Poverty of Mind: the Cognitive Debt of the Poor

A study by UK Warwick University has proved that poverty has a negative causal effect on cognitive ability. The effect is signficant — equal to losing a full night’s sleep or comparable to the reduction of cognitive performance in alcoholic adults.

The pressures of poverty exhaust cognitive resources, hinders the ability to make positive life choices and shackles the poor to life-long poverty.

The study, “Poverty Impedes Cognition” led by Dr Anandi Mani, Economics Professor at Warwick University, (link) sheds new light on the prison of poverty proving for the first time that it is the flaw of poverty, not the poor, that maintains the poverty cycle.

“The poor, in this view, are less capable not because of inherent traits, but because the very context of poverty imposes load and impedes cognitive capacity.”

She adds; “The findings,in otherwords, are not about poor people, but about any people who find themselves poor.” Dr Anandi Mani, Economics Professor, Warwick University.

Research techniques

Poverty was defined in the study broadly as ” the gap between one’s needs and the resources available to fulfull them,” enabling the study of both developed and developing countries.

To prove the hypothesis that monetary concerns tax the cognitive system, cognitive excercises were conducted on participants recruited from a New Jersey Shopping Mall consisting of a “poor” group (average $20,000 household income) and a “well-off” (average $70,000 household income) group.

The laboratory testings were backed up with field tests on farmers; an ideal candidate for study due to the cyclic experience of poverty and wealth during the planting cycle.

Test 1 – poor v rich group

The two groups were given identical reasoning tests which were designed to induce thoughts about finance, specifically their own.

Participants were asked to problem solve to find the best method of repair for a car. One solution involved a minimal cost of $150, the other $1,500.

The solution involving $1,500 reduced cognitive performance among the poor but not in the well-off group. Dr Mani comments on the significance -

“Just as an air traffic controller focusing on a potential collision course is prone to neglect other planes in the air, the poor, when attending to monetary concerns, lose their capacity to give other problems their full consideration.”

The hypothesis of the cognitive testing was thus proved. Financial problems were not seen to cause concern in those with sufficient resources. For those without adequate funds the “load” of a financial problem can overwhelm the cognitive system -

“We hypothesized that for the rich, these run-of-the-mill financial snags are of little con- sequence. For the poor, however, these demands can trigger persistent and distracting concerns.” Dr Anandi Mani.

Test 2 – Harvesting cognition

Farmers were tested for their cognitive ability during the planting cycle. Before harvest when “poor,” farmers were less likley to perform well in cognitive tests. After harvest when “rich,” the cognitive performance of farmers significantly improved.

This proved the cognitive depletion in the same group of people who experience cycles of wealth. According to researchers, the findings could not be explained by nutrition, time available, stress or work effort alone.

The human cognitive system has lim- ited capacity Preoccupations with press- ing budgetary concerns leave fewer cognitive resources available to guide choice and action.

The researchers pointed that health programmes can be timed around the harvest to ensure that campaigns, such as the HIV campaign can be

A new insight into poverty

Reserach into poverty has focused mainly on the behaviours of the poor; low attainment in education, struggling with appointments, budgeting personal finance, engagement with services. This study is the first to look into how the behaviuors that excasperate poverty first come about.

The study allows for a deeper understanding of poverty and is the first of its kind to prove that cognition is affected by the obstacles that poverty gives rise to.

Researchers hope that the findings inform policy makers to make education, training, health and funding straight forward and easy to access. Policy makers should avoid all complexity or a “cognitive tax” on the poor -

“First, policy-makers should beware of imposing cognitive taxes on the poor just as they avoid monetary taxes on the poor. The data reported here suggest a different perspective on poverty: Being poor means coping not just with a shortfall of money, but also with a concurrent shortfall of cognitive resources.”

Researcher suggest simple and cheap interventions such as -

- smart defaults (selections put in place that serve most people)

- help to fill out application forms

- planning prompts

- reminders for appointments

Policy and Poverty

“Filling out long forms, preparing for a lengthy interview, deciphering new rules, corresponding to complex incentives,all consume cognitive resources. Policy-makers rarely recognize these cognitive taxes; yet, our results suggest that they should focuson reducing them.”

The benefit system can be labryinthin. Historical decisions by government can mean that puzzling systems are in place to serve the most vulnerable.

In a deprived UK coastal town, a community centre for section 4 failed asylum seekers supported by NASA are given food vouchers as subsidy with no other means of financial support. This means a food voucher is issued, but no means to buy a bus ticket to get to the supermarket – a large store on the outskirts of town.

A 2 mile walk of 45 minutes for those who know the best route. This town is a dispersion centre for newly failed asylum seekers – many have just arrived from other parts of the UK to miserably eek out a non life where everything is no – no right to volunteer, attend free training, work even. The weekly voucher is their lot. As they walk to the main supermarket, they will pass countless stores that would provide goods for cheaper.

This was the case in 2010. Shortly after an “Azure” card replaced the vouchers for one store to enable fairer shopping. It rarely worked (link).

The vouchers forced asylum seekers to sell food vouchers; nearly always being ripped off and at the same time risking their tentative section 4 status.

“This page explains how you may qualify for short-term support if your application for asylum was unsuccessful, but you temporarily cannot return to the country you came from and will otherwise be homeless or unable to afford food. (We call this ‘destitute’.)”

http://www.ukba.homeoffice.gov.uk/asylum/support/apply/section4/

Notes:

Science Magazine: Poverty Impedes Cognitive Function

http://www.sciencemag.org/content/341/6149/976

Medical News Today article

http://www.medicalnewstoday.com/articles/265501.php

via WordPress http://sallyburr.com/2013/10/14/poverty-of-mind-the-cognitive-debt-of-the-poor/

The whereabouts of worry; perseverative cognition and the left front lobe

In a longitudinal stress study by the American Psychological Association, more Americans than ever before reported struggling to cope with rising stress levels with 1 in 5 reporting a level of stress beyond their capacity to cope.

Chronic stress, especially when long term, can impact adversely on health. Untreated, stress can lead to or worsen a number of existing conditions such as -

• cardiovascular disease


• digestive problems


• obesity


• insomnia


• depression and anxiety

Stress impairs the immune system. We can be stressed until we are broken.

Modern life is stressful.

Mobile technology enables communication but shackles us to be available, accessible and always “on”. Links have been found between mobile phone usage and rising anxiety levels in mobile phone users, especially the young and the anxious. Living alone 16% live and eat alone – that’s a lot of us living without the support of a family unit. The figure of single occupation has nearly doubled in the last 40 years ago.

Career V portfolio The world of work has changed. The concept of career has evolved into a ‘portfolio’ of work opportunities demanding us to shape shift for each employer -11 on average.

Take home Home ownership is an unlikley concept for many. A large section of the working population are working for the cognitve reward of not being unemployed.

Those most vulnerable are those unprotected from the sharp edges of a changeable economy and an unstable workplace; the young, the poor and those with a disability.

“Millenials” (18-24) reported the highest stress levels. They proved too the most likely to engage in negative, dangerous coping activity. Young people without family, without financial support face the biggest trials.

The government is proving to be a harsh task masker. In the UK, benefits for young people as well as those for people with a disability have faced the biggest cuts. Today sees further announcements to young people’s benefits if they are NEET (Not in Employment, Education or Training).

The future for young people without recourse to support looks fraught.

The Future

It comes as little surprise that the World Health Organisation predicts that depression will be the largest threat to global health in 2030.

In the New England Journal of Medicine “Global Mental Health” researchers identify the most vulnerable groups as the young who do not have easy access to mental health services, the old who are not adequately catered for in terms of dementia care or elderly mental health and those in developing countries. The authors warn of “intense suffering.”

Subject to the vagaries of scale, depression can impair an individual’s natural ability to manage their everyday responsibilities. At it’s very worst it can incapacitate, hospitalize and lead to loss of life through suicide. Almost 3,000 lives are lost each day according to the WHO.

The young and the old are forever exposed to health inequality. Despite us all travelling from one port to another, we seem ignorant to the vulnerabilities until arrival.

The Mechanics of Worry.

Some people make decisions quickly, expertly, like cognitive knee jerks. Others ruminate, incapacitated by the myriad of options that a decision presents.

A study by Sussex University into the inner workings of chronic worry has pinpointed the site in the brain — the left front lobe, the exact same spot as complex thought.

A team of Sussex psychologists analysed 30 years of cognitive research to breakdown the components of worry finding that the part of the brain used in complex thought processes or “systematic processing,” is also activated in cases of “perservative cognition” – chronic, debilitating worry found in severe cases of depression.

Depressed, anxious people experience “effortful” thought and trigger systematic processing, non-anxious people have a more “heuristic” process – a quick, effortless “short cut” to decision making.

Unlike animals, people can replay distressing past and potential future images. It is often a component of depression, anxiety and post traumatic stress. This “perseverative cognition” involves rumination, negative thoughts and excessive analysis, often triggered by stress and when left untreated can be debilitating.

Non anxious people have a much easier ride than depressed people when making decisions and imagining the future – this new discovery goes in some part to explain why.

Notes:

Clinical Psychology Review

Systematic information processing style and perseverative worry

http://www.sciencedirect.com/science/article/pii/S0272735813001232

Affects of worry on the body: http://www.sciencedirect.com/science/article/pii/S0022399905002151

Depression: A Global Crisis PDF report http://www.wfmh.org/00WorldMentalHealthDay.htm

Stress in America: http://www.apa.org/news/press/releases/stress/

Image: RGB Free Stock

via WordPress http://sallyburr.com/2013/10/04/the-whereabouts-of-worry-perseverative-cognition-and-the-left-front-lobe/

Being Human, Social Media and the Science of Loneliness

credit:tacluda

200 million tweets are sent through 50 million Twitter accounts every day, 665 million people share 2.5B in updates, photos and likes on Facebook each month.

The number of people living alone and eating alone has nearly doubled in the last 40 years, rising from from 9 to 16 per cent.

To put these two together, one might wonder if we prefer each other with a screen in between.

What it means.

Possibly nothing.

If we are disintegrating collectively and filling a communal void with tweets, it's not happening quickly. Visually, behaviors seem to be changing but perhaps it is only our tools that are evolving.

Social media is a new tool, just as the telephone was a new tool in 1876. Life changing, yes, but were we not already talking to each other before Alexandra Bell came along?

And before social media, we communicated in all its splendor.

President Rutherford B. Hayes, after seeing the telephone demonstrated apparently commented to Alexandra Bell; "That’s an amazing invention, but who would ever want to use one of them?"

Everyone, it seems.

Less than 150 years later, the National Office of Statistics report that 94% of adults own a mobile phone. On the last count there were 82.7 million mobile phone subscriptions in the UK alone -- more phone subscriptions than pairs of ears.

Social media has unshackled us from the limits of sleep, work and study cliques. Connecting us beyond the immediate reach of an arm's length, we are freed a little. We can communicate quickly, cheaply -- for free even, and most importantly, whilst on the go.

For everyone of us, especially those of us with a disability, social media has been an enabler.

For those who have a disability, social media is an opportunity to showcase what they CAN do, rather than what they can’t. It gives them an opportunity to have others get to know them as ‘a person,’ rather than a person with a disability." Rachel Strella, Owner of strellasocialmedia.com @RachelStrella

It's hard to see a downside to our social needs being courted by social media.

Those quick to point out a slope would perhaps suggest that we are over reliant on social media, "phubbing" a friend at any given opportunity, becoming lonelier, more anxious, less willing to socialize, observing and "drinking people in" through screens, choosing information over experience.

The innovation of loneliness - http://vimeo.com/70534716

The Science of Loneliness

People have always been lonely.

The human capacity to feel alone starkly realized by poets and the chronically alone, long before the first scientific paper.

In the paper "Loneliness," John T. Cacioppo & Louise C. Hawkley of the University of Chicago's Center for Neuroscience trace the first scientific paper on loneliness just 50 years to the now classic psychoanalytic treatise by Frieda Fromm-Reichmann in 1969.

According to John T. Cacioppo and Louise C. Hawkley, we are at our loneliest during our teens and in our 80s -- travelling from one lonely port to another, free temporarily bar the misfortune of befalling "chronic" or "state" loneliness;

Chronic: the experience of loneliness particular to an introspective, depressive personality

State: the temporary loneliness experienced when moving to an unfamiliar new country, for example.

Snowflakes

There will always be the sociable and the less so.

Genetic disposition, social exposure and our personal need to reach out to others will always differ. We are snowflakes in our social needs.

Social media seems to have nestled into civvy street, yet bars have not closed (many have - recession is a deal breaker for low footfall), clubs are yet to follow suite. As my colleague *John pointed out recently, there are some things for which old fashioned face-to-face contact can not be beat.

Arguably, rather than our networks consisting of 500 people that we could not exchange a furtive glance with, they are perhaps instead built up around a nucleus of people we would be with regardless of a wireless connection.

We have them not just in our minds but in our pockets too. We can connect during our lonely commute, quicken the reality of a slow day or simply say hello just because we can. We have our fill of information, follow our interests and connect with those we might not normally sojourn with, and enjoy that too.

Cavemen gravitated around a quota of 150 meaningful social connections. Despite the passing of thousands of years, our limit for meaningful social connection still sits tight at 150.

In an article in Bloomberg Business Week, writer Drake Bennet explains how Robert Dunbar, evolutionary psychologist, studied the capacity for families to sustain meaningful relationships before the net revolution, with no networks to analyse.

Dunbar counted the number of Christmas cards sent by families to quantify the number of meaningful relationships in a household. Card sending proved a solid method of identifying evidence of a meaningful relationship - you need an address before you even think about it and the enthusiasm to keep the relationship going to bother with the lick, stamp and post. 153 was the average number of cards sent by a household to friends, family and colleagues.

Until our brains double in size, 150 social connections will be the maximum number of relationships that we can maintain. Anthropologists note that any group formed and spilling over this number causes groups to sub divide to form new groups until the death knell of 150 forces the group to divide again.Businesses, communities and tribes all follow this rule of thumb.

Path, an online business offering 'one-to-one' or 'one-to-many' private messaging and sharing, based their maximum number of file sharers on the 'Durbar' number of 150, effectively moulding their businesss to the human limit -

What Dunbar’s research represents is that no matter how the march of technology goes on, fundamentally we’re all human, and being human has limits,” Dave Morin, Path co-founder told Business Week.

We might have more than 150 in our networks but the surplus is just padding with potential - fluff for following curiosity, intrigue and future possibilities. Surrounding the core of family and friends and useful, curious and potent in the possibility to turn into future friends, lovers, employers or clients.

Loneliness and inclusive fitness

Survival, in the fullest sense of the word; surviving to have offspring who survived to have offspring, depended on social bonds.

And in many ways, it still does.

Many offspring normally need little or no parenting to survive and reproduce. Humans, however, are born to the longest period of dependency of all species, essentially making us the biggest babies of them all.

To survive and evolve, simple reproductive ability is not enough. A social skill or two is needed to render you a part of a group, ensure your family are protected in your absence, provide provision when you are unable to yourself and thereby enhance your "inclusive fitness" -

Moreover, social connections and the behaviors they engender (e.g., cooperation, altruism, alliances) enhance the survival and reproduction of those involved, increasing inclusive fitness"
John T. Cacioppo & Louise C. Hawkley

Loneliness, and its avoidance, is a useful evolutionary tool. To be lonely, one might be spurred into action to "not be lonely." In doing so, social bonds might be repaired thus increasing your inclusive fitness and incidentally helping to secure the survival of genes in the process.

The dark side

Evolutionary dud - socializing that doesn't end in meeting and reproducing might be seen as an evolutionary waster.

Social mobility - there is little going on. Despite the technology, the social structures of class still prove to be a hard nut to crack.

Burned out - people are "forever switched on" which has proved in a study by the University of Florida to led to increased anxiety in younger people, and those who suffer anxiety.

Feel good factor - there is little, for young adults especially. A study into how young people felt after time spent on Facebook show that despite it being "an invaluable resource for fulfilling such needs by allowing people to instantly connect," it also points to a subsequent nose dive in wellbeing -

"Rather than enhancing well-being, as frequent interactions with supportive “offline” social networks powerfully do, the current findings demonstrate that interacting with Facebook may predict the opposite result for young adults—it may undermine it."
Dr Ethan Cross, University of Michigan.

Intimacy is awkward and awkwardness is to be avoided.

Sherry Turkle points to a leaning on technology at a cost to intimacy and authentic connection in "Alone Together: why we expect more from technology and less from each other."

We are however still the ones behind the screens.

The complaint is perhaps not with technology, but with the larger disappointment of finding that, despite the networks, social media and the myriad of ways to connect, we are still at the core, somewhat lonely -

"The whole conviction of my life now rests upon the belief that loneliness, far from being a rare and curious phenomenon, peculiar to myself and to a few other solitary men, is the central and inevitable fact of human existence. When we examine the moments, acts, and statements of all kinds of people -- not only the grief and ecstasy of the greatest poets, but also the huge unhappiness of the average soul…we find, I think, that they are all suffering from the same thing. The final cause of their complaint is loneliness." Thomas Woolfe

Notes:

University of Michigan - Facebook Use Predicts Declines in Subjective Well Being in Young Adults http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0069841

Twitter blog figures:
https://blog.twitter.com/2011/200-million-tweets-day

The Rise of the Lonely Single:
http://metro.co.uk/2013/03/07/the-rise-of-the-lonely-single-twice-as-many-people-living-alone-3532248/

Imagining the Internet
http://www.elon.edu/e-web/predictions/150/1870.xhtml

Business Week article: The Dunbar number
http://www.businessweek.com/articles/2013-01-10/the-dunbar-number-from-the-guru-of-social-networks

An Existential View of Loneliness http://www.philosophicalsociety.com/archives/an%20existential%20view%20of%20loneliness.htm

Image credit: thanks to Adrian van Leen of RGB Free Stock (taluda) http://www.rgbstock.com/user/TACLUDA

D is for Discrimination; The Rhetoric of Obesity.

Obesity is a threat to global health – the World Health Organisation reports that 2.8 million die each year as a result of obesity. 65% of the world’s population live in a country where overweight kills more than underweight.

According to the Trust for American Health, today’s generation will be the first in US history to live shorter and sicker lives than their parents.

The environment for many is “obesogenic,” by it’s very nature it contributes to obesity as a consequence of it being built up, urban, and offering only limited access to nutrient food and recreational space, yet an abundance of junk food.

In many ways, there is an element of powerlessness for the individual. This has been highlighted in the UK Gov Foresight report; “Tackling Obesities – Future Choices Project”, a UK Government Office of Science study into obesity. One of the main findings by the study is that obesity can no longer be prevented by individual action alone.

 

Major findings of the Foresight report  include -

• Modern living ensures that each generation is heavier than the one before
• The obesity epidemic cannot be prevented by individual action alone
• Preventing obesity requires a societal challenge, similar to climate change

 
 

Despite the research, the modern obesogenic environment that has been created is often ignored — blame set squarely on the lap of the overweight individual for being overweight. Disapproval for obesity is prolific; evident in media, society and individual opinion.

Images of obese individuals are prerequisite of articles on weight and obesity. The cliché of the typical overweight image in media made number 7 in the Independent Top Ten Visual Clichés, sharing the list of tired clichés along with wedding cake decorations for gay marriage, (number 1) and gas cooker flames for gas bill price hikes, (number 4).

Clichés are easy, and useful. The trouble with a cliché (excuse the one coming….) is that when a cliché is an image, it can speak a thousand words — most of them discriminative when compounding negative views held against a vulnerable group. A study published in PLOS One  found that most people considered overweight people as “lazy, unsuccessful, weak-willed” – an image of a large person at a fast food outlet will only cement the idea of the overweight as defective, less than.

 

D is for Discrimination

 

Women and children of low-income or low social economic status have been proven to be consistently more at risk of obesity than any other group, according to research by the Food Research and Action Center (FRAC).

Adult Poverty and Obesity, The Relationship Based on General Trends (excerpt) -

• Based on a large national study, body mass index (or BMI, an indicator of excess body fat) was higher every year between 1986 and 2002 among adults in the lowest income group and the lowest education group than among those in the highest income and education groups, respectively (Truong & Sturm, 2005).
  
• Wages were inversely related to BMI and obesity in a nationally representative sample of more than 6,000 adults – meaning, those with low wages had increased BMI as well as increased chance of being obese (Kim & Leigh, 2010)

With obesity proven to be the shackle of a specific group — low income, uneducated women and children, it is outdated to condemn the individual, to trivialize, or question the validity of obesity as a disease.

Yet, it happens, frequently and publicly. Obesity has made recent headlines in national media and the world has seen the best and the worst of  journalist puns on weight; “The Big Fat Lie,” “The Big Fat Truth,” “Fat Profits,” “Heavy Burden,” and even “F is for Fat,” — the title of an official study into obesity by the Robert Wood Johnston Foundation.

Obesity can cause obesity related cancers, Type 2 diabetes, cardiovascular disease. It is difficult to imagine any other disease so open to puns and play on words.

Is obesity, the last form of socially acceptable discrimination? Joseph Nadglowski of the President of the Obesity Action Coalition, thinks yes -

"Obesity carries with it one of the last forms of socially acceptable discrimination. We, as a society, need to make every possible effort to eradicate it from our culture.” Joseph Nadglowski, President and CEO,  Obesity Action Coalition

The Consequence of Weight Bias

In a study by Florida State University College of Medicine, researchers proved that perceived weight discrimination leads to longitudinal changes in obesity.

Published on PLOS One, “Perceived Weight Discrimination and Obesity,” researched by Angelina R. Sutin Ph.D.,  and Antonio Terracciano Ph.D studied  6157 patients over a 4 year period, tracking BMI’s and individual experiences of  perceived weight discrimination.

Participants rated  experiences of everyday discrimination in a psychosocial survey,   attributing perceived discrimination to weight, ancestry, sex, race, age, physical disability, any other aspects of their physical appearance, and/or their sexual orientation.

4,193 of the 6157 were at baseline BMI at the beginning of the study — 1,964 were clinically obese.

Of the 4,193 participants who were not obese at baseline, 357 (5.8%) became obese by follow-up, and of the 1,964 participants who were obese at baseline, 1,618 (26.3%) remained obese at follow-up.

Participants who reported experiencing a perceived weight discrimination were 2.5 times more likely to become obese, and obese participants 3 times more likely to remain obese than those who had did not report experience weight discrimination.

These effects held even when BMIs were used as  a variable to predict outcomes, and despite ethnic and other bias affecting results.

Why Weight Bias?

According to a Rudd Center for Food Policy and Obesity report, weight bias exists because as a society, we share a belief that individuals are responsible for their own weight and refuse to consider the environmental conditions that cause obesity. Culturally, we value thinness, and, anything that strays from the acceptable idea of body image is considered a flaw, a failure even, belonging to the individual. Negative views are further compounded by negative portrayal of obese individuals, coupled with a media obsession with the body and its appearance.

According to researchers, discrimination against obese Americans is pervasive in society. Such biased and negative attitudes are thought to lead to depression,  a negative effect on employment opportunities, salary disparities, healthcare access.

The Rudd Center found in a recent study that even mental health workers working specifically with patients with eating disorders were “not immune to weight bias.”

At its worst, discrimination against people with excess weight can lead to the very behaviors that exasperate obesity; avoiding physical exercise and binge eating, and, as the study by the Florida State University College of Medicine proves, a longitudinal weight increase.

The measure of a society has long been judged by how it treats its weakest -

"Any society, any nation, is judged on the basis of how it treats its weakest members — the last, the least, the littlest.” ~ Cardinal Roger Mahony, In a 1998 letter, Creating a Culture of Life

An inability for us to foster compassion for those who suffer the consequence of health and economic inequity, makes us all small.

Notes:

The Independent, Top Ten: Visual cliches

http://www.independent.co.uk/news/media/tv-radio/the-top-ten-visual-clichs-8665467.html

Foresight Report – Tackling Obesities – Future Choices (2007)

http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Publichealth/Healthimprovement/Obesity/DH_079713

FRAC: Relationship between Poverty and Obesity

http://frac.org/initiatives/hunger-and-obesity/are-low-income-people-at-greater-risk-for-overweight-or-obesity/

 

Perceived Weight Discrimination

http://www.plosone.org/article/info:doi/10.1371/journal.pone.0070048

Consequences of Obesity (FRAC)

http://frac.org/initiatives/hunger-and-obesity/what-are-the-consequences-of-adult-overweight-and-obesity/

Rudd Center for Food Policy & Obesity

http://www.yaleruddcenter.org/mental-health-professionals-treating-eating-disorders-are-not-immune-to-weight-bias

Image credit: RGB Free Stock

Thanks to photographer tacluda

Doctors, Identity, Socia Media. Crisis or Kink?

credit:saavem

A new platform, a new potential – a new potential problem. Tweets, blogs, posts, “many to many” e-communications have created fears over doctors having an online voice within a public domain.
For all health professionals, social media poses an opportunity and a challenge.
Fast and free, many-to-many messages enable engagement within communities, with patients, and an opportunity to set the health record straight in a misinformed media.

This new e-voice comes at a cost. By its very nature, the internet is a disobedient arena. A cause for concern for reasons highlighted by researchers at John Hopkins University -

• messages can spread with little control
• boundaries can blur
• mini blogging misdemeanours are open to public viewing at best, public sharing at worst

Official guidelines by the American Medical Association (AMA) advise physicians to consider a double online identity; one professional and one private.

Not since the strange case of the troubled Dr Jekyll has a doctor been subject to grapple so with their identity. The 21st century physician faces a far less odious and much more common conflict; to jump in with all 10 digits as a professional doctor, or as a Mr/Mrs/Miss/Ms, or not at all.

 

Identity Crisis or Kink?

John Hopkins University associate professors researched the modern day dilemma of doctors tweeting in a recent article in the Journal of the American Medical Association; "Social Media and Physicians’ Online Identity Crisis."

The team, Mathew DeCamp MD, Thomas W. Koenig, MD and Margaret S. Chisolm concluded in favor of doctors having an online identity within their professional capacity, rebuking guidelines to manage a double persona. The reasons put forward for engaging within social media as a professional health practitioner include -

⦁ to have two separate identities online is impossible. People can connect the “professional” you with the “personal” you in a snap
⦁ the positive impact of doctors tackling misleading medical information outweighs the potential pitfalls
⦁ opting out of the online conversation is not an option. Engagement is a must.

The recommendation by the American College and Federation of State Medical Boards (FSMB) to have two identities is impossible according to the John Hopkins team, simply because “with minimal information, searching the web can quickly connect professional and personal content.”

Dr Jekyll was never a good advocate for doctors dabbling with more than one identity. Even in the less curious of cases, managing dual identities is hard work and according to John Hopkins’s research team, essentially ”operationally impossible.”

As any good Careers Counsellor will tell you, the professional self is an extension of the personal; a complex interplay of everything that makes us individuals with the allsorts that adds meaning to our lives.

To divide the two would be a separation “verging on the nonsensical,” researchers conclude.
People are not just their jobs. As one Doctor, dying and intending to tweet from her death bed to normalize the death process demonstrates in her Twitter biography. Not just doctor, but patient too -

"Wife, daughter, sister, aunty, friend, doctor, patient and author. Always trying to look on the bright side of life…" Wakefield · theothersidestory.co.uk @grangerkate

 

What Tweets?

Dr Katherine Chretien, an Internist at the Washington DC VA Medical Center looked into the content of doctors tweets by analyzing 260 Twitter accounts. To be included in the study, each doctor had to have at least 500 followers.

A total of 5,000 tweets were analysed. The last 20 tweets of each user sent between May 1st and May 31st were categorised by Dr Chretien’s team as either “health related”, “personal” or “inappropriate.”
Agreement was implicit in 78% of cases. Of the tweets that were classified by a tweet judge as inappropriate, consensus was sought in the team to confirm the original moderator’s suspicion of a tweet.

The results were published in JAMA. Of over 5,000 tweets -

• 49% (2543) were health or medical related
• 21% (1082) were personal communications
• 14% (703) were retweets
• 58% (2965) contained links
• Seventy-three tweets (1%) recommended a medical product or proprietary service
• 634 (12%) were self-promotional
• 31 (1%) were related to medical education

One hundred forty-four tweets (3%) were categorized as unprofessional, of which -

• Thirty-eight tweets (0.7%) represented potential patient privacy violations
• 33 (0.6%) contained profanity
• 14 (0.3%) included sexually explicit material
• 4 (0.1%) included discriminatory statements.

You can very quickly match doctors with their content, according to Dr Kathleen Chretien and her research team.

“Of the 27 users (10%) in our sample responsible for the potential privacy violations, 92% (25/27) were identifiable by full listed name on the profile, profile photograph, or full listed name on a linked Web site.” Dr Kathleen Chretien comments in the JAMA article.

 

Still, It’s Good to Tweet

The John Hopkins article however would argue perhaps that despite the 3% of tweets being classed as unprofessional, physicians active on social media object to giving up an e-voice for exactly the same reasons that others argue it should be quashed.
The article highlights that social media by it’s very nature -

> blurs boundaries
> levels hierarchies
> leads to transparency

One self confessed twitter user would agree. Lisa Rodrigues CBE, NHS Chief Executive urges senior medical staff to tweet because “it is just a new way of communicating. It’s free, it’s easy and it’s totally in your hands.” Lisa Rodrigues, NHS Executive and CEO Sussex Partnership Trust.
Lisa adds, “Social media is just another way to network. And good leaders must be great networkers. Otherwise how can we learn, keep in touch with our own people and share what we are thinking or doing to help the people we are here to serve?”

Lisa’s reasons for using Twitter include -

1. To share good news, in 140 characters and via links to my weekly blog or other things on our website
2. To talk about the difficult stuff – such as when we make mistakes, or the stigma our patients, and our staff, face on a daily basis
3. To make contact with people whose ideas or chutzpah I admire
4. To hear about and discuss new ideas
5. To encourage and motivate people – myself and others
6. To signal change or challenges such as the impact of the recession on the NHS
7. To talk about trivia (eg *The Archers) * a popular UK radio serial
8. To hone my writing skills – you would be surprised what an improvement using 140 characters can make
9. To show I’m human
10. To say what I’m thinking without anyone editing it or giving it their own spin.
My name is @LisaSaysThis and I am a Twitter addict.

Social or Asocial Media?

Regardless of our position we should all tweet with care. For a doctor to ignore the online conversation is not an option. To juggle a professional and personal online voice is up to the particular tweeter, as long as they are aware that there is no guarantee that their professional identity is concealed. Armed with a wireless connection, anyone can quickly track you to your professional persona.
The real question is why wouldn’t you tweet/blog? The internet is the 21st century information party where everyone is clambering for health information. It’s where patients are answering their health questions, rightly or wrongly. Nibble a volauvent and rely, as John Mandrola suggests on common sense to see you through, but just make sure you are there -

The bottom line is always the same. Success comes from mastery of the obvious. Common sense, decency, truth and admitting one’s mistakes will rarely steer you wrong” John Mandrola is a cardiologist who blogs at Dr John M.

Notes:John Hopkins University: Social Media and Physicians’ Online Identity Crisis
Social Media JAMA article (link)
Dr John M, Heart Rhythm, Medicine and Health
www.drjohnm.org ‎
Blog of Dr John Mandrola: Commentary on electrophysiology, atrial fibrillation, healthy living, cycling, and knowledge.
Image: RGB Freestock “saavem”
http://www.rgbstock.com/user/saavem

Patients lose trust in “scruffy” UK doctors, or do they?

credit:lusi

The visual tell tale signs of a hospital doctor – long sleeved shirt, tie and white hospital coat banned in 2005 as part of the infection control measures against the spread of MRSA and C.difficil has led to patients apparently losing trust in “scruffy” NHS doctors.

According to critics, doctors no longer look like doctors. One anonymous consultant told the Sunday Times –

"If you come to see a consultant, you will be greeted by an open-neck-shirted doctor who will look as if he is the hospital DJ, but will in fact be the consultant.”

Dress code

In a bid to reduce the spread of MRSA and C.Diffficil, the NHS introduced a dress code banning ties, long sleeves and “superfluous” clothing.

The only “safe” dress options for doctors were scrubs and open necked short-sleeved shirts. A Dickie bow tie seemingly the only item at a male doctor’s disposal to set himself apart from the hospital DJ.
At the same time as the dress ban, a host of initiatives were introduced as part of the infection control measures including;

• hand washing
• sanitizers and gloving
• linen handling
• environmental cleaning
• increased hygiene reporting

MRSA and infection control

MRSA, a “staph” germ, is the only staph strain resistant to first line antibiotics. Typically spread through physical contact, once entering the body MRSA can spread to bones, joints, the blood, the lungs, the heart, or the brain.
Serious staph infections are more common in a weakened immune system; patients most vulnerable are those in hospitalized for long durations, on kidney dialysis, cancer patients or those who have had surgery within the last year.

The Health Public Authority (HPA) now publish MRSA and C.difficile infection data for every hospital each week. Mandatory surveillance now also includes figures for MSSA (Methicillin-Sensitive Staphylococcus Aureus) and E.coli infections.

The infection control measures of 2007 have so far been successful. Instances of MRSA cited on death certificates has fallen by 77 per cent:

In 2007 – a total of 1,593 cases of MRSA were recorded on death certificates.
By 2011 – only 364 cases of MRSA were recorded on death certificates.

 

Critics

Critics of the dress code are however not convinced that the dress ban has had any proven effect. Dr Stephanie Dancer, medical microbiologist in NHS Lanarkshire and member of working groups on antibiotic prescribing, MRSA and hospital cleaning, speaking on Radio 4 to Mark Porter on Inside Health commented -

“Yes figures of MRSA – certainly we have seen figures for those plummet, but to say that is attributable to the dress code? No, I don’t think we can say that. I don’t think there’s any evidence to support that.”

Dr Dancer added that is is not the lack of doctors in ties that has reduced infection rates, it is instead the result of a “bundle” of initiatives introduced since 2007. The compulsory scrubs she claims have simply “eroded the doctors status.”

NHS “v” private hospital

Mark Porter on Radio 4′s Inside Health noted the “transformation” seen in doctors attire depending on whether they were working within a NHS or private hospital. The very same senior doctors seen working bare below the elbow for the NHS will “transform into full pin stripes” for consultation work in private hospitals. Dr Stephanie Dancer added -

If the suit is good enough for the private hospital, it’s good enough for the NHS.”

 

Will the US follow suit?

Unlikely. In the US, the American Medical Association (AMA) considered adopting a similar UK dress code in 2009. A proposal for a “no hospital coat” policy was scrapped after US doctors voiced heavily in favor of keeping their traditional hospital garb. Dr Mark Hochberg, a professor of surgery at NYU’s Langone Medical Center claimed that a physician wearing a white coat was a symbol of 20th century medicine.
The US debate was policy free, but not mirth free with many suggesting the bare option, started by “Anonymous” on the “Not Running a Hospital Blog” -

Anonymous said…

I guess, if we are going to be absolutely safe, doctors should be naked.”

Doctor’s prognosis

What do doctors think? Opinion is divided. However, Dr Jonathan Afoke, Cardiac Surgery Registrar at Leeds General Infirmary commented that his identity as a doctor had nothing to do with his dress code.

Appreciating the need for basic professional attire and a personal tendency to opt for a pressed shirt and trousers, Dr Jonathan Afoke felt that the role of being a doctor was summarized aptly within a quote from a patient –

I had all these strange people I’ve never met see me every day, but I always knew that you would sit down with me and my family every day to explain things, so you’re my doctor.”

Hippocrates set out principles 2,500 years ago for doctors to adhere to, much of which makes up the professional code of conduct for doctors today. One notably reminds the practitioner to remember that the patient is a human being –

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being”

For this, you don’t need a hospital white coat, shirt, or Dickie bow tie.




Notes:

NHS dress code recommendations
http://www.nhsprofessionals.nhs.uk/download/comms/CG1_NHSP_Standard_Infection_Control_Precautions_v3.pdf

Hospital Infection figureshttp://www.hpa.org.uk/NewsCentre/NationalPressReleases/2009PressReleases/090910MRSAandCDifficilecontinuetofall/

Radio 4: Inside Health
http://www.bbc.co.uk/search/?q=scruffy%20doctors

Not Running a Hospital blog spot
http://runningahospital.blogspot.co.uk/2007/09/tie-one-on.html


Image credit: RGB Freestock "lusi" http://www.rgbstock.com/user/lusi

First generation in US history to live shorter lives than their parents.

Today’s US children are destined to be the first generation in 200 years to live shorter lives than their parents, according to a report by the Trust for American Health (TFAH).
Between 5 and 11 years is feared to be lost from the average life span of 75. Jeffrey Levi, PhD, executive director of TFAH claims that children’s lives will not only be shorter, but sicker too if current trajectories in obesity, cancer, Type 2 diabetes and heart disease continue at the current rate;

“Today’s kids could become the first in American history to live shorter, less healthy lives than their parents.” Jeffrey Levi, PhD, executive director of Trust for American Health

The antidote to the crisis is the Health Prevention Fund; a $14.5 billion US government investment enacted by the Affordable Care Act, 2010. The fund is the largest investment ever in prevention care. Prior to the Act, only 3% of health care funding was allocated to preventative health care. 75 per cent of the $2.5 trillion spent on U.S. medical care was spent on treatment of chronic, preventable disease such as heart disease and Type 2 diabetes.

Sequestering of government budgets has seen cuts to the Health Prevention Fund of $51 million. Despite this, the US government is confident that the fund can contribute to a preventative health care system to replace the current “sick care” system.

The Health Prevention Fund is the single largest investment in prevention health in the US, despite cuts or “safe guarding” of budgets.

The $14.5 billion dollars, to be attributed over a 10 year period, will lead to a number of investments to include:

• Vaccinations for Children (+$261.955 million)
• Chronic Disease Prevention and Health Promotion (+$128.699 million)
• Affordable Care Act Prevention and Public Health Fund (+$78.210 million)
• Domestic HIV/AIDS Prevention and Research (+$40.231 million)
• Health Statistics (+$23.150 million)
• Food Safety (+$16.735 million)
• Polio Eradication (+$15.079 million)
• National Healthcare Safety Network (+$12.628 million)
• Tobacco cessation (helpline and education) (+$6.040 million)

Community Transformation Grants (CTG) — ambitious, community-centered grants enabling communities to respond to health inequalities from within the community they originate have pre set targets to be achieved within a 5 year period.

CTG targets include:

• reduce a community’s rate of obesity by 5%
• reduce death and disability from heart disease and stroke by 5%
• reduce death and disability due to tobacco use by 5%

The TFAH report documents a number of successful CTG programs that have been in operation including in Akron, Ohio the CTG fund has helped to reduce the average care cost per month for type 2 diabetes by more than 10% saving an estimated $3,185 per person, per year. West Virginia has implemented policies for safety, school nutrition and physical activity and Iowa, which is cultivating healthy lifestyle accountability through a partnership between health providers and community agencies.

Adult obesity has doubled since 1980 from 15% to 30%. By 2030, more than 60% of adults in 13 US states could be diagnosed with obesity if current trajectories continue costing $196 in lost productivity and $213 billion in direct medical costs. Despite obesity costing the country $147 billion in direct healthcare costs each year and two thirds of Americans currently either obese or overweight, the US has adopted a tentative strategy towards the activity of the food industry.

The US drafted “Voluntary Guidelines for the Marketing of Food to Children” — self regulatory guidelines that are open to be adopted, or ignored. The UK, facing similar obesity issues, has set out a similarly tentative business ‘Pledge’ – companies volunteer to pledge to meet salt and fat targets and remove trans fats. Both are ‘opt in’ recommendations. According to Small Business, only 11% of UK companies have signed up for the Pledge scheme.

Investment in the future health of the US and UK needs to be big.  According to a report by The Telegraph, Kraft has recently set aside a massive $26million pound investment in the development of R & D Centre (Research and development) for its UK base alone. The opening of the centre which includes innovation labs, a pilot plant facility, 3D printers and a ‘collaborative kitchen’ for experimentation with new ideas, comes after Kraft revealed profits rose 54% to £521m ($830m) for the final quarter of 2011.

“Joyville” perhaps for Kraft, but not for the US and the UK who already face a tough battle for a healthy future.



Notes:

The Truth About the Prevention and Public Health Fund
http://healthyamericans.org/assets/files/Truth%20about%20the%20Prevention%20and%20Public%20Health%20Fund.pdf

Fact Sheet – Health Prevention Fund
http://www.apha.org/NR/rdonlyres/3060CA48-35E3-4F57-B1A5-CA1C1102090C/0/APHA_PPHF_factsheet_May2013.pdf

Dept of Health and Human services (budget appropriations):
http://www.cdc.gov/fmo/topic/Budget%20Information/appropriations_budget_form_pdf/FY2013_CDC_CJ_Final.pdf

Joyville at Cadbury (Kraft)
http://www.cadburydairymilk.co.uk/

Sleepless Nights and Restless Legs: New Study Offers Hope for RSL Patients.

John Hopkins researchers may have discovered why insomnia persists in patients with restless leg syndrome (RLS), despite successful treatment of the condition.

An estimated 5 per cent of the U.S. population has Restless Leg Syndrome, also known as "jimmy legs" - a common condition affecting the nervous system causing an uncontrollable urge to move the legs.  The condition varies in severity and can be painful, distressing and interrupt daily activities as well as disturb sleep.

RLS patients commonly suffer from poor sleep as the actual activity of lying down and relaxing in preparation for sleep can activate RLS symptoms - relieved only by rising and moving.

The disruption of neurochemical signals has been identified as a key factor in causing the involuntary movements in RLS, often characteristic of Parkinson's disease. Neurologists have previously based treatment on the understanding that Dopamine is the main culprit in Restless Legs Syndrome.

However, despite drugs that increase the levels of dopamine levels being used in the treatment for RLS, studies have shown that they do not improve sleep outcomes and only treat the restless legs.
A research team led by associate professor of neurology Richard P. Allen, Ph.D from John Hopkins University School of Medicine has looked into solving the sleep anomaly, using MRI to image the brain in a group of 28 RLS patients and 20 non RLS patients.

Glutamate, the neurotransmitter involved in arousal, was found in abnormally high levels in the RLS group. The higher the level of glutamate recorded in the brain of those with RLS, the worse the patient’s sleep.

The research team recorded MRI images and glutamate activity in the thalamus - the part of the brain involved with the regulation of consciousness, sleep and alertness.
RLS patients included in the study had severe symptoms which exhibited:

• six to seven nights a week
• persisting for at least six months
• an average of 20 involuntary movements a night or more.

The second stage of the study involved a two day sleep study on the RLS and non RLS group.  RLS patients were reported to have received 5.5 hours sleep on average.  A direct link between glutamate levels in the thalamus and the number of hours sleep received was identified. There was no such association within the non RLS control group.

Richard P. Allen, Ph.D., is hopeful that the team may have discovered the reason why Restless Legs Syndrome also affects sleep in RSL sufferers -

 “We may have solved the mystery of why getting rid of patients’ urge to move their legs doesn’t improve their sleep,” Allen says. “We may have been looking at the wrong thing all along, or we may find that both dopamine and glutamate pathways play a role in RLS.”

The results of the study could change the way RLS is treated and could potentially eradicate sleepless nights for patients with Restless Legs Syndrome.

Dopamine-related drugs which are currently used in the treatment of RLS do currently work, yet many patients lose the drug benefit and require ever higher doses. If  the dose is too high, the medication can aggravate RLS symptoms to a state worse than prior to treatment.

Allen points out that despite drugs already on the market being available which can reduce glutamate levels in the brain, such as the anticonvulsive gabapentin enacarbil, they have not been given as a first-line treatment for RLS patients.

As more is understood about this neurobiology, the findings may not only apply to RLS, he says, but also to some forms of insomnia.

“It’s exciting to see something totally new in the field — something that really makes sense for the biology of arousal and sleep,” Allen says.

Notes:
The study was funded in part by the National Institutes of Health’s National Institute of Neurological Disorders and Stroke (R01 NS075184 and NS044862), the National Institute on Aging (P10-AG21190) and the National Center for Research Resources (M01RR02719).

Other Johns Hopkins researchers involved in the study include Peter B. Barker, D.Phil.; Alena Horska, Ph.D.; and Christopher J. Earley, M.D., Ph.D.

http://www.hopkinsmedicine.org/neurology_neurosurgery/specialty_areas/restless-legs-syndrome/
Image: credit to xymonau at RGB Free Stock http://www.rgbstock.com/images/sleep

A Day in the Life of Shelley and Kev's 1066 Cake Stand. What's it like to run a vegan cake shop?

I am guest posting and guest sitting in Shelley and Kev's 1066 Cake Stand shop. It’s a real eye opener to the hard graft of working for yourself and running a shop. My hat off to you all. 

Shelley and Kev have a shop – The 1066 Cake Stand in Queen’s Road in Hastings and sells vegan cakes and savories and has been since 2012.


I normally work in an office so it is a right old treat to have the day off and be part of the comings and goings of a real live local shoppe.

I’ve been here since 11.30am and so much has happened today and yet it’s not even the book end of the day. We’ve had regulars coming in all morning for their weekly supplies of gluten free goodies, a lady who drove all the way from Crowhurst to pick up a giant vegan wedding cake for her daughter and a man from the council talking in dulcet tones about all the complexities of extending a license to include alcohol. Not any ole boozy woozy mind, but a select vegan and local beer and ale that is coming along soon. Hastings Vegan Brewery – very exciting and a marriage I approve of.



In my office, you don’t need to expect the unexpected but you DO it seems when you work on your todd in a shop. Shelley is like a skilled ninja of conversation and can talk to anybody who appears on her shop stop. At this very moment she is outside and touting her fresh bread to passers by. Ooh someone has just stopped to have a little crunch – a nice young chap having a nibble looking well chuffed; I can hear him promise to come back with his girlfriend to try some cake. Next there is a handsome man outside with, oh boo girlfriend/wife, and they’re sharing a nibble of gluten free bread on their way past. Cor you have to be brave to run a business. I do talk to people at work, but not in the way where I need to jolly them along into a purchase, more in a “pass the stapler” way. It’s a different world.

2.00pm - It’s all gone a little quiet. I think people are too weak from the heat to buy, eat, etc. Shelley said that the heat is like a slap in the face. Poignant.

2.45pm - how the landscape changes! A gaggle of 10 people are clamoring in the shop. What a surprise! A big group of workers on an away day from a Brighton nursery have popped out of nowhere and they seem well chuffed to find a vegan yum shop. You couldn’t predict that you would have a bale of hay one minute followed by a mass of people the next. Now the shop is teeming, everyone else wants a slice (ho ho) of the action and are all about the door and it feels all exciting like Christmas, except it’s boiling and not like Christmas at all.

3.00pm Shelley is all a busy bee now with doing business stuff on her computer  -  emails, invoices and oooh most exciting of all is the news that 1066 Cake Stand has been shortlisted for the 1066 “Eatery of the Year” award. So a posh black tie event is on the cards for next Friday and maybe a shiney award will be glinting in the window from next week. You will have to keep an eye out to see. Shelley reckons she will do a “Gwynth” if she wins and has to do a speech. Can’t wait to see her blub. Not really

1066 Business Award category –
Eatery (Restaurant / Pub / Cafe) of the Year
Sponsored by: Bannatynes Spa Hotel, Hastings
Award for a local restaurant, café, pub that can demonstrate outstanding creativity,
customer service and top quality dining / food in the Hastings and Rother area.

The till is running through. Not sure if it is polite to ask how much is chugging through but it sounds like a healthy noise.

4.11pm Shop is shut. Shelley has just put some gluten free bread in front of me and I am going to have some. Yum.

4.00pm – nearly shutty up shop time. It’s all quiet now and Shelley is washing up and putting things away and getting ready for tomorrow with all the efficiency an cuteness of a little Disney character bird.

4.15pm I didn’t travel in a time machine! I got my times mixed up. I think it is time for me to go home. Bit pooped strangely and in awe of how many skills you need to work for yourself – a right old melee of conversationalism, friendliness, business acumen and not to mention being able to master the craft of bakery too.

Thanks for having me Shelley and Kev. I am going back to the office though where it is safe. Good luck on Friday, 26th of July. I hope you win.

You’ve got my vote, super woman!

UK Gov: "Obesity can not be prevented by individual action alone."

Obesity is no longer a problem that just threatens the future of the US. A research paper published by Foresite of the Government Office for Science warns that 61.3% of adults and a third of children in the UK are now clinically overweight or obese.

Incidents of obesity have increased since 2001 with alarming speed. Figures published by the National Office of Statistics report that 11,736 children and adults were admitted to hospital with a primary diagnosis of obesity in 2011/12 - a ten fold increase in just ten years.

Stomach stapling, gastric bypass and sleeve gastroectomy have seen a year on year increase in the number of procedures recorded. 261 procedures were carried out in 2000/01, and according to the NHS this figure has risen to 6,723 in 20011/12. Gastric bands alone reportedly cost the UK health service £85 million a year.

Obesity is life limiting,  life threatening and leads to premature death. Obese patients can suffer heart disease, strokes, obesity related cancers, hypertension, arthritis and asthma as well as serious physical injuries resulting from falls. According to the UK Government research, obesity can also cause feelings of low self worth, mental health problems and difficulties in gaining and sustaining employment.

Three major findings of the Foresite report are -

• Modern living ensures every generation is heavier than the last
• The obesity epidemic cannot be prevented by individual action alone
• Preventing obesity is a societal challenge, similar to climate change
  

Costs are high to health and to society. Using Department of Health data, the projected price tag to the NHS could double to £10bn a year by 2050. The wider cost to employers and the economy will be much greater - higher rates of obesity are associated with absence from work, early retirement and an increase in disability pensions.

In response to the Foresite report, the government has set out a target for a "downward trend in obese adults and a sustained downward trend in excess weight in children." Tame rhetoric for a health crisis that is as pressing to health as climate change is to the environment.

The US and the UK are hit with an obesity epidemic which is only set to worsen. Marketing of "junk" - high fat and zero nutrient convenience foods, are a major factor in damaging public health. Yet, despite the role that the food industry plays in the health of future generations the guidelines for business set by the US and the UK are voluntary and self-regulatory.

The US drafted "Voluntary Guidelines for the Marketing of Food to Children" while the UK has similarly set out a tentative business 'Pledge' - companies volunteer to commit to a pledge to meet salt and fat targets and remove trans fats. Both are 'opt in' recommendations that businesses are free to adopt,or ignore. According to Small Business only 11% of UK companies have signed up for the scheme.

Critics claim that the Foresite report should push governments to react with more gumption. The British Heart Foundation said in response to the obesity report that if it was was setting off alarm bells, the government's response was "met only by repeated pushes of the government's snooze button."

Professor Rob Moodie of the University of Melbourne recently researched multinationals, their impact on health and government policy and expressed similar disappointment. Commenting on the "nudge theory" and reliance on voluntary self-regulation, he told The Independent;

"You can't expect self-regulation to work. It is like having the burglars install your locks. You think it might work and you are safe but you are not," he said.


Notes:

Foresight Report - Tackling Obesities - Future Choices (2007)
http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Publichealth/Healthimprovement/Obesity/DH_079713

National Office of Statistics -
https://catalogue.ic.nhs.uk/publications/public-health/obesity/obes-phys-acti-diet-eng-2013/obes-phys-acti-diet-eng-2013-rep.pdf

Food Pledges - UK Gov voluntary agreement for food companies
https://responsibilitydeal.dh.gov.uk/food-pledges
Image: RGB Freestock: nazreth (Michael Lorenzo)

"Mappiness" App Proves the Secret to Happiness is Outside

One of the world’s top social science universities, The London School of Economics and Social Policy (LSE), has joined the digital scientific community in harnessing the power of mobile apps to study human behaviour. The "Mappiness" app, created by Dr George MacKerrona of Sussex University and Dr Susana Mourato of the LSE, mapped the top habitats for optimum wellbeing using iPhone technology.

21,947 people downloaded the iPhone app which not unlike a digital mum, prompted participants for answers to their whereabouts, the company they were keeping and what they were doing. In addition, the app asked for a rating on how they felt; tired, happy or anxious.

Twice a day at random and over a 6 month period, participants were beeped to plot the following:

• location users coordinates were recorded via satellite positioning

• habitat users reported whether they were inside, outside,
  in a park, a barren landscape or an office.

• feeling users scored their subjective wellbeing from
  1 (not at all) to 100 (extremely) for happy, awake and tired

Robust as it was regular, the app was primed to ensure that the happy scores generated by green spaces were not confused with the pleasures derived from friends and family by accounting for activity, company and whether the activity was work related or recreational.

With 1,138,481 responses, there was plenty of data to play to whittle down the component happiness.

Whatever people were doing, they were happier outside. Although perhaps not surprising in itself, Professor George MacKerrona points out that quantifying happiness is the really exciting aspect of the Mappiness app project, "there really aren't a lot of surprises: it's all very intuitive, so the exciting thing is to be able to use quantitative evidence to (a) prove that these effects are real and (b) compare how big they are."

The belief that being outside improves our wellbeing has been long held, but before now there has been limited quantitative research until now to prove this. The sample size of 1,138,481 responses from 21,947 participants is believed to be the largest ever achieved by an Experience Sampling Method (ESM).

Three factors were identified to pinpoint why outdoor habitats improve our physical and mental health:

• 1. Pathways
  The existence of direct pathways known as "biolphilia" bring about stress reduction to the nervous system. Biolphilia has its roots in evolution; an affinity with nature and living organisms in general is an adaption to our historic reliance on natural environments.

• 2. Environment “bads”A natural environment is less likely to house environmental "bads" such as noise and air pollution than urban environments. This freedom to enjoy optimal health directly creates a cause for increased happiness and reported wellbeing.

• 3. Recreation
  Outside spaces naturally encourage recreational activities that are good for physical and mental well being. Sports, games, walking and socialising with others are all relaxing recreational pursuits that contribute to optimum health.

When outdoors, every habitat type except inland bare ground is associated with higher happiness levels than the inside, urban type. Marine and coastal areas are the happiest locations, with responses approximately 6 points higher than continuous urban environments on the 0 – 100 scale. The difference between the happiness in being inside or outside is equal to the difference between the happiness of attending an exhibition or doing housework.

All other green or natural environment types — ‘mountains, moors, and heathland’, ‘freshwater, wetlands and flood plains’, woodland, grasslands, and farmland — are between 2.7 and 1.8 points happier than continuous urban environments. Suburban or rural developed environments are a little under one point happier.

To take part in the research, participants needed an iPhone to download the Mappiness app. The principle that iPhone ownership was required restricted participation to wealthy households with an income of £48,000. The age of participants was young too with over 66% under 35 years and nearly 80% of the participants employed and 13% in education.


Interesting excerpts taken from the Mappiness study:

Tuesday is the unhappiest day of the week

Saturday is the happiest day of the week

Higher happiness reported in Scotland and Dorset

Lower happiness in Slough and parts of London

People are happier at home than at work

Higher temperatures and lower wind speeds make us happier

Rain, wind or fog make us less happy

People are more happy outdoors than indoors or in a vehicle

Physical activities running, hiking, birdwatching make us happy


Happiness is greater in natural environments is published in Global Environmental Change. Surprises or no surprises, the quantitative and substantial evidence reaped to prove that outside space is good for physical and mental health can be used for the first time to inform policy makers in decision making.

George MacKerrona, Economics Professor at the University of Sussex is reassured by the lack of surprise in the data,"the lack of surprises is also reassuring. If I told you people were happiest with the flu in Slough on a Monday, you'd probably think I'd made a mistake somewhere!"




Notes:

Mappiness, the happiness mapping app www.mappiness.org.uk

Happiness is greater in natural environments in press in Global Environmental Change:
http://dx.doi.org/10.1016/j.gloenvcha.2013.03.010

Happiness Map of the UK:
http://www.mappiness.org.uk/maps