Solutions for a sick city?
London played a very important role in the history of hot air ballooning, but when we gather at Wellcome Collection for a balloon debate, it’s not to extol or denigrate the virtues of this early form of human flight. Rather, we take an important problem, invite four speakers to each put the case for one solution or priority, and then allow the audience to vote them out, one by one, of an imaginary balloon which is losing height, leaving one victor at last.
Last week, the issue was public health priorities for London. During the week, on this very blog, each speaker had been given a chance to make their point, On Thursday night, the four came together, chaired by the BBC’s Home Editor, Mark Easton, to put their case to a live audience. Each speaker was given just ten minutes to get the facts and their argument across.
In the first round, Paul Farmer, chief executive of Mind, supported the case for putting mental health first, an invisible but widespread problem that underlies other health issues. Over 30 per cent of London residents have experienced mental disorders, 19 per cent have had suicidal thoughts and 11 per cent have attempted suicide. More time is lost at work through mental health issues than through musculoskeletal disorders. Worse, 90 per cent of people with mental health problems have encountered stigma and discrimination at work and in society at large. Mental health needs to be at the centre of a virtuous circle of changing attitudes, Paul argued.
Bobbie Jacobson argued for taking on child poverty. We all were children once, and 56 per cent of London’s children today are prevented from living a full participative life due to poverty. Even the richest London borough is without pockets of abject poverty. Any map of health problems is a map structured by an underlying map of poverty. Merely raising awareness of the problem without suggesting a solution is pointless, argued Bobbie. Her solution is the London Living Wage, a London-specific minimum wage of £7.85/hour, which takes into account the higher cost of living in London. There are half a million businesses in London, and all of them need to pay the London living wage.
Ajit Lalvani made the case for tackling tuberculosis, a medieval scourge that many might be surprised to find on the agenda. TB was the only threat presented to the audience that is an infectious disease. We might think of ourselves as beyond the age of cholera, but SARS, also a respiratory disease, caused 2 million deaths among 9m cases worldwide in its recent outbreak. London is the only western European capital with rising rates of TB, which is acquiring drug resistance and can kill in as little as 16 days. Latent TB, which can show no symptoms, is a silent killer – the full scale of which is unknown.
Finally, Alan Maryon-Davis proposed childhood obesity as London’s biggest health challenge. At current rates, by 2025, half the male population of London will be clinically obese. Overweight children are not only subject to teasing and low achievement at school, but massively increase their risk of ill-health from heart disease, diabetes and cancer, reducing their life expectancy by the same amount as smoking. In order to avoid a generation of children dying younger than their parents, we need to promote both healthy physical activity and better awareness of healthy cooking. Southwark, for example takes local kids to Borough market to learn about fresh food.
Such groundbreaking activity cut no ice with the audience. They raised their green cards and voted Alan out of the balloon. The remaining three speakers were then given four minutes each to develop and expand their position.
Ajit then outlined a course of action to fight TB: an outreach programme of mobile chest x-ray units to target the poor and homeless, who are most at risk. Improved tests on sputum can detect latent TB at much improved rates. These new diagnostic tools are already at risk from cuts and have to be saved.
Bobbie argued that Paul’s proposal offered no strategy for dealing with mental health, and that previous efforts to fight TB had been successful primarily because they housed and fed the homeless. She admitted that the London Living Wage couldn’t solve the problem of workless poverty, but rather would kick-start a bigger fight.
Paul argued that there were indeed concrete solutions for mental health. Mind’s Time to change campaign tackled stigma, working with teachers who are at the sharp end of fighting discrimination, and achieved improvements in public attitudes with very little public money. He questioned whether poverty was really a public health issue at all.
The final round
Mercilessly, the audience raised their cards, and voted Ajit and TB out of the balloon, leaving mental health and child poverty in the final face off. Bobbie read from an Evening Standard article by David Cohen, which describes burying the children of London’s poor in unmarked communal graves. Paul offered his respect for the fight against child poverty, but argued that ultimately it wasn’t a public health issue; the opportunity to make London a happier, and therefore, healthier place was unmisssable.
Before the audience got their chance to put questions directly to the remaining panellists, Alan and Ajit were asked who they would vote for: both plumped for mental health.
From the floor, Paul and Bobbie were asked what measurable improvements they could offer against their challenge. Bobbie answered with a reduction of a third in child poverty; Paul suggested a 10% shift in attitudes towards mental health. Another questioner wondered to what extent solution for London could be a blueprint for other cities. Paul answered that in fact much of Mind’s campaigning has been inspired by a similar effort in New Zealand; Bobbie suggested that we could, in fact, look to other countries like Cuba, where equality and healthcare are taken much more seriously. The question of whether small businesses could afford the London Living Wage was also raised; Bobbie answered that, as with elsewhere in the world, it was possible.
The audience was asked to choose one final time, between the state of poverty and the state of mind. Your humble blogger, who can now reveal that he was voting for Bobbie and child poverty down the line, had suspected throughout that it would come down to these two, and felt sure child poverty had an unanswerable case.
It did not, and the audience ultimately decided that mental health was London’s number one public health priority.
If you’re inspired by the audience’s decision, why not get involved with Mind, and start changing attitudes? If you disagree, the comments thread below is open for your thoughts. On this blog we’ve enjoyed playing host to an interesting and vital debate, but now it’s over to you.