The government must do everything in its power to combat obesity (Supermarkets must stop discounting unhealthy foods to tackle childhood obesity, say MPs, 27 March). Obesity is a public health disaster inextricably enmeshed with cardiovascular disease, obstructive sleep apnoea, gout, type 2 diabetes, hypertension, stroke, gallstones, cancers, osteoarthritis, breathing problems, dental decay and gum disease. The obesity statistics are staggering. The Lancet reported this year that around 700,000 new cancers caused by overweight are predicted by 2035 and that the number of those afflicted with diabetes in the UK alone has topped 4 million. The costs to the NHS are projected to reach £9.7bn by 2050.
Obesity is a vivid example of the link between general and oral health. Sugar is the main culprit in the unabated increase in obesity and dental decay. A holistic, comprehensive and sustainable approach is needed that transcends medicine and dentistry, challenging the avoidable consequences of modern lifestyles. Dr Munjed Farid Al Qutob London
• People in this country are consuming too many calories, many of them from sugar, which is contributing to unacceptably high levels of obesity. The government has published sugar reduction guidelines for certain types of food to bring overall sugar levels down, while still allowing people to enjoy their favourite foods. This is an important step and must form part of a broader range of initiatives to help individuals and families towards better diets and healthier lifestyles. To play their part, responsible food and drink manufacturers, retailers, restaurants, cafes and takeaways will adapt recipes and take action to encourage consumers towards low- and no-sugar options. In some foods, portion-size reductions will be necessary. Producers will keep consumer tastes and preferences at the heart of this work.
Health charities and professional bodies will support this ambitious agenda by providing clear advice, backed by robust science, and helping to combat often confused messaging around nutrition and health. As well as pushing for full and continuing industry engagement, these groups can also help to create an environment where recognition is given to companies’ efforts, challenges and achievements. This will encourage the sustained industry engagement that is needed. Ian Wright Food and Drink Federation Tam Fry National Obesity Forum
• The Commons health select committee has released a report admonishing the government’s plans to fight obesity, claiming that proposed measures do not go far enough to tackle the crisis. The committee argues that ministers had ignored recommendations from health bodies to regulate price promotions of unhealthy food and drinks aimed at children. Research from Oliver Wyman shows that 81% of UK shoppers have noticed that sugary products are more often on promotion in their supermarket than healthy options – and 60% of consumers say it is their supermarket’s responsibility to help them be healthier.
Rather than waiting for the regulatory hammer to fall, supermarkets in the UK should redefine themselves as health and wellbeing brands, by simplifying choices and building customer loyalty through healthy living programmes. By showing customers how their activity and shopping habits feed into their health outcomes and helping them make informed decisions and trade-offs, supermarkets can influence habits in a way that is positive for their business while also delivering health benefits. Duncan Brewer Oliver Wyman Consulting
• New NHS statistics show that one in four adults are inactive and levels of obesity have more than tripled since the 1990s (One in four adults take less than 30 minutes of exercise every week, 31 March). An easy solution to our sedentary lifestyle is getting more people walking their short, everyday journeys and yet the report shows that one in four adults aren’t even walking for half an hour a week. Getting off the bus a stop earlier, going for a lunchtime walk or choosing to park further away and walk the rest of the way are all easy ways to get moving more and can make a big difference to our health and happiness.
The report also shows that more than a third of children are overweight by the time they leave primary school. Creating safe walking routes and encouraging more children to walk to school will help the whole family get more active and ensure children develop healthy habits for life. This is vital if we’re going to protect the future of our health service. It’s Living Streets’ National Walking Month in May and we’re encouraging people to fit 20 minutes of walking into their day. We know from people who took part last year that it’s an achievable way to get active and stay healthy. Jenni Wiggle Living Streets
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Operatic soprano Greta Bradman was19 years old when she started to self-harm. Intense bullying through high school had coincided with her parents’ divorce. She felt isolated and started skipping school. A year earlier her grandfather, cricket star and national hero Sir Donald Bradman, had died.
Donald Bradman and his grand daughter were close – their relationship has been chronicled in a double episode of Australian Story – and he had instilled in her a love of classical music. Greta saw singing as “a kind of solace” for her pain, and she was accepted into the Elder Conservatorium of Music in Adelaide. But that overwhelming sense of self-loathing stayed with her, and she began trying to destroy the one thing that brought her joy: her voice.
“I wanted to take away the possibility of singing as a career,” she says. She describes it as needing to punish herself – for missing school, for being “completely worthless”, for having the audacity to wrap her identity up in art.
“It was a combination of wanting to hurt my voice and to get that sense of relief that can come from self-harm. But it’s a completely maladaptive coping strategy, which took me further and further down the cycle of self-loathing … It was bound up in me as an artist – not really knowing how to go about it, and not feeling like I could necessarily succeed, but at the same time being terrified of the prospect of success.”
‘I wanted to take away the possibility of singing as a career’: operatic soprano, radio host and psychologist Greta Bradman. Photograph: Pia Johnson
Eventually, Greta climbed out of the cycle. She stopped self-harming when she was 23 and became pregnant with her first child. Today, her voice well and truly intact, she is one of Australia’s leading sopranos, with a radio show on ABC Classic FM, an upcoming principal role as Mimì in La Bohème at the Sydney Opera House, and a plaque on the Adelaide Festival Centre’s walk of fame.
She also practices pro bono as a provisional psychologist, with a masters in clinical psychology. Bradman has combined both passions to consult on a major new industry-first initiative from Arts Centre Melbourne – the Arts Wellbeing Collective – to help others in the creative arts who have struggled in similar ways.
The collective, which launched on Thursday, is unprecedented – if not around the world, then certainly in Australia. It comprises close to 90 Victorian arts and culture organisations, including Melbourne festival, Melbourne Theatre Company, Victorian Opera and Regional Arts Victoria, who have come together with a common aim: to improve mental health and wellbeing for Victorian performing arts workers – those on stage and in front of the camera, as well as those working behind the scenes.
Developed in consultation with prominent psychologist Dr Michael Carr-Gregg, and drawing from the practice of positive psychology, the program, in its pilot phase, will feature a series of workshops and a dedicated website filled with resources tailored to the mental health needs of the performing arts sector – a sector which recent research has shown is in crisis.
Performing arts work: a lethal cocktail
In 2016, a major report was released by Victoria University and Entertainment Assist following an extensive study of entertainment industry workers.
The report – which focused on performing artists and composers, performing arts support workers and broadcasting and media equipment operators – was alarming. Levels of moderate to severe anxiety in the performing arts industry were 10 times higher than the general population; levels of depression in industry workers were up to five times higher; and workers were four to five times more likely to plan to commit suicide, and twice as likely to attempt it.
As Bradman explains, the performing arts industry comprises a unique cocktail of working conditions that, without the right levels of support, can prove deadly.
“As a performer, you’re working when everyone else is working, and then you’re working when everyone else is having fun,” she says. “The work hours are unique, and on top of that you’ve got the lack of work security, and the financial pressures.”
An Australia Council report released in 2010 found more than half the country’s artists were making less than $ 10,000 a year from their creative pursuits, regardless of the hours they put in. Many of those hours come in shifts, Bradman says, which come with their own set of risks – from obesity and cardiovascular disease through to sleep problems and other mental health issues.
There are social factors too, including an imperative to socialise and network at events that revolve around alcohol and drug consumption. “Looking at future work possibilities and career progression can be somewhat tied to that too,” Bradman says.
And all that’s to say nothing of work instability, and what it can do to one’s mental health. “For performing artists, and also for people backstage, you might go through a phase of getting a lot of work, and then all of the sudden the work drops off. That can have a big impact on your sense of identity.”
You have these immense highs of being part of a [big show] … and then suddenly it’s all gone
The extreme highs and lows of the work itself compound the issues. “I’ve experienced this myself,” Bradman says. “You have these immense highs of being part of a family, a community, that comes together for this incredible project – particularly if it’s a long project, like a musical, an opera, a long run of a dance. You’re so close to the people, and you’re all so bound up in it – and chemically, from a neuropsychological and psychological perspective, there is so much going on in those relationships … but it’s all bound up within that world of the show, and suddenly the show ends and it’s gone.
“There’s a huge sense of grief and loss that can come from that – and a sense of needing to renegotiate your identity.”
While Bradman fundamentally disagrees with the myth of the “struggling artist”, which romanticises mental health issues as a creative boon, she says there is something intrinsic to the arts that can make artists and workers particularly at risk.
“To be [an artist] we have to be vulnerable, we have to give of ourselves, hugely, we have to allow ourselves to feel an array of emotions – some of them good, some of them really difficult,” she says. That’s why it’s particularly important that arts workers can access resources and support tailored to their industry – a gap the Arts Wellbeing Collective is hoping to fill.
“What we do [as arts workers] is so bound up with who we are. This is not necessarily a good or bad thing, it’s just a way that a lot of us identify,” Bradman says. “We have to negotiate what that means, so that in the quieter times – in those times when there’s not as much work – we don’t equate a lack of achievement with a lack of self-worth, or an uncertainty about our direction.”
‘I’d spun out of control’
For Simon J Green, it started with scratching. He had been running an independent film company for eight years – a creative investment with huge financial strain, long hours and high responsibility – when his wife noticed him absent-mindedly digging paths across his forearms. “As soon as she mentioned it, I realised I’d been scratching my legs, too. I pulled up my pant legs and we both gasped at the ragged, bloody strips I’d torn in myself.”
Simon J Green experienced ‘extreme levels of stress and depression’ while managing a film production company in Melbourne for eight years
Green, who is based in Melbourne, was experiencing “extreme levels of stress and depression” combined with long working hours and a lack of sleep, which meant every small problem took on extreme proportions. It’s a spiralling feeling that many performing arts workers identify with.
“Taking on staff, and the pressure of keeping them both paid and creatively satisfied, weighed on me more than I realised,” he said. “Combined with managing [my] cystic fibrosis, and trying but failing to meet my own creative needs, I’d spun out of control to the point I was literally tearing myself up.”
There was another factor too, Green says: a lack of perceived value. “People don’t think our work is worth much, which puts pressure on us to make more for less.”
This is an issue Bradman raises too, which she is looking into with a new, broader survey which soft-launched in January. “Culturally, and particularly in the current climate, [there are questions] over the perceived value of the arts, not only within the performing arts community but the broader community.”
In 2015, the Abbott government slashed funding from the Australia Council – cuts which were handed down, for the most part, to the small-to-medium arts sector. In May 2016, the artistic directors of major theatre companies penned an open letter calling it an “unprecedented assault” on the arts, and individual artists were among the biggest losers.
“When funding is shifting and changing, and there is so much uncertainty, that can really play into one’s sense of where one is going in life, and one’s sense of self-worth,” Bradman says.
The issue of worth came up in the Entertainment Assist report too. “Performers working for free is a huge issue in our industry. It devalues our skills and puts us out of work,” said one participant. “[We need] more government support and to realise the importance of the arts,” said another.
In the film industry, Green says, that devaluation has specific repercussions. “There’s a real scarcity mindset that seems to undermine collaboration – a sense of a zero-sum game of work available, which isn’t true. I think it comes from that feeling that we aren’t really valued by society at large; from all of us being told at school, ‘Don’t be an artist, you’ll never make a living, be something else’, to the tired joke (that we perpetuate) that an arts degree is useless.
I pulled up my pant legs and we both gasped at the ragged, bloody strips I’d torn in myself.
“Performing artists are twice as likely to attempt suicide, and depression is five times higher than the general population. That’s a horrifying statistic,” he says. “Clearly there’s a problem, but no one really cares. If it were a different industry – say, manufacturing – there’d be a national discussion.”
Green remembers when the report came out, alongside an article on how little money is made by actors who are considered famous in Australia. “The comments sections were full of people saying, ‘Boo hoo, get a real job, they chose that life.’ With all this, how can the arts not be fatiguing our mental health?”
Beyond the performing arts
Although the report, and the Arts Wellbeing Collective which has sprung from it, are focused on the performing side, mental health issues in the arts are by no means confined to that. Mental suffering has a long and storied history with visual art, for instance, and a recent callout for arts workers who had experienced mental health flare-ups drew mostly anecdotes from writers, who spoke of anxiety, depression, bipolar disorder, eating disorders and recent, heartbreaking suicides among their community.
Developed by a performing arts company, the focus of the Arts Wellbeing Collective reflects its origins. Upcoming workshops are titled “the Green Room”, “Centre Stage” and “the Show Must Go On”. But Bradman hopes the resources made available will be of use across the industry and beyond, and has aspirations for expansion.
“There is absolutely nothing to preclude it from being broadened out, if it’s successful,” she says. “I think it’s really important to be slowly, slowly about it, to let it build up and evolve, to let this year really inform the shape that it takes in the next.”
Above all, she hopes it achieves a top-down recognition of mental health issues, removing stigma, generating conversation and increasing support: “A real sense of committing, on the part of the organisations, to a nonjudgmental, open and supportive relationship when it comes to mental health in the arts,” she says.
• Find out more about the Arts Wellbeing Collective
Are GPs to throw away the traditional box of wooden tongue depressors? People with sore throats are soon to be offered a new service – at the pharmacy. The NHS Innovation Accelerator, an organisation responsible for helping “with the adoption of promising new treatments and technologies”, has approved a new Sore Throat Test and Treat service that NHS England says is “evidence based and cost saving”.
My head is in my hands. This is neither evidence based nor shown to be cost effective, and may actually make pressure on the NHS worse.
Faced with a wait for to see a GP, it means effectively people will be able to access care faster if they pay for it
The pilot study – which occurred in Boots stores (whose head office analysed the data) – was not a randomised controlled trial. It showed it was possible for pharmacies to assess people with sore throats and use a “point of care” rapid antigen test to determine who should get antibiotics. This might sound superficially sensible. But the National Institute for Health and Care Excellence (Nice) does not recommend this rapid antigen test because it has a poor sensitivity for picking up relevant bugs.
It is already known – from randomised clinical trials – that this test does not help beyond normal care. Furthermore there has been no full cost-effectiveness analysis – let alone an independent cost-effectiveness analysis – of the Boots scheme. Without comparing the pilot to usual care, we have no way of knowing whether more or fewer antibiotics were prescribed. It is a travesty of evidence-based policymaking.
This scheme may actually increase demand on the NHS, fragmenting services but without improving care. More than half of the patients in the study said that if the pilot had not been available, they would have either have done nothing or treated themselves without assistance.This, if it held true, meant that antibiotics were subsequently used just because the scheme was there. Isn’t that good? Not necessarily.
The study concluded that if the pilot hadn’t been available then there could have been a “delay seeking medical treatment when it was needed”. But it didn’t show this, and not all bacterial throat infections need to be treated. In fact, antibiotics reduce the length of time of a sore throat by an average of 16 hours, with only a modest impact on complications such as ear infections. Balanced against common side-effects of antibiotics such as diarrhoea, as well as antibiotic resistance, there is often not a clear-cut reason to prescribe. This scheme expands the market for medicine, without clear benefits. Earlier is not always better. It gets worse.
In the pilot, patients paid £7.50 for the test and £10 for “antibiotics if required”. This is a clear subversion of the free at the point of use principle of the NHS. NHS England has not been able to tell me what the funding for the new service will be, where it will come from, or whether patients will still have to pay. Faced with a wait for a free appointment with a GP, it effectively means that people will be able to access care faster if they pay for it. Commissioners with stretched budgets may be content with that. But it should be absolutely resisted.
The relentless argument from rightwing thinktanks is that we need to charge for NHS appointments; and that the funding deficit in the NHS is so acute that all options should be on the table. But it is a dreadful argument. People who are poor have the biggest risk of earlier death and earlier disease. The very principle of the NHS – based on need, not ability to pay – subverts the otherwise natural course of allowing better healthcare to be only in the domain of the already better off.
This scheme isn’t the kind of change we need in the NHS. Sir Bruce Keogh, NHS England’s medical director, has said of it “innovation is not an option but a necessity if we are to built a sustainable NHS”. But “innovation” should not be an excuse for policymaking that isn’t evidence-based. There are far better ways to ensure that the NHS is sustainable.
The NHS does need more money. But it also needs to stop wasting money and effort on inadequately tested – or proven to be non-cost effective – but popular political policies. Take the health checks scheme or dementia screenings, for example – known to be ineffective and even harmful, through causing false positive diagnosis and over-treatment. Millions have been needlessly wasted that should have spent on useful care.
Similarly, there are multiple pressures on general practice that have been generated by appalling but avoidable political policy. The current benefits system is associated with worsening people’s mental health and has created an enormous amount of bureaucracy for GPs, which reduces the availability of appointments. And that is even before we get to the money and time spent administering to the competition and commissioning of the Health and Social Care Act, without evidence of gains for patients.
We are in the midst of an NHS financial crisis. If we want it to survive, we need real innovation. That means the bravery to stand up for evidence-based policymaking, and ensure that NHS policy always considers harms, and aims to reduce waste – and health inequalities.
‘Dozens of pubs are disappearing every single week, capitulating in the face of supermarket competition and an ever-developing range of leisure choices.’ Photograph: Alamy
Hardly ever a day passes with out yet another horror story about the UK’s consuming dilemma: alcohol-related violence, debauchery in city centres, record demand on A&E assets, a liver condition epidemic and families wrecked by addiction. Criminologists, well being experts, sociologists and politicians appear on information programmes, pointing the finger at individual more than-indulgence and calling for ever stricter measures: minimum pricing, tougher consumption tips, charging drunkards for health care support and limited pub opening hours.
This is all quite worthy and sensible, as the grave expenses of alcohol abuse can be readily quantified. And but, our strategy to the difficulty is partial and (historically) brief-sighted. The common public may possibly be excused for believing that the scenario has never ever been so bad, but similarly extreme issues have been voiced ahead of. These days, a single successful response might be to go beyond tighter controls and to bolster a time-honoured British institution: the pub.
Taking a long-term see, regular consuming volume figures were truly considerably increased in the past, with at least 600 litres of ale or beer consumed per head every yr on typical in the Renaissance (as calculated from surviving family accounts), compared with a mere 74 litres in the United kingdom in 2011. Offered the query marks over alcohol volumes and information recording, this kind of comparisons can by no means be exact, but the simple observation stands.
Rather than a exclusive crisis, what we are witnessing nowadays is the latest of a series of moral panics which have gripped Europe because the Middle Ages, most notably in the Reformation time period of the 16th century (spurred by religious fervour – no lesser figure than Martin Luther preached towards the “piggish” excess of his compatriots), in the course of the Enlightenment (boosted by a utilitarian concern about human wellness) and in the industrialisation of the Victorian age (out of fears for the destitution of the operating classes). Invariably, the extremely foundations of society appeared to be at threat.
Two principal attributes, I would argue, distinguish the current scenario from historical precedents: the growth in personal domestic consumption and the better visibility of hefty female drinking.
In pre-present day times before 1800, there were hardly any stores marketing alcoholic drinks and consuming was above all a convivial action. Considerably associated research points to the “optimistic” social functions of sharing a pint: hardly a organization deal and undoubtedly no feast day passed with out a gathering at the nearby alehouse. And during these feast days, as we can inform from the written and visual proof, youthful and old people, males and females, wealthy and bad congregated in and close to these communication hubs. Sole consuming, away from the public gaze, was frowned upon and extreme indulgence (particularly when top to violence) was topic to informal social handle. There were several tensions, undoubtedly, but the all round impression is of a problem contained.
Now we have huge numbers of folks drinking heavily at home, often alone and without any checks on volume or behaviour. The habit is facilitated by (not just cheap) booze stacked on supermarket shelves. In town centres, on the other hand, we see the unprecedented phenomenon of collective female drunkenness. In pre-contemporary instances, ladies had been expected to drink moderately, in line with period beliefs in their weaker bodily constitution and social strain to sustain their sexual honour. Such gender prejudices and inequalities have largely been consigned to the historical dustbin (although they persist in some quarters), but – from the stage of view of alcohol research – the apparent peer acceptability of hefty female consumption is a striking innovation.
Rather than currently being viewed as a result in of the difficulty, the pub should be observed as a answer. At current rates, dozens are disappearing each and every week, capitulating in the face of supermarket competitors and an ever-increasing assortment of leisure alternatives. Apart from residence consumption, consuming has shifted to specialised, group-certain contexts like bars, clubs, parks and purchasing malls.
Is it mere nostalgic romanticism to get in touch with for sustained efforts to stem this trend?
As an alternative of putting all our believe in in government/coercive measures, we may well just have to go to the pub more frequently, reclaim it as a socially inclusive room, carry our buddies/enterprise partners/relatives/children and restore its historical role as a local community centre. So, yes, let us preserve banging on about overall health hazards and social costs of extreme consumption, but we also need to have to remember that without having a good pub – this broadly-recognised “icon of England” – no village or neighbourhood is very likely to prosper.
In excess of the centuries, publicans have learnt to climate storms and adapt to changing demands, but today they genuinely could do with a helping hand from responsible patrons.
Rather than currently being viewed as a result in of the difficulty, the pub should be observed as a answer. At current rates, dozens are disappearing each and every week, capitulating in the face of supermarket competitors and an ever-increasing assortment of leisure alternatives. Apart from residence consumption, consuming has shifted to specialised, group-certain contexts like bars, clubs, parks and purchasing malls.