Pollution responsible for a quarter of deaths of young children, says WHO

Pollution is responsible for one in four deaths among all children under five, according to new World Health Organisation reports, with toxic air, unsafe water and and lack of sanitation the leading causes.

The reports found polluted environments cause the deaths of 1.7 million children every year, but that many of the deaths could be prevented by interventions already known to work, such as providing cleaner cooking fuels to prevent indoor air pollution.

“A polluted environment is a deadly one – particularly for young children,” says Dr Margaret Chan, director-general of the WHO. “Their developing organs and immune systems – and smaller bodies and airways – make them especially vulnerable to dirty air and water.”

The harm from air pollution can begin in the womb and increase the risk of premature birth. After birth, air pollution raises the risk of pneumonia, a major cause of death for under fives, and of lifelong lung conditions such as asthma. It may also increase the risk of heart disease, stroke and cancer in later life.

Children play on an open stove used for smelting woods at an unregulated charcoal factory in Manila, Philippines. Photograph: Ted Aljibe/AFP/Getty Images

The reports present a comprehensive review of the effect of unhealthy environments and found 570,000 children under five-years-old die each year from respiratory infections such as pneumonia, while another 361,000 die due to diarrhoea, as a result of polluted water and poor access to sanitation.

The WHO estimates that 11–14% of children aged five years and older currently report asthma symptoms, with almost half of these cases related to air pollution. It also suggests that the warmer temperatures and carbon dioxide levels linked to climate change may increase pollen levels, making asthma worse.

“Investing in the removal of environmental risks to health will result in massive health benefits,” said Dr Maria Neira, WHO director of environmental and social determinants of health. For example, tackling the backyard recycling of electrical waste would cut children’s exposure to toxins which can cause reduced intelligence and cancer.

In October, the UN’s children’s agency Unicef made the first global estimate of children’s exposure to air pollution and found that almost 90% – 2 billion children – live in places where outdoor air pollution exceeds WHO limits. It found that 300 million of these children live in areas with extreme air pollution, where toxic fumes are more than six times above the health guidelines.

The WHO announced in May that air pollution around the world is rising at an alarming rate, with virtually all cities in poorer nations blighted by unhealthy air and more than half of those in richer countries also suffering.

Pupils from Bowes primary school in Enfield, north London, protesting about levels of air pollution outside their school. Photograph: Chris Radburn/PA

Research in 2015 revealed that more than 3 million people a year die early because of outdoor air pollution, more than malaria and HIV/Aids combined. Chan told the BBC on Monday that air pollution is “one of the most pernicious threats” facing global public health today and is on a much bigger scale than HIV or Ebola.

Pollution responsible for a quarter of deaths of young children, says WHO

We are all responsible for proper social care | Letters

As a retired nurse, I agree with your correspondents on the crisis in social care (Letters, 17 January), but it’s about time we all took some responsibility for providing for care in our old age ourselves. I cannot believe how so many people think it’s not going to happen to them, when the statistics are out there and they are already looking after elderly relatives. In this day and age, it should not be down to the state to look after everyone in later life.

While I agree we should be looked after in our own homes if possible, most of us do not live in suitable homes. If more communities of affordable, suitable retirement homes were built, and people didn’t delay the decision to move until they were forced to, only those who were unable to live independently would need to go into residential care.

We all need to face up to the fact that we will some day be old and, by making informed choices now, should hopefully not end up like the 500,000 people in one room in a care home, possibly being neglected and abused. Until we take more responsibility for ourselves, no amount of money will make any difference.
Sue Hester
Shepton Montague, Somerset

• It is commendable that 45 former directors of social services should draw urgent attention to the consequences of deprivation of funding for social needs. While there is much emphasis on the elderly, there is brief reference to the deficiencies in mental health provision. The diverging and complex needs of adults with learning disabilities receive no mention.

Have the massive deficiencies in this area of need been brought about through the lack of funding, or – as overwhelming evidence confirms – because local authorities have been given the task of implementing provision for these people, which they lacked the experience and skills to do? The outcome over recent decades has been a spiral of decline that will soon be irreversible.

To demand more finance without identifying a rational, affordable, achievable, and equitable national care in the community policy would only compound the errors of judgment that have brought untold misery and distress on far too many people already. An open and informed debate is urgently needed.
Charles Henley
Bournemouth

• I support the demand for reform of elderly social care to prevent more care homes disappearing under government cuts. The argument that we are all living longer does not mean there has to be less care available. Greater provision is a necessity, which, in addition, would provide more jobs for care workers and for construction workers employed in building or refurbishing care homes. Apprentices would also benefit and those who teach them. The cuts in public services have continued relentlessly under this government, and provision and funding issues need immediate action.
Petronella Hopkins
London

• I would like to concur with your comment that “care work … makes demands on the intellect, the emotions and the capacity for attentiveness which are hard to measure but go far beyond the physical” (Editorial, 17 January). I have just completed a piece of research with Paradigm, a training and consultancy agency, into the barriers in voluntary organisations that hinder the provision of good-quality services for people with learning disabilities. What emerged was the very sophisticated range of skills required by staff, including very nuanced understandings of when, and how much support to provide, how to judge when someone has to develop the courage to take the risks which are inherent in learning new skills, and the capacity to just “be there”, quietly and gently, when someone is experiencing grief or pain. And what is truly amazing is that so many staff actually do possess these skills. But their terms and conditions of employment and the specifications of the contracts under which such services are provided and regulated rarely, if ever, reflect this.
Dr Christina Schwabenland
University of Bedfordshire, Paradigm Consultancy and Development Agency

• You make good points about long hours in care work. On the dementia unit in the care home which I know, the staff work 12-hour shifts and often look exhausted. But many will beg you not to complain. They say that with the 12-hour shift they can do a full week’s work in three days and, for those with young children, this means fewer hours to be paid for childcare.
Rae Street
Littleborough, Lancashire

• I would challenge anyone to spend a day with my care staff, to witness how they carry out their duties with empathy and professionalism that far exceeds the wage they receive. Staff are personally responsible for administrating prescribed medication and any errors, either in administration or written logs, could be used in a court of inquiry and legal action taken against them.

Care staff can often be the only person our client sees throughout their day. Care staff become proficient in recognising change in a person’s wellbeing and can alert the appropriate professional quickly and often avert illness or infection in our most vulnerable clients. My most experienced staff have significant knowledge of symptoms, prescribed medication and creams, provide basic nursing care, including some tasks previously only offered by district nurses.

Throwing money at social care will not on its own address the crisis. The government and media portrayal of home care workers also needs to change. Home care workers are portrayed as unskilled “glorified cleaners”, and a recently heard term that appals me is “arse-wipers”. Promoting care work as a profession in its own right through a national campaign similar to the recent government teachers campaign, shown on UK television, would advocate the role of the care worker as a worthy occupation.
Jane Jones
Managing director, Applewood Support

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We are all responsible for proper social care | Letters

As Ex-Gamers Sue NFL Over Use Of Painkillers, Who Is In the long run Responsible?

by Arthur L. Caplan & Lee H. Igel
The NYU Sports & Society Program

Perhaps you work in an office.  If you were badly injured at work and your company doctor told you there was a drug that could put you right back at your desk, would you take it? If you’re like most people the answer is “maybe.” You would probably have a few questions about this drug. But if your work takes place between end zones rather than cubicles, you’d be far more likely to do whatever it takes to get back to work as soon as possible.

The decision to return to the field using any means necessary is at the heart of a new lawsuit that involves more than 500 retired NFL players. They are accusing the league of encouraging a culture in which team physicians and trainers regularly supplied them with drugs to help speed-up their return to the field following injuries. The suit also alleges that those drugs, mainly a smorgasbord of painkillers, were administered to the players without proper prescriptions or warnings about many possible serious side effects. Now, years later, the players say that they’re feeling the pain in the form of heart, lung, and nerve dysfunction, kidney failure, muscle and bone disfigurement, and substance abuse and addiction.

Many people might hem and haw as they weigh the effects of seeking treatment for any serious injury on their lives and livelihood.  You would likely ponder what health effects are involved in taking a drug to ease the pain, the potential for long-term side-effects, and how quickly you want to return to work. The majority of professional football players are decidedly not among that group. Their default thinking almost as a rule tends toward how quickly they can get back out on the field—whatever the price.

In recent comments to the Associated Press, former pro lineman Kyle Turley said, “Obviously, we were grown adults and we had a choice. But when a team doctor is saying this will take the pain away, you trust them.” Another recently-retired player, Jeremy Newberry, said that he took the drugs because he felt that playing through pain and injury increased the likelihood that he’d be able to keep his roster spot.

Athletes and teams want to win. That desire often requires players returning to play within as rapid a time frame as possible.  So, who is to provide the ballast when the player says to do whatever it takes to get him back in the game?

Team doctors and trainers have a significant role in making that happen. They can subscribe to the ethos of winning and honoring the choices of athletes who wish to return to their sport as soon as is possible. But they have to balance that with the responsibility to promote athlete health and well-being, which often means they should err on the side of caution in responding to health risks and preventing further injury or reinjury. It’s a challenge that is tough when the coach is peering over your shoulder and when roster spots change if a player is in the training room more frequently than on the field.

Winning and getting injured players back onto the field as as quickly as possible are two goals that can be at odds with one another. And if that is not enough, consider that athletes, team executives, and medical staff members may try to advance those goals simultaneously, which raises further confusion about roles and responsibilities. Conflicts of interest are sure to arise.

One entry point for understanding why this occurs may lie in what George Loewenstein, who teaches economics and psychology at Carnegie Mellon University, calls the “hot-cold empathy gap.” People often “mispredict” how they and others will think, feel, and behave across different affective states. In “cold” states, when people anticipate some future condition and are unemotional, they underestimate preferences and behaviors that they would have in the actual future condition. In “hot” states, when people are sufficiently psyched-up and in the moment of the actual condition, they underestimate the influence the state has on their preferences and behaviors; as a consequence, they overestimate the stability of those preferences and behaviors. Put another way, imagine a decision-making process that might be transpire between an athlete, team officials, and medical staff members in a training room on an off-day versus a game day.

Like most human beings, professional athletes prioritize short-term gratification while discounting long-term consequences. The pressures associated with getting back on the field as soon as possible can compromise safe treatment protocols. They can also expose players to a number of potential health risks.

Protocols for treatment of injury that were acceptable years ago may not be acceptable today. That will hold true in the future, as well. The practice of medicine changes when advancements are made in our understanding of the science underlying it.

In the latest lawsuit to hit the NFL, the basic question is whether NFL players were properly informed about the drugs they were being administered. There is also some question about whether they felt compelled to consent to the treatments because of the nature and culture of their workplaces. But the biggest question is: Who should be charged with thinking for the long-term, since players may only be thinking about what they need to do now to get back on the field as soon as possible? That is where responsibility for thinking long-term lies.

Arthur L. Caplan, PhD, is the Drs. William F. and Virginia Connolly Mitty Professor and head of the Division of Bioethics at New York University Langone Medical Center. Lee H. Igel, PhD, is associate professor in the Tisch Center at New York University. Both are affiliated with NYU’s Sports and Society Program.

As Ex-Gamers Sue NFL Over Use Of Painkillers, Who Is In the long run Responsible?