friends, acquaintances and people in the public eye who struggled with addictions and took their own lives.
The statistics are indeed alarming. According to Stonewall research in 2014, 52% of young LGBT people report they have, at some point, self-harmed; a staggering 44% have considered suicide; and 42% have sought medical help for mental distress. Alcohol and drug abuse are often damaging forms of self-medication to deal with this underlying distress. A recent study by the LGBT Foundation found that drug use among LGB people is seven times higher than the general population, binge drinking is twice as common among gay and bisexual men, and substance dependency is significantly higher.
Why? As Todd puts it: “It is a shame with which we were saddled as children, to which we continue to be culturally subjected.” The problem gay people have isn’t their sexuality, but rather society’s attitude to it. It is “our experience of growing up in a society that still does not fully accept that people can be anything other than heterosexual and cisgendered [born into the physical gender you feel you are]”. There’s the weight of centuries of hatred and bigotry, with legally enforced discrimination only dismantled in very recent times. All gay and bisexual men – as well as women and trans people – grow up hearing homophobic and transphobic abuse. “Gay” is a word used in the playground as the repository for all that is bad. Popular films and TV programmes have largely lacked sympathetic, well-rounded LGBT characters, often resorting to crude homophobic tropes. Even the inability to hold hands with someone you love in almost any public space is a reminder that a depressingly large chunk of the population still rejects you. Coming out – a process that isn’t a one-off, but a wearingly repetitive event in different contexts – involves constant stress. And for those who think it’s all inevitably getting better, since the EU referendum, there’s been a 147% rise in homophobic hate crimes.
Society has damaged – and continues to damage – LGBT people. That’s not to overstate the case (and focusing on my experience as a gay man): being gay does not mean being in a state of misery. As Todd puts it, there are lots of contented, successful gay people, and progress in recent times has been astonishing, including equal marriage. Coming out is like coming up for air for the vast majority of LGBT people: the alternative is so much more miserable. But this is a health crisis that is not spoken about enough: the toxic combination of mental distress, drugs and alcohol abuse.
It is a crisis that is not being dealt with. Despite the government’s promises to grant mental and physical health parity of esteem, last year Mind reported an 8% real terms drop in mental health services funding since 2010. Cuts, according to health thinktank the King’s Fund, have contributed to “widespread evidence of poor-quality care”. Many LGBT services in particular have been devastated: as the TUC pointed out in 2014, they were “already coping on a shoestring. Some have faced drops in up to 50%.”
Because of our internalised shame, LGBT people often find it difficult to talk about the problems we collectively face. The danger is always of reinforcing the damaging stereotypes that have already caused so much distress. But we have to confront a crisis that is damaging health and taking people’s lives. Society has to take responsibility, too: it is its continued refusal to treat LGBT people as equals that is causing so much pain. If Theresa May’s government really does want to prove it isn’t just a pound-shop Ukip tribute band, perhaps it should take this issue seriously and review David Cameron’s cuts. The lives of LGBT people depend on it.
• In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here
A US Food and Drug Administration ruling this month bans the use of triclosan, triclocarban and 17 other antiseptics from household soaps because they have not been shown to be safe or even have any benefit.
About 40% of soaps use at least one of these chemicals, and the chemicals are also found in toothpaste, baby pacifiers, laundry detergents and clothing. It is in some lip glosses, deodorants and pet shampoos.
The current FDA action bans antiseptics like triclosan in household soaps only. It does not apply to other products like antiseptic gels designed to be used without water, antibacterial toothpaste or the many fabrics and household utensils in which antibacterials are embedded. Data suggest that the toothpastes are very effective for people suffering from gum disease, although it is not clear if they provide substantial benefits for those who don’t have gingivitis.
The FDA is currently evaluating the use of antibacterials in gels and will rule on how those products should be handled once the data are in.
Although antibacterials are still in products all around us, the current ban is a significant step forward in limiting their use.
As microbiologists who study a range of chemicals and microbes, we will explain why we don’t we need to kill all the bacteria. We also will explain how antibiotic soaps may even be bad by contributing to antibiotic-resistant strains of bacteria that can be dangerous.
Bacteria are everywhere in the environment and almost everywhere in our bodies, and that is mostly good.
We rely on bacteria in our guts to provide nutrients and to signal to our brains, and some bacteria on our skin help protect us from harmful pathogens.
Some bacteria present in soil and animal waste can cause infections if they are ingested, however, and washing is important to prevent bacteria from spreading to places where they can cause harm.
Washing properly with soap and water removes these potential pathogens.
If soap and water are sufficient, why were antibacterials like triclosan and triclocarban added in the first place?
Triclosan was introduced in 1972. These chemicals were originally used for cleaning solutions, such as before and during surgeries, where removing bacteria is critical and exposure for most people is short. Triclosan and triclocarban may be beneficial in these settings, and the FDA ruling does not affect healthcare or first aid uses of the chemicals.
In the 1990s, manufacturers started to incorporate triclosan and triclocarban in products for the average consumer, and many people were attracted by claims that these products killed more bacteria.
Now antibacterial chemicals can be found in many household products, from baby toys to fabrics to soaps. Laboratory tests show the addition of these chemicals can reduce the number of bacteria in some situations. However, studies in a range of environments, including urban areas in the United States and squatter settlements in Pakistan, have shown that the inclusion of antibacterials in soap does not reduce the spread of infectious disease. Because the goal of washing is human health, these data indicate that antibacterials in consumer soaps do not provide any benefit.
What’s the downside to having antibacterials in soap? It is potentially huge, both for those using it and for society as a whole. One concern is whether the antibacterials can directly harm humans.
Triclosan had become so prevalent in household products that in 2003 a nationwide survey of healthy individuals found it in the urine of 75% of the 2,517 people tested. Triclosan has also been found in human plasma and breast milk.
Most studies have not shown any direct toxicity from triclosan, but some animal studies indicate that triclosan can disrupt hormone systems. We do not know yet whether triclosan affects hormones in humans.
Another serious concern is the effect of triclosan on antibiotic resistance in bacteria. Bacteria evolve resistance to nearly every threat they face, and triclosan is no exception.
Triclosan isn’t used to treat disease, so why does it matter if some bacteria become resistant? Some of the common mechanisms that bacteria use to evade triclosan also let them evade antibiotics that are needed to treat disease. When triclosan is present in the environment, bacteria that have these resistance mechanisms grow better than bacteria that are still susceptible, so the number of resistant bacteria increases.
Not only are bacteria adaptable, they are also promiscuous. Genes that let them survive antibiotic treatment are often found on pieces of DNA that can be passed from one bacterium to another, spreading resistance.
These mobile pieces of DNA frequently have several different resistance genes, making the bacteria that contain them resistant to many different drugs. Bacteria that are resistant to triclosan are more likely to also be resistant to unrelated antibiotics, suggesting that the prevalence of triclosan can spread multi-drug resistance. As resistance spreads, we will not be able to kill as many pathogens with existing drugs.
Antibiotics were introduced in the 1940s and revolutionized the way we lead our lives. Common infections and minor scrapes that could be fatal became easily treatable. Surgeries that were once unthinkable due to the risk of infection are now routine.
However, bacteria are becoming stronger due to decades of antibiotic use and misuse. New drugs will help, but if we do not protect the antibiotics we have now more people will die from infections that used to be easily treated. Removing triclosan from consumer products will help protect antibiotics and limit the threat of toxicity from extended exposure, without any adverse effect on human health.
The FDA ruling is a welcome first step to cleansing the environment of chemicals that provide little health value to most people but pose significant risk to individuals and to public health. To a large extent, this ruling is a victory of science over advertising.
This article originally appeared on The Conversation
Magda, a 29-year-old software developer, regularly fends off questions about when she will have her first child. Coming from a close-knit family and having been with her boyfriend for a decade, the topic is brought up regularly. But Magda grimaces in response, only to be told: “Don’t leave it too late.”
For Magda, the question of when she wants to have a child is complex. There is a serious history of depression and psychosis in her family on both sides. In fact, her mother was sectioned for a long time after giving birth to her.
“I’m not just concerned about passing on mental health problems to any child I might have, I also have serious concerns about the risk to my own wellbeing from having a baby,” she says.
She also worries about the kind of treatment she might receive if she were to have problems. “I’m acutely aware of how awful the mental health support can be in the NHS. I have witnessed failing after failing in the care of my mother. If I speak to a GP about my concerns, will they care and offer advice? If I did decide to have a baby, would they make sure I’m looked after through pregnancy and beyond?”
This is just one of the individual stories sent to the Guardian as part of a project inviting people to discuss the often taboo topic of mental health and pregnancy.
Between 10 and 20% of women in the UK develop a mental illness during pregnancy or within the first year after having a baby. This costs the NHS around £8bn for each annual birth cohort. Conditions range from postnatal depression to obsessive compulsive disorder and psychosis.
It’s not just women either: one in eight first-time fathers suffer from depression while their partner is pregnant, according to a survey by scientists at McGill University in Canada.
Despite this, new NHS England figures show less than 15% of areas currently provide recommended services for mothers with mental health issues, and more than 40% provide no service at all. In almost half of the UK, pregnant women and new mothers do not have access to specialist perinatal mental health services – with even less specific support in place for men.
It’s an issue the government has pledged to address, with £365m allocated for specialist perinatal mental health services over the next five years, the the first tranche of which has just been made available.
So, why is help desperately needed and what sort of experiences do people have? Here are our readers’ stories.
The decision to have a child
For some, like Magda, the challenge begins before pregnancy – many women and men experiencing mental health problems worry about their children developing similar conditions. They also worry about how their condition could affect their ability to be a parent.
A lot of times my days are coping minute to minute. I don’t know if that puts me in a good position to raise a child
Daniel Stusiak, 37, from Aberdeen, South Dakota,has type-two bipolar disorder. In the audio recording above, he explains how his mental health problems influenced his decision not to have children.
When it comes to having children I have two thoughts. One, genetically I don’t like the idea of gambling and seeing whether I pass it on… Second, should that child not have to deal with that, they will have to deal with me as their father and a lot of times my days are coping minute to minute. I don’t know if that puts me in a good position to raise a child in the best way.
The medication question
A lot of women also have to weigh up whether or not they are prepared to come off their medication to have a child. While some drugs are considered relatively safe the evidence is not conclusive, and some have been linked to health problems in babies.
But those who come off any medication are at risk of getting ill again: for example, seven out of every 10 women who stop antidepressants in early pregnancy become unwell again.
Harriet, 32, Stoke-on-Trent
Giving birth was much more painful and difficult than I ever imagined it would be
I have been told that I may need medication for life to treat my anxiety and depression. When I decided to have a baby, my main fear was that the drugs would be dangerous and I’d have to come off them. I was scared of falling ill, which had happened when I came off medication before – when I was at my worst I had extreme panic attacks about 10 times a day.
My dad, who is a doctor, assured me that citalopram is generally considered OK during pregnancy. But babies born to depressed mothers can have worse growth and general health.
I talked to my husband and I decided it was safer for me to stay on the drugs. However, I still found the pregnancy very stressful. I worried constantly about miscarrying. I was offered a reassurance scan but it made me more stressed because they noticed a slight abnormality in the baby’s brain. It turned out to be nothing, but I completely broke down. I could not function for weeks and struggled with the rest of the pregnancy.
Since the birth my mental health has improved. I love being a mum and my daughter makes me very happy. Giving birth was much more painful and difficult than I ever imagined it would be. Afterwards, you wake up to a life and a body that you don’t recognise. It’s not great for your self-esteem. I put on a huge amount of weight but the pain was definitely worth it.”
Mandy, 36, north-west England
I have borderline personality disorder and a social anxiety disorder. I stopped taking my medication (Escitalopram) when I was pregnant because I was worried about the health of my baby. Some doctors thought it was better I stay on the drug, while others disagreed, and because of this varying advice I stopped. However, coming off it caused me a lot of problems. I started self-harming, for example, and worried about everything. I ended up hiding in my house, which meant I couldn’t go back to work. With borderline personality disorder I can go very quickly from being level-headed to mentally unstable. Being pregnant made it harder to cope with this. I didn’t feel like my body was my own. I couldn’t harm myself physically to rid my mind of distressing thoughts.
I was referred to a mental health assessment team and put back on medication on a low dosage. I had one visit with the assessment team but found the nurse dismissive and unhelpful. They didn’t realise I’d had past mental health problems and were treating me as if I had just turned up with thoughts of harming myself. Once I explained to them that I presented before pregnancy I hoped they’d adjust their attitude towards me, perhaps offer more contact, but they didn’t.
I coped throughout the pregnancy mainly thanks to my husband and my GP, who I could talk more openly with, but I wish there had been more support from the assessment team.
Hannah from Yorkshire experienced anxiety before pregnancy, but chose to come off medication to treat this in order to have a child. Listen to her story below.
Antenatal
Postnatal depression is often reported on, but less attention is given to mental health issues during pregnancy. While it’s normal for women to experience “baby blues” as a result of hormonal changes, for a large number this is much more extreme. In fact, it is estimated that 7% to 20% percent of pregnant women are affected by what is known as antenatal depression, which if untreated can lead to postnatal depression after the birth.
Women and men can also experience a great deal of anxiety during pregnancy – it is thought that more than one in 10 women struggle with symptoms of anxiety while carrying a child.
I started to have horrible thoughts about my baby – thinking I had made a terrible mistake and wanted to get rid of it
Ariana, 25, London
I have never experienced mental health issues other than while I was pregnant. When I was around eight weeks, I started to feel upset. The baby hadn’t been planned, but I was ecstatic at first. However, depression soon took over. As the weeks went on it got worse – I hated people talking about the pregnancy and wanted to pretend it wasn’t happening. I started to have horrible thoughts about my baby – thinking I had made a terrible mistake and wanted to get rid of it. Bizarrely, I also decided that when the baby was born, I would swap it with another child in the hospital, and at least then they wouldn’t be my responsibility any more.
Fortunately by the time I was heavily pregnant, I didn’t feel negatively any more. I only felt sad that this thinking had ruined my early pregnancy for me. I now have a huge amount of sympathy for anyone who experiences depression.
After having my son, I stayed up all night on the maternity ward just watching him. I remember thinking he was the best thing that had ever happened to me, and I still do now. He is three years old.
Postnatal depression is widely recognised, but there is less said about depression during pregnancy. I might have sought help if people talked about it more.
Leila experienced anxiety and depression during her pregnancy, having never had mental health problems before. You can hear about her experience in this recording.
I finally admitted to myself that I was seriously ill after weeks of considering throwing myself under the train
I finally admitted to myself that I was seriously ill after weeks of considering throwing myself under the train on my way to work, followed by weeks of not being able to get out of bed. I lacked the motivation to do anything: get dressed, wash my hair, let alone make any preparation for a new baby. There is a hormonal trigger to perinatal depression and the more the pregnancy progresses the greater the influence of hormones.
Miscarriages
There are no official government statistics held on women who miscarry (they are only collated for women admitted to hospital), but the pregnancy charity Tommy’s says around one in every four women with a BMI of over 30 will miscarry a child.
The effects of this last longer than you might imagine: a study in 2011 found that the depression and anxiety experienced by many women after a miscarriage can continue for years, even after the birth of a healthy child. Men are also affected, although perhaps differently. One British study of 323 men found that although they displayed less “active grief” than their female partners, they were more vulnerable to feelings of despair and difficulty in coping eight weeks following the loss.
Matt Allen, 38, from Brighton, shares his story of how miscarriage affected his mental health below.
Looking back on it it would have been better for me to have someone to talk to [after the miscarriage] and maybe drop the stigma that men have to be strong and carry everyone around them, because something like losing a child does affect us just as much emotionally.
Kaye, Manchester
I’m pregnant for the second time. My husband and I lost our first child when I had a miscarriage in my first trimester. It’s not something you get over. People around you think that it’s all about getting pregnant, but the waiting for the arrival of a healthy baby now is worse than any treatment. I suffer from crippling anxiety – crying at random times, waking up from nightmares. I can’t talk about being pregnant and am still trying to hide it at almost 20 weeks.
I wish that I could be offered some counselling. My partner and I received no support whatsoever from the NHS after the D&C [a surgical procedure often performed after a first-trimester miscarriage]. Only now, from reading the Miscarriage Association’s literature am I beginning to understand that the anxiety we are going through is common.
A viability scan should also be offered on the NHS at seven to eight weeks as a standard. This can really help to reassure new parents. I do think the NHS should have different support in place for people where this is a Pal (pregnancy after loss), and that includes silent miscarriages. Friends from abroad are often shocked at how few scans we get in the UK and that the chance to hear the baby’s heartbeat at midwife appointments isn’t standardised across the country.
Postnatal
Postnatal depression is an illness that affects between 10 to 15 in every 100 women having a baby. It can start within one or two months of giving birth. It’s also something that hits men too: studies predict about one dad in 10 has postnatal depression. Traditionally, the mother’s mental health gets more attention, but recognition of the dad’s mental health is increasing.
Alice, Midlands
I had my daughter a few years ago and read all the information I could get my hands on. After a difficult birth I eventually delivered my baby. I was exhausted (it took 48 hours in total) and shell-shocked. We stayed in hospital for a few days while trying to get my daughter to breastfeed. I was struggling so much with this that I refused to have any visitors as I didn’t want anyone to think I couldn’t cope. In the end I gave up so that we could all just go home. Luckily bottle feeding didn’t affect bonding with my baby.
However, my partner didn’t cope well at all. From seeing me in so much pain and out of control, he tried to take on far too much so that I could recover. His mental health spiralled as a result to the point where he couldn’t look at our baby. He couldn’t handle her crying and one day I found him crouched in a corner rocking. I got him to see a counsellor and the doctor advised that he would recover better if he moved out for a while. He went to live with his parents and we would visit, but he couldn’t cope with the guilt of leaving us.
Eventually we got through it and he was able to move back home with us. Unfortunately we didn’t make it as a couple; the strain was too much. Looking back I wish we’d have had more support in trying to deal with his depression but even though this was a few years ago, there was very little awareness about male postnatal depression and a lot of shame attached to it. I wish I could have helped more.
Emma, Manchester
I’d already had a baby and enjoyed being a mum, so when I fell pregnant again I never expected to experience postnatal depression.It was four months before I plucked up the courage to go and see the doctor. I kept telling myself to keep going, and that I could be a perfect mum like the ones you see plastered all over social media. Now I realise that it’s not real. To me, during the dark days that perfect picture wasn’t my life but boy did I try to achieve it. I was really struggling and I told no one. Admitting weakness was like putting my hand up and saying: “Look at me, the bad mum over here.”
The day I told my sister and my mum I was at my wits’ end. I cried the whole time. I paced the length of my house for half an hour before I finally made the call to my family. After that I went to the doctor. I thought he was going to laugh and tell me to just get on with it like every other mum, but he didn’t. He told me that this would be the last time I would feel this way and that every day, from today, I would start to feel better. Most importantly he made me realise for the first time in four months that I wasn’t a failing mother-of-two. I’d managed to keep my head above water through one of the most challenging times of my life.
We discussed options and I agreed that I would take tablets for depression and anxiety – it was time to give my body a little helping hand. He made me see some things are out of my control and postnatal depression can happen to anyone.
Psychosis
One of the most severe forms of illness seen in psychiatry are postpartum psychoses. In rare but tragic cases it can lead to women taking their own lives.It’s thought that postpartum psychosis affects women in every 1-2 of 1,000 births. It’s more likely to affect women who have had it before (or have a relative who has) or have a serious mental health condition, such as bipolar disorder or schizophrenia.
Lisa Abramson, who suffered from postpartum depression after the birth of her daughter
Lisa Abramson, from San Francisco, experienced severe mental health difficulties after giving birth to her first child. She talks about postnatal psychosis in the audio recording below.
Leila, interviewed above, also experienced psychosis after pregnancy – as well as antenatal depression and anxiety. She talks about this below.
I completely lost touch with reality and was convinced my phone was communicating with me in code
I started to get hyper-manic and the effect that had, in terms of behaviour, meant that I would be wide awake all night. My mind would be racing and I was really driven to do things, for example I would reorganise the kitchen cupboard at 3am to 4am in the morning. I also wrote lists compulsively and used hand gestures, which I don’t normally do … then after that I became psychotic. I completely lost touch with reality and was convinced my phone was communicating with me in code. I thought it might be my father who had died three years previously. I thought I would just will with my mind ordering a pizza and it would be delivered to the door.
Post-traumatic stress disorder
Research is limited but estimates of post-traumatic stress disorder (PTSD) after delivery tend to be around 1-2% in high-income countries. One study in Sweden put the rate of postnatal PTSD at 2% in the first year after birth. While some women experience it after a particularly traumatic birth (with medical difficulties), others have PTSD from the birth process itself.
A spokesperson for the Birth Trauma Association said: “The help on offer for women is very patchy and generally poor. Individual health visitors and midwives may help but waiting lists are long – up to a year – and almost no one gets on a list for cognitive behaviour therapy or other treatment unless they have been symptomatic for at least 12 weeks.”
Bill, Staffordshire
My wife and I experienced the stillbirth of our first child, Andrew. It was very sudden, my wife noticed a lack of movement and we went to hospital. We saw a classic scan, but this time with no heartbeat. I carry the image with me to this day. The following days and weeks were traumatic. We were told that the chances of a future successful pregnancy were higher if my wife delivered Andrew naturally, so labour was induced gently. We then went to a dedicated maternity suite (where we were handled with exceptional care and attention by all staff). The delivery was normal, except that Andrew was not alive.
Following the stillbirth, I experienced post-traumatic stress disorder for which I have since received cognitive behavioural therapy. I had flash-backs of the traumatic delivery and the events immediately before and after, including my son’s funeral. I also suffered from an intense anxiety as we went through four more pregnancies – two ended in miscarriage and two ended inthe births of two wonderful boys. We constantly wondered about miscarriage, stillbirth and the chances of a good outcome. The mental health problems affected my work – I was constantly on high alert.
On the whole the NHS was marvellous. Their care when we lost Andrew was excellent in the circumstances. My wife got support during the pregnancies and for the way in which the stillbirth affected her. However, there was less attention on the father. I was not prepared mentally for the immense impact that this would have on me.
On the whole the NHS was marvellous. Their care when we lost Andrew was excellent in the circumstances
Emma, Midlands
I had a traumatic first birth and my baby was in neonatal care, which left me struggling with what I know now to be PTSD and perinatal anxiety. I didn’t understand what was happening, so tried to carry on as normal. I became pregnant again 14 months later by accident and really suffered. I believed I would die, writing letters to all my family and counting down the days until I would leave this world. I had awful anxiety, flashbacks and was terrified all the time. I didn’t trust healthcare professionals, hated going to the hospital for appointments and didn’t know who I could approach for help. I became a shell, empty and full of fear.
I wish that my traumatic birth had been acknowledged and that I had been asked how I was coping in my next pregnancy. I wish that there had been counselling, more information around having a difficult birth. I wish I’d just been asked how I was, not physically but mentally. I wish there had been continuity of care so that I had someone I trusted care for me. It took me 15 years to get a correct diagnosis after the second birth and even then there was no specialist treatment support available.
Obsessive compulsive disorder
It’s thought to affect 2-4% of all new mothers, but – until recently – has received relatively little research attention. Some women develop obsessive compulsive disorder (OCD) for the first time either during pregnancy or shortly afterwards, while others find it makes a pre-exisitng condition worse. This is partly down to the fact that pregnancy is a time of increased stress, with most women becoming concerned about protecting their baby. It is a time of major physical change, which can cause difficulties.
It’s not just down to hormones, however, and some fathers also experience postnatal OCD because of their feeling of responsibility to protect their new baby.
May, Birmingham
I was diagnosed with OCD following the birth of my first child. I was experiencing intrusive thoughts about my son coming to harm (and that I might actually be the one to harm him). I have suffered from recurrent depressive episodes throughout my life.This and the severe anxiety I was experiencing led me to spend a lot of my maternity leave sitting at home, waiting for something terrible to happen.
My midwife noticed during my pregnancy that I was feeling anxious and referred me to a mental health clinic at the local women’s hospital. I continued to attend there after my pregnancy and, as things spiralled out of control, I was prescribed antidepressants and given a place in a group therapy session. I was admitted to hospital – in a dedicated mother and baby unit – for two months as things failed to improve.
The care I received was wonderful – I cannot fault it at all. I had never imagined that I might be suffering from OCD, and once I had my diagnosis and began cognitive behavioural therapy, the depressive episodes in the past began to make sense. I was treated with utter respect and kindness both as an outpatient and an inpatient, and have since been able to return to work. I feel very lucky that I had access to this service, and that it was so close to home. I know that this isn’t the case for most women.
•Some names have been changed.
• In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here
