Sunday, February 10, 2008

British Dentists 'under pressure to treat fewer children'

Dentists are under pressure not to treat children as the NHS cannot afford to fund their care, it was claimed yesterday. Health trusts want dentists to concentrate on targeting adult patients who have to pay for treatment, according to a pressure group. The claims, to a Commons health select committee, come as figures show that one in three children has not visited a dentist for up to two years.

Eddie Crouch, a founding member of dental pressure group Challenge, said: "There is a danger that children will be turned away because of undue pressure from primary care trusts to get revenue from dentists. This money obviously comes from adult patients who pay for treatment." He added: "The new arrangements have failed to provide many of the important benefits that the Department of Health wished to achieve. "There are growing inequalities in access to care, and the quality assurance mechanisms are woeful."

Early last year many dentists were forced to stop treating children until April after local health trusts ran out of money at the end of the financial year. The trusts faced budget shortfalls after the Government overestimated how much would be raised from dental fees.

Mr Crouch's comments were backed by the London Regional Group of Local Dental Committees. In a statement to the committee it said there was increasing pressure to treat more adults and that people from deprived backgrounds would suffer. "Children and adults who are exempt from NHS charges are among the most in need of dental help," it said. "Yet PCTs require dentists to ensure that a certain proportion of the patients they treat are sufficiently well off to pay for their own NHS treatment, in order to maintain the PCT's financial balance. "We know of dentists who have been told that unless they see a higher proportion of paying NHS patients, they will have their contract capacity curtailed."

Other experts told the committee that dentists would actually be better off financially if they pulled out children's teeth rather than go through the time-consuming process of attempting to save the tooth with a root canal filling.

The Government set up the select committee to investigate the state of NHS dentistry after it emerged that 250,000 fewer patients saw a dentist in the year since the introduction of the new contract in April 2006. The number of children seeing a dentist within the previous two years has fallen by 19,000 from the figure in 2006 and only half of adults have seen a dentist within the past 24 months. With an average patient list of around 2,500, that would mean 1.25million patients have lost access to a dentist.


Let's call a ceasefire in the 'war on obesity'

In tackling an imaginary fat epidemic, the British government is intruding into our lives, guilt-tripping parents and stigmatising chubby children

New year, same old obesity panic. Yesterday, the UK government launched its latest strategy document on tackling fatness, Healthy Weight, Healthy Lives (1). Like every other measure the government has ever announced on obesity, it promises greater intrusion and regulation of our everyday lives, and to make our society a more fraught and joyless place.

The report opens with a smiling prime minister, Gordon Brown, assuring us that: `Heart disease, stroke, cancer and diabetes have taken the place of nineteenth-century diseases as the illnesses that curtail life prematurely, cause long-term incapacity, reduce quality of life, and on which we focus our healthcare resources.' These diseases `represent as big a threat to our ambitions for world-class services as a lack of investment in the National Health Service did 10 years ago', he says - a neat double-whammy of fearmongering and self-congratulation for his government's health spending.

So how bad is the `obesity problem', or `epidemic', as the government likes to call it? The new strategy document says it is on a par with that other planetary emergency that is pushing us towards oblivion: `[We] are facing a public health problem that the experts have told us is comparable with climate change in both its scale and its complexity.' Climate change is now the new model of how to build a social panic to justify government intervention, as we have noted previously on spiked (see The dangers of fried food and a fried planet, by Rob Lyons). With `global warming' implanted in the public consciousness as a product of man's greed and folly, a phenomenon that could end up killing off humanity, it has become a cheap, easy fallback phrase for our scaremongers-in-chief who want to issue dire warnings on everything from terrorism to bird flu to overeating.

In truth, however, there is no `obesity epidemic'. What really lies behind the government's obsession with our waistlines is not a burning necessity to slim down an apparently waddling nation, but rather a deeply unhealthy urge on the part of officialdom to monitor our lifestyles and attitudes.

Some critical experts question whether there is an `obesity problem' to be solved at all. Of course a small percentage of the population is very fat. These morbidly obese individuals do struggle with a range of health problems because of their weight. They need help - although many of the current solutions for morbid obesity, like surgery to reduce stomach size, seem to be as risky and severe as the problems they're designed to fix.

However, the vast majority of people, from `normal' weight through to the mildly obese, do not face any particular difficulty as a result of being overweight. In fact, the definitions of `overweight' and `obese', and the way the two terms are used interchangeably in popular discussion of the issue, blur the distinction between normal body shapes and the morbidly obese. In adults, these definitions are based on body mass index (BMI) (basically, a ratio of weight to height). A BMI of 25 or more is defined as `overweight', while a BMI of 30 is regarded as `obese'. But most of the population has a BMI greater than 25, so by definition, most of us are `ill'. As it happens, recent statistics from the US Centers for Disease Control and Prevention (CDC) suggest there is little difference in mortality figures for those with a wide range of BMIs, including those who are at the lower end of the `obese' range (see Who's afraid of. being fat?, by Patrick Basham and John Luik).

For children, the situation is even more complicated because their bodies are going through rapid changes. As a result, adult definitions of obesity are generally regarded as unsuitable for children. In the new report, government ministers state `a third of children are either overweight or obese'. Apart from the familiar problem of blurring `overweight' and `obese' to produce a more startling number, it is worth noting that the figures used are based on an outdated definition. A different and more widely accepted definition of childhood obesity suggests fewer children are affected. (For further discussion of this area, see Fattened statistics by Peter Marsh.)

As the American academic Paul Campos neatly put it, maybe the best way to win the war on obesity is to stop fighting it; to stop waging war on actually quite normal people who enjoy eating nice, rich foods.

Healthy Weight, Healthy Lives argues that the problem of obesity is, at core, an imbalance of `energy in' (food consumption) with `energy out' (our metabolism plus our physical activity). We all have to take responsibility for our weight, the authors argue, but there are also `genetic, psychological, cultural and behavioural factors which. have an important role to play'. In other words, as well as having to tolerate the ongoing tsunami of advice and lectures from government advertising campaigns, media health experts and doctors about our personal behaviour, we should also expect to see big changes in our environment and culture in the name of tackling the illusory obesity epidemic.

The reorganisation of aspects of society around the war on obesity is already happening, and it is undermining parents and unnecessarily stressing out children. There have been changes to school meals that dictate much more rigidly what children eat during the day, and there are regular inspections of kids' lunchboxes to check that they aren't secretly consuming chocolate or fizzy drinks. Such measures not only deny children the sugary perks of childhood that the rest of us enjoyed; they also implicitly undermine parental authority. If a teacher or other school employee rifles through a child's lunchbox and sends a stern letter about the contents to mum or dad, what message does it send to the child? That your parents cannot be trusted; that the health-aware and caring authorities know better than your mother how you should be brought up.

The weighing and measuring of children's BMI has now been institutionalised in some schools. Children are given a letter for their parents, like a school report advising mum and dad on little John or Jane's `progress' in the subject of weight and healthiness. As Dr Michael Fitzpatrick has argued on spiked, these public weigh-ins, effectively designed to measure children's obedience to New Labour's new health regime as much as their weight, will cause distress to perfectly happy and healthy children who may simply be carrying a bit of puppy fat or childhood chubbiness: `The mass weigh-in will inevitably stigmatise overweight children and provoke widespread anxiety and distress among both children and parents.' (See Stop bullying fat kids, by Dr Michael Fitzpatrick.)

Meanwhile, the ban on junk food advertising during kids' TV programmes exposes the illiberal edge to the war on obesity. You may not care very much whether massive corporations like Coca-Cola can book a 30-second slot during Dora the Explorer, but we should be concerned when the authorities take it upon themselves to control the dissemination of images and information in the name of protecting us from our own worst instincts. It is censorship of the most patronising kind (see Advertising is a free speech issue, by Brendan O'Neill).

On top of these developments, Healthy Weight, Healthy Lives outlines some new and pointless proposals. The document suggests there should be a unified system of colour-coded food labelling to warn people of the fat, salt, sugar and calorific content. Cookery classes will be made compulsory for 11- to 14 year-olds, even though many schools simply don't have the facilities to host such classes. UK health secretary Alan Johnson, displaying the anti-obesity crusader's dictatorial instincts once more, says he wants to use planning legislation to prevent burger bars being built in the vicinity of schools. Yet according to the Local Government Association: `There is no evidence that where fast-food joints are located makes the slightest bit of difference to obesity.' (2)

From turning home economics into a pious lecture on good food/bad food, to marking every fatty or salty food product in supermarkets with a red warning label, to restricting the building of burger joints. it seems the government wants to win the war on obesity by making eating food - one of the everyday joys of our lives - into such a tedious and scary task that we all might just give it up.

The war on obesity is a joyless and fear-underpinned initiative. Its effects could well include making parents feel guilty and chubby children feel isolated (possibly even making them the victims of anti-fat bullies); and the war will likely turn the everyday pleasure of eating into a fraught task, while making society and TV ever-more tightly policed arenas. New Labour, a government without any wider vision of how to lead or change society, has become obsessed with micro-managing our lives. And its micromanagement is increasingly backed up by some fairly nasty measures. At the start of this month, Gordon Brown indicated that patients could be denied treatment if they didn't stop smoking, lose weight or exercise more, as part of a NHS `constitution' (3).

It is time there was a ceasefire in the war on obesity - and time that the government decommissioned and put beyond use its weapons of fearmongering and fatty-bashing.


Lawyers lose for once: "Law firms that grew rich by exploiting sick miners are to be forced to repay tens of millions of pounds that they wrongly sliced from their clients' compensation. The multimillion-pound payback follows an investigation by The Times into a series of abuses linked to the Department of Trade and Industry's 7.5 billion pound coal health compensation scheme. An estimated 75,000 former pit workers are likely to receive payments under a nationwide scheme that has been agreed in principle by the Government. The cost to those solicitors who improperly deducted money from awards given to elderly and vulnerable clients may top 50 million. Claims were registered by more than 760,000 former miners with chronic lung disease or a crippling hand condition caused by their work underground. Solicitors handling each claim were paid a fixed fee by the Government, but many chose to make additional deductions from the compensation awarded to their clients. The money they sliced off was sometimes banked by the law firms themselves and in other cases was passed to miners' unions or claims handling companies."

Vicious mullah banned from Britain: "Yusuf al-Qaradawi, a controversial Muslim cleric who defends suicide attacks, has been refused a visa to enter to the UK after a campaign by David Cameron. The Muslim Council of Britain (MCB) said that it deplored the decision and accused the government of caving in to "unreasonable demands spearheaded by the Tory leader". Muhammad Abdul Bari, the secretary-general of the MCB, said that Dr al-Qaradawi enjoyed respect as a scholar throughout the Muslim world. "I am afraid this decision will send the wrong message to Muslims everywhere about the state of British society and culture," he said"

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