France lends Britain the Bayeux tapestry (from 196 BC) on show and this (see below) is how The Sun and its cartoonist respond. (I can’t help but wonder if the way we Europeans in Britain feel about this is more or less how Muslims feel about some cartoons about their culture and religion. )
And nobody in my home country can believe that this is really happening. After all, it is going on in a neighbouring country that is only separated from the Netherlands by a sea, not an ocean.
“Surely Dutch people are treated with normal human respect in Britain. Maybe people from the middle east aren’t, yeah, but Dutch people, or French people, nah, they have nothing to worry about.” That must be their reasoning, more or less.
Complaining to IPSO (Independent Press Standards Organisation) will be useless as its clause about discrimination does not include nationality, culture or even political orientation. (Britons who want to remain in the EU will feel affected by this too.)
Have filed a complaint. This is what it says:
If you read that “revised tapestry”, you can’t help getting the sense that British paranoia is getting completely out of hand. When I was still living in Amsterdam, 15 years ago, I bought the book “When Cultures Collide” by Richard Lewis (British). The image below shows a passage in that book:
Where on earth does this crazy paranoia come from? A British woman once told me it was all related to when the Vikings invaded Britain. Really?
But that’s the only explanation I’ve heard, so far.
1/ Today is the 7th anniversary of one of the most important and notorious UK human rights cases ever. I think we need to keep talking about it, even if it’s uncomfortable for advocates of the human rights system. Here’s why.
2/ I don’t think there is another case which has been used as much as this one to “prove” that human rights have gone wrong, that they are not for “us” but for “them”. Can you guess which I’m talking about? Here are some clues… pic.twitter.com/iNzbFHM6j7
3/ Yes it’s Abu Qatada. A much-hated Islamist preacher who supported ideas of terrorism and potentially actual terrorists, although he was never charged or convicted for a terror-related offence. He arrived a a refugee in 1993 but by the 2000s the UK had had enough of him
4/ He was involved in two important human rights cases. One, the so-called ‘Belmarsh Case’ where the Law Lords said that it was a breach of the right to a fair trial to detain people for years without charge for security reasons, even in the threat of Islamist terror.
5/ The 2nd was his human rights challenge to deportation to Jordan. It went on for years. Ultimately it came down to this: there was a real risk that if he was sent back to Jordan, he would be tortured and evidence obtained by torture would be used in a trial again him pic.twitter.com/S0mM5bbYk4
6/ He was deported to Jordan in the end. The (then) Home Secretary Theresa May negotiated a change in the Jordanian constitution and assurances that torture evidence would not be used and he would not be tortured.
7/ People still remember Abu Qatada’s case as an example of “human rights gone wrong”. But there is another way of looking at it. Dostoyevsky wrote “the degree of civilization in a society can be judged by entering its prisons.” I think there is a wider truth too…
8/ The degree of civilisation can also be judged by how a society treats people it doesn’t like. That is why the right to a fair trial – the right in play here along with the right not to be tortured – are so fundamentally important to human rights laws.
9/ Theresa May is not a huge fan of the European Convention on Human Rights – and her views are clearly clouded by this case in which she played a central role as Home Secretary. But she should be proud, in a way, of the outcome.
10/ Britain, the land which outlawed torture as part of the justice system hundreds of years ago through the 1689 Bill of Rights (where “cruel and unusual punishment” comes from), should be a beacon to the world on this issue. In this case it was.
11/ Right to a fair trial cases often involve villains. But principles of fairness and the rule of law should be universal, not least because we could all be the subject of a wrongful or malicious prosecution. And we should aim to be a beacon to the world on those issues.
Amsterdam court hearing on British citizens seeking to retain their EU citizenship post Brexit. Packed with British people. An estimated 45,000 Brits live in Holland. If they win, will have implications for UK citizens across EU and UK
Barrister for Brits in Holland: “This is an unprecedented situation, the departure of Britain from the EU”. “While it has been possible to leave the EU since 2001” it was expected it would have been an event such as 1967 junta takeover in Greece #Brexitamsterdam case
Amsterdam court hears that “that it is possible for the UK to leave the EU against the will of some member states” because the withdrawal agreement is voted on by 20 of 27 countries. Where does that leave British citizens existing EU citizenship asks barrister for British.
Netherland state lawyer attacks case brought by Brexpats. That one person holds position of chair, secretary and treasurer “prima facie evidence …. that it cannot legally be deemed to be representative of a potentially large population, 15,000 Brits in Amsterdam”
Brexpat barrister hits back at Dutch state lawyer’s claim that they are not representative of British in Holland…. Since Guardian story yesterday, they have 70 new members in just 24 hours, he points out. https://t.co/YNiGbCOhF3
1. Poverty – worry about debts, about how to acquire necessities such as food for one’s children, and what to pay for first – can cause a drop in IQ of up to 15 points. This indicates how much stress debts can cause for a child’s parents, creating a stressful environment for the child, not to mention various forms of deprivation (for which forced adoption is definitely not the appropriate solution, but I shouldn’t have to explain that).
Poverty is also linked to lower physical health, as you know from various studies conducted in Britain. Merely think of the combination of black moulds and cold homes. Tens of thousands of people die in Britain every winter as the result of being unable to afford to heat their homes properly. In insufficiently heated or insufficiently insulated homes, the probability of mould growth due to condensation against cold walls is higher as well. Then add lack of proper nutrition.
2. “Economic inequality harms societies”
Richard Wilkinson and other researchers, in various papers and presentations
3. “IMF research has shown that excessive inequality hinders growth and hollows out the country’s economic foundation. It erodes trust within society and fuels political tension.”
Christine Lagarde in a public speech at Harvard’s Kennedy School of Government, October 2017
4. Low wages are a major cause of poverty hence of debt in Britain. Parents have no control over this.
5. Problems with benefits are another major cause of severe poverty in Britain. Parents have no control over this either, but these issues can aggravate stress immensely, particularly debt-related stress.
6. All humans have human rights and human needs (such as the need for food and shelter), not just a few lucky people for whom fate decided that they were born and are growing up in lucky circumstances.
So I welcome the Government’s introduction of a breathing space scheme and statutory repayment plan, but it has to be the right scheme, not be a tiny plaster on a gaping wound that may look pretty but accomplishes nothing. Its design must give it the best chance of achieving its aim of helping people repay their debts while not locking themselves into a corner from which they can never escape and [where they] can do no more than, essentially, wait for death, as dramatic as this may sound. I believe the following five principles will help do this:
1. ‘Breathing space’: Six weeks is helpful but it is not enough and there cannot be any gaps in this protection.
A six-week breathing space is a positive step that will give many families in problem debt the time and protection to seek advice and arrange a suitable solution.
However, evidence from a similar Scottish scheme shows that it takes on average 120 days to seek advice and apply for the right debt solution, so a longer breathing space would be more helpful. I believe that 6 months could be more effective and certainly more realistic. It depends on the time of year, however, and other factors.
If it is to be six weeks, there should at least be flexibility to ‘roll-over’ into a subsequent breathing space period if a repayment plan is being arranged but needs more time to be finalised. Otherwise, any gap in protection could risk the debtor falling back into problems under pressure from creditors.
Whatever the length of the breathing space, the Government should review how well it is working a year after its introduction AND amend the scheme accordingly if it turns out that it is not working optimally.
2. ‘Statutory repayment plan’: Flexibility is crucial to deal with temporary shocks
The statutory repayment plan option is a vital part of the proposals, as it offers the long-term sustainable solution allowing debts to be repaid in full over time. This component has to provide the necessary flexibility to put in place the most effective plan for each family’s circumstances.
Most problem debt is caused by a ‘negative life event’ such as job loss, illness or problems with benefits (delays of up to 6 months that can leave people without any income whatsoever, although common delays are 6 to 8 weeks). This can mean it is difficult to make any payments in the short term, but once things settle down most people will be able to restart payments.
A debt adviser therefore needs the flexibility to start the statutory repayment plan with a period of nominal ‘token payments’, allowing a short-term shock to pass before full repayments begin. The ability to use periods of token payments at any point during the repayment plan in response to unexpected temporary shocks should also be considered. A similar Scottish scheme allows payment suspensions for up to six months at any time within its debt payment programme phase.
3. All debts should be covered, with certain debts prioritised.
I support the principle that all debts should be covered, including debts to national government, local government and public bodies.
Some types of debt, such as rent arrears, need to be prioritised within a scheme. This would protect tenants from the risk of eviction.
4. Eligibility based on affordability assessment
The key eligibility test should be whether it is the most appropriate solution for each applicant, so there should be no general exclusions. An affordability assessment by a debt adviser, following well-established industry approaches, should determine whether a statutory repayment plan is the right option.
Regulations should ensure that the affordability assessment properly factors in the additional financial vulnerability of families with children.
This scheme should also be non-discriminatory, and for example not exclude someone because he or she threw a snowball at a police officer 10 years ago. Having a criminal record should make no difference with regard to this scheme. (To the contrary.) It does for the support rape victims receive, which is an abomination [particularly when it concerns “crimes” that are part of victims acting out after having been raped].
Naturally, this scheme should also be available to families with one or more family members who do not have British citizenship. (It is quite possible that they contributed a great deal in British taxes in the past and then for example got laid off. At the moment, Theresa May and her colleagues are making it very hard for anyone who isn’t British to sustain or acquire employment within Britain.)
5. Maximise support for families with children
Debt advisers should also be empowered to signpost families with children to appropriate support services to help deal with other underlying problems. This, however, should not be a blame game. British governments cause a lot of problems for many families in Britain, and these families have no control over this. It is not appropriate to blame families for the failures of the British government.
Interview with Mark Easton, BBC. Date unknown, but near the end of Tony Blair’s premiership.
Keep in mind that “hooliganism” and “anti-social behaviour” are often labels used to indicate (and reject) people from a lower socioeconomic class in Britain and that this “hooliganism” for example gets expressed in graffiti.
Of course, causing (increased) financial hardship for parents by taking any benefits away is most definitely not “in the best interest of the child”.
Tony Blair did consider graffiti “anti-social behaviour”. During a photo-op as part of his crusade, he hosed down graffiti and said that older generations of his family would have abhorred such behaviour. It then turned out that his own grandmother had been a “commie” graffiti vandal.
There probably is a work by Banksy somewhere in response to all of this.
Tony Blair also criminalized a lot of behavior that is essentially merely human behavior. That too was in nobody’s best interest and probably did nothing toward decreasing inequality in Britain.
A designer baby is any baby who is preferred over another baby, the way one might pick a handbag or a rug.
The only exception should be when the resulting baby ends up having a life not worth living. In my book “We need to talk about this”, I give a definition of “a life not worth living” that has held up so far. This definition does not represent what I feel, but what could be doable to work with in practice.
This also means, however, that parents should get all the assistance they need. This means that the baby (and child) should get all the assistance he or she needs to enable him or her to FLOURISH.
Society creates so many hindrances for anyone who isn’t mainstream. We should embrace diversity as it enriches society and we should address the artificial impairments so that they disappear.
I also believe that techniques like CRISPR should be used first to help remedy these “lives not worth living”. Why? Because it is a logical approach, based on the application of (generally globally accepted) principles instead of personal preferences.
Model and former Miss Great Britain Danielle Lloyd is flying to Cyprus for a designer baby:
I am wrapping up the much improved version of “We need to talk about this”. There is now a chapter on euthanasia, for instance, with a discussion of the Groningen Protocol.
I didn’t write this book to convince you that my views are the right ones, even though I hope you will agree with many of them. I wrote this book to encourage as many people as possible to develop their own opinions in these areas, to go beyond impassioned exclamations like “this is so wrong” or “this is very good” and to make their opinions known to their governments and academics, and to discuss these issues with their friends, relatives and colleagues. Continue reading →
The uproar over allegations that Hollywood producer Harvey Weinstein sexually abused and harassed dozens of the women he worked with is inspiring countless women (and some men) to share their own personal sexual harassment and assault stories.
With these issues trending on social media with the hashtag #MeToo, it’s getting harder to ignore how common they are on the job and in other settings.
I have studied sexual harassment and ways to prevent it as a diversity and inclusion researcher. My research on how people often fail to speak out when they witness these incidents might help explain why Weinstein could reportedly keep his despicable behavior an open secret for decades.
Of course, Weinstein’s alleged wrongdoings went well beyond sexual harassment, which University of British Columbia gender scholar Jennifer Berdahl defines as “behavior that derogates, demeans or humiliates an individual based on that indiviudual’s sex.”
But sexual harassment is such a chronic workplace problem that it accounts for a third of the 90,000 charges filed with the federal government’s Equal Employment Opportunity Commission (EEOC) in 2015. Since only one in four victims report it, however, the EEOC and other experts say the actual number of incidents is far higher than the official number of complaints would suggest.
The usual silence leaves most perpetrators of this toxic behavior free to prey on their co-workers and subordinates. If sexual harassment is pervasive on the job, and most women don’t report it, what can be done?
Some business scholars suggest that the best way to prevent sexual harassment, bullying and other toxic workplace behavior is to train co-workers to stand up for their abused colleagues when they witness incidents. One reason why encouraging intervention makes good sense is that some 70 percent of women have observed harassment in the workplace, according to research by psychologist Robert Hitlan.
The trouble is that most people who witness or become aware of sexual harassment don’t speak out. Screenwriter, producer and actor Scott Rosenberg has both admitted to and denounced how this dynamic enabled Weinstein to become an alleged serial abuser. “Let’s be perfectly clear about one thing,” he wrote in a private Facebook post published in the media. “Everybody-f—ing-knew.” He also said:
“in the end, I was complicit.
I didn’t say s—.
I didn’t do s—.
Harvey was nothing but wonderful to me.
So I reaped the rewards and I kept my mouth shut.
And for that, once again, I am sorry.”
Researching how people respond
To understand why witnesses often don’t speak up, a colleague and I did a study in 2010 that asked participants to review hypothetical sexual harassment scenarios and indicate if they would respond.
The results seemed promising: Participants generally said they would take steps to stop harassing behavior if they saw it happen. People indicated they’d be more likely to respond if two conditions were met: It was a quid pro quo – that is, if the harasser promised benefits in exchange for sexual favors – and the workplace valued diversity and inclusion. In such cultures, there are open lines of communication, and leaders embrace diversity and inclusion.
Other researchers find similar patterns with reactions to racists. People think they will recoil and experience distress when hearing racist comments. But when they actually hear those remarks, they don’t.
Participants, all of whom were women, expected to feel angry, confront the harasser and refuse to answer the hypothetical interviewer’s inappropriate questions. Some of the questions, for example, included asking the job applicant if she had a boyfriend or if women should wear bras at work.
However, when they witnessed this simulated behavior during the experiment’s mock interviews, people responded differently. In fact, 68 percent of participants who only read about the incidents said they would refuse to answer questions. Yet all 50 of the participants who witnessed the staged hostile behavior answered them.
Drawing from these studies, my team conducted an experiment in 2012 to determine how harassment bystanders would react to hearing inappropriate comments about women.
Some of the female participants read about a hypothetical scenario in which harassment took place, while another group observed harassment occurring in a staged setting. We determined that the participants, who were college students, overestimated how they would respond to seeing someone else get harassed.
The reason this matters is that people who don’t feel distress are unlikely to take action.
What stops people from reacting the way they think they will?
Psychologists blame this disparity on “impact bias.” People overestimate the impact that all future events – be they weddings, funerals or even the Super Bowl – will have on them emotionally. Real life is messier than our imagined futures, with social pressures and context making a difference.
This suggests a possible solution. Since context matters, organizations can take steps to encourage bystanders to take action.
For example, they can train their staff to speak up with the Green Dot Violence Prevention Program or other approaches. The Green Dot program was originally designed to reduce problems like sexual assault and stalking by encouraging bystanders to do something. The EEOC says this “bystander intervention training might be effective in the workplace.”
Especially with workplace harassment, establishing direct and anonymous lines for reporting sexist incidents is essential. They also say employees should not fear negative reprisal or gossip when they do report harassment.
Finally, bystanders are more likely to intervene in organizations that make their refusal to tolerate harassment clear. For that to happen, leaders must assert and demonstrate their commitment to harassment-free workplaces, enforce appropriate policies and train new employees accordingly.
Until more people take a stand when they witness sexual harassment, it will continue to haunt American workplaces.
And now I’m going to finish the post I started writing 6 days ago (lol!) Please forgive me if it’s a little disjointed or repetitive or something! 😉
Minimalism is the trend. It’s not a new thing; Zen Buddhists and other cultures have been practicing it for years. But Americans (I admit, I’m not sure about the rest of the world) have suddenly “discovered” it, and like anything else we do, especially anything new and “exotic”, we (collectively speaking) feel the need to do it to excess. And we have this fetish for politicizing things. Yes, including minimalism.
I would like to inject a little sanity into the wayward convo; can I get an amen?
Let’s start at the beginning. What’s minimalism, anyway? Well, according to The Minimalists themselves (the self-proclaimed spokespeople for the subject, although I will give them a hats-off for humor! They’re kinda funny)…
The Victorian Parliament will consider a bill to legalise euthanasia in the second half of 2017. That follows the South Australian Parliament’s decision to knock back a voluntary euthanasia bill late last year, and the issue has also cropped up in the run-up to the March 11 Western Australian election.
With the issue back in the headlines, federal Labor’s justice spokesperson, Clare O’Neil, told Q&A that in countries where the practice is legal, “very, very small” numbers of people use the laws.
Whether or not you agree with O’Neil’s statement depends largely on your interpretation of the subjective term “very, very small”, but there is a growing body of data available on how many people are using euthanasia or assisted dying laws in places such as the Netherlands, Belgium, Luxembourg, Colombia, Canada and some US states.
Assisted dying, assisted suicide and euthanasia
Many people use the terms “assisted dying”, “assisted suicide” and “euthanasia” interchangeably. But, technically, these phrases can have different meanings.
Assisted dying (sometimes also assisted death) is where the patient himself or herself ultimately takes the medication. Euthanasia, by contrast, is usually where the doctor administers the medication to the patient.
Assisted suicide includes people who are not terminally ill, but who are being helped to commit suicide, whereas assisted dying refers to people who are already dying. Some reports do not, however, distinguish between assisted dying and assisted suicide, and I will not distinguish them here.
In some jurisdictions, the word “euthanasia” is used to refer to both assisted dying/suicide (where the patient himself or herself takes the medication) and to euthanasia (where the doctor administers the medication to the patient). So “euthanasia” can sometimes be used as a broad term to cover a range of actions.
Euthanasia and assisted suicide rates around the world
According to a peer-reviewed paper published last year in the respected journal JAMA:
Between 0.3% to 4.6% of all deaths are reported as euthanasia or physician-assisted suicide in jurisdictions where they are legal. The frequency of these deaths increased after legalization … Euthanasia and physician-assisted suicide are increasingly being legalized, remain relatively rare, and primarily involve patients with cancer. Existing data do not indicate widespread abuse of these practices.
The authors of that paper said that 35,598 people died in Oregon in 2015. Of these deaths, 132, or 0.39%, were reported as physician-assisted suicides. The same paper said that in Washington in 2015 there were 166 reported cases of physician-assisted suicide (equating to 0.32% of all deaths in Washington in that year).
Interestingly, the same paper noted that US data show that:
pain is not the main motivation for PAS (physician-assisted suicide)… The dominant motives are loss of autonomy and dignity and being less able to enjoy life’s activities.
The authors said that in officially reported Belgian cases, pain was the reason for euthanasia in about half of cases. Loss of dignity is mentioned as a reason for 61% of cases in the Netherlands and 52% in Belgium.
A 2016 Victorian parliamentary report has quoted from the UK Commission on Assisted Dying, which in turn referenced the work of John Griffiths, Heleen Weyers and Maurice Adams in their book Euthanasia and Law in Europe. The commission said:
There are no official data in Switzerland on the numbers of assisted suicides that take place each year, as the rate of assisted suicide is not collected centrally. Griffiths et al observe that there are approximately 62,000 deaths in Switzerland each year and academic studies suggest that between 0.3% and 0.4% of these are assisted suicides. This figure increases to 0.5% of all deaths if suicide tourism is included (assisted suicides that involve non‑Swiss nationals).
Around 3.7% of deaths in the Netherlands in 2015 were due to euthanasia. The Netherlands’ regional euthanasia review committees reported that there were 5,516 deaths due to euthanasia in 2015. That is out of a total of around 147,000 – 148,000 deaths in the Netherlands that year.
This figure represents an increase of 4% of deaths due to euthanasia compared to 2014.
A 2012 paper published in The Lancet reported on the results of nationwide surveys on euthanasia in the Netherlands in 1995, 2001, 2005 and 2010. The researchers said:
In 2002, the euthanasia act came into effect in the Netherlands, which was followed by a slight decrease in the euthanasia frequency … In 2010, of all deaths in the Netherlands, 2.8% were the result of euthanasia. This rate is higher than the 1.7% in 2005, but comparable with those in 2001 and 1995.
Another Netherlands-based study published in the journal JAMA Internal Medicine reported in 2015 that:
Certainly, not all requests are granted; studies conducted between 1990 and 2011 report rates of granting requests between 32% and 45%.
A 2015 paper in the New England Journal of Medicine about euthanasia rates in the Flanders region of Belgium (the northern half of the country) noted:
The rate of euthanasia increased significantly between 2007 and 2013, from 1.9% to 4.6% of deaths.
Filling in the bigger picture
It can be hard to put these rates in context, but what is clear is that euthanasia is by no means a leading cause of death in countries where it is legal. For example, Statistics Belgium said that for the year 2012, cardiovascular disease was the most common cause of death (28.8%), and cancer was the second most common cause of death (26%).
And in the Netherlands – where 5,516 of deaths were due to euthanasia in 2015 – more than 12,000 Dutch people died from the effects of dementia in 2014, approximately 10,000 Dutch people died from lung cancer and nearly 9,000 died from a heart attack. In 2013, 30% (about 42,000) of Dutch deaths were from cancer and 27% (about 38,000) of Dutch deaths were from cardiovascular disease.
If this article has raised issues for you or if you’re concerned about someone you know, call Lifeline on 13 11 44.
Here are two stories that are completely utterly unimaginable to anyone from my oh so prosperous and egalitarian home country.
The Dutch are convinced that this only happens to utter losers who can’t count to two because this, seeing this as normal yet beyond people’s fault, this simply doesn’t fit within their world view and their own experiences, in which everyone is provided for.
They blindly assume – and aren’t aware of that assumption, let alone its falsehood – that the rest of the world works exactly the same as their own tiny, mighty country.
As a psychiatrist, I find that one of the hardest parts of my job is telling parents and their children that they are not to blame for their illness.
Children with emotional and behavioral problems continue to suffer considerable stigma. Many in the medical community refer to them as “diagnostic and therapeutic orphans.” Unfortunately, for many, access to high-quality mental health care remains elusive.
An accurate diagnosis is the best way to tell whether or not someone will respond well to treatment, though that can be far more complicated than it sounds.
I have written three textbooks about using medication in children and adolescents with emotional and behavioral problems. I know that this is never a decision to take lightly.
But there’s reason for hope. While not medically able to diagnose any psychiatric condition, dramatic advances in brain imaging, genetics and other technologies are helping us objectively identify mental illness.
Separating out normal behavior from problematic behavior can be challenging. Emotional and behavior problems can also vary with age. For example, depression in pre-adolescent children occurs equally in boys and girls. During adolescence, however, depression rates increase much more dramatically in girls than in boys.
It can be very hard for people to accept that they – or their family member – are not to blame for their mental illness. That’s partly because there are no current objective markers of psychiatric illness, making it difficult to pin down. Imagine diagnosing and treating cancer based on history alone. Inconceivable! But that is exactly what mental health professionals do every day. This can make it harder for parents and their children to accept that they don’t have control over the situation.
Most important of all is making sure your child is assessed by a licensed mental health professional experienced in diagnosing and treating children. This is particularly important when medications that affect the child’s brain are being considered.
Seeing the problem
Thanks to recent developments in genetics, neuroimaging and the science of mental health, it’s becoming easier to characterize patients. New technologies may also make it easier to predict who is more likely to respond to a particular treatment or experience side effects from medication.
Our laboratory has used brain MRI studies to help unlock the underlying anatomy, chemistry and physiology underlying OCD. This repetitive, ritualistic illness – while sometimes used among laypeople to describe someone who is uptight – is actually a serious and often devastating behavioral illness that can paralyze children and their families.
Through sophisticated, high-field brain imaging techniques – such as fMRI and magnetic resonance spectroscopy – that have become available recently, we can actually measure the child brain to see malfunctioning areas.
We have found, for example, that children 8 to 19 years old with OCD never get the “all clear signal” from a part of the brain called the anterior cingulate cortex. This signal is essential to feeling safe and secure. That’s why, for example, people with OCD may continue checking that the door is locked or repeatedly wash their hands. They have striking brain abnormalities that appear to normalize with effective treatment.
We have also begun a pilot study with a pair of identical twins. One has OCD and the other does not. We found brain abnormalities in the affected twin, but not in the unaffected twin. Further study is clearly warranted, but the results fit the pattern we have found in larger studies of children with OCD before and after treatment as compared to children without OCD.
Meanwhile, the field of psychiatry continues to grow. For example, new techniques may soon be able to identify children at increased genetic risk for psychiatric illnesses such as bipolar disorder and schizophrenia.
New, more sophisticated brain imaging and genetics technology actually allows doctors and scientists to see what is going on in a child’s brain and genes. For example, by using MRI, our laboratory discovered that the brain chemical glutamate, which serves as the brain’s “light switch,” plays a critical role in childhood OCD.
What a scan means
When I show families their child’s MRI brain scans, they often tell me they are relieved and reassured to “be able to see it.”
Children with mental illness continue to face enormous stigma. Often when they are hospitalized, families are frightened that others may find out. They may hesitate to let schools, employers or coaches know about a child’s mental illness. They often fear that other parents will not want to let their children spend too much time with a child who has been labeled mentally ill. Terms like “psycho” or “going mental” remain part of our everyday language.
The example I like to give is epilepsy. Epilepsy once had all the stigma that mental illness today has. In the Middle Ages, one was considered to be possessed by the devil. Then, more advanced thinking said that people with epilepsy were crazy. Who else would shake all over their body or urinate and defecate on themselves but a crazy person? Many patients with epilepsy were locked in lunatic asylums.
Then in 1924, psychiatrist Hans Berger discovered something called the electroencephalogram (EEG). This showed that epilepsy was caused by electrical abnormalities in the brain. The specific location of these abnormalities dictated not only the diagnosis but the appropriate treatment.
That is the goal of modern biological psychiatry: to unlock the mysteries of the brain’s chemistry, physiology and structure. This can help better diagnose and precisely treat childhood onset mental illness. Knowledge heals, informs and defeats ignorance and stigma every time.
Dogs have been part of human social groups for at least 30,000 years. So it’s not unreasonable to suppose that we might have had some influence on their behaviour, and perhaps their understanding, during that time. We certainly know that dogs have developed ways to communicate with us, for example by whining when they are distressed or barking to alert us to intruders.
Many dog owners would probably say their pets can even tell us things using facial expressions, just like humans do. But is that really true? Perhaps they are just showing emotion without meaning to communicate (just like humans also sometimes do). New research published in the journal Scientific Reports suggests it might be, but there are still reasons to be sceptical.
In a rather elegant experiment, the researchers set up four scenarios. They offered a dog food (a guaranteed way to get their interest) while the human handler was facing towards and also away from the dog. They also had the handler face towards and away from the dog without offering food. They found that the animals showed facial expressions more often when the handler was facing towards them than away, regardless of whether or not food was involved.
Until now, there has been little work on whether or not facial expressions in dogs are involuntary. You might be able to see when a dog’s happy, angry or sad from their face, but that doesn’t mean they are purposefully trying to tell you how they felt.
The new paper suggests that the expressions may be a means of communicating something to the person. It is certain that the expression is more frequently displayed when the human is facing towards the dog, even though the handler did not look directly at the dog during the trial, and that humans respond to that expression.
That dogs are able to understand when a person is paying attention to their behaviour is well documented. We also know that dogs show different facial expressions when in the presence of humans, especially in the case of that “guilty” look that every dog owner knows. That particular expression doesn’t actually mean they are feeling guilty. It’s more an attempt to appease the owner who is angry for some, to the dog, unknown reason.
But there are some questions about the particular facial expressions the dogs made in the new study that mean the evidence isn’t conclusive. For example, one of the expressions the authors noticed was the raising of the inner end of the eyebrows. This increases the size of the eyes and makes the dog look more puppy-like.
Studies have shown that humans prefer animals that look like infants. This explains the popularity of breeds with short noses and large eyes, such as boxers and pugs. Dogs that raise their eyebrows more frequently seem to be more popular with people than those that don’t. This could have led to the breeding of dogs that are more likely to show these more attractive expressions alongside those that have childlike anatomical features.
Another important indicator that the authors noted was when the dogs showed their tongues. Unfortunately, the researchers didn’t separate tongue movements that indicate stress, such as licking the nose or lips, which can be an appeasing signal, from those that indicate pleasure, anticipation or excitement, such as panting or hanging the tongue out of the mouth. Without this distinction it is difficult to draw conclusions about the emotional state of the dogs.
Previous research also suggests that dogs are aware of when a human is paying attention to them and may change their behaviour accordingly. It is possible that these dogs, aware that the human is facing them felt a level of anticipation, excitement and possibly some anxiety which affected their facial expression. The fact that the food produced no extra interest when the person was turned towards the dog or away from them, could be influenced by the fact that the dog was not actually given the food.
The authors suggest that the dog’s facial expressions may be partly a result of their emotional state and partly an attempt to actively communicate with the handler. Without any evidence about the effect of the expression on the behaviour of the handler, it is difficult to say if that is true.
If further research could make distinctions between the type of tongue movements involved in these expressions, as well as the raising of the eyebrows, we might be able to say with more certainty. But whatever the outcome, many dog owners will probably continue to swear their pets are trying to tell them something.
Maasai warriors wearing red and women wearing beads have come to be seen as symbols of “traditional” Africa. These colourful glass beads and red blankets play an important role in Maasai culture.
For thousands of European tourists who travel to East Africa, a visit would be incomplete without buying beads and blankets. What few know is the intricate cultural interconnection between Africa and Europe that resulted in these “traditions”.
Glass beads first arrived in Africa from the first millennium AD through the trans-Saharan and coastal trade. Because they were produced in India they were very expensive and only used by royalty.
From 1480 onwards, the mass export of beads from Europe to East Africa started from Venice and Murano in Italy, Bohemia and the Netherlands. By the late 19th century huge quantities of beads were being used as trade goods.
Although beads were readily available, the Maasai did not develop an interest in them for quite some time. The Iltalala age-set, who were warriors from 1881 until 1905, were the first to use larger numbers of beads to decorate themselves. An age-set is an institutionalised stage in life which is shared by people that are in the same age-category. Maasai age-sets are determined by the circumcision-ceremonies of boys, which initiate them into warriorhood. The time of circumcision defines who belongs to a certain age-set.
The age-sets have names and their members used to paint their bodies and shields to distinguish themselves. When the colonialists prohibited warriors from wearing their weapons in public, the Maasai instead began to wear beaded ornaments which made a public statement about the wearer.
The Iltalala age-set, who were warriors from 1881 until 1905, were the first to use larger numbers of beads to decorate themselves.
Beadwork fashions come and go
Beadwork can tell you several things about the wearer. Specific ornaments and colours indicate whether the person is Maasai or from another ethnic group. Different Maasai clans also use certain beads and colour combinations to indicate their affiliation. Finally, a person’s beadwork reflects his or her position in life. The belt of a young woman is different from the belt of a young man, and an unmarried girl’s earrings are different from those of a married woman.
Within those cultural rules, beadwork fashion changes all the time. Each new generation develops a particular style, including certain materials, colour placements and symbols that unite and identify them. In the spirit of creative competition, the girlfriends of a new age-set make new ornaments to ensure that their men outshine the previous age-set.
Other changes in the fashion result from a shortage of beads of certain types or colours for trade reasons. A good example is the blocking of the Suez Canal during the third Arab Israeli war in 1967.
Rivalry between age-sets also sparks change. Competing age-sets have often chosen to incorporate symbols of adopted technology. For instance, the Iseuri age-set, which was circumcised in the 1950s and 1960s, chose the telegraph pole as their symbol, as a reference to the speed of communication between warriors and their girlfriends.
The next major age-set, the Ilkitoip, elaborated on this theme by adding a large button eye on top of the telegraph pole to symbolise the swirling blue light of a police car. Succeeding age-sets created ornaments with a helicopter rotor blade because helicopters are faster than police cars.
Tourists are often quite surprised and a little disappointed when they find out that Maasai beads are imported from Europe. They would like African beadwork to be “authentic”. And it’s true that some ornaments have more cultural meaning than others.
Some are adapted to tourists’ preferences. For instance Maasai women started to use colours and designs they would not normally use in their own beadwork, just because tourists liked them. And ornaments for tourists are often made of cheaper Chinese beads.
Some items have such symbolic significance that they cannot easily be sold. An example is the Elekitatiet belt, which a woman makes for her daughter-in-law when she has delivered her first baby.
Nowadays uncircumcised boys in the city wear beaded necklaces in Rastafari colours, and warriors buy beaded straps that give their watches a Maasai touch.
So Maasai beadwork continues to be the result of the interaction between European and African cultures, and there is nothing isolated or timeless about it. Rather than exotic, static and detached, it forms an ever changing, multi-cultural realm of exchange of materials and ideas between Africa and Europe.
When the European Space Agency (ESA) launched a satellite into orbit on Oct. 13, it did so despite opposition from Inuit leaders in Canada and Greenland over its potential to contaminate an important Arctic area.
Most, but not all, of the rocket’s highly toxic fuel is burned during the launch. So, when the second stage of the rocket detached and fell back to Earth, it may have contained up to a tonne of unburned hydrazine fuel that was “deliberately deposited” into the North Water Polynya in northern Baffin Bay, between Nunavut and Greenland.
The polynya, or Pikialasorsuaq in Inuktitut, is an area of open water surrounded by sea ice. It is a critical habitat for Arctic species such as narwhal and seals, and is one of the Arctic’s most biologically productive areas. It is also considered to be an important part of the food supply for the Inuit communities who fish and hunt there.
Prior to the launch, the former Prime Minister of Greenland, Kuupik Kleist, called the deposit of potentially dangerous rocket fuel into the Pikialasorsuaq “unacceptable.”
According to a study published earlier this month, at least 10 similar launches have discarded rocket stages in Pikialasorsuaq or in the Barents Sea, off the northern coasts of Norway and Russia, since 2002.
Article 29 of the UN Declaration on the Rights of Indigenous Peoples asserts that states must ensure hazardous materials are not disposed in Indigenous territories without their consent. However, last week’s launch — like the others before it — involved no prior consultation with Inuit.
For Inuit, the rocket launch transcends geopolitics. It strains their ongoing concerns over food safety and food security. It also raises tensions over the rights of Indigenous peoples in contemporary Canada, including their right to food.
In Nunavut, food security remains a serious public health issue. More than two-thirds of Inuit households lack reliable access to enough affordable, nutritious food. Climate change, environmental contaminants, high food prices and low income all affect food security.
The average cost of healthy foods in Nunavut is considerably more than the average in Canada, including chicken ($13.54 vs. $7.17 per kilogram), apples ($6.70 vs. $3.85 per kilogram) and carrots ($5.93 vs. $2.03 per kilogram). Meanwhile, employment income in small Nunavut communities such as Arctic Bay is less than half the median income of $32,800 that is the norm across Canada.
What if something goes wrong?
Hydrazine is an extremely toxic chemical now rarely used by space programs due to its immediate dangers. Researchers know little about how humans may be affected by long-term exposure to hydrazine, nor have they studied its behaviour in Arctic marine environments.
Hydrazine was used in last week’s ESA atmosphere-monitoring satellite launch from Plesetsk Cosmodrome in Russia. The ESA has denied the rocket stage presents any threat to the Arctic environment and Global Affairs Canada deemed risks to the marine environment as “very low.”
As Inuit have repeatedly pointed out, any risk associated with the Arctic environment may have an impact on their food security, nutrition and health, as well as on their livelihood and culture. To what extent have the potential harms to Inuit food systems been taken into account when governments evaluate the risks associated with falling rocket debris or other industrial activities?
‘This is our home’
Even though much of the Arctic is far removed from the world’s industrial centres, global pollution is having a profound effect on the North. Contaminants can travel long distances along ocean currents, rivers and streams, and in the atmosphere, reaching high levels in Arctic ecosystems.
Inuit generally prefer to eat food obtained through fishing, hunting and gathering, collectively called country foods. It is mostly through these country foods that Inuit are exposed to environmental contaminants such as persistent organic pollutants and heavy metals such as mercury. Studies show that Inuit living in Nunavut have higher levels of contaminants in their blood than the general Canadian population.
Contaminants are among many contemporary pressures on Inuit food systems.
“Hunting and gathering, this is how we live. This is our humanity,” said Jerry Natanine, the former mayor of Clyde River. These mounting pressures on marine ecosystems highlight how country foods are an existential matter for Inuit.
Inuit food systems can no longer simply be an afterthought to international sovereignty disputes and risk assessment. Indigenous Peoples in Canada and globally have drawn attention to the false imagination of their homes, lands and waters as a terra nullius – an empty no-man’s land.
As Okalik Eegeesiak, former chair of the ICC, has said of previous launches: “This rocket will not be falling into no-man’s land… This is our home.”
The prospect of engineering the world’s climate system to tackle global warming is becoming more and more likely. This may seem like a crazy idea but I, and over 250 other scientists, policy makers and stakeholders from around the globe recently descended on Berlin to debate the promises and perils of geoengineering.
There are many touted methods of engineering the climate. Early, outlandish ideas included installing a ‘space sunshade”: a massive mirror orbiting the Earth to reflect sunlight. The ideas most in discussion now may not seem much more realistic – spraying particles into the stratosphere to reflect sunlight, or fertilising the oceans with iron to encourage algal growth and carbon dioxide sequestration through photosynthesis.
But the prospect of geoengineering has become a lot more real since the Paris Agreement. The 2015 Paris Agreement set out near universal, legally binding commitments to keep the increase in global temperature to well below 2°C above pre-industrial levels and even to aim for limiting the rise to 1.5°C. The Intergovernmental Panel on Climate Change (IPCC) has concluded that meeting these targets is possible – but nearly all of their scenarios rely on the extensive deployment of some form of geoengineering by the end of the century.
How to engineer the climate
Geoengineering comes in two distinct flavours. The first is greenhouse gas removal: those ideas that would seek to remove and store carbon dioxide and other greenhouse gases from the atmosphere. The second is solar radiation management: the ideas that would seek to reflect a level of sunlight away from the Earth.
Solar radiation management is the more controversial of the two, doing nothing to address the root cause of climate change – greenhouse gas emissions – and raising a whole load of concerns about undesirable side effects, such as changes to regional weather patterns.
And then there is the so-called “termination problem”. If we ever stopped engineering the climate in this way then global temperature would abruptly bounce back to where it would have been without it. And if we had not been reducing or removing emissions at the same time, this could be a very sharp and sudden rise indeed.
Most climate models that see the ambitions of the Paris Agreement achieved assume the use of greenhouse gas removal, particularly bio-energy coupled with carbon capture and storage technology. But, as the recent conference revealed, although research in the field is steadily gaining ground, there is also a dangerous gap between its current state of the art and the achievability of the Paris Agreement on climate change.
The Paris Agreement – and its implicit dependence on greenhouse gas removal – has undoubtedly been one of the most significant developments to impact on the field of geoengineering since the last conference of its kind back in 2014. This shifted the emphasis of the conference away from the more controversial and attention-grabbing solar radiation management and towards the more mundane but policy relevant greenhouse gas removal.
But there were moments when sunlight reflecting methods still stole the show. A centrepiece of the conference was the solar radiation management experiments campfire, where David Keith and his colleagues from the Harvard University Solar Geoengineering Research Programme laid out their experimental plans. They aim to lift an instrument package to a height of 20km using a high-altitude balloon and release a small amount of reflective particles into the atmosphere.
This would not be the first geoengineering experiment. Scientists, engineers and entrepreneurs have already begun experimenting with various ideas, several of which have attracted a great degree of public interest and controversy. A particularly notable case was one UK project, in which plans to release a small amount of water into the atmosphere at a height of 1km using a pipe tethered to a balloon were cancelled in 2013 owing to concerns over intellectual property.
Such experiments will be essential if geoengineering ideas are to ever become technically viable contributors to achieving the goals of the Paris Agreement. But it is the governance of experiments, not their technical credentials, that has always been and still remains the most contentious area of the geoengineering debate.
Critics warned that the Harvard experiment could be the first step on a “slippery slope” towards an undesirable deployment and therefore must be restrained. But advocates argued that the technology needs to be developed before we can know what it is that we are trying to govern.
The challenge for governance is not to back either one of these extremes, but rather to navigate a responsible path between them.
How to govern?
The key to defining a responsible way to govern geoengineering experiments is accounting for public interests and concerns. Would-be geoengineering experimenters, including those at Harvard, routinely try to account for these concerns by appealing to their experiments being of a small scale and a limited extent. But, as I argued in the conference, in public discussions on the scale and extent of geoengineering experiments their meaning has been subjective and always qualified by other concerns.
My colleagues and I have found that the public have at least four principal concerns about geoengineering experiments: their level of containment; uncertainty around what the outcomes would be; the reversibility of any impacts, and the intent behind them. A small scale experiment unfolding indoors might therefore be deemed unacceptable if it raised concerns about private interests, for example. On the other hand, a large scale experiment conducted outdoors could be deemed acceptable if it did not release materials into the open environment.
Under certain conditions the four dimensions could be aligned. The challenge for governance is to account for these – and likely other – dimensions of perceived controllability. This means that public involvement in the design of governance itself needs to be front and centre in the development of geoengineering experiments.
A whole range of two-way dialogue methods are available – focus groups, citizens juries, deliberative workshops and many others. And to those outside of formal involvement in such processes – read about geoengineering, talk about geoengineering. We need to start a society-wide conversation on how to govern such controversial technologies.
Public interests and concerns need to be drawn out well in advance of an experiment and the results used to meaningfully shape how we govern it. This will not only make the the experiment more legitimate, but also make it substantively better.
Make no mistake, experiments will be needed if we are to learn the worth of geoengineering ideas. But they must be done with public values at their core.
Death does not concern us, because as long as we exist, death is not here. And when it does come, we no longer exist.
We are in the midst of two great ethical debates: marriage equality and assisted dying. The results of the marriage equality postal survey will be announced on November 15; meanwhile, the Victorian parliament is this week debating a new law to allow doctor-assisted dying in the last year of life.
What is striking is the volume of the respective public debates. Everyone is talking about marriage equality; very few are discussing assisted dying.
Given that the ethics of assisted dying are more complex than marriage equality, and what happens in Victoria is likely to provide a template for other states, why is it receiving so much less attention?
How fear of death affects public debate
Public ethical debates are fuelled by emotion and psychological biases on both sides. In the case of assisted dying, most of us are not like Epicurus: we fear death. We hate talking about it.
Despite the fact that polls show that 73% of Australians favour assisted dying, it is not clear whether the legislation will pass, although the mood seems to be leaning slightly in favour: 40 out of 87 MPs in the Legislative Assembly told the Herald Sun they would vote yes.
So, there should be an enormous impetus to show MPs the level of public support. But it has been rather muted. Perhaps for similar reasons we post photos of weddings on Facebook, but not funerals: both are important, but only one makes good dinner party conversation.
Terror management theory, evolution and social signalling
Our fear of death might even be linked to our love of marriage, according to terror management theory (TMT). Neuroscientist Claudia Aguirre writes:
When we’re faced with the idea of death, people defensively turn to things they believe will shield them from death, literal or otherwise. Thinking about death also motivates people to indiscriminately uphold and defend their cultural world views, whatever those may be.
TMT has been linked to our development of regulation and rituals around sex.
So, a fundamental commitment to marriage being between a man and a woman may be more of an immovable foundation on which group membership is based to guard against our shared fear of death than an ethical position that can be defended or rebutted on rational grounds.
While fear suppresses talk about dying, marriage equality involves sex. People are intensely interested in love and sex. And sex has been more important than death in evolutionary terms.
As evolved animals, we were only here to survive long enough to reproduce. Reproduction is evolution’s goal, and so practices around its rituals and norms are hugely important in evolutionary and religious terms.
Religions and societies seek to control reproduction. In the Judeo-Christian tradition, sex was to occur within marriage between one man and one woman. Death at an old age is of much less evolutionary significance.
We are social animals, motivated to support our in-group and reject out-group members. Tribalism can help explain our devotion to football teams, for example. We have developed social signalling to show our group which side we are on and maintain trust.
Add to that a status quo bias, and public debates where the topic in question is seen to express something foundational about ourselves can become little more than cheering for our own team.
Anchoring is a psychological bias that means we evaluate how good or bad something is relative to the anchor of existing examples.
In the UK, the 2013 same-sex marriage legislation was fairly uncontroversial. One reason could be that civil partnerships – same-sex marriage in all but name – were created back in 2004. Each step in the UK’s progress towards marriage equality was a short step from the previous state of being.
In contrast, the Australian campaign against same-sex marriage portrays the choice as a paradigm shift in our culture, extending far beyond marriage. Former prime minister Tony Abbott linked the debate to political correctness, gender fluidity and even the date of Australia Day, saying:
This isn’t just about marriage … there are lots and lots of implications here and we’ve got to think them through before we take this big leap into … the dark.
A better approach
For assisted dying to be an appropriate activity for medicine, we should show that death can be an appropriate therapeutic end and in a patient’s best interests. That is, that their life is no longer worth living.
That is an extremely difficult case to prove, and I haven’t seen any good arguments for how to evaluate that. Why wouldn’t we just go on what a competent person says? If a suffering person believes they’re better off dead, they’re probably right.
But here is another way to think about it. The Victorian legislation will provide assistance only to those in the last year of life from a physical illness. They are effectively in the process of dying.
One major objection to the assisted dying bill is that we don’t need it because good palliative care is sufficient. Relief of suffering is very important, and more should be spent on end-of-life planning and palliative care.
But this objection is complicated for several reasons. If palliative care is outstanding, people won’t request assistance in dying. So there is no need to ban it.
More importantly, while palliative care may be able to control pain and suffering, it cannot do everything.
Together with colleagues at Barwon Health and Oxford University, we surveyed 382 people from the general population and 100 attendees at an advance care planning clinic, where people think about and express their values relating to end-of-life care. We didn’t ask them about assisted dying, but we did ask them to rank four factors at the end of life: pain relief, dignity, independence and living as long as possible.
The highest proportion of both groups ranked the relief of pain and suffering as the most important value, followed by maintaining dignity and remaining independent.
Living as long as possible was ranked as most important by the lowest proportion of participants – only 4% of palliative care patients and 2.6% of the general population (30–35% regarded this as either not important or not very important).
People care not only about pain relief, but also about dignity and independence at the end of life. These are much more subjective and less amenable to control by palliative care. So while palliative care can address part of what people care about, it may not be able to address all their values.
Moreover, people can already shorten their lives by more than a year for any medical condition, or no medical condition at all, by refusing to eat and drink by mouth. It takes around ten days to die of thirst. Such people could be given palliative care to relieve their suffering during this period of suicide.
But surely the Victorian law offers a better way to die? As with the palliative care, this kind of death does not provide the dignified death, or the independence, that people value.
As distressing as public debate on heartfelt, emotive issues like assisted dying and marriage equality can be, it is an important collective exercise. Like many other people, I thought the marriage equality survey was a waste of money. But on reflection, this idea maybe misplaced. When the views of one part of the community are deemed politically incorrect and suppressed, they foment, then erupt in a Brexit or a Trump.
Debate is vitally important to democracy. What we should hope is that people engage in these debates with their heads, not their hearts. It will take considerable effort on both sides to overcome the psychological obstacles to finding the most fair and reasonable policy.
As Epicurus also said:
The art of living well and the art of dying well are one.
Julian Savulescu, Uehiro Chair in Practical Ethics, Visiting Professor in Biomedical Ethics, Murdoch Childrens Research Institute and Distinguished Visiting Professor in Law, Melbourne University, University of Oxford
A world mental health survey shows that about 5.2% of people who lose loved ones suffer from PTSD. But how do you know who suffers from PTSD after a traumatic loss so that you can give them the care they need?
Unfortunately, in Africa most people go undiagnosed. This is because only two countries on the continent have carried out national surveys on mental health – South Africa and Nigeria. Concerning trauma and PTSD, the only significant data emanated from the South African Survey, since the Nigerian one did not have a high enough prevalence rate to enable detailed analysis.
The recent global survey identified a number of predictors that significantly increase the risk of PTSD after a loss. These include: whether the deceased is either a spouse or child, being female, believing that one could have done something to prevent the death, prior exposure to a traumatic event and having a previous mental disorder before the trauma.
Using these predictors it was possible to construct a model that can be used to determine those with the highest risk of developing PTSD after the unexpected death of a loved one. This model makes it feasible for clinicians helping people who have suddenly lost loved ones to develop interventions that are evidence-based and with high probability of success. This should provide opportunities for affected people being able to be provided with the appropriate care after this traumatic event.
PTSD and death
PTSD happens after a person is exposed to an event that poses a threat to their life. It is a group of symptoms that include re-experiencing the event, changes in emotions and cognitive functions. Irritability, reckless or self-destructive behaviour, sleep problems and low concentration are common.
Families and caregivers can recognise PTSD in a loved one because the symptoms are a change from their usual behaviour. These signs and symptoms begin within a month of experiencing the traumatic event like the unexpected death of a loved one.
The person may experience nightmares or flashbacks, will avoid distressing memories, thoughts, or feelings associated with the traumatic event.
Due to the trauma, the person may also develop memory problems and feelings of detachment from friends, colleagues and family are common. The person may also display exaggerated negative beliefs about themselves, others or the world. In some cases, depression and drug abuse is noted.
People who have unexpectedly lost a loved one are at a higher risk of getting PTSD so they should be identified early enough and appropriately counselled.
The high prevalence and meaningful risk of PTSD makes the unexpected death of a loved one a major public health issue. Due to a collaborative initiative under the World Health Organisation (the World Mental Health Surveys Initiative) it is now possible to predict the occurrence of PTSD after a traumatic event such as the unexpected death of a loved one.
The resulting screening assessments will be useful in identifying high risk individuals prone to PTSD for early interventions.
Raising relevant data is one of the biggest challenges to tackling the issue of PTSD in Africa.
African countries should carry out national mental health surveys because they provide information that can be used for planning care and rationally allocating resources in mental health. They also provide information necessary in policy formulation and mental health interventions.
Without a national survey, countries often misallocate resources, ending up with situations in which they neglect the most important problems and intervene disproportionately in low priority areas. This is responsible for the current situation in which what is probably a silent mental ill-health epidemic which is sweeping across the continent.
Lukoye Atwoli, Dean, Moi University School of Medicine, Consultant Psychiatrist and an Associate Professor in the Department of Mental Health, Moi University
Large health inequalities exist in Australia. Car ownership and its costs add to the health inequalities between low-income and high-income households. The physical characteristics of neighbourhoods influence our transport use and, in turn, make health inequalities better or worse.
Rising housing prices have forced many low-income families to live on the fringes of Australian capital cities. Residents of these sprawling outer suburbs often have worse access to public transport, employment, shops and services. They need one or more motor vehicles simply to get to work and take children to school.
Buying and maintaining vehicles in Australia is expensive. These costs have a large impact on household budgets. Household finances then affect health in two main ways:
through the ability to access health-related resources, such as healthy foods, health care and high-quality living conditions (like heating and cooling)
through stress caused by financial difficulties, insecure incomes and exposure to poorer environments such as crowding, crime and noise pollution.
Living in the car-dependent urban fringes also often dooms residents to long sedentary commutes.
Four scenarios of transport costs
The following four hypothetical households demonstrate the costs of varying levels of car ownership and transport behaviours.
Scenario 1: A household with two cars that are 15,000km and 10,000km, respectively, per year. The car that is driven 15,000km is assumed to be less than three years old, bought new and financed with a loan. The other car is assumed to be 10 years old and owned outright. This household aligns with estimates by the Australian Automobile Association.
Scenario 2: Scenario one, minus the used car and substituting five return public transport trips a week to the Melbourne central business district from the outer suburbs.
Scenario 3: No cars, substituting 10 return trips to the CBD from the outer suburbs.
Scenario 4: No cars, substituting three return trips to the CBD (i.e. occasional public transport use), with walking and cycling as the main forms of transport.
Table 1 shows how reducing household car ownership, even after adding the cost of public transport, can improve household finances.
Moving from a two-car household to a one-car household cuts weekly costs by as much as A$41, even after increased public transport use adds a A$41-a-week cost.
Moving from a two-car household to having no cars can improve weekly finances by as much as A$237, after adding 10 return trips to the CBD.
The fourth scenario, emphasising walking and cycling, shows the greatest improvement in household finances. These families are $294 per week better off.
The impacts on households of each of these car ownership and transport scenarios differ depending on their incomes. To illustrate this, we’ve taken the median disposable household income from the lowest, middle and highest quintiles from the ABS in 2015-16.
Although becoming car-free will increase disposable household income after paying for transport, the largest proportional differences are for the lowest-income households. This means these households will benefit most from reducing car ownership and switching to more active and affordable forms of transport.
Urban design can boost household health and wealth
So how do we help households make the transition from private car ownership? The answer lies in the environments we live in.
The evidence from research suggests several strategies to improve uptake of active and affordable transport, while reducing car dependence and related health inequities. These include local urban design features such as:
connected and safe street networks (including pedestrian and bicycle infrastructure) that reduce exposure to traffic
Australia has yet to fully realise the potential of promoting active transport and reducing car dependency as a way to reduce health inequities.
For example, the Victorian government recently announced 17 new low-density suburbs for Melbourne’s outer fringes (up to 50 kilometres from the CBD). It did so with a goal of creating more affordable housing. But urban planning experts have criticised these plans for increasing car dependence and commute times – due to the lack of nearby destinations and amenities – which have been shown to be bad for health.
In another case, the Planning Institute of Australia described the proposed A$5.5 billion West Gate Tunnel as a “retrograde solution”. The institute expressed concern about “entrenched inequality for those in the outer suburbs”.
Changes to city transport environments can take years or even decades, and funding is often limited. Phased interventions that target lower-income neighbourhoods should be considered first as these are likely to produce the greatest gains in health equity.
This approach does have some caveats. Urban renewal projects carry a risk of gentrification, whereby higher and middle-income households displace those on lower incomes. Place-based government investment, such as improvements to public transport, has been shown to increase local housing prices. That could force lower-income households to relocate, often to car-dependent neighbourhoods on the urban fringes.
In these scenarios, a lack of government policies that safeguard against displacement of low-income residents can make health inequities worse.