The Observer view on curbing air pollution | Observer editorial

Pollution has long blighted the air that we breathe. Complaints about fumes generated by coal-burning in London were recorded as early at the 13th century. The heavy smogs that descended on the capital in the 1950s killed thousands. Governments have long attempted to regulate the pollution of our cities: in 1273, authorities introduced a prohibition on burning coal in London due to it being “prejudicial to health”.

In recent years, air pollution has become less visible, but no less deadly. The noxious oxides and particulates that are linked to higher incidence of cardiovascular and respiratory diseases and cancer may not create the pea soup of industrial times, but they are estimated to be responsible for 40,000 premature deaths a year, a public health crisis on the scale of smoking or obesity.

London breached legal annual pollution limits in just the first five days of 2017. But this is not just a problem affecting the capital: almost nine out of 10 urban areas have had levels of nitrogen dioxide above legal limits since 2010.

While no one is immune, pollution particularly affects children, whose lungs are still developing. Key culprits are diesel vehicles, followed by gas combustion from boilers and cookers.

Air pollution shares none of the intractable characteristics of problems such as climate change and microbial resistance. Unlike the latter, air pollution, on the whole, respects international borders and does not require the international treaties and agreements that can take years to hammer out.

Local action to tackle air pollution can immeasurably improve air quality: the thinktank Policy Exchange has estimated that properly investing in reducing air pollution in London would increase life expectancy for its residents by an astounding six months.

As the problem has become less detectable to the naked eye, so, it seems, has been the willingness of successive governments to do anything about it. In fact, government policy over the last 15 years has, on balance, made air pollution worse, not better. The car tax regime was rebalanced to favour diesel over petrol, because diesel vehicles used to emit lower levels of greenhouse gases and policymakers believed manufacturers would deliver cleaner diesel cars. The market share of diesel cars rocketed as consumers responded to incentives: nearly half of the new cars sold in the UK now have diesel engines.

But thanks to lax standards in European emission standard testing, the vast majority of diesel cars continue to belch out poisonous fumes far in excess of the legal limit. There is now evidence that diesel cars may even emit more carbon than petrol engines. With hindsight, incentivising consumers to buy diesel cars must surely count among one of the most counterproductive environmental policies.

Cleaning up our air is eminently achievable with the right package of measures. We need a mix of clean air zones that include charging owners of diesel vehicles to drive into densely populated urban areas, a scrappage scheme for diesel cars, a tax system that discourages owners from buying diesel and much tougher European testing.

Despite the dreadful death toll, the government has dragged its feet for seven years. It ignored the legally binding European targets on air pollution that the UK was obliged to meet by 2010 and only produced a plan when it was forced to do so after a lengthy court battle instigated by the environmental campaign group Client Earth. The plan it produced under duress was so thin that the supreme court ruled it had to produce a better one by the end of last month.

Still, the government tried to delay further, arguing that it was prevented from publishing a plan under the purdah convention that the government makes no new policy announcements before a general election. The high court ruled against the government last month. The document it finally published last Friday was rightly condemned as utterly inadequate to the task, lacking any specific proposals for tax changes or a diesel scrappage scheme. It kicks the issue into the long grass at the expense of people’s health.

The government is clearly concerned about proposing any measures that would hit diesel drivers a few weeks before the general election. Yet Thursday’s local election results show it has nothing to fear: barring an electoral earthquake, it is on course for a decisive victory. Votes before lives: that’s Theresa May’s telling choice.

The Observer view on curbing air pollution | Observer editorial

The Observer view on social care

There is now an unprecedented consensus that the care system for older people and disabled adults in England is on the brink. It has gone far beyond the party political. Those who have spoken out include the health select committee, NHS leaders, local government leaders from all parties, independent health thinktanks and the regulator.

This diverse chorus of voices reflects the terrible human and financial cost of inadequate funding for care, revealed by Sonia Sodha today . The visible side of the crisis manifests itself in our hospitals. A lack of care funding means older people can’t be discharged when they are well enough to leave hospital, contributing to a dire shortage of hospital beds. It means older relatives end up in hospital with broken hips because they couldn’t get the help they need to wash and dress themselves.

The less visible side of the crisis is no less tragic. It is wreaking misery behind closed doors across the country. How must it feel to be an older person who struggles to eat and go to the toilet, living in virtual isolation with no support? Or to be struggling to combine working with taking responsibility for ensuring your elderly mother with dementia doesn’t hurt herself?

It also has a dreadful impact on those paid to provide state-funded care. How terrible must it be to work as a care assistant who has to choose between feeding or bathing someone who desperately needs help with both, on a 15-minute care visit?

How do you cope with the emotional stress of being asked to provide care, but never enough to support a decent quality of life, to whizz in and out to take care of someone’s physical needs with so little time it’s hard to show them some love?

How can anyone provide decent, human residential care on rates equivalent to £2 an hour, the rate some local authorities pay?

Enough is enough. The government’s continuing failure to heed the warnings are not just irresponsible but inhumane. It must take two steps.

First, and most urgent, when communities and local government secretary Sajid Javid sets out the local government finance settlement next week, he must make more funds available to councils to support people with their care. In particular, he must channel more money to the poorest areas of the country, which have the greatest levels of need.

Second, the government must once and for all come up with a long-term solution for funding care. Many of us will end up needing to use professional care services in later life. But who wants to imagine, plan and save for a future with dementia while they are in their 30s and 40s? This basic aspect of human psychology means the right way to fund our care services is the same way we fund our NHS.

The founding principle of the NHS was that healthcare should be available to all on the basis of need, free at the point of delivery. Seventy years later, that principle is as cherished as ever.

As long ago as 1999, the royal commission on long term care recommended this principle should be extended to personal and nursing care: free at the point of delivery, available to all on the basis of need. These recommendations were implemented by the Scottish government. Across the rest of the country, they were not, leaving the anomaly that someone suffering from cancer will have their care needs met by the NHS, whereas an older person suffering from dementia has to fund their own care unless they qualify for means-tested support.

The problem is not a want of a solution. It is a lack of political willpower. Yes, it will be expensive, but there are a myriad ways to pay in a country as rich as ours: through increasing income tax rates, through compulsory insurance payments for those aged over 40, as for instance in Japan, or through reversing this government’s cuts to inheritance tax.

The current path we are treading only ends in one place: a two-tier system where those who can afford to pay get the support they need; and those who cannot are condemned to suffer. We would not tolerate it in our hospitals, our GP surgeries and our schools; we must not tolerate it in our care services. The Observer urges the prime minister to act.

The Observer view on social care

The Observer view on the BMA and the junior doctors’ dispute | Observer editorial

“Safe”; “fair”; “a really good package of things for equalities”. This was how Ellen McCourt, the new chair of the British Medical Association’s junior doctor committee, described the renegotiated contract the BMA agreed with the Department for Health earlier this year. Yet just weeks later, the BMA has announced an unprecedented level of strike action over that same contract: four five-day strikes, including the removal of emergency care. How have we got here?

After more than three years of contract negotiations, it’s easy to lose sight of why the junior doctor contract was being renegotiated in the first place. All sides agreed the old contract – which resulted in unpredictable pay packets, and equal rewards for doctors working very different levels of unsocial hours – was unfit for purpose.

Despite protracted negotiations neither side has been able to reach agreement. Before the summer, the BMA and the government finally agreed a new compromise contract after eight days of intensive Acas negotiations. Yet despite the BMA endorsement, junior doctors rejected this contract by 58% to 42% in a vote.

This left the BMA in somewhat of a quandary. But having recommended the contract to its members as fair and safe, it is impossible to make sense of its decision to aggressively escalate strike action in the wake of the vote.

For medical professionals, the decision whether to strike must be one of the utmost gravity. Every day of strikes means thousands of operations cancelled, causing huge patient suffering. Withdrawing emergency care at short notice for sustained five-day periods creates serious risks to patient safety.

In the past, the BMA has justified strike action by arguing that the government’s proposals – even after significant modifications made in February – represented an even bigger risk to patient safety, although it failed to set out a convincing public explanation of why and how that was the case. But to escalate strikes on the basis of a contract the BMA itself has declared safe seems bizarre at best. At worst, it leaves the BMA vulnerable to the charge these strikes are politically motivated.

As this paper has argued, the government has been far from blameless in this dispute. Jeremy Hunt originally approached the negotiations in an unnecessarily combative style. His decision to rhetorically link contractual reform to an unfunded Conservative manifesto commitment for seven-day NHS services was a mistake, and had an incendiary effect. But the government has shifted its approach in recent months, making significant concessions.

Yet as the government’s approach has become more conciliatory, the BMA has upped the ante. The public has the right to expect industrial action should be deployed as an absolute last resort given doctors’ ethical responsibilities. But the Health Services Journal has published leaks of private messages between the BMA’s junior doctor committee that suggest that – far from being deployed as a last resort – strikes were seen as a tool to prolong the dispute, causing maximum difficulty for the government. One committee member said weekend pay was “the only real red line” for doctors, directly contradicting the BMA’s public stance that this was a dispute about patient safety.

It remains unclear what this strike is actually about. In the media, the BMA and many grassroots doctors continue to argue it is about the government putting patient safety in danger by pledging to deliver seven-day services across the NHS without increasing the number of staff. But the contract itself neither requires doctors to work more weekends, nor reduces staffing during Monday to Friday. It emerged yesterday that in May the Department for Health was willing to issue a statement to junior doctors that made clear seven-day services would be limited to emergency care, with extra staff deployed. The BMA at first signed off this statement as part of the Acas process, then insisted the department refrained from releasing it as they regarded it as irrelevant to the contract.

This clarification could potentially have won more junior doctors round to voting for the compromise contract. Why did the BMA not want this statement publicised, and why are its leaders continuing to argue this contractual dispute is about the government’s commitment to seven-day services? In the absence of a good explanation, it is hard to avoid concluding this dispute has morphed from an industrial one about contractual reform into a political attack on the government, with insufficient regard for the cost in patient suffering.

There is also evidence the BMA might be out of step with its members. Just 32% of the 7,000 doctors that took part in a leaked BMA survey back in May said they supported time-limited strike action, and 36% unlimited action. Despite its serious escalation, the BMA has not balloted its members on strike action since last November.

Of course junior doctors work long hours in difficult conditions. Many have legitimate grievances, including serious concerns about the current NHS funding crisis. But these grievances are not contractual. Using escalated strike action on the basis of a contractual dispute to air these grievances may be tempting, but it is ultimately counterproductive.

This paper is a staunch defender of the critical right to take industrial action. But with that right comes responsibilities. The BMA’s leadership, looking increasingly driven by political rather than industrial concerns, has failed in those responsibilities: to its members, to the NHS, and ultimately, to the public.

The Observer view on the BMA and the junior doctors’ dispute | Observer editorial

The Observer view on the government’s childhood obesity strategy | Observer editorial

While the nation was enveloped in Olympics fever last week, celebrating the success of British athletes at the peak of physical perfection, the government published its long-awaited childhood obesity strategy. It was a disgrace, so thin on action it barely deserves to be labelled a strategy. It will condemn too many British children to a lifetime of health problems and a premature death.

One in three children leaves primary school overweight or obese, putting them at significantly greater risk of developing cardiovascular disease, cancer and type 2 diabetes later in life. Simon Stevens, the chief executive of the NHS, has described obesity as “the new smoking”; the health secretary, Jeremy Hunt, has labelled childhood obesity a “national emergency”; and the government’s chief medical officer, Sally Davies, has called on the government to include obesity alongside terrorism in its national risk planning. This is far from hyperbole: poor diet is the nation’s biggest premature killer, ahead of smoking and drinking, and costs the NHS around £6bn a year.

Last year, the government promised a “draconian” approach to tackling childhood obesity. Yet there were really only two significant measures in the watered-down plan. First, a sugar levy on soft drinks, already announced under David Cameron, which would have been very difficult for Theresa May to renege upon. While a positive step, this is unlikely to achieve anything like the progress needed without being part of a broader package of measures to cut children’s sugar and fat intakes. It is also likely to be tied up for years in the courts as it is subject to challenge by soft drinks manufacturers, if it is ever implemented at all. Second, the strategy set out measures to promote physical exercise, which, while uncontroversial, cannot alone counteract the impact of unhealthy diets.

The food industry is notorious for using friendly cartoon characters and online games to market directly at children

Just as telling is what’s missing. A year ago, Public Health England reviewed the evidence about what works in reducing obesity. It called for far-reaching measures: to reduce junk-food advertising directed at children, to limit the number of supermarket promotions on unhealthy foods, and to force manufacturers to gradually reduce the sugar content of high-sugar foods. None features in the government’s strategy: it simply sets out a voluntary approach to asking manufacturers to reduce sugar levels over time. This is the same approach adopted by former health secretary Andrew Lansley in his 2011 “responsibility deal”, which left it up to the food and drinks industry to voluntarily change its approach. Yet studies have shown it failed to work.

This is hardly surprising. There is a race to the bottom at work in our food industry. Packing foods with addictively delicious – and cheap – fat, salt and sugar is one of the fastest ways to a healthy profit. Once the worst offenders go down this road, conditioning our palates to crave more of the unhealthy in a way that puts paid to the idea of free consumer choice, others follow. There’s little point to one manufacturer taking action; consumers will simply switch away from their products. This is why enlightened members of the industry are pushing for a compulsory approach to reducing sugar and fat contents: they want to take action, but need a level playing field.

The food industry is notorious for using friendly cartoon characters and online games to market directly at children, pushing them to pressure parents into buying fat- and sugar-laden foods. It is known for misleadingly passing off products, such as breakfast drinks that contain more sugar than a can of cola, as healthy. There are parallels with the 1950s tobacco industry, which offered guarantees its products were safe that companies knew they could not make stand up.

Except this is even worse – this time, the target is young children. And food manufacturers are winning; children consume, on average, three times the maximum recommended amount of sugar. Tooth decay is the most common reason for children aged between five and nine to be admitted to hospital.

Obesity may be a national crisis, but it is a crisis we know how to address. The tragedy is that, prior to 2010, the UK was a world leader in nutrition policy. The previous Labour government devolved responsibility to the independent Food Standards Agency, insulating nutrition policy from heavy industry lobbying. The FSA led the way on the reformulation of food products, brokering industry-wide deals to get the industry to reduce salt contents. As a result, Britain was the first country in the world to successfully reduce salt intakes. It is an approach that has been copied around the world; countries such as South Africa, Chile and Argentina have applied it not just to salt, but sugar and fat, with great success.

Related: Theresa May’s climbdown on obesity is her first big mistake | Jackie Ashley

In 2010, the coalition government rubbished this approach. In response to industry lobbying, nutrition policy was restored to the Department of Health, with disastrous effect. Policy again became vulnerable to the powerful food and drinks lobby that, like the once-mighty tobacco industry formerly did, spends vast sums on influencing ministers and MPs. Companies that make billions from selling unhealthy food argue that if the government increases regulation of the industry, there will be a heavy price to pay in terms of job losses and economic output.

These arguments are easily demolished. The global bank Credit Suisse, hardly a bastion of anti-business sentiment, published a report calling for a sugar tax in 2013 and argued that it would have positive impacts on the economy in the long run. The only companies that greater regulation hurts are those that seek to make their money from pushing sugar. But what kind of society puts their economic interests over and above the health of our children?

When Theresa May stood on the steps of Downing Street last month, she pledged to the British public: “When we take the big calls, we’ll think not of the powerful, but of you.” Yet her government’s anti-obesity strategy echoes the costly vulnerability of governments around the world to big tobacco lobbying in the 1960s and 70s.

Damningly, it could not do more to promote the interests of the powerful at the expense of the health of our children. And it bodes terribly for other sectors of the economy in which regulation is needed to ensure decent businesses flourish and the cowboys don’t win out. Just five weeks into May’s premiership, capitalism has never looked less responsible.

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The Observer view on the government’s childhood obesity strategy | Observer editorial

Henning Mankell: chronicler of his very own decline | the Observer profile

For the duration of a prolific career stretching back nearly half a century, the Swedish author Henning Mankell, greatest identified for his Wallander series, has developed many million phrases, many of them dealing with ghastly crimes. But couple of of his sentences have carried quite so disturbing resonance as the a single published in the Göteborgs-Posten newspaper last week.

“When I returned to Gothenburg the following day I came back with a serious diagnosis of cancer,” he announced. Mankell had gone to see an orthopaedic surgeon in Stockholm with what he assumed was a slipped disc, but tests exposed he had a tumour in his left lung, an additional in his neck and there was evidence to propose that the cancer had metastasised elsewhere in his entire body.

Monday is Mankell’s 66th birthday. A couple of years in the past, he informed an interviewer he was not afraid of dying. But not currently being afraid is not the very same as not caring, especially when the prospect leaps forward a couple of decades. “My anxiousness is extremely profound,” he acknowledged in Göteborgs-Posten, “despite the fact that by and massive, I can maintain it underneath control.”

Like numerous writers just before him, he has decided to channel his nervousness into writing a chronicle of his disease. It should make a compelling account. One particular of the strengths of the Wallander novels is the way that he documented the detective’s ailments and frailties. Brooding and introspective, Kurt Wallander was handed diabetes by Mankell, who appeared to consider a writerly delight in describing male bodily decline.

By contrast, Mankell has usually been a guy of action. His childhood was shaped by the divorce of his mothers and fathers when he was one particular. His mother left her 3 children to move in with yet another guy. Mankell barely noticed her until he was 15, and in her absence he came up with an imaginary model of his mother. It was a inventive talent that he would later put to lucrative use a writer, but such was his talent for invention that he was severely disappointed when he at some point met the real female. Although he belatedly got to know her, they had been in no way close.

He has since stated that what she did in leaving was only what several males do. There may possibly have been a note of self-criticism in this observation, simply because he has four boys from distinct relationships and, as he later on admitted, he invested two many years in Mozambique partly to escape from “domestic ties”.

His mother died comparatively youthful, at 55. And his father, a judge, took his younger young children to dwell in a little neighborhood in central Sweden (he died when Mankell was 24).

The motherless loved ones lived above the law courts. “Ever because I was a youthful kid,” he later on remarked, “I have been interested in the justice system and how it performs.”

At 16, he left college to turn out to be a merchant seaman, dreaming of romantic journey and exotic locations. But as a stevedore on a coal ship, the spot he most often visited was Middlesbrough. He moved to Paris at 18 and it is stated that he nevertheless carries a scar courtesy of a police baton wielded for the duration of the 1968 événements.

He was and remains avowedly leftwing. In the 1970s, he lived in Norway with a lady who was a member of a Maoist get together and the Norwegian newspaper Dagbladet stated that he took element in the actions of the Workers’ Communist party of Norway. Most of all, Mankell’s politics are informed by an previous-fashioned internationalism in which the west performs the part of ruthless imperialist.

In 1972, when he was 24, he ultimately reached the spot he’d been dreaming of on these icy trips across the North Sea to Middlesbrough: Africa. He 1st visited Guinea-Bissau but produced repeated return trips, living for a even though in Zambia, before taking up a position as artistic director of the Teatro Avenida theatre business in Maputo, Mozambique. Since 1987, he has divided his time amongst Mozambique, Sweden and, far more lately, his vacation property in Antibes in the south of France.

Theatre was Mankell’s very first adore. He began out operating as a stagehand in Stockholm and by the age of 20 he had written his initial play, The Amusement Park, about Swedish colonialism in 19th-century South America. Although Mankell has subsequently explained it was not extremely good, the perform was properly received.

In any situation, four many years later on he published his first novel, The Stone-Blaster. Even though Mankell was only in his early 20s, the book worries an old guy reflecting on his daily life and the need for social solidarity. As the two debut functions suggest, Mankell was not just a political thinker, he was also an overtly political writer.

In Sweden, crime fiction was transformed in the 1960s into a leftwing political genre by Per Wahlöö and Maj Sjöwall, who are typically cited as the godparents of “Nordic noir”. But it was not till May 1989, after publishing a succession of other novels and plays, that Mankell came up with the thought of Wallander.

He had just returned to Sweden from two years in Mozambique and he was struck by an increase in racism and attacks on immigrants. “Racism is a crime,” he later explained, “and I thought: Okay, I’ll use the crime story.” Apparently he plucked the title Wallander from a telephone directory.

Even though the Wallander novels are political – the poor guys tend to be fascists or members of a shady elite or the two – the detective himself is not. For all his ideological instincts, Mankell the craftsman realised that a politically right hero would not be really appealing. So Wallander became a flawed human becoming with bad eating habits, a problematic romantic relationship with females and a tendency to drink too much.

Wallander also grew to become a large bestseller, although it took a whilst for him to catch on internationally. When he did, nevertheless, other Scandinavian authors quickly followed. Mankell has in contrast himself in this respect to Björn Borg, who just took place to be the very first in an amazing line of best Swedish tennis gamers.

If racism was the catalyst for Wallander, the crime genre was also given higher urgency by the murder of Olof Palme, the Swedish prime minister, in 1986. The nonetheless unsolved killing shocked the country and prompted an extended time period of self-analysis and moral doubt. Mankell has dismissed this reasoning, arguing that non-Swedes produced a false picture of a social democratic paradise that Palme’s murder supposedly brought to an end.

“We did not lose our innocence with his death,” he said. “Politics would have followed the very same course. Industry liberalism would have took place.”

This is no doubt accurate, but the shooting of the prime minister in the centre of Stockholm, and the method in which the killer vanished into the night, left a psychological appetite for answers, a deep-seated necessary for mysteries to be explained and crimes to be solved, and Wallander, in his very own idiosyncratic way, answered to this need.

That Mankell was fascinated by the crime is clear from the truth that he wrote each a play and a Wallander short story about Palme, and the politician also featured in the last Wallander book, The Troubled Man (published in Sweden in 2009).

Considering that Wallander’s death, Mankell has focused on his other writing, which, which includes children’s stories, makes up a lot more than 75% of his corpus. But it has been his political actions that have gained headlines, most notably his decision in 2010 to join an support flotilla that was bound for Gaza.

In the event, the boats were halted by Israeli troops in an action that left nine members of the convoy dead. Mankell was arrested and then sent back to Sweden. Mankell sees the democratic state of Israel as a criminal nation, likening it to the South African apartheid regime.

Known for his irascibility, the writer has in 1 sense softened in late middle age. When he turned 50, he embarked on his fourth and, it looks, happiest marriage – to Eva Bergman, a choreographer and theatre director who is the daughter of the movie-maker Ingmar Bergman and the dancer Ellen Lundström.

In his column about his cancer diagnosis, Mankell stated that he had no memories of the trip back to Gothenburg other than a deep sense of gratitude at his wife’s presence. Obtaining older, he stated three years in the past, alterations our notion of love. In his 60s, he has produced a touching and proximate sense of mortality.

“At my age,” he explained, “I would say that the greatest definition of adore is you are with the man or woman you want to hold your hand when you die.”

Born 3 February 1948 in Stockholm. His father, Ivar, was a district judge his mother worked on the Swedish National Biography. They divorced when he was a single.

Greatest of occasions The publication of Faceless Killers in Sweden in 1991 started one of the most successful recent crime series.

Worst of instances Some of his feedback on Israel and Palestine have brought on controversy. He as soon as said it was unusual that there are not a lot more suicide bombers.

What he says “Society and its contradictions become clear when you create about crime.”

What other individuals say Mankell’s works “transcend their picked genre to grow to be thrilling and moral literature”.

“Mankell’s series is the exemplary situation of the fate of the detective novel in our era of global capitalism.”

Henning Mankell: chronicler of his very own decline | the Observer profile