Helen McDowall – Written evidence (INQ0004)
This is my submission in accordance with questions asked. I have as always, answered truthfully insofar as I can comment from a healthcare professional, philosopher and environmentalist perspective. I have discovered after a lifetime of campaigning, that truth is only very rarely appreciated in one’s lifetime and in one’s locality, let alone heard or acted upon. People much prefer lies to truth. However, here it is.
“Life span has increased over recent decades, but health span has not kept pace”.
Whilst this may be true now, will it be true in the future? Will it be true of the world population or even, true of the UK population one generation from now? In short, are you preparing for a real emergency or an imagined one? I looked after my husband as he gradually succumbed to cancer over about five years. We did it together; without claiming benefits we were entitled to; because we loved each other so completely. He didn’t want to die in a hospice, but at home. I am not alone in this. Unpaid carers do this for their loved ones everyday for many more years more than I did.
From an evolutionary- development perspective, there will always be a greater or lesser portion of society that needs additional help to adapt to their environment when temporarily or permanently unable to do so. Life, as they say in Jurassic Park, finds a way. Evolution works on a trial and error basis – a bit like finding where an individual piece fits in the jigsaw- puzzle of survival and reproductive success. The 21st Century scientific zeitgeist is towards ‘solving’ problems with the assumption that humankind is supremely powerful and immune to evolutionary forces that determine what survives, applicable only to non- human animals. We assume as a species that we are able to manipulate natural processes always to our advantage. The hope is to eradicate illness, disease, suffering and dying by finding ‘panacea cures’ and ‘magic bullets’ using our scientific ingenuity and technical abilities. Just for one moment I want you to imagine a world where this was true – a world with no pain, no suffering, no death and ask yourself if it might also be a world without compassion, understanding, endeavour, endurance and duty of care towards others? Do I wish Allan hadn’t died or that he had lived another five years of aggressive treatments, operations and pain relief? No.
How we die is as much a part of life as how we live.
There is demographic evidence to show rapid changes in millennial- generation choices – choosing to remain single, to limit their family size to a maximum of two, to not have children at all or to delay starting a family until early to mid-forties. This is particularly so in an increasingly secular, prosperous, career- oriented West where women are expected to be and have the expectation to be an equal part of the workforce whilst facing unprecedented climatic uncertainty. Net population will fall whilst the resources, willingness and time available to care for the sick and elderly also falls. Factor- in other variables affecting this generation- like plastic pollution entering the human food chain (emerging evidence of infertility, birth defects, cancer and diabetes resulting from endocrine disruptors entering, being stored and processed by the human body) and the life- limiting effects of the obesity crisis (infertility, developmental defects, birth complications decreasing live- birth rates and children beginning to die before their parents), - the picture becomes even less certain.
Climate Change will cause mass migration to where conditions are more favourable – very probably the UK will be a destination that migrants whose Countries have become uninhabitable want to come. Migrants bring diseases and inherited health- tendencies unique to their Country of Origin and Ancestry for which the UK will need to be prepared – especially if the changing climate increases incidences of illnesses (e.g. tropical malaria, Ebola and dysentery) to which the native population and health care system have little or no immunity to or experience of managing.
The categorisation, stereotyping and labelling of ‘older people’, ‘the elderly’ and ‘ageing population’ when used in conjunction with negative outcomes – particularly those involving the universal human emotion of disgust and in terms of ‘financial cost’, is unhelpful at best, potentially prejudicial and discriminatory at worst. Please STOP this categorisation of people according to their symptoms and ‘cost to society’! The recent obsession with ‘mental- health’ is especially alarming in this respect.
People are just people - with different needs and adaptation- potentials, that live under the same umbrella- of- normal- population- distribution as everyone else (McDowall, 2015). Focussing on specific minority-needs alienates the majority who don’t feel they fall into that category or who feel they must be held financially responsible for problems they don’t yet have. If no-one had mentioned for example, that Meghan Markle was of ‘mixed race’ when she married THEN, it might have been true to say we had advanced somewhat in our thinking – but that didn’t happen. Consigning people to boxes, individualism and seeking short- term solutions to long- term problems - a result of our Greek, debating, cultural heritage needs to change to a more collective, collaborative, species- wide, human- rights, long term outlook.
Plan instead for ‘prevention and promotion of wellness for everyone - across the lifespan’ rather than the symptom- management and crises- mitigation approach adopted within the current medical- model.
On the positive side, new cures and understanding of dementias, the somatic- ageing process, cancer incidence, autoimmune disease, neurological decline and the potential for gene therapies may yet reduce the scope of current (largely negative) predictions. Research into the positive effects of the female menopause (uniquely human and female) – inclusive fitness, the role of grandparents in bringing up their grandchildren and acting in support- roles that enable the biologically young and therefore, more likely to be reproductively- successful, to function in the workplace. Think ‘beehive’ or ant colony here (examples of enduring success for millennia) - where everyone is valued equally regardless of their economic contribution (linked to the protestant- work- ethic) and paid employment.
The attitude towards assisted suicide and dying also needs to shift towards a more ‘quality of life’ agenda. I for one do not wish to end my life in a ‘care home’ or undergo chemotherapy which will probably kill me sooner than if I had had no treatment at all. I do not want to become a burden on my children or society in general. I want to die in my own home at a time of my own choosing even if that means suicide by poison. I want to be as independent as possible on my own terms (not anyone else’s), for as long as possible.
My health, my behaviour and my wellbeing is my responsibility insofar as I have control over it, BUT, it is also the responsibility of those who plan and build our homes and transport systems, plan our open spaces, limit environmental exposure to toxins and pollutants in our food and drinking water and those who determine our working- life conditions in the wider environmental context. These things need to be talked about if you’re going to talk about technology and healthy living – not just in relation to ‘an ageing population’. We are ALL ageing!........
There is scientific understanding, but contributions need to be made from all scientific fields that have potential to influence population demographics. All science needs to be freely shared, (with an end to scientific- protectionism) and understood in relation to other fields of scientific endeavour...
I refer you to BBC Radio 4 - Reith Lectures 2001 - The End of Age. Lecture 3: Sex and Death by Tom Kirkwood and to a growing body of evidence about the impact of plastic ingestion, inhalation and skin contact with plasticisers and transport up the food chain of adsorbed substances that may survive the recycling process, becoming concentrated poisons in new products and in the bodies of higher mammals that store fat as an energy source.
I refer you to the WHO organisation of health as being not merely the absence of disease or illness. Can we just talk about health? The mind and body do not operate in isolation from one another as separate entities. Comorbidity and holism should be the general rule and the individual cannot be studied outside of environmental and lifespan context. The focus on symptoms, treatment, labelling and diagnosis is unhelpful when looking at holistic wellbeing and planning for health needs Nationally and globally.
Focus on the people who are healthy and what they get right. Please? I did my BSc Psychology dissertation on obesity in health service staff and why obesity is so much more prevalent within the NHS than in equivalent sectors. I looked at perceptions of healthy- lifestyle advice given by health professionals dependent on personal appearance and whether the advice they gave was likely to be taken. Results showed that perceptions of health have a marked unconscious, negative effect on uptake of healthy lifestyle advice. This response has its roots in innate ‘healthy prejudice’ (as distinct from phobia) towards a real threat (obesity). Basically, if you as a health professional can’t do what you expect your patients to (e.g. lose weight), then forget it. The obesity-effect transferred to other healthy- living advice e.g. smoking cessation. For what it’s worth – I think the successful lowering of smoking rates has more to do with having to ask for cigarettes – making it more ‘effortful’ to obtain them, than on the packaging (message framing) per se. Human beings are lazy by default.
As for mental health. I left psychiatry after 30 + years because of the obsession with ‘mental illnesses. Most people never suffer mental illness – they are surprisingly rare given the current zeitgeist. NB: Dementia is not a mental illness but an organic, progressive and terminal brain death. Other cultures absorb temporary and even permanent mental health ‘difficulties with daily living’ with acceptance and coping- strategies that don’t involve medication or incarceration. I am opposed to the ‘medicalisation’ of everyday life. It’s normal to have times when one cannot function in response to grief, to trauma, to moving to a new house, to insecurity and loss of a role when made redundant for example. The answer lies not in lowering or raising neurotransmitter levels to adjust mood or thought patterns. One can never be sure of the direction of correlational relationships for one thing and non- human trials are wholly unsatisfactory. One must look to the root causes. I cured my husband of schizophrenic symptoms by giving him the unconditional acceptance and love he craved - to make him secure enough he didn’t need to live in an altered reality. Further to this, one needs to design interventions on health at the appropriate level. Individual- level therapies must be tailored to the individual – like gene therapies are. Social- level interventions must be introduced on a social level. Blaming the individual for their addiction and perceived weaknesses, relying on self- control in making them responsible for their ‘cure’ and buying decisions without facilitating the changes they need to make in their environment, is a ludicrously stupid way of getting people to change behaviour. For example, the sugar tax. Sugar is poison. If you want to tackle the obesity crisis look at the Tesco Manual for getting people to buy and reverse the psychology – like you do with tobacco or drugs. Make it more difficult to get hold of. This inevitably brings government into conflict with commerce – it all depends on what you want really a fossil- fuel and sugar- addiction- based economy now and go to hell in a hand cart or whether you really want to change the health of a Nation and save the planet for the greater good.
Address poverty and inequality in opportunity. Make public transport free and reduce the need for travel generally - to reduce pollution and increase activity i.e. decentralise healthy activity, health care and service delivery – become more community- oriented. After all, human beings are by virtue of their brain- size and brain complexity supposed to live in small social groups involving around 150 social relationships (See the Human Zoo by Desmond Morris 1969). Removing dementia sufferers to an unfamiliar routine and unfamiliar place, disrupting routine and habits, permanently harms. Keep family and social support networks intact by e.g. instead of long-distance commuting – work from a community business hub. Reduce loneliness by increasing people’s sense of belonging, of place- attachment and maintaining a valued role past ‘retirement from the workplace’. Reduce the working week to three days. Increase wellbeing and productivity with full employment for life– according to ability, regardless of age. Reduce the amount of time at work and improve autonomy and flexibility in working environments. I take the opportunity to remind you here that money, like god, does not exist outside the human brain that created it. They are tools we use to structure our living but – these concepts have no reality that bind us to them.
Science and technology driven by human ingenuity and need are tools we use to manipulate our world. We are truly capable of great things. Things we once thought impossible are possible, driven by our insatiable thirst for knowledge. But. I urge you to think about when belief and science overlap and beware of mistaking one for the other. I refer you to Alan Turing’s work on Morphogenesis and the limiting factors that separate what is possible from the impossible- the difference between wishful thinking and hope, and what is possible. It may just turn out that ageing and dying are as necessary to living a good life as breathing and that try as you might, evolution is the ultimate regulator that we would do well to work with, rather than against. (I am NOT talking about eugenics or survival of the fittest).
Climate Change resulting from Global Warming will become irreversible by 2050, evidence suggests, quite probably sooner. Then the problem of ageing will not arise because most life on Earth will be extinct. We are witnessing and are responsible for a Mass Extinction Event which will render this inquiry redundant.
15 August 2019