Thursday 9 May 2024

The paradoxes of public health

 First published in LibDemVoice.

The promotion of public health is a liberal policy. It is an effective tool in the development of fairness and equality, it contributes notably to health and happiness (thereby reducing the need for, and the expense of, medical care; and reducing the cost to businesses of time off work), it enables people to have much more effective control over their own lives, and many of the activities associated with it resist financialisation, which is one reason why it is so unpopular in right wing circles.

It is also a wide ranging field. Healthy populations need good quality, warm, dry housing; good education; good food; good opportunities for both rest and exercise. On the other hand, reduction of social housing, the obsession with reducing education to league tables, corporate control over food prices and ingredients, the selling off of parks and playing fields, all contribute to reductions in public health.

Fundamentally, good public health reduces the impact of poverty, ignorance and conformity in people’s lives.

Public health requires a community based rather than an individualistic response. This again is a liberal value. While we champion the freedom of individuals, we also champion the notion that we live together in communities, and that we affect, and must support, each other. It is an effective sphere for government to do what we cannot do so well ourselves. It utilises “the power of government to change conditions that are constraining people’s freedom”.

As a country we allow the debate to be dominated by advocacy of a freedom that takes no responsibility, by far too much misinformation, and far too little information. (A very clear example at the moment is when both government and media notice that the number of people off sick has notably increased recently, and wonder why. Without ever mentioning Covid, which we know has severe long term consequences for many who have had it.) As a party we allow ourselves too often to be trapped within those terms rather than campaigning to change them.

The party currently has very creditable policies on public health: well thought out, detailed and workable. (I encourage you to go and read them.) I doubt that they will gain much prominence in a LibDem manifesto in the near future, any more than any other party’s. (I understand the reasons for this; the bandwidth in an election campaign is severely limited.) But perhaps we, as the foot soldiers of liberalism, should be making a much more concerted noise about the benefits of public health as well as the possibilities for local as well as national action in that sphere.

Friday 15 March 2024

The shadow of covid

 First published in LibDemVoice on Long Covid Awareness Day, March 15th, 2024.

Today is Long Covid Awareness day. It is strange that such a day should be necessary, given how many people’s lives Covid and Long Covid have touched in this country and around the world. Yet it is very necessary as the prevailing public discourse is that Covid is over, and it was never much of a problem to start with. Yet it still kills every week throughout the year, and an estimated 2 million people have Long Covid, affecting their health, and the country’s economy.

The ongoing Covid pandemic is a catastrophic example of the failures of the UK’s public health system. (I refer here primarily to English experience. The devolved administrations have done better than England, but are still affected to a large and tragic extent by the factors discussed below.) Covid requires both treatment and prevention, both medical and public health intervention, and both short and long term strategies with public, professional and political support.

The NHS did immensely well and the government moderately well in the initial phases; the public in general also did well in dealing with the restrictions and exigencies of lockdown. But there were clearly right from the beginning several negatives, which broadly compromised the capacity of public health approaches to be as effective as they could, and have badly compromised government action and professional and public response in the years since the emergency phase:

a) the instinctive reaction of our right wing governments that private provision must be better than public, so wasting billions of taxpayers’ pounds employing immensely expensive private firms to set up a ramshackle test and trace system rather than using existing public health capacity.

b) corruption in government, making sure for instance that funds for the provision of PPE went to their friends rather than to companies with proven track records in such provision.

c) vociferous anti-science and anti-clear thinking conspiracists given far too much air time on both social and traditional media.

d) a kind of neoliberal reductionism in which marginal increases in economic activity like enabling people to go to pubs again are valued far more than keeping people healthy; and school attendance is valued far more highly than reducing transmission – which has resulted in current high rates of absence of both children and teachers through sickness.

e) a refusal from government to take simple steps that might reduce transmission, such as ensuring air filtration in all classrooms and other public spaces which could easily and relatively cheaply have been done in the last four years.

f) short term and blinkered thinking in government and in public debate, in which the most important, and sometimes, the only important metric is death rates, leading us to ignore the creeping epidemic of long term illness and other forms of severe damage which Covid is wreaking on millions of people. We seem to be terrible at assessing long term risk: the fact that we got over a bout of Covid means we ignore the mountain of evidence that it will have done damage to one or more of our organs, which we will regret in ten or fifteen years time.

This is a massive failure on the part of our entire social and political system. All parties, including the LibDems, are complicit in downplaying and denying the damage this disease has done and is still doing to our health. Is it not time for the LibDems to find a bit of non-conformist spirit, and start saying what no other party will say – that Covid is still here, and we need to be taking it seriously?

Saturday 9 December 2023

Covid, measurement and public health

Some thoughts, not necessarily connected.

The first is inspired by a letter to the Guardian in September this year. The writer criticised general vaccination measures as not cost effective when judged against  hospital admissions and deaths.  These are very short term and limited criteria.

There is now a mountain of evidence showing that, even among those who get covid mildly, the long term effects on their body is significant - albeit currently not detectable - with notably increased risk of cardiovascular problems, including heart attacks, compromising of kidneys, liver and other organs, increased likelihood of diabetes and other long term conditions, and more besides. And for those who are infected more than once, the effect and the risks increase with each infection. Not shielding everybody, even those in the rudest good health, is storing up a landslide of health conditions in ten or twenty years time that will dwarf the cost of a widespread and continuous vaccination programme. 

Then there is also long covid, which is already causing a strain to the economy with hundreds of thousands in this country alone unable to work or contribute as they could if they were healthy. 

I would argue also that we should be taking other precautions, for instance making normal the wearing of masks instead of privileging people's freedom to infect everybody around them. In all of this, my primary concern is enabling as many people as possible to live a life free of illness and disability, but in this context we are talking about money. If Professor Majeed would calculate the long term costs to the economy of illnesses made more likely by covid, I am sure he would re-evaluate his opinion on the cost-effectiveness of widespread vaccination. 

And then there was another article about mental health: "People who stuck by UK Covid rules have worst mental health, says survey". I think we need a very serious examination of how much it was lockdown that damaged people's mental health, or the crazy and lethal messaging around it. UK public health practice and narrative wasn't just bad, it was actually destructive. Largely because driven by the squalid Johnson and his friends, as we have just been reminded by Boris Johnson’s blathering appearance at the Covid enquiry. If the people who stuck by the rules, who took responsibility and deprived themselves had been told constantly over the ensuing years that they had done the right thing, they would certainly be feeling a lot better now. 

But the subtext beneath the government's messaging was always that being irresponsible was the right way to go, and very little credit was ever given to those who obeyed the rules to their own cost. How could it have been different when we had the most lethally irresponsible Prime Minister of modern times in charge, and an entire government either in thrall to him or looking to profit?  

Saturday 14 October 2023

Johnson at 10

Seldon and Newell’s “Johnson at 10” is a deeply dispiriting book. I read it because a friend of mine with normally reliable opinions told me I really had to, as it contained such a stark and detailed portrayal of the depths Johnson was prepared to plumb. I didn’t much look forward to it, but agreed I would, and, because I’d agreed, I read it from start to finish. As I started, I reflected on the fact that I was pretty sure that nothing could make my opinion of Johnson any lower than it was already, but also prepared for the possibility that what I read might do just that.

It did. There wasn’t anything worse than we already knew about. But the sheer relentless detail of it made clear what an utter reprobate of a human being Johnson is with not one redeeming feature. He has a great gift with words, he can be charming, he can be nice, he can be generous (as long as it’s with other people’s money). None of those redeem his utter lack of morals. I recently heard of the concept of an “energy drain”, a person who is so negative that they drain the life out of you. I expect we all know one or two.  Johnson is an integrity drain. Whatever integrity there is in a situation, Johnson’s very presence just drains it away. I knew that already, although I’ve only now coined the phrase. But the book confirmed for me in black and white, with no shades of grey in between, just what an integrity drain he is.

In its way this book will be seen as a contribution to the historical record. It is a detailed account, using many eye witness statements, and noting provenance where appropriate (though more of that a little later). It gives detailed and apparently accurate accounts of many events, issues and relationships in a period that will receive intense examination from future generations, not just out of macabre historical interest but also with a view to not making the same mistakes again. (On p470 the authors note a supreme irony with regard to a book entitled “How To Run A Government”: "Barber was chuffed to have been told that Johnson had read his book "How To Run A Government". (Johnson was a voracious reader, but this title sounds incongruous: a more implausible title for him to read would be hard to conceive.)" This passage is one of many showing – apparently – that they had no illusions about the man they were writing about.

And yet. And yet.

Throughout the book, through almost six hundred pages, every one packed with detail of how impossible it was for Johnson ever to do anything systematic or responsible, and comments which make it clear that the authors were completely aware of the person they are portraying, they repeatedly, repeatedly, repeatedly seem to be trying to find ways to exonerate him, to portray him as a man capable of goodness but somehow repeatedly mistaken, misled or falling short.

For example, the quote above about the inappropriateness of Johnson’s reading material is followed soon  by p471 "[Rosenfield] was on a hiding to nothing from the start, doing a job no one wanted, working for an impossible man..."

Sandwiched between these two excoriating statements we find this: p470 "The appointment [of Barber] revealed Johnson at his best." There is no "best". Occasionally the shopping trolley points in the right direction. Occasionally Johnson's capacity to produce the right sounding words while meaning absolutely none of them, would fortuitously result in the right person being put into the right place. The authors mistake happenstance for moral character.

Earlier on they write of his victory speech after the 2019 election that he was "gracious in victory" (p135). He wasn't: he wrote words that made him seem gracious in victory. He's actually a human generative AI - "Johnson, write a speech that looks like one delivered by someone gracious in victory". Knowing what we know of Johnson – of which the authors have supplied thousands of examples in this book – we would need proof that he was actually being gracious rather than not. Later on we get references to his speeches about Ukraine. The same caveat applies: "Johnson, write me a speech about the invasion of Ukraine, Churchillian with echoes of Thatcher." And out it comes. Given everything Seldon and Newell have themselves said about Johnson, it is not believable that he actually meant any of it. Ukraine's need happened to coincide with Johnson's desires of the time, and that is all. Eton’s teaching of rhetoric has a great deal to answer for.

And so on throughout: p482 "Why did it all go wrong? Simple. Johnson repeated, though it's hard to believe, exactly the same three mistakes..." I don't find it hard to believe at all; and, given what they've written about him in the previous 481 pages, neither should they. The reason they write that "hard to believe" is that they still believe deep down that Johnson is somehow fundamentally a serious and decent man, and he has just made "mistakes". With a bit of guidance he could have been put on the right path. Everything they write about what he actually does shows that this is not true, is never true. These are not mistakes; they are the essence of Johnson.

And, having inserted that “hard to believe” they then add, just a couple of pages later: p484 "Johnson seemed to have learned little over his three successive regimes in no 10. There is no reason to believe that, were there ever to be a fourth regime, he would not make exactly the same mistakes." Absolutely right, no reason to believe it at all, yet they still seem to want to.

As I noted above, the book is buttressed with contemporary evidence - notes of and conversations with participants in the chaos. But the forgiving asides they insert are not often so buttressed. I have not made a detailed analysis of all the phrases, but it seemed to me as I read that more often than not such forgiving asides were not supported by evidence. From the same section of the book, here is an example: p478 "For all his frustrations with Mirza he mourned being abandoned by his moral compass." If you want to make a statement about Johnson’s inner feelings, you must have detailed evidence from a contemporary source who was close to Johnson, very close. No such evidence is offered. Quite aside from the lack of evidence, this is an astounding sentence. They have demonstrated repeatedly in the book that there is no room for a moral compass anywhere in Johnson's life. How can they let themselves, after all they've said about him, actually believe that he would in any way respond to a moral compass? Particularly as she resigned because of an egregiously immoral statement about Starmer failing to prosecute Jimmy Savile, and then equally immorally – as they themselves explain - not apologising after he promised her he would.

And so they continue. In chapter 10 (“Downfall” with a presumably deliberate, but distasteful, echo of Hitler’s last days) after examining all the possible culprits, they exonerate them all, and conclude that it was Johnson who brought Johnson down. Pp564-5: "An ability to govern is the most crucial of all qualities Prime Ministers need to display... Johnson never understood how to be Prime Minister or how to govern."  They're right - and he was never going to. Even while examining the death throes of his Prime Ministership, they insist that he was capable of learning. “He could improve in some areas where he could learn from repeated errors…”. I have never seen a man less capable of learning than Johnson - at least unless the learning were of immediate benefit to him.  And immediately after saying this - well, to be precise, two pages later, they say "He never listened, never learned, never changed: he never believed he had done anything wrong." Their summary of his personal weaknesses on p567, ending with a quote "He possessed a chronic aversion to the truth, lying morning noon and night", is devastating.

P577: "his most successful performance, showing he was capable of taking effective decisions and producing statesmanlike leadership in response to the invasion of Ukraine. It was no coincidence that his best moment was in a area where he had learned from experience". I doubt there was any learning, and I do not see any effectiveness or statesmanlike actions over this period. He was not "being" statesmanlike, he was playing being statesmanlike as he always did. What made him successful on this occasion was that - completely fortuitously - what he was good at was what was demanded. The Ukraine crisis combined two things he likes to do most of all a) be a showman  b) spend other people's money - both of which have been a lifelong habit. There was very little serious decision making – all he had to do was to headline what everybody else wanted. There was no genuine concern for the people of Ukraine; we know, for example, that his trips to Ukraine were generally timed to take the spotlight off moments of domestic difficulty. The facts that it was in a good cause, and one that everybody else rallied round to, are merely fortuitous. Perhaps they're right to call it a "successful performance", because that is what it was, a performance. On a stage. For the consumption of the media.

Right to the end, they're desperate to portray him as capable of being serious. p579 "Had he been prepared to work harder and in a more systematic way, as affirmed by those working at his shoulder, he would have achieved…". Every piece of evidence brought up in the 578 previous pages demonstrates that that was never going to happen. Johnson is not capable, and never was, of hard or systematic work.

The final sentences read, p582 "Johnson had the potential, the aspirations and the opportunity to be one of Britain's great Prime Ministers. His unequivocal exclusion from that club can be laid at the feet of no one else, but himself." I agree with every word of that, except one, "potential" - it ought to be blindingly clear to the authors as well as to everyone who has read what they have written, that Johnson never had the potential to be great. He has a very strong and very defined character, with no moral compass whatsoever: his character excludes greatness. It makes him incapable of system or responsibility.

Thus it is a useful book because of the wealth of historical evidence it contains. But also a book whose analytical aspect is fatally flawed by the authors’ consuming need to find mitigations for one of the most squalid characters of all time.

Updated 15 Oct 23 to correct typos.

Saturday 7 October 2023

Restore Trust has changed the way I vote in National Trust elections

Restore Trust has changed the way I vote in National Trust elections, which is ultimately unhelpful for the long term robustness of the National Trust.

Several seats on the governing body come up for re-election every year. The council recommend those they think best. Up till now I have looked at all the candidates. I usually accepted most of the council's recommendations, but substituted one or two choices of new candidates who I thought would bring fresh thinking or fresh skills to the council.

I don't do that any longer. I accept the council's recommendations in their entirety. The danger of a Restore candidate getting in because of a council recommendation not getting votes is too great a risk. I outline in another post the reasons why I find Restore Trust dangerous for the National Trust and ultimately dangerous for what is left of our democracy.

I think it is a shame that I find it necessary to vote in this way, because it reduces the possibility of vibrant new opinions finding their way on to the council. But I will continue to do that as long as it thwarts Restore Trust's regressive, destructive, anti-democratic agenda.

I have also looked at the resolutions, some of which are supported by Restore Trust. Again, it is clear that the resolutions they support are not designed to improve governance or democracy, but to make it easier for Restore Trust to promote their own deceitful agenda. I shall vote in line with the Trustees’ recommendations in all cases. 

Friday 8 September 2023

The Resistible Rise of Restore Trust

 ‘Tis the season for National Trust voting again. And once again Restore Trust have posted their very helpful list of people not to vote for.

Restore Trust thinks the National Trust has a problem. Or, to be more accurate, Restore Trust wants the rest of us to think the National Trust has a problem. On the face of it, Restore Trust are very nice people. But there is a not so very hidden agenda.

First of all, they claim to be independent. They claim that having an office at 55, Tufton Street is just coincidence. 55, Tufton Street houses a bunch of opaque organisations with right wing libertarian and climate sceptic agendas. Their common feature, apart from their very right wing politics, is their opaqueness. Restore Trust claimed not to be connected to any other organisation there until it was pointed out that board member Neil Record was chair of the IEA and climate change deniers Net Zero Watch. Restore Trust’s director, Zewditu Gebreyohanes, previously worked at Policy Exchange, which is described by George Monbiot as “a dark money lobby group, and one of the most deadly anti-environmental organisations in the UK”. They claim that all their funding is from small donors without revealing any of the sources – in common with most if not all the other tenants of Tufton Street.

They rely on imprecision, impression and deniability. For instance, the X (Twitter) handle RestoreTrustNT mimics National Trust practice, such as ClandonParkNT, SheffieldParkNT, giving the impression that they are connected to the main body. When pressed they will deny it, "Of course not, don't be silly", but the impression is there in the background.

They have a mantra - a form of words that gets repeated and repeated and repeated. In this case it is "get back to its original purpose". They provide little evidence that it has strayed from its initial purpose, and the evidence they do provide is very low quality. (More of that later.) They couch the idea of "original purpose" in their own language, without referring to the formal objects of the National Trust, which might not help their cause.

Such evidence as they use tends to get reused and repurposed over and over again, and is of very poor quality. The most notorious is the Hanbury Hall torchères, which they alleged had been removed because of a "woke agenda". Hanbury Hall corrected them, saying that the torchères were in a fragile state and had been removed from public view for protection and renovation. The inaccurate tweet has not been deleted, which would be standard practice for an organisation that respected the truth. (The tweet is here - checked on Sept 8th 2023.)

You might wonder what would happen if the National Trust did all the things Restore Trust wants. But culture wars, such as the campaign Restore Trust is waging, are not about results. They don't care if the National Trust changes or not; what they want is to keep their audience angry, like Dacre's Daily Mail, just angry enough to keep supporting Restore Trust. If the National Trust changed everything to be the way Restore Trust says it wants them to be, Restore Trust would find something else to complain about. What they want is a constant state of pre-emptive resentment.

What is the end game? They don’t say. Apart from abolishing woke. But I have a notion. It comes in two forms. One is to be a permanent thorn in the flesh - that would suit them quite nicely, so that they can push Tufton Street's exploitative agenda in the culture sphere. The second is more ambitious, and, frankly for me more frightening. They would enjoy being in charge of the National Trust. They would enjoy having a majority on the Council, appointing a chief executive sympathetic to their aims. They could claim to have won and no doubt all reference to slavery would disappear from all NT properties. And Restore Trust would have a direct line to the minds of the National Trust's membership: nearly six million thoughtful British people (thoughtful, but mostly "unpolitical" hence ripe for cultivating). What might they do with publications like the NT magazine to push their right wing exploitative agenda? Restore Trust, in my opinion, does not have the interests of the National Trust at heart at all. What they want is disruption and control for their own agenda. I would urge all National Trust members to resist. The immediate way to resist is to vote for the Council’s recommended candidates, and nobody else.

Thursday 22 June 2023

Covid is not over

 First published on LibDemVoice.

The UK’s response to Covid has been, and still is, characterised by delay and indifference. This is largely but not wholly because Boris Johnson was Prime Minister when it struck. Johnson made being irresponsible fun, and we all paid the price for it, as the Covid inquiry is now slowly and painstakingly beginning to make clear. The British electorate was shallow enough to fall for it, and resistant enough to taking responsibility seriously to make it very risky for a political party to advocate it. But sometimes it is right for political parties to say unpopular things.

A liberal response to Covid would start from the basic principle: we should be free to do everything we want, provided we do not infringe other people’s freedom. Conrad Russell noted that that proviso is far more of a limitation than most people realise.

During the crisis we did all the things we were asked to do (unlike Johnson et al). Once it was over, most of us embraced our “freedom”, and stopped counting the cost to other people. More than a million clinically extremely vulnerable people remain effectively trapped in their own homes because they cannot count on the rest of us to keep them safe. The population at large (including, unfortunately, a lot of medical practitioners) embraces the fictions that it’s over (while the aptly named FU.1 variant is spreading globally 50% faster than previous variants) and that it’s just like flu. But currently 200+ people die every week with Covid on the death certificate (this is known to be significant underreporting). Flu doesn’t kill people in the summer. Flu doesn’t cause the long term sequelae that Covid does. People don’t get Long Flu, whereas currently in the UK alone two million are suffering from Long Covid (ONS figures).

80% of Japanese people still mask in public. The instant reaction will be they’re different, they’re more conformist, we believe in freedom. But it doesn’t have to be about ideology or culture. It can and should be about common sense. I am free to not wear a mask; but my not wearing a mask increases the risk of you getting Covid. And that is a much worse fate than the tiny inconvenience of a mask. Back to the key principle that we are free to do whatever we want provided it does not impact on other people’s freedom. This principle says that we must take responsibility for the effect we have on other people. Going about unmasked and not taking other sensible and barely inconvenient precautions puts other people at risk. To be liberal, we should take account of that and act responsibly.

It is time for the Liberal Democrats to say, “Hey, this is our core principle. It’s time to be sensible about this. People are suffering dire long term consequences, or even dying, because we refuse to take responsibility for the effect we have on others.  People are suffering dire long term consequences, or even dying, because we won’t press the government to do sensible things like allocating meaningful budgets for air filtration in schools and public buildings. ‘Living with’ Covid actually means dying with it.”

It seems to me that this would be the liberal way, despite the public’s impatience with it.