San Franciscos Air Quality Matches Beijings

Air quality in San Francisco sank to the level of smog-choked Beijing this week, as soot from more than a dozen wildfires in California’s wine country blanketed the Bay Area.

As San Francisco residents woke up to a hazy sky for the fifth day in a row, the concentration of dangerous particulate matter was forecast to be 158 on the air-quality index, according to the Bay Area Air Quality Management District. That’s roughly on par with notoriously smoggy Beijing, which clocked in at 165.

The gauge, known as PM2.5, refers to particles with a diameter of less than 2.5 micrometers, which can be inhaled and penetrate deep into the lungs. While long-term exposure is correlated with lung and heart disease, Bay Area residents should only experience temporary discomfort with no permanent effects, said John Balmes, a professor of medicine at the University of California, San Francisco.

Lenard Lesser, a doctor at primary care group One Medical, said he has seen several patients with smoke-related complaints, including sore throat and difficulty breathing, at his San Francisco office this week. Children, older adults and people with lung disease such as asthma should stay indoors while the air quality is bad, and wear an "N95"-rated mask when outdoors, Lesser said in an email.

    Read more: http://www.bloomberg.com/news/articles/2017-10-13/san-francisco-air-quality-matches-beijing-s-as-wildfires-burn

    Oxford city center could be electric vehicle-only by 2030

    The dreaming spires could soon be the first to benefit from being in a 'Zero Emission Zone'
    Image: Shutterstock / elesi

    A lot can happen in three years, but banning combustion engines from a major city centre? That seems a bit of a stretch.

    Oxford City and Oxfordshire County Council have proposed plans to rid the city centre of all diesel- and petrol-fuelled vehicles — buses and taxis included — by 2020. This could potentially make Oxford centre the very first Zero Emission Zone, and the council also wants to expand this Zero Emission Zone twice more, in 2025 and 2030. 

    The council cites the health risks caused by pollution as the reason behind this bold proposal. In a statement, Oxford council says, “Oxford city centre currently has illegally-high levels of toxic nitrogen dioxide, which contributes to diseases including cancer, asthma, stroke and heart disease – and contributes to around 40,000 deaths in the UK every year.”

    The council projects that this new plan will lead to a 74% reduction in nitrogen dioxide on the centre’s most polluted street by 2035.

    The City Council had already made some headway, as they state in their press release that they have won £500,000 in government funding to install charging points for electric taxis, and a further £800,000 for charging points for use by Oxford residents.

    However, as optimistic as this plan may seem, The Memo picked up on a slight catch.

    The area that would be covered by the 2020 no-emission zone is incredibly small, and already contains “very little traffic,” according to the Oxford Zero Emission Zone Feasibility and Implementation Study. It notes that implementing the diesel and petrol ban in this area “would potentially have little overall effect on air quality”.

    The 2020 area only covers 3 roads, and they’re not particularly busy thoroughfares.

    On the other hand, three years is not a long time to adapt a city centre to electric vehicles, so changes would have to be incremental. 

    TheOxford Zero Emission Zone Feasibility and Implementation Study also suggests that the council could incentivise people to switch to electric vehicles by offering free EV (electric vehicle) parking in 2020 and then introducing EV-only parking areas in 2025.

    James McKemey at Pod Point, a company which installs EV charging points, believes that the real incentive to switch to EV won’t come so much from the public sector, than from consumer experience. He told us that government grants and tax breaks encouraging the purchase of electric cars are “small incentives which are helpful in the early days […] but ultimately the real incentive to drive an electric vehicle will be that they are fundamentally better.” 

    He also thinks that Oxford City Council’s 2020 goal isn’t an unreasonable target, given that EV battery pack prices have recently become far more affordable at a rate that is “far beyond what we expected”.

    So from this point of view Oxford centre wouldn’t be forcing a change to electric vehicles so much as keeping up with a trend.

    However, this doesn’t mean that enforcement won’t be an issue. Oxford council’s study recommends the implementation of Automatic Number Plate Recognition to help identify anyone infringing on the Zero Emission Zone, regardless of the “illuminated signs” they would put up.

    The plans are still only a proposal, and from Monday Oxford residents will have six weeks of public consultation to voice their opinions about their town going electric. Lovely though the plans to reduce pollution sound, they’re bound to make disrupt life for local businesses, as well as the few Oxford professors who don’t ride to work on penny farthings. 

    There goes the history department.

    Image: Laura De Meo/REX/Shutterstock

    Of course if Oxford does go electric, it will make for much more environmentally friendly car chases on Lewis. And what about Endeavour? Hard to say.

    Read more: http://mashable.com/2017/10/13/oxford-city-centre-zero-emission-zone-2020/

    The psychology of gold and why it has that allure

    (CNN)When you think of the color gold, images of grandeur and extravagance are likely to come to mind.

    For millennia, the metal has adorned crowns and hilts of swords. It has been used to enhance paintings and ornaments to increase their value.
    That led to the metal being associated with a shining, otherworldly character attributed to the gods in the religions of many different cultures. “Some of these were bodily associations,” the authors write.
    The Aztecs described gold as the “excrement of the gods,” while the Incas thought of it as the “sweat of the sun.” In ancient Egypt, gold was considered the “flesh of the gods.” Across cultures, it was a sacred material.
    The book goes on to illustrate the importance of gold in health and medicine. Chinese alchemists believed that drinking potable gold in the form of elixirs, eating from gold plates and using gold utensils helped attain longevity.
    “Before the 20th century, gold was used to treat conditions as varied as syphilis, heart disease, smallpox and melancholia,” the book notes.
    Today, gold compounds are still thought to have some anti-inflammatory effects.

    Attracting the eye

    The incorruptible nature of gold has an otherworldly allure to it and the reflective quality of the metal gives the impression that it glows from the inside, said Oakley.
    When viewed by candlelight, gilded medieval manuscripts, statues and icons in the Eastern Orthodox Church exuded a transcendental quality, glowing as if they were illuminated from the inside.
    Human vision can discriminate millions of colors, but it can discriminate trillions of chromatures — colored textures, said Donald Hoffman, professor of cognitive science at University of California, Irvine.
    “It is the chromature that targets the human emotions more specifically than uniform color patches,” he said.
    Hoffman believes the reason chromatures can target human emotions more specifically than uniform color patches is that they contain far more information than color patches.
    He demonstrated the concept with two pictures — a section of brown grizzly bear fur and the same brown color in plain background. When looking at the chromature, our mind can immediately grasp that we are looking at a bear, he explained.
    “Evolution would have more success training the emotional system to be wary of the bear fur chromature than to be wary of the uniform color patch of the same average color.”
    Similarly, when we look at a gold ring versus a standard patch of uniform color, we see interesting highlights on the ring because the metal is highly reflective.
    “Companies are using genetic algorithms to evolve chromatures and target specific emotions they want people to experience with respect to their product or brand. It turns out to be quite powerful,” he adds. For example, “A company might, for instance, want to convey the idea that their product is soft and warm. Then we would start with closeup images of patches of soft things, such as the fur of a rabbit and the down of a goose, and warm things, such as glowing embers of charcoal or a warm sunset,” Hoffman explained.
    The same could be applied to evoke emotions linked to gold — how does it make you feel?

    A sign of success

    In ancient Rome and medieval Europe, sumptuary laws prohibited people from wearing too much gold — or not wearing it at all unless they were from a noble family.
    Gold leaf has been used liberally in artwork which hinted at the status of the patron who commissioned it.
    All societies value gold and investing in gold has survived for centuries through marketing — even glorified.
    “(Gold) carries with it the messaging that you should own it. It is a learned, conditioned response,” said Eiseman — but not so much that it becomes tacky, she adds.
    In popular culture, musicians flaunt their gold bling. The underlying message being that they are good at what they do and have amassed a lot of wealth. “In a lot of cultures, the word for money derives from the word for gold. In China, the ideogram for money is the ideogram for gold,” Oakley said.

    Tell us your story
    We love to hear from our audience. Follow @CNNHealth on Twitter and Facebook for the latest health news and let us know what we’re missing.

    Gold continues to be featured heavily in religion and religious rituals alike. It decorates the papal regalia, spires, domes and minarets of temples, churches, monasteries and mosques worldwide.
    Golden trophies like Olympic medals, the Nobel Prize, Oscars and Emmys are presented to people who display a unique talent. “The idea is the prize made of a rare material is given to people with display talent as rare as the material,” said Sally Augustin, an environmental and design psychologist.
    Psychologically, this results in gold being a color of motivation.
    Are you motivated?

    Read more: http://www.cnn.com/2017/10/13/health/colorscope-gold-allure/index.html

    More than 25 million people dying in agony without morphine every year

    Concern over illicit use and addiction is putting morphine out of reach for millions of patients globally who need it for pain relief

    More than 25 million people, including 2.5 million children, die in agony every year around the world, for want of morphine or other palliative care, according to a major investigation.

    Poor people cannot get pain relief in many countries of the world because their needs are overlooked or the authorities are so worried about the potential illicit use of addictive opioids that they will not allow their importation.

    Staring into this access abyss, one sees the depth of extreme suffering in the cruel face of poverty and inequity, says a special report from a commission set up by the Lancet medical journal.

    In Haiti, for instance, says the report, there are no nursing homes or hospices for the dying and most have to suffer without pain relief at home.

    Patients in pain from trauma or malignancy are treated with medications like ibuprofen and acetaminophen, says testimony from Antonia P Eyssallenne of the University of Miami School of Medicine. Moreover, nurses are uncomfortable giving high doses of narcotics even if ordered to do so for fear of being responsible for the patients death, even if the patient is terminal.

    Death in Haiti is cruel, raw, and devastatingly premature. There is often no explanation, no sympathy, and no peace, especially for the poor.

    A doctor in Kerala, India, which has a palliative care service, told of the arrival of a man in agony from lung cancer. We put Mr S on morphine, among other things. A couple of hours later, he surveyed himself with disbelief. He had neither hoped nor conceived of the possibility that this kind of relief was possible, said Dr M R Rajagopal.

    But when he returned, morphine stocks were out. Mr S told us with outward calm, I shall come again next Wednesday. I will bring a piece of rope with me. If the tablets are still not here, I am going to hang myself from that tree. He pointed to the window. I believed he meant what he said.

    The commissions three-year inquiry found that nearly half of all deaths globally 25.5 million a year involve serious suffering for want of pain relief and palliative care. A further 35.5 million people live with chronic pain and distress. Of the 61 million total, 5.3 million are children. More than 80% of the suffering takes place in low and middle-income countries.

    Jim Yong Kim, president of the World Bank, said things had to change. Failure of health systems in poor countries is a major reason that patients need palliative care in the first place. More than 90% of these child deaths are from avoidable causes. We can and will change both these dire situations.

    Morphine is hard to obtain in some countries and virtually unobtainable in others. Mexico meets 36% of its need, China meets 16%, India 4% and Nigeria 0.2%. In some of the worlds poorest countries, such as Haiti, Afghanistan and many countries in Africa, oral morphine in palliative care is virtually non-existent.

    Oral and injectable morphine is out of patent, but costs vary widely and it is cheaper in affluent countries like the USA than in poor countries. A second issue is opiophobia the fear that allowing the drugs to be used in hospitals will lead to addiction and crime in the community.

    The world suffers a deplorable pain crisis: little to no access to morphine for tens of millions of adults and children in poor countries who live and die in horrendous and preventable pain, says Professor Felicia Knaul, co-chair of the commission from the University of Miami, calling it one of the worlds most striking injustices.

    Knaul says she only realised that many people suffered without pain relief when she was working to improve access to cancer treatment in low-income countries. I was shocked. I had no idea. When people were showing me the data I thought it cant be in this world, she told the Guardian.

    She had also experienced the need for morphine herself after a mastectomy for breast cancer. When I woke up I couldnt breathe because the pain was so bad. If they hadnt arrived with the morphine I dont know how I would have got through it. And as a young girl in Mexico, she had to watch her father suffer as he died without pain relief.

    I dont think that we have cared enough about poor people who have pain, she said. It doesnt make them live any longer. It doesnt make them more productive. It is simply the human right of not suffering any more pain and we dont care about that for people who are poor.

    The commission recommends that all countries put in place a relatively inexpensive package of effective palliative care for end of life conditions that cause suffering, including HIV, cancers, heart disease, injuries and dementia.

    One of their most emphatic recommendations, says Knaul, is that immediate-release, off-patent, morphine that can cost just pennies should be made available in both oral and injectable formulations for any patient with medical need. The disparity and access abyss between the haves and have-nots is a medical, public health and moral injustice that can be effectively addressed by the commissions recommendations.

    Read more: https://www.theguardian.com/science/2017/oct/12/more-than-25-million-people-dying-in-agony-without-morphine-every-year

    Trumps pro-coal agenda is a blow for clean air efforts at Texas’ Big Bend park

    For decades the national parks stunning vistas have been compromised by poor air quality, and prospects of improvement were derailed by Trump Tuesday

    Big Bend national park is Texas at its most cinematic, with soaring, jagged forest peaks looming over vast desert lowlands, at once haughty and humble, prickly and pretty. It is also among the most remote places in the state.

    Even from Alpine, the town of 6,000 that is the main gateway to the park, it is more than an hours drive to one of the entrances.

    So far from anywhere, it might seem an unlikely location to be scarred by air pollution. Yet for decades its stunning vistas have been compromised by poor air quality that Texas, working with the federal Environmental Protection Agency (EPA), is supposed to address.

    But environmental advocates fear that the Trump administrations pro-coal agenda will derail the prospects of improvement, at least in the short term. Tuesdays announcement that the EPA plans to abandon the 2015 Clean Power Plan to reduce carbon emissions came less than two weeks after the agency revealed a revised plan to combat regional haze in Texas and Oklahoma that critics say will do little to cut pollution.

    Chrissy Mann, Austin-based senior campaign representative with the Sierra Clubs Beyond Coal campaign, said: Taken in combination with the Clean Power Plan, what were seeing is an attempt from this administration and this EPA to dig in their pockets and find whatever kind of tricks they think are going to stick to provide a lifeline to the coal industry across the country and here in Texas. Its disappointing.

    Texas is part of a multi-state coalition that sued to stop the Clean Power Plan, which was placed on hold by the US supreme court last year.

    Ken Paxton, the Texas attorney general, said in a statement: Its gratifying that our lawsuit against Obama-era federal overreach was a catalyst for repeal of the plan. We look forward to working with the administration to craft a new strategy that will protect the environment without hurting jobs and the economy.

    The
    The Perseid meteor shower at the Texas Bend in Big Bend national park in August 2016. Photograph: Jason Weingart / Barcroft Images

    A back-and-forth between the EPA and Texas over regional haze has been in motion since 1999, when the agency launched a concerted effort to deal with the problem, bidding to improve the air quality in Big Bend national park, Guadalupe Mountains national park and in Oklahoma, the home state of the EPA administrator, Scott Pruitt.

    In 2009, the state enforcer, the Texas Commission on Environmental Quality, issued a plan that would restore natural visibility to Big Bend by the year 2155. That was rejected as inadequate by the EPA in 2014.

    The EPA wanted Texas to cut 230,000 tons of sulphur dioxide emissions per year to improve visibility and reduce the risk of worsening respiratory diseases and heart disease and damaging soil, water, fish and wildlife.

    Two years later, finding Texas relied on an analysis that obscured the benefits of potentially cost-effective controls, the EPA replaced parts of Texass emissions plan, calling for plant upgrades and a target of natural visibility by 2064.

    Texas sued the agency and won a stay of implementation in a federal appeals court. The state argued that it is making reasonable progress and, along with industry representatives, claimed that enacting the structural improvements notably fitting some electricity plants with sulphur dioxide scrubbers would cost $2bn and be a backdoor way of forcing the closure of coal-fired power plants. That, it said, might put the state at risk of power shortages and increased prices for consumers.

    Last December, in the sunset days of the Obama administration, the EPA proposed another scheme that would also have required older plants to upgrade their technology.

    But in August this year, Pruitts EPA asked a federal court for more time until the end of 2018 to come up with a way forward. When the judge refused, on 29 September the EPA unveiled a path that is much more palatable for Texas and the power companies: one that wouldnt require retrofitting, instead claiming to achieve comparable results with an intrastate cap-and-trade programme. That would give polluters allowances within an overall emissions budget that can be used or traded in a marketplace.

    Such programmes can be effective, but Mann, of the Sierra Club, contends that the cap is too high so will not provide any incentive for meaningful reductions. Its not very aggressive. In other words, the amount of pollution that coal plants in Texas are allowed to produce is actually higher than our emissions from last year from the same coal plants, taken all together, Mann said.

    The National Park Service and EPA carried out a study in 1999 to understand what causes haze in Big Bend, which is worse in the warmer months. It found that sulphate particles formed from sulphur dioxide sources such as coal power plants and refineries were a key cause.

    Researchers discovered that substantial amounts of sulphate particulates came not only from Texas and Mexico, but the distant eastern US. When air flows from the east, production in Americas coal heartlands has an effect on Big Bends scenery.

    Even if Trumps efforts to boost coal collide with economic reality and market forces spur more growth in renewable energy, any delays in transitioning to cleaner energy and reduced emissions prolong the haze problem.

    Air quality has not improved and ozone has seen a slight deterioration over the past decade, according to Jeffery Bennett, physical sciences program coordinator at the park. Nitrogen deposition has not changed and remains a significant concern. Desert landscapes are especially sensitive to nitrogen, he wrote in an email in July.

    Mercury is an emerging concern, he added, based on levels found in fish; it is unclear whether this is because of atmospheric deposition or the legacy of nearby abandoned mercury mines.

    The park faces Mexico and since Donald Trump entered the White House it has attracted attention as a particularly unsuitable place to build a wall.

    Still, in a few years, tourists might find that while Trump might have failed to wall off the Big Bend from Mexico, the view is blocked all the same. If youre standing here in Panther Junction and not able to see the Sierra del Carmen thats 20 miles away, because of the sulphates and other pollutions that blew in, youre missing a big part of why this became a park, Jennette Jurado, the parks public information officer, said earlier this year at the main visitor centre.

    Read more: https://www.theguardian.com/environment/2017/oct/11/trumps-pro-coal-agenda-is-a-blow-for-clean-air-efforts-at-texas-big-bend-park

    US police killings undercounted by half, study using Guardian data finds

    Harvard study finds over half of deaths wrongly classified, in latest example of databases greatly undercounting police killings

    Over half of all police killings in 2015 were wrongly classified as not having been the result of interactions with officers, a new Harvard study based on Guardian data has found.

    The finding is just the latest to show government databases seriously undercounting the number of people killed by police.

    Right now the data quality is bad and unacceptable, said lead researcher Justin Feldman. To effectively address the problem of law enforcement-related deaths, the public needs better data about who is being killed, where, and under what circumstances.

    Feldman used data from the Guardians 2015 investigation into police killings, The Counted, and compared it with data from the National Vital Statistics System (NVSS). That dataset, which is kept by the Centers for Disease Control and Prevention (CDC), was found to have misclassified 55.2% of all police killings, with the errors occurring disproportionately in low-income jurisdictions.

    As with any public health outcome or exposure, the only way to understand the magnitude of the problem, and whether it is getting better or worse, requires that data be uniformly, validly, and reliably obtained throughout the US, said Nancy Krieger, professor of social epidemiology at Harvards Chan School of Public Health and senior author of the study. Our results show our country is falling short of accurately monitoring deaths due to law enforcement and work is needed to remedy this problem.

    Read more: https://www.theguardian.com/us-news/2017/oct/11/police-killings-counted-harvard-study

    How your blood may predict your future health

    New research into bloodstream biomarkers aims to unlock the full impact of social status on peoples lifetime health outcomes. The key is exposure to stress

    Health is a well-known inequality issue. While ageing is inevitable and most of us will get sick at some point, the rate of your decline is likely to be faster the lower down the socioeconomic ladder you started.

    The intriguing thing is, nobody exactly knows why. Tempting though it is to blame the usual suspects poor diet, obesity, smoking they dont account for the whole story.

    If you exactly knew somebodys diet, exercise level, smoking habit or alcohol consumption, you would be about 30 to 40% likely to accurately predict how long they are going to live, says Mel Bartley, professor emerita of medical sociology at University College London, who has dedicated her career to understanding the links between society and health. But whats the rest? Thats the big question.

    Unpicking the biological connections between external socioeconomic forces and an individuals health is no easy task. But Bartley and others in her field believe important clues can be found in the very lifeblood of a nation.

    The idea that measurable biological markers (biomarkers) in the bloodstream can reflect an individuals underlying health status and even offer some kind of prediction of their life expectancy gained popularity in the 1950s, as scientists started searching for tell-tale markers linked to the epidemic of heart disease spreading through the US.

    High blood pressure was the obvious one, but they also discovered that the level of bad cholesterol in the bloodstream was a good indicator of risk. By monitoring blood cholesterol levels in healthy people before they show any outward signs of heart disease, doctors can predict who is most at risk. The resulting medical interventions, such as dietary changes and statin drugs, can demonstrably improve those peoples long-term health.

    Now, researchers are using the same approach to measure the impact of social status on the body, in the hope of developing policies that can reduce the health toll on societys most deprived section (on average, the poorest people in the UK miss out on more than a decade of life compared with the richest).

    One of the most ambitious projects, currently being undertaken by the University of Essexs Institute for Social and Economic Research (ISER), is looking at blood biomarkers from some of the 40,000 UK households taking part in its Understanding Society study, which covers the entire socioeconomic spectrum.

    A biomarker is an objective measure of health, explains Professor Meena Kumari, the epidemiologist leading the study along with health economist Dr Apostolos Davillas. These chemicals are like molecular flags: they allow us to see what happens inside people as theyre going through their life course which they themselves might not be so aware of.

    According to Kumari, Whats happened historically is that social scientists have tended to measure health in a simple way just asking people: How do you rate your health right now? But we wanted to bring together the biology and the social science.

    Published in the journal Scientific Reports, the ISER teams initial analysis focused on measuring the levels of two molecules, fibrinogen and C-reactive protein (CRP), that are produced by inflammation the bodys response to infections, stress and other harmful stimuli. Chronic long-term inflammation is linked to poorer health outcomes including heart disease, diabetes and cancer.

    According to Davillas and Kumari, measuring an individuals CRP and fibrinogen levels and matching them against their socioeconomic position starts to reveal the hidden mechanisms connecting social inequality and health. And the missing link appears to be stress.

    The impact of chronic stress

    When we experience something stressful, we activate the hypothalamic pituitary adrenal axis: a convoluted network involving the brain and the pituitary and adrenal glands. This results in the release of cortisol and other stress hormones such as adrenaline, which have a range of effects on the body.

    The complex biological conversation between this stress response and the bodys inflammatory processes actually damps down inflammation in the short term. But this careful balance seems to shift in the face of chronic stress, resulting in more inflammation over time. Thus the levels of CRP and fibrinogen, as markers of chronic inflammation, are a proxy for the impact of long-term stress on a persons body.

    CRP
    CRP levels at different ages by household income, left, and education. Photograph: Davillas et al/Scientific Reports

    For Kumari and Davillass biomarker study, blood samples were gathered from nearly 8,000 adults in the Understanding Society cohort. While CRP and fibrinogen levels increase in all of us as we age, the ISER team found that differences in the levels of CRP and fibrinogen between socioeconomic groups begin to show relatively early in life and on average rise faster and peak sooner in poorer people.

    The research shows differences in CRP levels start around 30 years old and peak around the age of 55, Davillas says. Then the gap starts to narrow again theres not so much difference between the lowest and highest socio-economic groups in later life, although of course the social inequalities are still there. People in both groups end up with similar CRP readings by their mid-70s.

    The analysis suggested people in lower socioeconomic groups have a demonstrably longer exposure to chronic inflammation with all its knock-on impacts on long-term health even once the team corrected for the usual suspects of health inequality, including diet and smoking. Theres clearly something else at work.

    If you ask people about their health, you dont really see differences early in life people tend to become unhealthy later in life, Kumari says. But were starting to see these underlying biomarker differences in people in their 30s; so whats that about?

    Fibrinogen
    Fibrinogen levels at different ages by household income, left, and education. Photograph: Davillas et al/Scientific Reports

    Kumari and Davillas are now considering the causes of chronic stress that might contribute to the patterns they have found, starting with employment or lack of it and the associated issues of poor pay, job insecurity, long hours and the burgeoning gig economy.

    You have stressful life events such as bereavement or divorce, but were talking about understanding chronic long-term stresses, Kumari says. One of the things we think about is why is disadvantage stressful? For something like low income, it could be because you dont have the same levels of control over your life. Maybe you can manage it for a little while, but over the long term it becomes a chronic stress. These things are hard to measure and capture.

    Bartley agrees more needs to be done to understand the financial causes of stress across society. Debt is deadly for people its the ultimate lack of control, she says. Housing is also a huge issue and it doesnt get researched enough living in poor situations is depressing, especially if youre bringing up children. People in poverty can end up in social isolation, and thats known to be associated with all kinds of unhealthy outcomes.

    Changes in policy

    Its all very well to be able to measure levels of inflammatory biomarkers, and link them to stress and worse health outcomes but the big question is what to do about it. If its as simple as lowering inflammation, then maybe we should just hand out anti-inflammatory drugs such as aspirin to poorer people?

    I dont believe thats the answer, says Bartley. We need to understand what it is about living in a tougher social and economic situation that causes this underlying stress, in order to argue for more effective changes in policy.

    From a policy perspective, if you know when health inequalities begin and when they peak, this can help you target these age groups and allocate resources more effectively, says Davillas, pointing to the example of retirement timing. If youre doing a stressful job and this impacts your health more compared to someone in a less stressful occupation, this is an important issue to consider from a public health perspective. Perhaps people in more stressful jobs should retire earlier.

    Measuring biomarkers across society could also give researchers a way of monitoring the impact of policy interventions. But to do that effectively will require a lot more data. While the ISER teams findings suggest a link between inflammation, stress and poor health outcomes in the most disadvantaged sectors of society, the study is only a snapshot of biomarker levels in individuals of different ages at one point in time. Whats really needed is detailed, long-term research, monitoring and following people over decades as their lives change.

    If we have 30-year-olds with high CRP, we want to know what happens to them five years later, says Bartley. We need to study people over their whole life course to find out if that early high CRP reading is fixed, and does high CRP at age 30 condemn someone to get sicker faster later on or does their health outcome change if they improve their situation and lower their stress levels?

    The challenge with this long-term approach is finding ways of measuring biomarkers in large numbers of people across the full spectrum of society. It would be good if we could collect them by some electronic means, instead of having to stick needles in people for blood samples, Bartley speculates. Theres a lot of scope for improvements in technology such as mobile phones, in terms of understanding how society gets under the skin.

    The ISER study also highlights another striking issue: the general lack of research focuses on people in midlife a time when life paths can become entrenched.

    There are a lot of studies looking at older age groups, because thats when people get sick, and lots involving children because child development is interesting, but theres not a lot going on in the middle of the age span, Kumari says. And yet we found the difference between biomarker levels was biggest in working age groups, where we have the least amount of data.

    Understanding the underlying biological pathways will help us to target what it is we should be focusing on. Our data suggest that it might be stress that we need to be thinking about, particularly for working age people. But this is just the beginning theres still a lot to do.

    Share your experiences by emailing inequality.project@theguardian.com, or follow the Guardians Inequality Project on Twitter here

    Read more: https://www.theguardian.com/inequality/2017/oct/10/how-your-blood-may-predict-your-future-health-biomarkers

    NHS future precarious, says regulator

    The Care Quality Commission (CQC) says the health system is “straining at the seams” and faces a “precarious” future.

    The England’s regulator’s annual report raised concerns about staff shortages, rising demand and the number of patients with preventable illnesses.

    It said so far the quality of NHS and council care has been maintained but warned standards were likely to drop.

    Health Minister Philip Dunne suggested that extra money for social care, mental health and A&E was enough.

    “With record funding and more doctors and nurses, the NHS was recently judged the best healthcare system in the world, despite the pressures from increasing demand,” he said.

    In its report, the CQC highlighted:

    • Staffing shortages with vacancy rates in the NHS rising by 16% over the last two years despite an increase in staff of 4%
    • Bed shortages in hospitals with occupancy levels being consistently above recommended levels since April 2012
    • Falling numbers of nursing homes beds – down by 4,000 in two years at a time when more are needed
    • Rising numbers of people not getting support for their social care needs with the numbers hitting 1.2m, up 18% in a year
    • Number of detentions under the Mental Health Act up by a fifth in two years to more than 63,000 last year

    The CQC’s report – its yearly round-up on the state of the sector – comes after it completed its new inspection regime of hospitals, mental health units and care services.

    ‘Quality will fall’

    CQC chief executive Sir David Behan said that while the quality of care was being maintained currently thanks to the efforts of staff, that resilience was not inexhaustible given the rising pressures.

    “We are going to see a fall in the quality of services that are offered to people and that may mean that the safety of some people is compromised,” he added.

    He said the NHS is “struggling to cope with 21st century problems” including increasing numbers of people with illnesses linked to unhealthy lifestyle choices like obesity, diabetes, dementia and heart disease.

    “We are living longer but are not living healthier so I think what we are signalling is that the system now and into the future has got to deal with those increased numbers of older people who are going to have more than one condition.”

    He said one of the immediate priorities was finding a solution to funding social care – ministers have promised a Green Paper by the end of the year after providing an extra £2bn of funding over the next three years to keep services going.

    Image copyright Science Photo Library

    Caroline Abrahams, of Age UK, said the findings made worrying reading.

    “Really this tells you everything you need to know about the state of care today – it’s like a rubber band that’s been stretched as far as it will go and can’t stretch any further.”

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    Read more: http://www.bbc.co.uk/news/health-41559669

    Global cost of obesity-related illness to hit $1.2tn a year from 2025

    Health bill will be enormous burden without more preventative measures to check worsening epidemic, say experts

    The cost of treating ill health caused by obesity around the world will top $1.2tn every year from 2025 unless more is done to check the rapidly worsening epidemic, according to new expert estimates.

    Obesity and smoking are the two main drivers behind the soaring numbers of cancers, heart attacks, strokes and diabetes worldwide, grouped together officially as non-communicable diseases. They are the biggest killers of the modern world.

    The United States faces by far the biggest treatment bill, with a rise from $325bn per year in 2014 to $555bn in just eight years time, partly because of the high cost of medical care in the US. But all countries are looking at a very steep rise in costs that will be unaffordable for most. In the UK, the bill is set to rise from $19bn to $31bn per year in 2025. The NHS chief executive, Simon Stevens, has already warned that obesity threatens to bankrupt the NHS.

    Over the next eight years, the experts say, the US will spend $4.2tn on treating obesity-related disease, Germany will spend $390bn, Brazil $251bn and the UK $237bn if these countries do not do more to try to prevent it.

    The new figures come from the World Obesity Federation (WOF), which says there will be 2.7 billion overweight and obese adults by 2025, many of whom are likely to end up needing medical care. That means a third of the global population will be overweight or obese.

    The WOFs estimates show adult obesity continuing its steady climb. In 2014, a third of men and women in the US were obese (34%). By 2025 that is predicted to be 41%. In the UK, more than a quarter of adults (27%) were obese in 2014 and that will rise to 34% by 2025. Egypt is predicted to go up from 31% to 37% of adults in the same period, while Australia and Mexico will rise from 28% to 34% if nothing changes.

    The annual medical costs of treating the consequences of obesity, such as diabetes and heart disease, is truly alarming, said Prof Ian Caterson, the president of the federation. Continual surveillance by WOF has shown how obesity prevalence has risen dramatically over the past 10 years and with an estimated 177 million adults suffering severe obesity by 2025, it is clear that governments need to act now to reduce this burden on their national economies.

    For its new analysis, ahead of World Obesity Day on Wednesday, the federation has for the first time costed in not just cancer, diabetes and heart disease but other harms, including damage to joints which may result in hip and knee replacements and back pain. Thats why the figures are pretty astonishingly high, said Tim Lobstein, its policy director. Some poor countries are already swamped.

    Low income countries have healthcare systems that barely manage to cope with childbirth and infectious diseases, and have neither the money nor staff to deal with the epidemic of chronic illness such as cancer and heart disease that is being fuelled by obesity.

    For middle income countries we are going to see an enormous impact, said Lobstein. Countries in the Middle East and Latin America where health services are stretched are going to become highly stretched. These are the regions where obesity among children and adults has soared in recent years.

    But the increasing costs will be a problem for every country in the world. This is going to be an enormous burden either on the state, the individual or the insurance services which simply wont be able to cope. How high can an insurance premium go? said Lobstein.

    Sugary drink taxes are an important measure governments can take, said Johanna Ralston, the federations CEO. Right now there is a big focus on sugar-sweetened beverages, which is fantastic. I think as with tobacco, you want to find something that is tangible that governments can do and is measurable. But it is not enough.

    The experts say spending more on treating and preventing obesity will save countries many millions in the long term. Bariatric surgery to reduce the size of the stomach is very effective in reducing appetite, and studies have shown it can reverse type 2 diabetes, dramatically improving peoples chances of a healthy life. But there is not enough treatment available, said Ralston.

    One of the reasons is that the consensus that obesity is a disease is only really emerging now, she said. That will also help with the stigma. Bariatric surgery is a fantastic intervention but realistically it will only be for a smallish proportion of the population. It has to be offered in concert with other forms of weight management. Every single individual has to be offered multiple interventions.

    Read more: https://www.theguardian.com/society/2017/oct/10/treating-obesity-related-illness-will-cost-12tn-a-year-from-2025-experts-warn

    Beyond just birth control: Rollback leaves some women fearful

    (CNN)Rachel Jarnagin was on her way to a post-surgical checkup Friday when she heard the news: The Trump administration had rolled back Obamacare’s birth control mandate, opening the door for nearly any employer or insurer with religious or moral convictions against contraceptives to exclude those benefits from their health plans.

    The announcement struck close to home: Jarnagin, 30, had an ovary removed because of endometriosis just over a week ago and was prescribed hormonal birth control to keep the disorder in check. Endometriosis is an often-painful condition in which uterine tissue grows outside the uterus.
    “My doctor told me, ‘Unless we start you on birth control to manage it, there’s no guarantee that you won’t get endometriosis on the other ovary and lose it, too,'” said Jarnagin, who works at a bath and beauty store in Denver. “It’s a necessity for me.”
      Her reaction to the administration’s decision: “I deserve to have affordable medications for a condition that I have no control over. I have always been an advocate for access to health care, and it’s frustrating that I may have to fight or pay more for health care that I’ve already do.”
      Much of the controversy over providing contraception to women centers on its use for family planning. But many medical conditions also require the use of hormonal birth control methods.
      “I saw this announcement, and it made me really angry,” said Jarnagin’s older sister, Allison Phipps, 32. “Endometriosis is a very common problem. My mom had it when she was 27 and had a portion of both of her ovaries removed. I might even have it, because many women don’t even know it’s there until the symptoms start.”
      Phipps herself was on the pill for 11 years and believes it might have protected her from developing the condition that has plagued the women in her family.
      “Personally, that’s why it’s important to me for birth control to be covered,” said Phipps, who works as an art director in Denver, “but I also believe it’s very important to women as a family planning method.
      “I remember when I was in college and having to pay for it,” she said. “For a generic mini pill, it was $30 a month, and with no job and student loans, that was a big deal. That was ramen noodle packages for a month.”
      Phipps, like many women, took to social media to express outrage, often using the hashtag #HandsoffmyBC.
      Jennifer Lawson, 43, a best-selling author and blogger from San Antonio, used the hashtag to share how she used birth control in her youth to control excruciating cramps.
      Her cramps, she wrote in an email, were “so severe they made me physically sick. A doctor put me on birth control pills to help and it made a big difference. I still had cramps and nausea but they were finally manageable to the point that I wasn’t missing days of school and falling behind in life.”
      Children’s book author Jessie Talbot had an even stronger reaction. “If I didn’t have BC, I’d be dead now,” she posted.
      “My issues came to an abrupt end when I got a hysterectomy 17 years ago,” Talbot said in an interview. “The birth control helped for a while but there was actually too much wrong for it to save the day. At least I had that option at the time.”
      Atlanta interactive designer Deb Nilsen has polycystic ovary syndrome, a hormonal imbalance often treated with birth control. If left untreated, it can lead to serious health issues such as heart disease and diabetes.
      “I think that the idea of the rollback on birth control is ridiculous and shortsighted,” Nilsen posted on Facebook. “Women like me, who have PCOS, typically do not have regular cycles and take birth control in order to get a period and not to prevent pregnancy. If a woman with PCOS doesn’t have access to birth control, I think it could be a risk factor for her.”
      None of these reactions comes as a surprise to Dr. Anne Davis, an OB-GYN in New York who serves as consulting medical director for the nonprofit Physicians for Reproductive Health. After the 2016 election, she says, she heard women warning each other that their access to birth control might dwindle once the president-elect took office.
      But worry is much different from reality.
      Friday, Davis was fitting an intrauterine device for a patient who has a condition that makes it medically dangerous to have more children. “I asked her if she’d seen the news,” Davis said. “She told me that she saw it and it was really hard for her not to cry.”
      Just a decade ago, says Davis, most women in her practice never considered using an IUD. “I would tell them, ‘Your insurance isn’t going cover it, and it’s 800 bucks.’ And people just shrugged their shoulders and said, ‘Well, I don’t have 800 bucks.’ It was completely out of reach financially for most of my patients.”
      One of those patients, she recalls, used a condom for contraception but, due to accidents, ended up having an abortion, and then another.
      “After the Obamacare mandate, she was able to get an IUD,” Davis said. “Years later, she’s planning a family, in a place and time in her life where she can support children. It was a sea change for her.”

      See the latest news and share your comments with CNN Health on Facebook and Twitter.

      What’s next for women who find themselves reliant on birth control for their medical conditions?
      “People are feeling deeply unsettled,” Davis added. “They don’t know what’s going to happen.”
      Lawson, the author and blogger, said, “No employer knows me well enough to decide what is or isn’t acceptable for myself, my daughter, or anyone else. And they shouldn’t have to know me well enough because it’s none of their business.”
      Lawson says she no longer has to take birth control pills but would be terrified of how the Trump decision would affect her if she were still suffering as she did when she was younger.
      “But just because it doesn’t affect me personally doesn’t mean I will stop fighting for those who it will negatively impact,” Lawson said. “We’re in this together. Or at least, we should be.”

      Read more: http://www.cnn.com/2017/10/06/health/women-react-trump-birth-control-mandate-bn/index.html