Unnecessary Battles

Consensus is assumed on a few fundamentals such as a democratic government, a mixed economy, equal rights and equal opportunities, which equates to societal responsibilities to make available the necessities of food, shelter, healthcare and education.

Sound in theory but not working too well in practice. Why?

Apart from ‘natural’ disasters (climate change occurrences exempted), and personal losses from inevitable death, it can be argued that all our struggles and sufferings are man-made (or, to avoid any confusion, human-made). Unnecessary. Avoidable. But we know that Utopia is not a realistic option, so neither is passivity.

Today we have multilayers of actors with a spread and depth of knowledge, experience and expertise. No longer the polymaths of yesteryear. Consequently, there is an even greater need for collaboration and a skill requisite to identify the most appropriate players for any particular situation; an area where competitive factions can surface, be it political, professional, commercial, or between specific groups within society.?

Here, I give two of the most obvious examples of where groups feel so keenly that they are on the higher moral ground in society that their actions physically challenge the activities of others: the attempts to stop a horse race by invading the course to attach themselves to the fences; attempts to protect the environment - blocking cars from travelling on motorways - by attaching themselves to roads. In both cases consensus is already there for making changes and actions already being taken. So, would it not be more productive to find ways to work alongside those in the racing industry and animal welfare groups who are making great strides in that area, and similarly with the even greater number of diverse groups working to improve the environment? I ask the question as I have limited experience in those areas.

I qualified and worked as a dietitian before moving to health promotion where dietary aspects of my work was as a nutritionist. The distinction is important. As too is the distinction between prevention and cure, with a consensus that where possible prevention is better than cure. Both dietitian and nutritionist have a role in prevention of ill health but only the dietitian has a role in treatment, by way of a therapeutic diet. It can be compared with the example of a manufacturer producing fire retardant materials to help prevent fire: in the event of a fire we call the fire brigade not the cloth manufacturer.

However, clear though the distinction is, prevention and cure have been confused on more than one occasion. For example, sugar intake is restricted in the treatment of diabetes mellitus, but sugar intake is not the cause. And whilst it is not advisable to have an excess of sugar (it is inadvisable to have an excess of most things) avoidance should not be thought of?as the preventative against development of diabetes mellitus. More seriously, a ketogenic diet sometimes prescribed, and very carefully monitored, for one of a few conditions where the body’s physiological management of energy is impaired, is most definitely therapeutic not a preventative. We must take care that information taken out of a fuller context can risk using it inappropriately. In that respect, it is always important to be aware of what we don’t know: measuring levels of glycated haemoglobin can be an indication of how well glucose levels are being managed in diabetes mellitus; higher levels are also associated with iron-deficiency anaemia (the incidence of which is on the increase), but the mechanism remains unclear.

Is the confusion and subsequent relaying of misinformation due to ignorance, or one of the possible competitive factions?

Clear communication is critical in all things. Ashley Arnold in his post on 13th April, cites Daniel Bürkle, a senior lecturer in psycholinguistics, who notes multigenerational differences in the use and interpretation of language. I am guilty of what some of the younger generation apparently find baffling, the use of ellipsis. In my defence, it is partly because there are so many things that interrelate, but not so similar as to fit an ‘etc’, that it often seems the easy way out to use the three dots …, or sometimes even six dots, … … , or … , rather than risk missing out a significant example. I can always later say “well, of course, that … is what I was thinking of”. I confess to a possible overuse, no passive-aggressive intention. And I sometimes use capitals to make something stand out from a written stream of consciousness. Again, sorry, no intention to raise my voice to a shout.

To return to the question of sugar, briefly, it has already had more media attention than is good for us. In the early 1800s some Quakers notably avoided sugar because of its production being associated with the slave trade. That is not of the same relevance today (modern day slavery is a separate issue). Instead, we have considerations such as cane, beet, or alternative syrups; environmental factors; fair and wise trading - as with all products.

Professor Sumantra Ray Sumatra Ray, licensed medical doctor, public health registered nutritionist, and????the Founding Chair and Executive Director of NNEdPro, has been instrumental over many years in getting more nutrition onto the curriculum for medical students, which helps them identify when a referral to a dietitian is required. NNEdPro now has a broader role as the Global Centre for Nutrition and Health based in Cambridge. It includes work with other organisations and practical applications on many fronts. This blending of specialisations and actions within local communities is key.

My move from dietetics to health promotion was prompted, in part, by an invitation to speak on healthy eating to a group of teachers, who were meeting in a local health education and promotion unit. This is not a personal work profile, though it is pertinent to mention the rewarding involvement (once in the health promotion environment) in projects to help people to stop smoking. As with dietetics, there was a great deal of individuality. Sometimes the only thing two smokers had in common was that they smoked.?It made for some very interesting conversations and a great feeling of satisfaction (on all sides) when they gave up the habit.?It was collaborative work with a range of options of help offered, one of which was nicotine replacement patches. The head of pharmacy at the acute hospital trust at which I worked, was very supportive and agreed to a 12 hour nicotine release product even though a cheaper deal was on offer for 24 hour nicotine release: evidence was showing that a 24 hour release was more successful in the short-term but longer-term success was achieved when the smoker used alternative strategies for resisting the ‘first cigarette in the morning ritual’, and benefitted from the nicotine replacement that kicked in later.

I was particularly appreciative of the support from pharmacy as so often cost becomes the dominating factor. The words ‘independent’ and ‘evidence’ are not always trustworthy; other words to use in conjunction are ‘funding’ and ‘motivation’.

The help offered to smokers was prior to the vaping craze. Many aspects of that previous experience make me sceptical about promoting vapes as a useful tool in stopping smoking. Other factors come into play (absence of carbon monoxide and tars accepted as the positive): vaping is much cheaper than smoking - increasing the cost of cigarettes was a useful contributory factor to stopping; it is not certain that long-term there will be no lung damage from inhaling vapours; the addictive nature of nicotine is still present - wearing a patch rather than holding a ‘cigarette’ is more of an incentive to overcome the addiction; disposable vapes in different flavours and colours are becoming almost a fashion accessory, fun and trendy; an environmental hazard of the future from the plastic, electronic and ‘hazardous chemical’ waste. So, unfortunately, e- cigarettes are neither a preventative nor a cure. There is not a valid reason to ‘promote’ rather than permit.

My understanding of a mixed economy is that we combine opportunities for generating income from products and services from the non-essentials of life, with contributions made (usually to our government) by those able to make them in order to support those who are in a less fortunate position. The latter part of the mix, with which people are most familiar, is exemplified by our National Health Service. And that is why, in the 1990s, I was concerned to discover I was in a mix of unsavoury economic proportions.?

This is a mere outline of the experience. The health promotion post in question was based in the Occupational Health Department of an NHS University Hospital Trust. An American firm was to act as our consultants on how to attract work from the outside. In exchange we, the NHS, paid them a fee, expenses for travel and a sizeable portion of our income (not profit, income) from the outside contracts. No person we dealt with had any qualification in health education or health promotion. No contributions to staff salaries, or any parts of our work, were made by the consultancy firm - in practice it seemed more of a franchise. Their logo was printed on promotional materials used with clients: materials that our nursing staff worked on in order to ‘better fit’ the working practices of our NHS, before the American firm visited other NHS Trusts to gain further business. (Incidentally, one of the outside contracts was to provide a health promotion service to the staff at Quarry House, Leeds, home to the Department of Health. There, an extra layer of consultancy monitored their contract with us, though again no person was qualified in health promotion.) The crucial point is that I had done similar work in another district, based in a dedicated health education and promotion unit, where all generated income went directly into the NHS. ?

There is a well known quip those who can’t ‘do’ , teach. A teacher extended that to those who can’t teach, consult. The remark was made in relation to changing structures in education. Changes that pose similar concerns about decision-making, independence and use of limited funds that are raised in other public services. I have not the personal experience in schools to make assessments, I merely repeat what can be found on documents relating to academy trusts. Conversion to an academy trust from a local authority -run school is too complicated to detail here. Among other moves it involves land transfer, review of contracts already held for such as software licences, cleaning and catering (here a word from experience can be is permitted. Practice from a catering ‘chain’ can be less flexible, employees can lack the autonomy to collaborate on healthy eating projects). The governance structure of an academy trust will include members, a trust board, executive leaders, senior leaders, an audit and risk committee, and other committees or panels as decided upon individually. Salaries in the comparative ‘top’ posts: the Chief Executive Officer of an academy trust, or multi-academy trust, can vary - according, for example, to how many academy trusts come under the same governance - from in the region of ￡200,000 to ￡800,000 (no economy of scale); the salary of a Chief Education Officer in a local authority ranges from around ￡45,000 to ￡91,000 (presumably the range is also because of the number of schools under governance, though that has not been confirmed). School governors on a local authority board are not paid. They are all unpaid volunteers.

Perhaps Dr Thomas Young, born into a Quaker family in 1773, is not as well known currently as his knowledge and extraordinary life warrants.

He came to my notice when I was exploring the provenance of a porcelain service over 200 years old. The service was commissioned by a British engineer William Weston, and the sub-title of my subsequent book was In search of the Weston Connection. William Weston Young (a financial backer of the potter William Billingsley, a protagonist in the story) was a cousin of Dr Thomas Young. As a point of interest, great friends of the Young family were the Gurneys and the Barclays (linen merchants). The Gurneys were involved in banking from as early as the 17th century. By around 1830, Gurneys had 20 offices whereas their competitors had only a third of that number. Two Gurney sisters married into two generations of the same Barclay family unit. If the Gurneys had had sons, and the Barclays had had daughters, the well known banking institution we know today may well have been Gurneys. But no cause for a battle of the sexes on that score. Women can choose what name to use. It is of no comparison to the injustices and denial of rights to women that are taking place today.

But my reason for bringing Dr Thomas Young into the conversation in this context can be gleaned from the title of his biography by Andrew Robinson, The Last Man Who Knew Everything. As the cover of the book reads, the Polymath who proved Newton wrong, explained how we see, cured the sick, and deciphered the Rosetta Stone, among other feats of genius.

Professor Ray makes a considered distinction between training and education. Training is described as a strategy that can change knowledge, attitude and practices providing it is delivered effectively - it can provide tools and skills. Education has a greater focus on the ‘why’. Why are those skills needed? Why are those particular tools useful??

In order to answer the questions objectively we need to keep in mind the shared societal goals of the first paragraph.

To state the obvious, in summary. Education is paramount. Knowledge, expertise and experience, in depth and breadth, has to be shared. When this is in the form of committees or commissioned groups of various sorts, the members chosen must be appropriate for the task in hand (from an earlier example, in a fire risk assessment task one would not expect the seller of fire retardant material to be a decision-maker). In turn, the task must comply with the basic principles of fairness and equality for which we assume a consensus.?

11/05/2023