For seven years, people in Britain have been forced to hold their breath and wait for a comprehensive plan to tackle the nation’s toxic air crisis. After a series of humiliating defeats in the courts, Friday’s government plan was meant to finally deliver.
But instead ministers hit the brakes and slammed the policy into reverse – the farcical new strategy has even less detail than the one already ruled illegal. What was the impassable roadblock in the way of finally starting to cut the 23,000 early deaths diesel pollution causes every year? Nothing but pure political expediency.
The only sure way to bring the toxic nitrogen dioxide spewed out by dirty diesel vehicles down to legal levels is to keep them out of cities and towns. The law demands the fastest possible action, which means deterring polluting drivers with charges – as will happen in London. But backing new taxes on drivers in the heat of an election campaign promises a political car crash, so ministers have simply swerved and crashed into the nation’s health instead.
The most shocking aspect is that buried in the documents are candid admissions that the crisis is the “largest environmental threat to public health in the UK” and that it is a “direct result” of car makers gaming emissions tests for years, so that their vehicles pump out far more pollution on the road than in the official lab tests.
Ministers even say: “We will continue to press car manufacturers to develop options for recalling existing vehicles to improve their real world emissions performance.” But unlike in Germany and France, the government’s pressing of car makers has driven precisely zero action.
Rather than tackle air pollution head on, the government has passed the buck to local authorities, daring them to impose the needed charges instead and face the electoral consequences. Ministers suggest councils should penalise any diesel cars more than two years old – most of them – but lack the courage of their convictions.
In place of meaningful action, the government’s plan suggests gimmicks such as removing speed bumps and re-phasing traffic lights, measures as likely to increase traffic and emissions as to cut them.
One of the few good parts of the new plan is funds to clean up older buses, lorries and taxis but even this is old money, already announced in the budget. The much vaunted scrappage scheme is mentioned only as a possibility and even then would only cover 0.1% of all diesel cars.
The new plan will leave the nation gasping for years to come and it seems likely that ClientEarth, the lawyers who have twice had the government’s plans declared illegal, will return to the courts for a third time.
The government is likely to view its manoeuvring as a political success, having buried its feeble plan under the local election results. The government’s cynical calculus is that diesel drivers are more of a political force to be feared than people angry about the health damage being caused to them and their children.
Every weekday, millions of primary school children across the UK put their lives at risk. Break time brings relief for busy teachers and is often met with screams of delight as children run out onto the playground. But in many of our major cities, tens of thousands of children in hundreds of schools, nurseries and colleges are at risk as they inhale diesel pollution breaching EU air quality standards.
Across the UK, more than 40,000 people die prematurely from diesel pollution, at a cost of £20bn each year, according to the Royal Colleges of Physicians and of Paediatrics 2016 report. Now 50% of new cars are diesel, with each car producing many times more fumes than laboratory tests had previously indicated. The VW scandal has shown that the motor industry cannot be trusted and the royal colleges’ report finds that babies and children are particularly at risk. Foetuses in pregnant women exposed to air pollution are more likely to suffer effects to their lungs, heart and neurological development. Children in “clean air zones”, areas where the air quality problem is most serious, have a 10% reduced lung capacity and have more respiratory problems, together with effects on their nervous, immune and cardiovascular systems. This leads to physical and mental health problems in later life.
The government has compelling evidence to act now. Instead it fears the backlash of diesel drivers who bought their cars in good faith and are still encouraged to do so by lower vehicle tax rates. The public-health risks of diesel particulates have been well known since the days of Margaret Thatcher. However, the impact of nitrogen oxides and the scale of underestimated pollution from lab tests compounded by the sheer volume of cars has now become a public-health catastrophe. That’s why the demand for a new Clean Air Act grows. Meanwhile, the supreme court has demanded that the government produces a clean air strategy, to fulfil our EU air quality obligations. Today, I publish my clean air bill to give shape and ambition to the government’s plan.
Britain needs to take bold leadership. We already know that four capital cities – Paris, Madrid, Athens and Mexico City – have plans to remove diesel vehicles by 2025 and that the markets are investing in zero-emissions futures. Tesla, founded in 2003, produces just 76,000 electric cars and is valued at $ 49bn (£38bn) – $ 3bn more than Ford, founded a century earlier, which produces 6.6m vehicles.
The clean air bill is a route map to reach World Health Organization air quality standards by tackling emissions in our cities, ports and airports. It provides the signals and incentives for consumers and producers to change their behaviour to do so.
Rather than penalising diesel car-owners who bought in good faith, the bill calls for recall and refit of cars, fiscal incentives and scrappage schemes largely funded by manufacturers for drivers to switch to vehicles that produce fewer – or ideally, zero – emissions. It provides for a national electric and hydrogen refuelling network and gives local authorities a responsibility to measure and publicise pollution levels, in particular close to vulnerable groups such as children and the elderly. Councils will have powers to restrict access or introduce pollution charges if communities so wish, based on local evidence.
What’s more, new powers are proposed to combat diesel pollution belching into communities from idling ships in port by requiring a switch to port-provided electric power. The bill also addresses freight transport, pollution at airports and “cheat devices” installed on cars. Overall, the bill aims to make our right to clean air a reality.
Our first duty as parents is to protect our children. Break time, walking to the shops and football in the park shouldn’t be life-or-death decisions beyond our control. They needn’t be. For the sake of all our children, let’s do something about it now.
A vaccine capable of enduring scorching temperatures for months at a time could strike a decisive blow in the fight against rotavirus, preventing nearly half a million children around the world from dying of diarrhoea each year.
Médecins Sans Frontières (MSF) has hailed successful trials of the BRV-PV vaccine in Niger as a “game changer” in tackling rotavirus infection, which is the leading cause of severe diarrhoea globally and claims the lives of an estimated 1,300 children daily, most of them in sub-Saharan Africa.
According to results published in the New England Journal of Medicine, the vaccine has proven as effective as those currently used to treat severe gastroenteritis. Trials in Niger’s Maradi region successfully treated 4,000 children under the age of two.
Unlike existing vaccines, the BRV-PV vaccine does not require refrigeration and can remain stable for up to one year at 37C or six months at 40C. It is particularly effective against the strains of rotavirus found in sub-Saharan Africa, as well as affordable: at only $ 2.50 (£2), the vaccine could potentially be rolled out quickly in routine immunisation programmes.
“This is a game-changer,” said Dr Micaela Serafini, MSF’s medical director. “We believe that the new vaccine can bring protection against rotavirus to the children who need it most.”
Diarrhoea is the second largest cause of death in infants and children worldwide, primarily in low-income countries where access to clean water and sanitation is limited. Rotavirus is highly contagious, particularly among babies and young children, and can be spread by contaminated hands, objects such as toys and surfaces, and water and food.
Children in the world’s poorest countries account for 82% of rotavirus deaths, but vaccines make a significant difference. In Mexico, diarrhoeal deaths among children under five declined by as much as 50% after rotavirus vaccines were introduced.
The trials in Niger – the first of their kind to be approved in an African country – were conducted by MSF’s research and epidemiology branch Epicentre, in collaboration with Niger’s ministry of health, the Cincinnati children’s hospital and the makers of the vaccine, the Serum Institute of India. According to MSF, the results demonstrated no safety concerns and as a result the vaccine is hoped to fill the current supply gaps of the existing rotavirus vaccines, RotaTeq and Rotarix, both of which require refrigeration.
The World Health Organization recommends that rotavirus vaccines should be included in all national immunisation programmes, and considered a priority in south and south-east Asia and sub-Saharan Africa. The BRV-PV vaccine is awaiting pre-qualification from the WHO before it can be rolled out.
Licensing the product could take up to 18 months, said Anna-Lea Kahn, a WHO technical officer looking at innovations for facilitating vaccine supply and delivery. During that period, WHO scientists evaluate data supporting the vaccine’s quality and safety, drawing on independent specialist help when needed.
Most difficulties with vaccine delivery tend to arise during the “last mile” of the vaccine supply chain, said Kahn. “That’s where it goes wrong the most: where being able to maintain the cold chain is hardest; where constraints are most pronounced, be it due to lack of electricity or lack of resources, or inability to maintain a cold fridge. There may be geographical barriers, too, presenting a logistical challenge.
“In these scenarios, not having to depend on the cold chain … can make a valuable difference in getting vaccines to those who otherwise might not receive it.”
Serafini said: “The success of this trial shows that research and development into vaccines that are specifically adapted for use in low-income countries yields results.”
A spokesperson for Gavi, the international vaccine alliance, said BRV-PV’s results were encouraging.
“Adding more flexibility to the cold chain could allow more vaccines to reach the hardest-to-reach locations, boosting coverage and giving many more children access to lifesaving vaccines,” the spokesperson said. “However, it is anticipated that an important consideration for the countries will be the final recommendations on temperature control conditions of the vaccine, which could be different than the conditions used during the clinical trial.”
Children and young people are being denied the latest cancer treatments by outdated European regulations. Pharmaceutical companies are able to use a loophole in EU legislation to avoid trialling cancer drugs in children – despite evidence that these treatments could work. An analysis of European Medicines Agency data by the Institute of Cancer Research shows that since 2012, the loophole has been enacted to prevent 33 new cancer drugs from being evaluated in children. There is evidence that at least some of these treatments could be effective against children’s cancers.
Children’s cancers are rare, and there is little financial incentive for companies to develop drugs for them. The current EU paediatric regulation could do much more to ensure that children benefit from the dramatic advances in treatment we are seeing for adult cancers. The regulation is badly out of date. It allows pharmaceutical companies to opt out of running paediatric trials simply because the adult cancer a drug targets does not occur in children. But these days, scientists understand that it is a cancer’s genetic causes – rather than where it happens to grow in the body – which are the most important factor in determining which treatments work.
Children are missing out on a range of treatments that could effectively target the genetic changes within their cancers. Children and young people deserve the same access to new drugs as adults. The European commission is carrying out a consultation on the paediatric regulation and we believe this is our chance to change the rules to ensure potentially effective cancer drugs have to be trialled in children. If this loophole is not closed now, children could miss out on new cancer treatments for years to come. Professor Paul Workman Chief executive, Institute of Cancer Research Cally Palmer Chief executive, Royal Marsden Siobhan Dunn Chief executive, Teenage Cancer Trust Cliff O’Gorman Chief executive, Children with Cancer UK Professor Bobbie Farsides Chair, Nuffield council on bioethics working group on Children in clinical research: ethical issues Amanda Walker and Ray Mifsud Founders, Abbie’s Army David and Sara Wakeling Founders, Alice’s Arc Lynn and Lynn Lucas Founders, Chris Lucas Trust Karen and Kevin Capel Founders, Christopher’s Smile Diego Megia Founder and president, CRIS Contra el Cancer Lola Manterola Founder and president, CRIS Cancer Foundation Martin and Sian Waite Founders, Elin Rose Appeal Mark Proudlove Founder, Faye’s Wish Dr Jennifer Kelly General practitioner and founder, Grace Kelly Ladybird Trust Samantha Wearne Founder, Jack Mylam Foundation Andrew and Jo Williams Founders, Lucas’ Legacy Richard and Nikki Bowdidge Founders, Tom Bowdidge Foundation Clinton and Adele Prince Founders, Tom Prince Cancer Trust
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The NHS and social care system are suffering a virulent illness and the cause is obvious: a chronic lack of funding. Yet the government is refusing to provide the treatment needed. Four in five hospitals are now not safe enough, we are seeing longer waits for operations, slower ambulance response times and patients delayed in hospital for days and weeks on end because the social care they need isn’t available. The sick note is a long one.
This shouldn’t really come as a shock – this ailment has been obvious to anyone who uses the system. We spend a lower proportion of our GDP on health than almost any of our European neighbours and the government propose to further slash spending, while demand continues to rise. How exactly do the chancellor, Philip Hammond, and the health secretary, Jeremy Hunt, expect services to cope? The chief inspector of the Care Quality Commission said just last week that the NHS “stands on a burning platform”. When he speaks this vividly, we should listen.
So there should be one essential priority for the chancellor when he delivers his budget on Wednesday. Save our most treasured national institution. Give the NHS and care systems the money they need.
The Liberal Democrats are calling for an emergency injection for 2017-18 of £4bn – to be split between health and social care – to bring these services back from the brink of real crisis. I don’t claim this will solve every frailty in our system, but it would be an urgent, short-term boost.
When the government faces a £100bn shortfall in public finances due to a Brexit squeeze, I realise the chancellor’s room for manoeuvre is limited; the economic situation is as grim as it is self-inflicted. But that doesn’t mean it is acceptable to leave the huge, gaping holes in our most essential social safety nets remain unrepaired. These are services we will all need, services that will be there for us when we are at our most desperate and vulnerable. We must do whatever is needed to safeguard them for generations to come.
Ultimately, we must find a long-term solution to the crisis in funding for the NHS and social care. Short-term injections of cash alone will not make services more sustainable indefinitely. That is why my colleague Norman Lamb, the former health minister, has assembled a commission of some of the country’s leading experts (don’t tell Michael Gove) to assess in more detail the scale of the financial need, and options for raising this revenue in the longer term – including through tax increases.
‘We cannot ignore a situation where NHS trusts are declaring services to be in a state of emergency.’ Photograph: Christopher Furlong/Getty Images
We need a funding settlement that will stretch beyond one parliament or one economic cycle, and I am proud that my party is prepared to be honest with the public about the challenges we’re facing and to be bold in proposing realistic solutions, which the Conservative Brexit government might not think sound quick or easy, but that I am convinced are essential.
He has also reached out to politicians of other parties, asking them to join him in working to secure a long-term, sustainable funding solution for the NHS and our care services. Protecting our NHS is a slogan Labour and the Conservatives have fought countless elections under. Well, now is the time to put those words into action. And while this battle is made a lot tougher by the economic challenges posed by that painful Brexit squeeze, I am in no doubt that it is still one worth fighting.
We cannot ignore a situation where more than a million older people are not getting the care they need and NHS trusts are declaring services to be in a state of emergency. The £4bn injection might seem a relatively modest one, considering this deeply concerning diagnosis. But it might just be enough to get it out of intensive care. I hope all progressives will join me in backing my campaign to give the NHS and care the funding it deserves, and so desperately needs.
GPs are missing vital opportunities to intervene and potentially save the lives of people experiencing domestic abuse, a leading charity has warned.
Two women are murdered every week in England and Wales by a current or former partner. The latest crime statistics show that 332 women and 78 men were killed by their partners or ex-partners between March 2012 and March 2015. An analysis of 24 domestic homicide reviews (DHRs) from murders committed over the same period show that in more than half of the cases examined, doctors missed vital opportunities to identify risks and seek help for the victim.
The research, by the charity Standing Together, also found that in 25% of cases GPs failed to make inquiries following disclosures or warning signs displayed by the perpetrator. Now it is calling for domestic abuse awareness training to be made compulsory after results from an initiative set up to help GPs spot the signs of domestic abuse found referrals to specialist services increased considerably when doctors’ surgeries had been given appropriate training.
As the only stakeholder group that consistently and actively engages with both victims and perpetrators, GP surgery staff play a crucial role in preventing murders. “Our research shows both parties are more likely to seek help or make disclosures to their GP than any other agency,” says Standing Together’s chief executive, Nicole Jacobs.
DHRs are multi-agency accounts of the circumstances in which the death of a person aged 16 or over has resulted from violence, abuse or neglect by someone they were related to, shared a household with or with whom they were in, or previously in, an intimate relationship. Murders between intimate partners accounted for the DHRs studied as part of a wider sample by the charity in partnership with London Metropolitan University. Of the victims murdered by a partner or former partner, 22 were women. The youngest was 20 and the oldest was 81. “When we use the term ‘missed opportunities’ we are talking about blatant warning signs that are indicative of domestic abuse,” Jacobs explains.
Most frequently observed was a “lack of professional curiosity about relationships with partners or children’s fathers”, according to the report. In one case a woman reported having “an accident or fight” and had been punched, but “also had tenderness in the abdomen”. Another review found that a surgery failed to make inquiries after a patient attended the clinic with an ear injury that she said was not self-inflicted. “In these cases the GPs may have treated the physical injuries, but have not referred the person to specialist support. And they certainly did not note an instance of domestic abuse in the patient’s medical records. So when we say ‘missed opportunities’ we mean quite specific key indicators,” Jacobs adds.
In one case the offender rang the surgery requesting a home visit for an injection to ‘put [the victim] to sleep’
Six DHR reports also noted missed opportunities for GPs to ask the perpetrators about domestic abuse. In one case the offender even rang the surgery requesting a home visit for an injection to “put [the victim] to sleep”. He later presented with a painful shoulder, which he said was the consequence of him trying to “throw a bottle”, yet there was no follow-up. Another man presented injuries following three separate violent altercations, including one that involved assaulting a police officer – yet no further inquiries were made. And while one patient was “impulsive, controlling and had anger issues”, according to his GP, these were not considered to be risk factors in his relationship.
Lack of information sharing between GPs, emergency departments and mental health services was also cited as cause for concern. In one case a man told his GP he “felt angry and felt like destroying things” but was not asked about his family circumstances. Meanwhile, hospital records sent to the GP about the same man stated he had “consumed six cans of lager and phoned police to say he needed help or would kill himself and his girlfriend”. Yet there was no attempt by the GP, hospital or police to follow up.
More than 400 DHRs have been completed since they were made mandatory in April 2011. “These reviews are not intended to be about blame, but exercises in understanding the environments in which people made certain decisions and choices with a key purpose of making the future safer,” says Frank Mullane, founder of Advocacy After Fatal Domestic Abuse, which has guided 160 families through the process of a DHR. Mullane says he regularly sees issues around missed opportunities in GP surgeries. “It seems many GPs are inadequately informed about domestic abuse and may not be spotting the risk indicators. Many don’t know what to do if they suspect abuse, or if it is disclosed to them overtly, or inferred.”
However, there have been marked improvements where specialist training has been provided. The Identification and Referral to Improve Safety – or Iris – project has been commissioned in 34 areas in England and Wales since 2010 and is in more than 1,000 general practices.
Medina Johnson, Iris national director, says research shows patients in practices using the initiative were 22 times more likely to have a discussion about domestic abuse and that resulted in them being six times more likely to be referred to specialist services. They were also three times more likely to have domestic abuse noted in their medical records.
She explains: “GPs always say we are so busy, we only have 10 minutes and now you are asking us to do something additional. And we are, but it could save someone’s life. The simplicity of our message is: ask about domestic abuse, give an understanding response, offer a referral and make a note in the patient’s medical records.”
Under Iris, one specialist full-time worker can support up to 25 general practices, with each named worker conducting training as well as dealing with referrals. Gene Feder, the domestic abuse lead for the Royal College of General Practitioners, admits that some of the failures by GPs are “spine-chilling”. But he points out that the issue is far more complex because most domestic abuse is hidden and the presentation is far more subtle.
“I’m not trying to make excuses for GPs, but it’s hard to blame professionals when most have had zero to one hour of training around domestic abuse as medical students,” he says.
While guidelines from the National Institute for Health and Care Excellence (Nice) now recommend there should be training around domestic violence at every level, it remains minimal or absent in most medical schools.
Feder says that while Iris has good evidence on how doctors can respond safely to women disclosing abuse, the project was still working towards the best model for when patients disclose perpetration abuse. He adds: “The other thing is when you have male victims and female perpetrators – they are a minority, but men can also be victims and suffer serious mental health consequences.”
In some areas where Iris operates, such as Bristol and the east London borough of Hackney, there is sufficient funding for all general practices to be trained, but elsewhere the level of investment is insufficient to cover all surgeries.
The government has recently invested £2.4bn into primary care, part of which is to provide ongoing training for GPs. And last week Theresa May announced she will oversee the creation of a new law, the Domestic Violence and Abuse Act, to increase prosecutions across England and Wales and eradicate a postcode lottery in the way victims are dealt with by police forces. “There are thousands of people who are suffering at the hands of abusers – often isolated and unaware of the options and support available to them to end it,” says May.
But Feder, who is also professor of primary healthcare at Bristol University and the architect of Iris, warns that the impact of any health initiatives on victims of domestic violence is likely to be severely constrained by threats to the funding of domestic abuse services – and GPs who are under huge pressure from the demands of an ageing population. Since 2010, 17% of specialist women’s refuges have closed due to funding cuts.
Domestic abuse charities insist that with hundreds of women being murdered each year by a current or former partner, it is vital to protect the funding needed to keep these important referral pathways open.
‘My stepfather was abusive and should have been sectioned’
Annabella Bell’s mother, Chloe, was murdered in January 2013 by her violent and mentally ill husband, three days before her 81st birthday.
The couple were registered at the same surgery in north London and Bell, a 59-year-old mental health practitioner from Newcastle, had contacted her mother’s GP in the south of England to warn them she was at risk. She explains: “My stepfather was becoming increasingly paranoid and delusional, believing there was a plot to kill him. He missed hospital appointments and my mother was asked to intervene, but this would make him very angry.”
The couple divided the house they were living in and used separate entrances, but Bell’s mother continued to suffer violence at the hands of her husband. Bell says: “I told her doctor I was worried about my stepfather, and my mother also went in to explain, but they continued to involve her in his health matters.”
Then both the hospital and GP failed to make inquiries after her mother presented with a black eye at A&E, a month before she was brutally murdered. Bell’s stepfather killed himself after the fatal attack.
Bell was left so traumatised by her mother’s death that she “struggles every day” and is unable to work. She says more should have been done to protect her mother. “I’m not saying he wouldn’t have killed her if the doctors hadn’t involved her, but I’m saying there should have been some kind of warning.”
She adds: “It’s textbook stuff, but people seem to miss it and then it’s too late because somebody is murdered. My stepfather was abusive and psychotic and should have been sectioned.”
Everyone who heard Steve Hewlett’s moving account of his oesophageal cancer will be sad to know that, for him, there was no cure (Report, 21 February). But I write as the wife of a survivor of this disease. My husband, now 81, was diagnosed in November 2011.
After a course of chemo, he was operated on to remove the tumour just five years ago, one of thousands who are full of thanks to the oncologists and surgeons who saved their lives. The specialist nurse at the hospital where my husband was treated told us that this cancer is becoming more common, particularly for men, and the UK incidence is probably the highest in Europe.
I do want to point out that this month is oesophageal cancer awareness month, when pharmacists and GPs aim to make people realise that it is not normal to have to continually take over-the-counter remedies for stomach acid. In that case, people should see their GP so that further investigations can be put in train. As for all cancers, early diagnosis, before any cancer has spread, gives the best chance of a cure. Susan Chesters Winchester
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Dozens of hospital stroke units should be shut and the service reorganised into fewer centres of excellence in order to improve care, the charity representing stroke survivors has insisted.
Centralising stroke treatment at a much smaller number of hospitals will increase patients’ chances of survival and reduce their risk of long-term disability, the Stroke Association says.
Juliet Bouverie, the charity’s chief executive, accused hospitals of risking lives by retaining stroke units when medical evidence suggests they should be moved. While reconfiguration is controversial, patients and their families generally understand that travelling longer distances to get a higher standard of care and reduce the risk of dying is worthwhile, she insisted.
“At the moment there are 126 hospitals in England which routinely admit stroke patients. That number needs to be reduced to somewhere between 75 and 100. But progress on that is very variable across the country and so unnecessary costs are being incurred and unnecessary mortality is happening,” she said.
She urged hospital and NHS chiefs to learn lessons from studies showing that scores of lives are being saved every year by the reorganisation of stroke units in the capital in the 2000s. “Previously there were more than 20 hospitals providing acute care in London and there was strong evidence that actually reducing the number of acute stroke units and creating a hub and spoke model [of bigger hospitals supporting smaller ones] on stroke would not only save lives but it would also save the NHS money.
“So they reduced the number of acute stroke units from 20 down to eight and the evidence shows that each year more than 100 patients extra are saved as a consequence. That’s now been replicated in Manchester, with equivalent numbers of lives saved.”
Tony Rudd, the national clinical director for stroke at NHS England, says: “The changes to stroke services in London have saved lives, proving it is right to concentrate expertise in selected centres. One advantage of the local planning arrangements is they can identify where there are opportunities to provide this more focused care for stroke patients.”
Centres of excellence would offer better care by having larger numbers of patients and would tackle the shortage of specialist doctors and nurses by concentrating them in fewer places. They could then offer patients clot-busting drugs and, potentially, 35 to 50 could undergo a new surgical procedure called mechanical thrombectomy, in which even large blood clots in the brain can be enclosed in a stent. Many more hospitals than the current handful should be offering the £7,000-a-time “game-changer” operation, said Bouverie.
Hospitals’ self-interest is “stalling” what should be an NHS-wide drive to improve stroke care, she claimed. “Too many hospitals are protecting their own interests and not doing what is in patients’ best interests. No hospital wants to give up some of those life-saving treatments, but it’s not in patients’ interests for these smaller hospitals to be delivering services.”
Too many of the sustainability and transformation plans drawn up by NHS leaders in 44 areas of England do not include clear ways of reorganising stroke care, despite evidence that fewer units reduce the risk of death and disability.
Hyper acute stroke units usually administer life-saving treatment for three days and then transfer patients to a stroke unit, with patients then moving to a rehabilitation unit or going home. Centres of excellence would help overcome the postcode lottery that means that 82% of stroke patients treated at Ipswich hospital, for example, receive clot-busting drugs within the recommended four hours but only 15% of those attending Wexham Park hospital in Slough.
Bouverie blamed the NHS for neglecting survivors after their discharge from hospital: “More than 46% of patients told us in our most recent survey that when they’re discharged from hospital they feel isolated and abandoned. They say that physiotherapy is not adequate and they’re not given access to the right psychological support. People are not getting access to speech and language therapy in a timely manner,” she added.
“Many stroke survivors have a physical disability, depression or psychological needs, suffer chronic fatigue or have aphasia, where they cannot speak. You’ve got stroke survivors at home with serious disability, often still in wheelchairs, unable to communicate, suffering the damaging psychological effects of what is a life-changing condition and not being given the proper support. ”
She criticised NHS bosses and ministers for refusing to draw up a strategy to reduce the UK-wide toll of 40,000 deaths caused by the 100,000 strokes that occur every year, despite the government’s pledge to reduce premature deaths. Stroke campaigners feel “ignored” because NHS England chief executive Simon Stevens is concentrating on improving cancer, mental health, maternity care and dementia services rather than prioritising Britain’s fourth biggest killer.
Security guard Gilbert Morris will stop at nothing to talk to other black men like himself about cancer screening. He once defused a late-night fight in a Manchester club by asking five scuffling men whether they had had their prostate tested.
“It was like I had a magic wand that lowered their aggression,” laughs Morris. “They stopped in their tracks and put their fists down. Two of them said their fathers had prostate cancer and another’s uncle had it. We ended up sitting round the table talking about their fears of having their privates looked at.”
The success of this 51-year-old six footer in communicating the risk of cancer is being harnessed by health chiefs in Greater Manchester as part of the launch of a social movement to sign up 20,000 people as cancer champions.
The idea, led by Greater Manchester Cancer Vanguard Innovation, (part of Greater Manchester Cancer – the cancer programme of Greater Manchester’s devolved health and social care partnership), is to use people power to create a cultural shift in one of the UK’s cancer hot spots, and make it normal to talk about screening, healthier lifestyle options and catching symptoms early.
Working with the voluntary sector, the aim is to sign up 5,000 cancer champions by autumn 2017, and to reach 20,000 by 2019. Mobilising this cancer army is one of a series of measures to cut premature cancer deaths in the area by 1,300 by 2021.
Gilbert Morris developed prostate cancer in his 40s and couldn’t find anyone to talk to about it. Photograph: Karen Wright
The cancer death rate in Greater Manchester is 10% higher than the national average, according to Cancer Research UK figures. Manchester comes bottom out of 150 local authorities for premature deaths (under 75 years). Cancer experts reckon that around 40% of cancer deaths could have been prevented by screening or lifestyle changes, the potential for saving lives in Greater Manchester is great, since 6,700 people died of the disease in 2013.
Cancer champions programme director, Jenny Scott, explains: “By creating champions we will create support for active lifestyle changes. We need to engender people’s interest and then it will spread like a wave. I hope that people will soon be chatting about what they can do – whether it be at the bus stop or a football match.”
This radical approach is the result of a realisation that health systems are not having an impact in many sectors of society.
Morris’s story underlines this. He developed prostate cancer in his 40s and could not find anyone to talk to about it. He volunteered with the Manchester-based Black Health Agency to highlight the heightened risk of the disease in the African-Caribbean community. As his experience shows, the mention of prostate cancer can stop people in their tracks.
Morris says: “Doctor does not always know best, because some men never go to the doctor. I will speak to men anywhere – at a street corner or a bus stop. I am not embarrassed about talking about it, because if I can save one life I have done my job.”
He joins 1,000 plus existing volunteers willing to become cancer champions. More will be recruited through formal links between local authorities, Action Together and Voluntary Sector North West. Interested individuals will be put in touch with voluntary organisations across the 10 local authority areas, and receive advice and training. Workshops and publicity campaigns are planned. A web platform is also being built where people can become a champion and share their experience.
The rewards of volunteering are rich according to cancer champion Zoe Ashworth, a 29-year-old single parent from Stockport. She spends around three hours a fortnight at a nearby GP surgery in a deprived area calling people who have not returned their bowel cancer screening kits.
“Volunteering gives me real personal satisfaction,” says Ashworth. “Of all the people I have called, every single one has agreed to receive a screening kit. My friends will not listen to anybody else, but they can’t get away from me!”
Findings from the cancer champions project, will be combined with other data and public health information, to create a national dashboard to help prevent avoidable deaths across the rest of the UK. It will also be shared with cancer alliances being set up all round the country.
Leading Greater Manchester’s social movement projects, Ben Gilchrist, sees the cancer champion work in the context of a step change in society, in which many people no longer take their health messages from a health system.
He is clear that volunteering is not a replacement for NHS and public services, or a cost-cutting measure but the “right thing to do” to empower communities.
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In what is believed to be the first procedure of its kind in the world, doctors in Canada have saved a young mother’s life by resorting to a radical solution – they removed her lungs for six days while she waited for a transplant.
In April, Melissa Benoit arrived at a Toronto hospital with a severe lung infection. Doctors soon realised that Benoit, who had been born with cystic fibrosis, had just hours to live, leading them to consider the unprecedented approach.
“It was a difficult discussion because when we’re talking about something that had never to our knowledge been done before, there were a lot of unknowns,” Dr Niall Ferguson of the University Health Network, the health authority responsible for the Toronto general hospital, told a news conference on Wednesday.
A recent bout with influenza had left the then 32-year-old fighting off respiratory failure, forcing doctors to keep her sedated and on a ventilator to help her breathe. “She got into a spiral from which her lungs were not going to recover,” said Ferguson. “Her only hope of recovery was a lung transplant.”
Benoit was put on a temporary life support device but her condition continued to deteriorate; the bacteria in her lungs became resistant to most antibiotics, sending her body into septic shock and her blood pressure dropping. One by one, her organs began shutting down.
Her team of doctors gathered together to weigh a bold solution they had contemplated for years but never carried out – the removal of both her lungs in hopes of eliminating the source of the bacterial infection.
The list of unknowns was long, from the risk of bleeding into the empty chest cavity to whether her blood pressure and oxygen levels could be sustained once her lungs were removed.
“What helped us is the fact that we knew it was a matter of hours before she would die,” said Dr Shaf Keshavjee, one of three surgeons who operated on Benoit. “That gave us the courage to say, if we’re ever going to save this woman, we’re going to do it now.”
Benoit’s husband, Chris, gave doctors the go-ahead, thinking of their three-year-old daughter. “We needed this chance,” he said. “Things were so bad for so long, we needed something to go right.”
In mid-April, a team of 13 began a nine-hour surgery to remove Benoit’s lungs. Filled with mucous, each lung was swollen and as hard as a football, said Keshavjee. “Technically, it was difficult to get them out of her chest.”
Hours later, her condition began to dramatically improve. “And literally within minutes – it was probably around 20 minutes after having taken those infected lungs out – her blood pressure normalised, and they could remove all the blood-pressure-supporting drugs and just leave her on the pumps that were providing the circulation,” Keshavjee told the Canadian Press.
A small artificial lung was connected to Benoit’s heart, while other devices oxygenated and circulated her blood. As they waited for replacement lungs to become available, doctors wondered how long she could be supported like this. “We didn’t know if we’d get [them] in one day or one month,” said Keshavjee.
Six days later a pair of donor lungs became available and Benoit underwent a successful lung transplant.
Since then, her strength has steadily improved. Months in the hospital had initially left her without the ability to hold her head up, sit up or stand, but in the past month she has begun walking without a cane or walker. The ordeal also damaged her kidneys, but Benoit is soon hoping to be well enough to receive a kidney transplant from her mother.
When Benoit first learned of the surgery that had saved her life, she didn’t believe it. “It took me a while to realise what happened. I just couldn’t piece it together,” she said. “You really come from the brink of death to back living at home. But I’m just so grateful, so happy to be home.”
Not all celebrities are self absorbed. Here are four celebrities doing their part to save the environment, and it’s time we follow suit.
Leonardo DiCaprio
Leo is well known for his efforts to save the environment. DiCaprio understands that his popularity and that of other celebrities can be used as a platform to help bring awareness and change to climate change. Climate change will not just affect an unlucky few, it will affect us all. Leo gets it. And he is doing everything he can to try and bring about solutions that will address climate change.
Erin Brockovich
Maybe she isn’t a movie star, but they did make a movie about her. Brockovich’s help in uncovering PG&E’s pollution and cover up led to the largest settlement of its kind. The people of Hinkley, Ca were awarded $ 333 million. Brockovich uncovered the illegal dumping of unfiltered contamination into local groundwater. According to Filtra Systems, “Industrial water filtration opportunities present a considerable opportunity for the machining, mining, semiconductor, and other industries to improve the quality of their water while preserving the water in the environment”. PG&E would be $ 333 million richer if it had invested more in safety.
Jack Johnson
Jack Johnson is a surfer that lives in Hawaii and has a special opportunity to see the effect of climate change. He uses his celebrity status to help bring awareness to environmental issues. Jack Johnson promoted Green Touring in 2014 as a way for artists to reduce their environmental impact on tour. Jack and his wife, Kim, founded the Johnson Ohana Charitable Foundation in 2008. The foundation helps support communities by promoting education in art, music and the environment.
Daryl Hanna
Not all celebrities are willing to put themselves on the front line when it comes to protecting the planet. Daryl Hanna does not just talk the talk but walks the walk. Risking jail time in order to help the cause. Hanna has been arrested more than once in her efforts to save the environment. She was arrested while protesting the Keystone XL Pipeline construction, physically placing herself in front of construction equipment. Hanna was arrested twice protesting outside of White House against the pipeline development. Before those arrests, she had previously been arrested in 2009 and 2006. In 2009 she was part of a protest to stop mountaintop removal for surface mining. In 2006 she was involved in protesting against the bulldozing of an urban garden in south central Los Angeles. Her efforts in protecting the environment have been heroic, to say the least.
The most senior official in the Department of Health, Chris Wormald, told MPs yesterday that he was considering asking hospitals to check patients’ passports to find out whether they should be paying for NHS care. In doing so, Wormald may not have been trying to make anti-migrant political capital. But he certainly generated plenty of it.
The implicit message in his disclosure is that we are being overrun with health tourists who are fleecing our cash-strapped NHS and that we must protect what is rightfully ours.
But there were a few things Wormald failed to mention. The number of migrants who pay their way when they use the NHS, for instance, and how many with serious health conditions are denied NHS treatment in a system policed in an increasingly zealous way.
London has the largest number of migrants of any UK city. In 2014, a series of freedom of information requests I made to 20 London hospitals revealed that many had received substantial payments from overseas visitors using the NHS, and that debts from this group of patients were relatively small – too small, perhaps, to justify introducing a vast and expensive new layer of bureaucracy to police and intimidate patients. Many migrants now have to pay a health surcharge and have been doing so since April 2015 as a condition of living here.
What is the definition of a health tourist? Someone who gets on a boat or a plane with the sole purpose of using NHS services on arrival here? Or is it also someone who is in the UK from overseas and then falls ill while they are here?
One man who falls into the latter category is an asylum seeker who was tortured in his home country in west Africa. His asylum claim was refused and he is preparing a fresh bid based on new evidence. He does not qualify for NHS treatment as a refused asylum seeker. In 2013, a charity gave him a bike because he could not afford public transport. He was hit by a car in January 2014 and badly injured. Of course he did not ask to be hit by the car, nor did he plan to use any NHS services at all when he set off on his bike on that fateful day.
As usual with all matters migration, a sense of proportion has been lost here. Populism has tossed morality aside
The London hospital he was admitted to made sure he received nothing more than the basic emergency treatment that everyone is entitled to (although this too may change). He was denied surgery for the chronic and painful injuries he was left with. Since then he has been disabled, in agony and can only walk short distances with the help of a crutch. Yesterday he received a settlement from the insurance company of the driver who injured him. He pursued the claim in order to pay the NHS for the treatment he desperately needs. Although he is destitute, he will be making a net contribution to the NHS.
Another asylum seeker gave birth to twins who were treated for a few days in a special care baby unit. She was sent a bill she could not pay, because as an asylum seeker she is not allowed to work. She is a deeply religious Christian and was so distraught about the bill that she set her alarm at intervals through the night so she could get up and pray that somehow the debt would vanish. She lived in terror of the consequences of not paying the bill. Eventually the NHS wrote off the debt, accepting that as an asylum seeker who is banned from working she could not pay.
The National Audit Office estimates that the uncollected fees are £200m a year, which is around 1% of the current NHS debt. And that figure does not take into account the extra income from those who are paying for their NHS treatment.
As usual with all matters migration, a sense of proportion has been lost here. Populism has tossed morality and ethics out of the window. As Dr Ben White tweeted: “Well, I won’t be asking anyone for their passport before resuscitating them, thanks.”
The hostility towards migrants is piling up. It used to be the job of the Home Office alone to police immigration, but now schools, health professionals, landlords and others have been co-opted, whether they like it or not. Passport checking may save the NHS a few pence as long as the cost of administering such a system does not outweigh these slender savings.
But what is the cost of the humanity we are losing in the process? And what is the deficit in decency and solidarity with other members of the human race? That deficit is piling up and the negative consequences are not just for migrants, but for everyone who inhabits this country.
At the upmarket Cloudnine hospital in Gurgaon, the latest accessory among parents is a temperature-taking bracelet for newborns.
The bracelets, made by Bangalore-based startup Bempu, constantly monitor a baby’s temperature and sound an alert if it goes too high or too low. Doctors use the bracelets while babies are in neonatal intensive care or prescribe them for babies being discharged.
“New mothers are very worried about whether their babies are too warm or too cold,” says Dr Sanjay Wazir, director of the neonatal intensive care unit at the hospital. “[The bracelets] are better than a thermometer because they are continuously monitoring the baby’s temperature.”
In India, 8 million prematurely-born underweight babies every year are at high risk of developing hypothermia, where body temperatures fall below 36.5C, which contributes to fatal conditions such as asphyxia, sepsis and pneumonia. India has the highest number of infant deaths caused by premature birth, most of which could be prevented. Maintaining a newborn’s body temperature is critical to its survival.
Baby in Gudalur wearing a Bempu bracelet. Photograph: Bempu
Bempu is currently running a pilot scheme in the desert state of Rajasthan, funded by health foundation WISH, which aims to make its bracelets a staple free handout for all babies discharged early from government hospitals.
The chaos of government hospitals can lead to oversights when monitoring newborns’ temperatures, says Gini Morgan, head of public health at Bempu, which has benefitted from grants from the Bill and Melinda Gates Foundation, USAid, UK Aid and other agencies.
“The beds are always filled, the entire family is in the waiting room every day, there are often three babies in one incubator, where there should be only one. There’s a lack of staff, the nurses are overworked, running around with competing priorities. In all that, its hard to manage all these high-risk babies.”
Many hospitals discharge babies early to free up cots, or because parents need to return to remote villages and cannot afford to wait for long periods at the hospital. “Parents travel to district hospitals and they need to get back home,” Morgan explains. “Every day that they’re away from work, they’re missing a pay check.”
Once home, parents are less likely to notice symptoms of hypothermia or have adequate information about how to keep babies warm. Half the world’s newborn babies die at home, almost all of those who die are in developing countries. Hypothermia is one of the leading contributors to these deaths. Fortunately Bempu bracelets are powered by a battery that runs for a month, the critical period for newborns.
Bempu bracelets are powered by a battery that runs for a month, the critical period for newborns. Photograph: Bempu
“It’s not the same as using a thermometer because the device is constantly monitoring the baby’s temperature. Say you take the baby’s temperature now, it can fall after 30 minutes, and you may not notice,” says Dr Wazir, who hopes a crowdfunding campaign will help supply Bempu bracelets to underprivileged mothers at his Premature Babies Foundation, ahead of the winter months, when the risk of hypothermia rises.
But the bracelets alone are not enough, says Dr Vishnu Bhat from the Jawaharlal Institute of Postgraduate Medical Education and Research in Pondicherry, who conducted an independent study of their accuracy, the results of which are yet to be published. “We found that the nurses were taking temperatures more accurately than the Bempu bracelets. But the bracelets were good, we found they gave an accurate temperature reading between 85-90% of the time,” he said.
“The bracelets would be useful to mothers who live far from the hospital, the alarm system provides a warning to the mother that the baby is unwell. It would also be good in postnatal wards where nurses are in short supply. But of course, the temperature is not the only issue, mothers need to be trained, they need to be told what to do if the temperature is too low or too high,” he said.
It’s 5am, just before sunrise in the Himalayas. We wake to heavy snowfall, which has slowed our progress to the summit of Kala Patar. It soon becomes clear we will have to wait for the weather to improve. I am the medic with a group of students and staff from special educational needs schools from across the UK. We hunker down for the day and occupy ourselves playing games while we await a weather window.
The role of a medic on expedition has many faces, from doctor to chef, photographer, teacher, pot-washer, latrine-digger and counsellor. You have to earn your salt as a fully-fledged team member, which means being able to fulfil all of these roles and comfortably complete the expedition itself.
For me, expedition medicine offers an exciting combination of the two things I love: medical practice and the outdoors. I have worked all over the world in some incredible places, from Iceland to Belize, the Philippines to Tanzania, Nepal and the Arctic. But it can be challenging combining this with working in the NHS. So how do you go about working abroad as an expedition medic?
Your morning commute as a medic on expedition in Nepal. Photograph: Extreme Medicine
What opportunities are available in expedition medicine? How do you find out about them?
There are a multitude of optionsfor medics to accompany expeditions or projects overseas. Companies running charity trips often seek medics, and there are also expeditions organised by universities, aid or relief work, commercial expeditions and TV work, although this is harder to come by.
Opportunities are advertised in a variety of ways. I was working in a small emergency department in the north of Scotland when I was contacted about a job in Nepal at short notice, but it is also worth following World Extreme Medicine’s Facebook page for the latest opportunities.
What qualifications do you need? Are there any personal qualities that help?
Doctors usually need to be at least two years qualified; other medical professionals should follow guidance from their governing body. You need to attend an expedition medicine course, to learn how to apply your medical skills in remote environments. World Extreme Medicine run courses several times a year all around the UK and abroad.
Experience in emergency medicine and general practice stand you in good stead to deal with the wide range of medical problems on expedition, and the former is usually a prerequisite. You should have a good working knowledge of managing fractures, wound management and dressings, so spending time learning from nursing staff in your department cannot be underestimated.
Crucially, you need to make sure you possess all of the technical skills required of the expedition itself, from winter mountain skills to simple camp-craft, to ensure you are comfortable operating in extreme environments. It helps to be naturally sociable and able to fit easily into a team, and it goes without saying that you need to be physically fit.
‘Make sure you possess all of the technical skills, from winter mountain skills to simple camp-craft.’ Photograph: Claire Grogan
When is a good time to take time out of a career? How do you ensure you will get a job on your return?
There are natural career breaks in the traditional training paths in medicine and it is now common for doctors to undertake an “FY3” year to pursue a particular interest. Some people warned me that taking time out could pose problems for job applications on my return, but my experience was that these were unfounded. At interviews I was often asked more about what I had learned from my experiences as an expedition medic than other details on my CV.
Now I work full-time in the NHS, and it is possible to get away on trips within annual leave restrictions with some creative rota management and a few swaps here and there.
What kind of situations might you face?
Most problems on expedition are minor but occasionally full casualty evacuations need to be carried out, so it is worthwhile ensuring you have a robust system in place for this eventuality. My biggest tip is try to anticipate the unexpected.
In spring 2015, I was volunteering at a high-altitude rescue post in the Gokyo Valley in the Himalayas, running awareness talks on altitude sickness and providing medical assistance to trekkers and porters. A colleague and I had just finished the Saturday morning clinic when a 7.8 magnitude earthquake struck. We knew immediately what was happening and ran outside to safety. Bad visibility masked our view but we heard avalanches roaring in the valley around us.
Over the coming days we established communication with home and our colleagues further up the valley, and helped our local community get back on to its feet. Our rescue post became a place for people to gather and support each other.
‘Try to anticipate the unexpected’ – such as polar bears. Photograph: Claire Grogan
Earthquakes had been one of the risks we discussed before leaving the UK, and we had agreed to always have a grab bag with water, passports and food ready to go in an emergency. It seemed like overkill at the time, but that small amount of forethought really helped. Now I have a grab bag on every expedition, and always keep a head torch by my bed in case of emergency.
How can I gain additional qualifications or experience for this kind of work?
I teach at World Extreme Medicine and we run courses in expedition and wilderness medicine in the UK, as well as environment-specific courses all over the world, such as polar medicine in Arctic Norway, jungle medicine in Costa Rica, and mountain medicine in Nepal. It is a fantastic way to learn when you are immersed in the environment.
In conjunction with University of Exeter Medical School, WEM also run a Masters in Extreme Medicine which may be of interest to those looking to pursue a formal qualification or research in this area.
The World Extreme Medicine Conference, in Edinburgh from 18–21 November 2016, is set to be a brilliant gathering. I love going because it is a chance to meet, share experiences and learn from world-renowned experts in the medical fields of pre-hospital care, expedition, endurance, disaster and humanitarian medicine, and sport, space and extreme medicine.
Claire Grogan is an emergency medical doctor, honorary clinical lecturer at the University of Exeter Medical School and fellow of the Royal Geographical Society.
Register here for the World Extreme Medicine Conference and enter the code EXTREMEMEDGUARDIAN10 for a 10% discount on tickets.
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Climate taxes on meat and milk would lead to huge and vital cuts in carbon emissions as well as saving half a million lives a year via healthier diets, according to the first global analysis of the issue.
Surcharges of 40% on beef and 20% on milk would account for the damage their production causes people via climate change, an Oxford University team has calculated. These taxes would then deter people from consuming as much of these foods, reducing both emissions and illness, the team said.
Food production causes a quarter of all the greenhouse gas emissions that are driving global warming, largely from the raising of cattle and other livestock. These emissions are increasing as people around the world become richer and eat more meat.
Marco Springmann, from the Oxford Martin Programme on the Future of Food, who led the study, said: “It is clear that if we don’t do something about the emissions from our food system, we have no chance of limiting climate change below 2C.
“But if you’d have to pay 40% more for your steak, you might choose to have it once a week instead of twice.”
Meat and dairy tax
The research, published in the journal Nature Climate Change, evaluated the tax required for each food type to compensate for the climate damage its production causes. Beef has a heavy footprint, due to the deforestation and methane emissions associated with cattle and the grains they are fed, and needed a 40% tax on average across the world.
The scientists then assessed how much less of each food type would be eaten as a result of the taxes. They examined different tax regimes and found the optimum arrangement in terms of both emissions and health was to combine the taxes with subsidies for healthy foods, such as fruit and vegetables, and payments to people to compensate for price increases. This ensured poorer people did not end up with worse diets as the result of taxation.
This optimum tax plan would reduce climate emissions by 1 billion tonnes a year – the same as the entire global aviation industry. This huge potential cut in emissions surprised Springmann, as did the heavy impact of dairy products.
Changes to how food is produced and consumed have largely been ignored in the battle against climate change, due to public sensitivity about their food choices, fears about increasing hunger in poorer parts of the world and the lack of straightforward measures to tackle the problem.
“If people see any food price rise, they get angry, so you have to explain why you are doing it,” said Springmann, adding that a successful food tax policy could spend all the money it raised on ensuring people could afford healthier diets. He said a tax in Denmark on unhealthy saturated fats, where the government simply kept all the revenue, was aborted after a year. But in Mexico, a sugar tax on soft drinks has been successful after the funds were spent on free drinking water in schools.
Most of the foods with big climate impacts also happen to be unhealthy when eaten in large quantities, such as beef and dairy. Therefore, if climate taxes cut consumption, fewer people would die from related diseases such as heart disease, strokes and cancers. In the US, for example, people eat three times the recommended level of meat. The researchers found climate taxes would save more than half a million early deaths every year, largely in Europe, the US, Australia and China.
However, cutting the demand for meat and dairy would not be easy, said Rob Bailey, research director at UK thinktank Chatham House: “The challenge is political. As the new research demonstrates, in many countries there is a very strong public health and climate case for dietary change, but it isn’t happening. Governments are reluctant to ‘interfere’ in people’s lifestyle choices for fear of a public backlash and criticism for ‘nanny statism’, as well as the reaction from powerful interests in the food industry and agricultural lobby.”
Bailey said there was currently little pressure on governments to act, partly because the public understanding of the link between diet and climate change is low. But, when people are informed, they find meat taxes far less unpalatable than is supposed, he said.
Calls to cut meat-eating, by the UN and high-profile figures including climate change experts and the economist Lord Stern, have so far been both rare and controversial.
The new research found the taxes needed to compensate for climate damage were 15% on lamb, 8.5% on chicken, 7% on pork and 5% on eggs. Vegetable oil required a large tax of 25%, but this was due to the low initial price of the product, making a relatively modest surcharge look high.
These tax levels were global averages but there was significant variation with, for example, the beef tax being higher in Latin America, where cattle-raising produces more emissions than in other regions. The optimum tax plan also had regional variations, including limiting climate taxes to beef in the lowest income countries, to ensure people there were still able to afford decent diets.
Springmann said it was critical to find a way to cut the environmental impact of food production: “Either we have climate change and more heart disease, diabetes and obesity, or we do something about the food system.”
