Saturday, March 17, 2007

A demented approach to the ageing population

Scary headlines about a 'dementia timebomb' expose today's miserabilist view of the human success story that is longer life.

A report published last week by the UK Alzheimer’s Society, Dementia UK: a report into the prevalence and cost of dementia, confirmed what many people already knew: that dementia is one of the main causes of disability in later life. What was disappointing was the way the research was framed as another ‘ageing timebomb’.

Today, about one-in-five people over the age of 80 has a form of dementia. As a progressive disease, the impact on the individual ranges from mild to severe, so that only a small proportion lose most of their capacity for independent living. But for those worst affected it is extremely distressing for themselves and especially for their caring relatives.

The study could have been greeted simply as a rational contribution to helping society adjust its priorities to an ageing population. With demographic shifts, the types of illnesses that society should focus on change. With substantially reduced infant mortality and more people living to an old age compared to 100 and even 25 years ago, less medical research can be devoted to defeated or contained diseases such as polio, smallpox, tuberculosis, scarlet fever, measles or typhoid, and more can be devoted to heart disease, stroke, cancer and dementia. That’s rational social adaptation.

Unfortunately, a review of the media headlines illustrates a much more alarmist and miserabilist message: ‘Dementia timebomb warning’, ‘The country’s looming dementia crisis’, ‘Dementia timebomb will cost NHS millions’. Such a reaction to the underlying research in this report is not only unjustified but also counter-productive. The Alzheimer’s Society itself warns that such alarmist talk is misleading. It argues with reason that: ‘The use of phrases such as the demographic timebomb, or the view that older people are a burden on our society, does not encourage the view that a sustainable system can be developed.’ (2)

There is nothing new here. The threat of a ‘timebomb’ is frequently invoked in relation to ageing - just look at the debate about pensions. But this fear and anxiety is not a good way to plan transformation and progressive adaptation. Instead, fear-mongering today tends to reinforce a fatalist resignation to the future, epitomised by a naturalist view of ageing: we’re ageing, old age historically brings negative consequences, so we have to put up with it.

Knee-jerk responses in the face of an ‘emerging crisis’ make things worse, more often than not. (That’s also the story of the perverse, counter-productive impact of pension reforms over the past 20 years.) For example, the report draws attention to the ‘starkly different ordering of [research] priorities: cancer 23.5 per cent, cardiovascular disease 17.6 per cent, musculoskeletal disorders 6.9 per cent, stroke 3.1 per cent and dementia 1.4 per cent’. I’m sure it is not the authors’ intention but when legitimate calls for more specific research funding are made in the hyperbolic context of a perceived looming ‘cost crisis’, one can easily imagine the response will be ‘okay, let’s cut funding to these other areas and reallocate to dementia instead’. In the short term, this might seem to support the prospects for potential dementia sufferers, but overall could produce a worse future for old people if other age-related chronic disorders lose funding as a result.

These anxieties about the social and economic impact of ageing are unjustified. We need to challenge an intensifying paradox of our times: that even though we are living longer, healthier and more prosperous lives than ever in human history, we are also more negative about ageing and old age. In the past, old age had both positive and negative connotations – experience and wisdom, not just decrepitude. Today, we only seem to recognise the negative: a timebomb bringing about an intolerable economic and social strain based on millions more dependent people.

Whatever the specific issue, there are always three ways to expose this paradox of ageing.

Firstly, society is getting wealthier all the time. Whatever the extra costs associated with an older population, the trend of rising productivity means that we will have even more resources in the future, so we can bear these costs easily.

History justifies that perspective. There is nothing new or unprecedented about ageing. Developed countries will age over the next half-century at much the same rate that they have for the last hundred years. In contrast to the warnings today that ‘ageing will slow down future economic growth’, this demographic shift hasn’t stopped us from getting more prosperous as a society and older people have benefited from this greater social wealth.

Secondly, a narrow ‘telescope’ view of the future tends to mislead when broader social consequences are drawn. Focusing on one particular feature of the future can fail to incorporate offsetting factors.

The most obvious example as it applies to ageing is that fewer young people necessarily offset more old people. Hence, more absolute spending on old age-related costs is offset by less on younger sections of the population - for example, on education and the specific health costs of the young.

Even in the narrow area of health within wider social spending there are inevitable offsets. Some forms of morbidity rise with age, so more old people mean more illness to be treated. But we are living not just longer lives but longer healthier lives. This trend counteracts the impact of increased health spending related to old age.

This is even more the case when the main influence on the ageing of society is no longer falling birth rates but longer life. For most of the twentieth century, ageing populations mostly represented a changed ratio between young and old people – falling fertility reduced the size of younger cohorts producing an automatic increase in the average age and in the proportion of old people in the population. More recently, since about the 1960s, greater longevity has become a bigger influence on the age structure. The fact that we are living longer is partly attributable to the defeat, or better treatment, of diseases that used to debilitate or kill off younger people. People, including those who are already old, are living to a greater age. Postponed death of this sort tends to go along with people being fitter and healthier during their lives because they are both reflections of social progress and higher living standards.

Most of us are getting through youth and middle age without requiring much medical support, and much less than our parents and grandparents needed. Lower health costs earlier in life means a healthier society, which is good, and which brings about an inevitable concentration of health resources on the older segment of the population because of the higher probability of disease and death with advancing age. 

A related factor that is often downplayed in discussions of age-related health costs is that the cost of dying is more relevant than the cost of ageing. The highest costs arise in the final six-to-18 months prior to death, whatever the age of death. Focusing on the costs of people with dementia in their final years forgets that this means we are paying the cost of these final months for fewer younger people - and in the context of dementia, ‘younger’ means people below the age of 80. 

In other words, just because there will be more people with dementia in an ageing population doesn’t tell us anything about total social expenditures in the future.

Thirdly, the future is one of transformation and adaptation, not extrapolation. This is the statistical distinction between ‘projections’ and ‘forecasts’, which invariably get mixed up in everyday discussion. This confusion is a boon to those who make fearful speculations about the future. A statistician can make a projection about the future based on certain present-day assumptions and extrapolating from them. But every serious professional statistician will add the warning that this is not a forecast of the future, because things will change - society progresses - and therefore the assumptions made for the projection will become invalid.

This misleading shorthand applies to the dementia study itself. It claims: ‘The total number of people with dementia in the UK is forecast to increase to 940,110 by 2021 and 1,735,087 by 2051, an increase of 38 per cent over the next 15 years and 154 per cent over the next 45 years.’ Hence the alarmist BBC News headline: ‘1.7m “will have dementia by 2051“‘. (3) These figures are really projections, not forecasts, based on the researchers’ assumptions about the numbers of elderly people, the incidence of conditions such as high cholesterol and blood pressure, and levels of exercise. Many of these assumptions will not work out exactly.

More importantly, the prevalence of dementia could fall if some means of preventing or, in the shorter term, postponing dementia were discovered. This is the message of the report that should be heeded – more research can accelerate building upon the existing indications of scientific and medical progress in this area. But this gets a little lost in the hyperbole. 

More broadly we can reasonably expect further improvements in standards of health in the future. The general trend is that in most countries a symptom of living longer healthier lives is that the age of onset of particular illnesses is postponed. The average 65-year-old today is much healthier than one in 1950 due to a combination of improvements in living standards and medical progress; healthy life expectancy is growing with increases in overall life expectancy.

The only uncertainties are the pace of improvements in healthy life expectancy and total life expectancy - and the relation between them. In general, morbidity is being postponed. There are indications for some illnesses, though not yet dementia, of tendencies to their compression as well as postponement. This means that some chronic disorders might be concentrated into a smaller proportion, and even a shorter absolute period, at the end of a person’s life. That’s because the older you are when you become ill, the quicker you may finally succumb to that illness.

This report on dementia is one more example of the unjustified negativity with which an ageing population is perceived these days, alongside the ongoing fears and panics about the cost of pensions and other age-related phenomena such as the cost of long-term care. All this pessimism about the human success story of people living longer older tells us more about society’s collective sense of uncertainty and anxieties about where we are heading, than it does about a rational understanding of any of these age-related issues.


Offsetting your "carbon footprint" takes decades

SCHEMES used by environmentally conscious consumers to cut their "carbon footprint" could take up to a century to deliver the promised benefits, a study has suggested. Researchers found it takes that length of time for "carbon offsetting" - which often involves the planting of trees in the developing world - to absorb the greenhouse gases emitted by a single flight. Dozens of fortunes have been made in recent years by entrepreneurs offering people and businesses the chance to neutralise their carbon emissions for a fee.

The new research, carried out by scientists at the Tyndall Centre, based at the University of East Anglia, and Sweden's Lund University, suggests that such schemes may, in fact, do little more than salve the consciences of those paying for them. "What we are seeing here is the emergence of a new and completely unregulated financial market," said Lund's Professor Stefan Gossling, who led the study. "These schemes may eventually recapture the carbon people emit now but will only finish the job after most of them have died. That is too long."

The schemes studied by Gossling included one offered by British Airways to its passengers through Climate Care, a British carbon offsetting company. It found that an offset bought through the scheme would take about 100 years to recapture the carbon emitted by a flight. This is because Climate Care includes forestry in its offsetting portfolio, meaning that carbon emitted can be recaptured only as fast as a tree can grow.

The research coincides with a sharp rise in the political temperature over climate change. Last week EU leaders agreed to cut European carbon emissions by 20% from 1990 levels by 2020. The voluntary carbon offsetting market has sprung from the same global concern over carbon emissions. There are now dozens of companies charging fees to help people and organisations deal with their carbon emissions. One of the richest is Climate Change Capital, a merchant bank specialising in low-carbon investments, which controls funds of more than 500 million pounds and has made millionaires of its founders, James Cameron and Lionel Fretz. The firm specialises in big industrial projects. Most offsetting companies prefer, however, to support smaller energy-efficiency projects and renewable energy schemes.

A favourite is to buy low-energy lightbulbs for distribution in developing countries. Such schemes can take years to recover the carbon emitted by, say, a flight, but when forestry is the chosen offset mechanism this can stretch into decades. "When companies offer to offset a single flight over a period of 100 years then the schemes lose credibility," said Gossling. "How can anyone predict the fate of a forest? A hundred years from now it could burn down and all that carbon would be released."

Some forestry projects have ended in spectacular failures. Coldplay, the rock group, sponsored 10,000 mango trees in southern India to offset the environmental impact of its 2002 album, A Rush of Blood to the Head. By last year, however, the trees, supplied by Future Forests, now The CarbonNeutral Company, had withered and died. Jonathan Shopley, chief executive of The CarbonNeutral Company, said the firm had since moved out of forestry and in to schemes such as wind farms and low-energy lighting. "Any offsets taken out with us in future will recover the relevant carbon emissions within four years," he said.

The turnover of the CarbonNeutral Company has risen sharply to 4 million pounds a year and it has just signed up Silverjet, a new air-line dedicated to business class passengers. It charges an average 999 for a return flight between New York and London - of which 11 goes towards offsetting each passenger's carbon emissions. David Wellington, managing director of Climate Care, said: "Many of the criticisms raised over offsetting were valid. This is a young industry and it is still settling down, but the standards are improving very fast. For example, we have already moved out of forestry into renewable energy projects that reduce the time over which offsets take effect."

But others believe that carbon offsetting is deeply flawed. Dieter Helm, professor of energy policy at Oxford University, said it was little more than a mechanism to allow rich westerners to ease their consciences. "What we are really doing is paying poor people to reduce their carbon emissions so that we can maintain our luxury lifestyles. If we really want to live sustainably we are going to have to accept the knocks and give up things like flying. In the end they are unsustainable," he said.


Early Years Foundation Stage: UK Childhood Indoctrination

Post lifted from Random Observations. Melanie Phillips also has some scathing observations on this. Her summary: "This surely is the Nanny State gone stark staring mad"

It is just me, or is this UK precedent, reported in the Telegraph, distinctly creepy?

Babies will be given marks for crying, gurgling or babbling under the Government's new curriculum for 0-5 year olds which all nurseries must follow.

Playgroups and childminders will also need to show that they help babies make progress in 69 areas of education and development or risk losing funds.

The new Early Years Foundation Stage curriculum lays down how children are expected to develop from birth to the end of the first year of compulsory schooling, the year in which they turn five. The document, which has the force of law, was published yesterday alongside a book of guidance and cards containing the main requirements and underlying principles.

And of course:

By three years and four months, children will begin citizenship lessons so they understand that "people have different, needs, views, cultures and beliefs, that need to be treated with respect".

What does it mean to be a British citizen? It means recognizing others are different. Is that it? Different how? And what does "respect" actually entail?

This working document [pdf, as HTML] on the curriculum reveals there's a huge focus on indirectly instilling cultural relativism in 3-year-olds though their caregivers. In fact, it's apparently the first thing that pops into the authors' minds:

The first page of this document states that it is to be ’a single framework for care, learning and development for children in all early years settings from birth to the August after their fifth birthday’. This statement has huge implications for racial equality. It means those responsible for working with young children must:

* have an understanding and knowledge about how racism* is deeply embedded in our society and its implications for working with all children and their families

* ensure that every child is equally cared for. This means ensuring equality of treatment, being knowledgeable about the needs, family background, culture, religion (or none) ... of every child, being observant and watchful about their experiences within the setting and being aware and understanding of any potential racial prejudice or discrimination a child may experience or manifest and how to address them effectively...

* encourage every child equally to develop ... their ability to stand up for themselves about fairness and justice as well as standing up for others who are treated unfairly

How to break this down? First, let's note that little tiny asterisk next to the word "racism", where the footnote reveals "racism" doesn't simply mean actual racism -- which all good-minded people oppose -- but rather also includes "cultural racism", "enthnocentrism", "institutional racism", and "structural racism."

And what do these various terms mean? For example, here's what "cultural racism" denotes:

The culture of minority groups is seen as flawed in soem [sic] way, and thus as standing in the way of their progress. Unlike post-reflective gut racism, however, cultural racism does not involve belief in the existence of any biological incapacity to change. On the contrary, change is exactly what is sought. Minorities are encouraged to turn their back on their own culture and to become absorbed by the majority culture.

So it turns out these alleged "citizenship" lessons ultimately mean we convince children there is nothing better about British culture than, say, a society ruled by the Taliban. (But certainly not the reverse. Down with assimilation!)

And "institutional racism"?

... institutional racism generally refers to the way that the institutional arrangements and the distribution of resources in our society serve to reinforce the advantages of the white majority... [necessitating] the moral judgment that once the discriminatory consequences of the institutional practices are raised to consciousness, anyone seeking to perpetuated them is guilty of racism

Example: If some minority group is more often arrested for some category of crime, whether the police and lawmakers have racist motives or not, those involved are guilty of "institutional racism" -- and anyone who still insists due process should be racially blind "is guilty of racism", ironically.

So the goal here is, amazingly, neo-Marxist* structural analysis, where the caregiver (and thus, by influence, child) is taught to think in terms of membership groups, rather than as individuals; in terms of relative societal power of those groups rather than goodness or badness of an individual's behavior; and in term of outcomes rather than traditional standards of fairness -- by which I mean applying the same rules equally to all.

And thus the instruction to be "observant and watchful" for "discrimination a child may experience or manifest" means that we watch for traditional ethics and values instilled in children from "family background, culture, [or] religion" and counter it. Indeed, the document further admits the curriculum must "plan how to support children in learning positive attitudes and unlearning any negative attitudes to differences between people... helping children unlearn any prejudiced attitudes..."

Concerning the selection of caregivers, the document adds:

At present there are great differences in qualifications, knowledge and experience about racial equality among providers and practitioners. This means that this document must be explicit about such issues. It points to the considerable need for training for them about equality issues

And, they add, "recruitment practice" (hiring of new caregivers, presumably) must "ensure only those knowledgeable or committed to implement equality are selected." Note the exact phrasing: "those committed to implement equality", apparently in a revolutionary sense. The focus, again, is a desired societal outcome, not merely to prefer individuals who have a heart for small people, or those who will apply the same rules equally to all kids.

In fact, quite to the contrary:

... treating all children equally – this does not mean treating them all in the same way because every child is different from every other one

So the upshot here is that if you want to take care of a child in the UK, you will be gauged and even selected henceforth on your committment to these dogmas.

A nice, efficient way of taking control, it would seem, of "all nurseries" in the UK and turning them into state-run creches -- while halting the transmission of familial and majority moral, religious, and cultural values. (Under the guise of providing "uniform care", of course.) In fact, it seems this particular document addresses nothing else.

So why am I writing this? Not because I wish to defend racism, that's for sure. But what we see is the installation of an entirely different moral paradigm and value set -- one which is rampant in today's university -- into very young children, under the guise of fighting racism. That's why you see so many different words with "racism" appended, like "cultural racism" which is simply the charge of not buying into cultural relativism, framed so to make those who disagree "racists."

And ultimately, I believe this alternative morality create citizens who are conditioned to avoid critical thinking, and who are more malleable to the needs of a strong, centralized government. Dewey would have been proud.

600,000 pounds compensation for a man whose wife died in a NHS hospital

The husband of a woman who died from blood poisoning six days after giving birth to their second child received 600,000 pounds in compensation yesterday after two NHS trusts apologised for a series of blunders that led to her death. Ben Palmer's wife, Jessica, was 34 when she suffered a cardiac arrest in the operating theatre, leaving him to bring up their two children, Harry and Emily, now five and two.

Mrs Palmer, a personal assistant to the Conservative MP Peter Lilley, was discharged from Kingston Hospital in Surrey the day after she gave birth, even though she had low blood pressure, a fast pulse and a high temperature - all signs of infection. As her condition deteriorated and she developed a red patch across her stomach, the couple contacted Mrs Palmer's GP, who prescribed painkillers for back pain, and her midwife, but she was not readmitted to hospital until five days later. She died the next day from multiple organ failure caused by streptococcal septicaemia.

At the inquest into her death, a community midwife from St George's Hospital in Tooting, south-west London, admitted that she had made a "gross mistake" in not referring Mrs Palmer to a doctor earlier. The deputy coroner for West London concluded that Mrs Palmer's death could have been avoided had she been sent back to hospital earlier, but she stopped short of formally finding neglect. She recorded a verdict of natural causes.

The final settlement figure of 600,000 against Kingston Hospital NHS Trust and St George's Healthcare NHS Trust, which both accepted liability, includes the provision of 23,667 pounds each to Harry and Emily. Robert Wilson, solicitor for the trusts, said at the High Court yesterday that both trusts expressed their "sincere apologies" to Mr Palmer and the family for "the shortcomings in care" which led to the death of Mrs Palmer.

"Inevitably, this has led to a great deal of soul-searching and I would particularly like to convey the profound regret of all the clinicians and staff involved in her care," he said. "Of course, they recognise that the family has to live with the consequences for the rest of their lives and an apology is of scant help in these circumstances, but it is sincerely offered."

After the hearing, Mr Palmer, 36, called on the Government to improve maternity services to prevent such a tragedy happening again. "This should never have happened," he said. "My son cries in my arms at night because he misses his mother, my daughter cries in sympathy and because she never knew her mother. I cry for them both, for the loss of their mother, my wife and best friend, and for the joys of motherhood that Jessica has been denied. "With mothering Sunday coming up this weekend, I would like the health secretary to try explaining to my children why Jessica isn't going to tuck them up in bed tonight."

Claire Fazan, his solicitor, from Irwin Mitchell, said: "Each stage of Jessica's care was provided by someone different. Her ante-natal care was at one hospital, her delivery was at another, the community midwife was from another trust and the health visitor she never lived to see was from yet another trust. Jessica's case highlights the need for extra resources and continuity of care for mothers." Mr Lilley said yesterday: "Jessica was simply one of the most delightful people you could know."


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