Tag Archives: epidemic’

NHS urges 1.4m staff to have flu jab to reduce risk of epidemic

NHS bosses are writing to all 1.4 million staff to say they must have the winter flu jab as soon as possible to reduce the risk of them infecting patients who might die.

Those who decline the jab will have to tell the NHS trust that employs them why, and it will have to record their reasons, as part of a bid to drive up what the NHS admits are “disappointing” staff take-up rates.

The move comes as the chairman of NHS England admitted on Thursday that health service chiefs were “more scared than we have ever been” about how bad winter could be. There is a strong likelihood of hospitals being inundated with flu sufferers, Prof Sir Malcolm Grant said.

The prospect of a flu epidemic presented a real crisis, added Grant. NHS leaders are seriously concerned that Britain could be hit by its biggest flu outbreak in years this winter. There is acute anxiety because Australia and New Zealand have been experiencing their worst flu season for many years with struggling to cope.

NHS bosses have got tough on staff’s jab uptake as part of a new series of “intensified cross-NHS winter preparations” in a bid to reduce the estimated 8,000 annual deaths from flu in England and Wales.

They are sending out letters to healthcare workers across England urging them to get vaccinated as soon as possible, to reduce the risk of them passing on the flu virus to vulnerable patients, especially older people and those with breathing problems such as asthma, pneumonia and emphysema. It is staff’s professional duty to have the jab, they say.

The letter says: “As winter approaches it is worth reminding ourselves that flu can have serious and even fatal consequences.

“Healthcare workers, as members of the general population, are susceptible to flu. When coupled with the potential for a third of flu cases being transmitted by asymptomatic individuals, it means patients are at particular risk.”

Although a record proportion of NHS staff received the jab last year – 63% – in some trusts as few as 20% of staff took up the offer of free vaccination at work.

In another previously unused tactic, NHS England bosses are writing to all 234 NHS trusts telling them to do much more to ensure staff have the jab. “We require each NHS organisation to ensure that each and every eligible member of staff is personally offered the flu vaccine, and then either signs the consent form or states if they decline to do so,” that letter says.

Grant, speaking at the national children and adult services conference in Bournemouth, said: “We face winter better prepared than we have ever been, but more scared than we have ever been.

“We have the strong likelihood of hospitals being inundated with people suffering flu.”

The NHS is expanding its £237m winter flu campaign by offering free vaccination for the first time to over 1 million people who work in care homes, at a cost of £10m, and also to the 670,000 eight- and nine-year-old pupils in school year four. Those aged two, three and four will be offered a flu vaccination in the form of a nasal spray rather than an injection, however.

In all, 21 million people in England will be offered free immunisation on the NHS. They include pregnant women and anyone over 65 and anyone deemed at clinical risk, for example due to asthma.

“This move to help keep care workers stay well during flu season is a really positive step by the NHS. Not only will it help to protect thousands of care home residents from getting sick, but it sends a strong signal about the importance of social care staff in providing an integrated health and care service,” said Imelda Redmond, the national director of the campaign group Healthwatch England.

Last winter, 133 people died as a direct result of flu after being treated in an intensive care or high-dependency unit in England, Public Health England said.

The NHS has also responded to the widespread shortage of A&E doctors by deciding to expand the number of doctors training to become specialists in emergency medicine from 300 to 400 a year for four years from next year. Currently, about 6,300 different grades of medics work in A&E units across England.

NHS urges 1.4m staff to have flu jab to reduce risk of epidemic

NHS bosses are writing to all 1.4 million staff to say they must have the winter flu jab as soon as possible to reduce the risk of them infecting patients who might die.

Those who decline the jab will have to tell the NHS trust that employs them why, and it will have to record their reasons, as part of a bid to drive up what the NHS admits are “disappointing” staff take-up rates.

The move comes as the chairman of NHS England admitted on Thursday that health service chiefs were “more scared than we have ever been” about how bad winter could be. There is a strong likelihood of hospitals being inundated with flu sufferers, Prof Sir Malcolm Grant said.

The prospect of a flu epidemic presented a real crisis, added Grant. NHS leaders are seriously concerned that Britain could be hit by its biggest flu outbreak in years this winter. There is acute anxiety because Australia and New Zealand have been experiencing their worst flu season for many years with struggling to cope.

NHS bosses have got tough on staff’s jab uptake as part of a new series of “intensified cross-NHS winter preparations” in a bid to reduce the estimated 8,000 annual deaths from flu in England and Wales.

They are sending out letters to healthcare workers across England urging them to get vaccinated as soon as possible, to reduce the risk of them passing on the flu virus to vulnerable patients, especially older people and those with breathing problems such as asthma, pneumonia and emphysema. It is staff’s professional duty to have the jab, they say.

The letter says: “As winter approaches it is worth reminding ourselves that flu can have serious and even fatal consequences.

“Healthcare workers, as members of the general population, are susceptible to flu. When coupled with the potential for a third of flu cases being transmitted by asymptomatic individuals, it means patients are at particular risk.”

Although a record proportion of NHS staff received the jab last year – 63% – in some trusts as few as 20% of staff took up the offer of free vaccination at work.

In another previously unused tactic, NHS England bosses are writing to all 234 NHS trusts telling them to do much more to ensure staff have the jab. “We require each NHS organisation to ensure that each and every eligible member of staff is personally offered the flu vaccine, and then either signs the consent form or states if they decline to do so,” that letter says.

Grant, speaking at the national children and adult services conference in Bournemouth, said: “We face winter better prepared than we have ever been, but more scared than we have ever been.

“We have the strong likelihood of hospitals being inundated with people suffering flu.”

The NHS is expanding its £237m winter flu campaign by offering free vaccination for the first time to over 1 million people who work in care homes, at a cost of £10m, and also to the 670,000 eight- and nine-year-old pupils in school year four. Those aged two, three and four will be offered a flu vaccination in the form of a nasal spray rather than an injection, however.

In all, 21 million people in England will be offered free immunisation on the NHS. They include pregnant women and anyone over 65 and anyone deemed at clinical risk, for example due to asthma.

“This move to help keep care workers stay well during flu season is a really positive step by the NHS. Not only will it help to protect thousands of care home residents from getting sick, but it sends a strong signal about the importance of social care staff in providing an integrated health and care service,” said Imelda Redmond, the national director of the campaign group Healthwatch England.

Last winter, 133 people died as a direct result of flu after being treated in an intensive care or high-dependency unit in England, Public Health England said.

The NHS has also responded to the widespread shortage of A&E doctors by deciding to expand the number of doctors training to become specialists in emergency medicine from 300 to 400 a year for four years from next year. Currently, about 6,300 different grades of medics work in A&E units across England.

‘Our society is broken’: what can stop Canada’s First Nations suicide epidemic?

“… And I hope that we will not have to bury one more innocent child – the future of our communities and the future of our nation.”

Sheila North Wilson, grand chief and representative of more than 75,000 indigenous people living across northern Canada, was in Ottawa last February to discuss the many issues plaguing First Nations communities. The memory of the conference speech she made there is now etched on her mind.

“Throughout the speech, my phone wouldn’t stop buzzing,” she recalls. “I didn’t think much of it.” But what she read next brought her to the floor.

“The text said my cousin Gabe had died – he had committed suicide that morning. I just went numb. Here I was giving a speech about the detrimental impact suicide had on our communities – and in the cruellest irony, my cousin had taken his life that morning.”

This was not the first time suicide had impacted Wilson’s family. “Gabe was 33, had three kids and so much life to offer. The only way I could come to terms with it was to say to myself that at least he wasn’t a teenager.” Four years ago, Wilson’s teenage nephew also killed himself.

The suicide epidemic affecting First Nations communities across Canada has been a national crisis for decades, but it attracted international headlines after three indigenous communities were moved to declare a state of emergency in response to a series of deaths.

A candlelight vigil in the Attawapiskat First Nation reserve marks a shocking series of suicide attempts.


A candlelight vigil in the Attawapiskat First Nation reserve marks a shocking series of suicide attempts. Photograph: Chris Wattie/Reuters

In the spring of 2016, Attawapiskat First Nation reserve in Ontario declared a state of emergency after 11 young people tried to commit suicide in one night – adding to the estimated 100 attempts made over 10 months among this community of 2,000 people.

Not long after, it was revealed that six people, including a 14-year-old girl, had killed themselves over a period of three months in the Pimicikamak Cree Nation community of northern Manitoba. In the aftermath, more than 150 youths in this remote community of 6,000 were put on suicide watch.

Then in June this year, another First Nations reserve in Ontario lost three 12-year-old girls who had reportedly agreed a suicide pact. This string of tragic events has seen media and government turn the spotlight on an issue too often ignored in Canada.


People call us freeloaders. They call us dirty Indians. I am judged because of my culture and heritage

Across the country, suicide and self-inflicted injury is the leading cause of death for First Nations people below the age of 44. Studies show young indigenous males are 10 times more likely to kill themselves than their non-indigenous male counterparts, while young indigenous females are 21 times more likely than young non-indigenous females.

Katrina, 16, lives on a reserve in central British Columbia with her family. She recently confided to a counsellor that she had contemplated suicide, and had even made a detailed plan on how she was going to carry it out.

“I felt like I had no other option; I felt hopeless,” Katrina recalls, adding that the stigma attached to being an aboriginal youth played a huge role in her contemplating suicide. “People call us freeloaders. They call us dirty Indians. I am judged because of my culture and heritage.”

Accounts of such prejudice are prevalent across the country. The government has been criticised for its lack of support and funding for First Nations communities, which total 1.4 million people – just under 4.3% of Canada’s population.

“We call that injustice,” says Roderick McCormick, an expert in indigenous health and suicide at Thompson Rivers University in Kamloops BC. He suggests a complex web of severe poverty plus lack of education and basic necessities underpins the rise in suicides among indigenous youths.

“In terms of educational opportunities, healthcare and child welfare, the government is doing an injustice by not adequately funding our communities,” McCormick says. “When these remote reserves compare themselves to other communities across Canada, there is a huge gap that has become really evident.”

Recent research has found more than 100 reserves still lack housing, electricity or running water – with almost 90 of them being advised to boil their drinking water. Another study by the Canadian Centre for Policy Alternatives found that 60% of children on these reserves are living in poverty.

“The communities I represent are living in abject poverty,” Wilson says. “My people are the poorest in this country, and that’s not right.”

Health and educational services on First Nations reserves are also far below the national averages. “Secondary schools on reserves are about two grades behind urban schools,” Wilson says. “So when you tell young people to go to college, they are so behind in the curriculum they get overwhelmed. Youth are expected to succeed, but it is setting them up to fail.”

A youth panel meeting to discuss suicide attempts in Attawapiskat First Nation reserve.


Canada’s minister of crown-indigenous relations Carolyn Bennett, left, and former chief Bruce Shisheesh, right, at a youth panel meeting to discuss suicide attempts in Attawapiskat First Nation reserve. Photograph: Nathan Denette/AP

Experts say all of these factors are contributing to the lack of hope indigenous youths have about their futures – and that this creates a perfect breeding ground for mental health and addiction issues.

“When I fly into these isolated communities, all I do is contain the situation,” says Hilda Green, a psychotherapist who specalises in mental health and wellbeing in indigenous communities. “I am temporarily putting out fires – but if the community does not have full-time mental health experts to help them after I leave, those fires will ignite again.”

Green, who grew up on a First Nations reserve in central British Columbia, lost both her boyfriend and her brother to suicide as young adults. She believes there needs to be a shift in how the government handles mental health issues within indigenous communities. Instead of responding to crises after they have occurred, she says, funding needs to be allocated towards prevention.

“I have a client who has been through so much trauma,” Green explains. “All five of my client’s siblings committed suicide, leaving them as the only one left in their family. Yet I am expected to help them and so many others within a few hours and with little-to-no resources. That is not right. More needs to be done to prevent this from happening.”

Horrifying stories

Many regard the suicide epidemic as a symptom of a much bigger and deeper-rooted issue: Canada’s systemic, long-standing neglect of its indigenous people. This is encapsulated in the ongoing impact of the country’s residential school system, which saw more than 150,000 indigenous children taken from their homes in an attempt to forcibly assimilate them into Canadian society.

Amber, 23, whose grandmother was a survivor of the residential school system, recalls horrifying stories her grandmother would share with her of sexual and physical abuse. “She would tell me about the teachers who would come into her room in the middle of the night and take her away and rape her. She was only nine years old.”


Our society is broken – we are failing our future generations. This is unacceptable, and it is time for change

Stacy Wormell-Street

Rife with neglect and abuse, at least 6,000 residential schoolchildren are documented to have died as a result of their school experiences. In 2008, the Canadian government finally acknowledged this system as a dark chapter in the country’s history – but the effects of the schools can still be felt among First Nations communities today.

Amber says the lack of affection and guidance her grandmother received as a child prevented her from being a good mother herself. “The only thing my grandma knew was abuse,” she says, “so that’s what she did to my mother.”

This cycle of abuse, combined with deplorable living conditions, often made Amber contemplate suicide herself. She says she first attempted suicide at the age of 12: “It’s just a reality we live with. It’s easier to end [your life] than to get help in most cases.”

Stacy Wormell-Street, director of operations at ASK Wellness Society (a non-profit helping indigenous communities struggling with addiction) agrees the impact of residential schools – the last of which closed its doors in 1996 – still permeates indigenous communities today.

“The deep-rooted trauma which Canada’s aboriginal people suffered through the assimilation of their culture by the Canadian government has been carried on through generations,” she says. “Today we continue to see a drastic and tragic rise in death by suicide within our aboriginal youth.”

According to Wormell-Street, many children are being lost into the child welfare system because mothers and fathers do not have the supports necessary to make good decisions. “Our society is broken,” she says. “We are failing our future generations – this is unacceptable and it is time for change.”

Katrina, who received help from counsellors and went through an outreach programme aimed at helping youth struggling with depression and anxiety, feels lucky to have been given another opportunity at life.

“I know so many kids who never got this kind of help – it’s sad,” she says. “I understand why [they kill themselves]. I felt ashamed of who I was. And I felt like I had nothing to live for.”

While the prime minister, Justin Trudeau, has pledged to dedicate more resources and funding to grassroots organisations and programs, Wilson says much more must be done to combat the high rates of suicide.

“We need to empower our communities to be prosperous and independent, and the only way to do that is create programmes where we all benefit from the resources,” she says. “[Our young people] need stable housing and running water before they can make the most of any opportunity afforded to them.”

McCormick agrees: “Before we can address this crisis, we need to solve the underlying issues so other communities do not go through the same things. We are putting a Band-Aid over the symptoms, and not getting to the root causes of why this is happening.”

In the meantime, for Wilson and countless families like her’s, burying loved ones who die too young is set to remain a tragic part of life among Canada’s indigenous communities.

“When I was going through the grieving process for Gabe in Ottawa,” she recalls, “an elder who was with me said this is just typical of our communities. We are always in a constant state of crisis, so we are constantly grieving … It should not come to the point where nine-year-olds are killing themselves for our voices to be heard.”

  • Some names in this article have been changed at the request of the interviewees
  • Kids Help Phone, Canada’s leading counselling service for young people, is available at any time at 1 800 668 6868. The Canadian Association for Suicide Prevention gives a list of crisis centres here
  • Follow the Guardian’s Inequality Project on Twitter here, or email us at inequality.project@theguardian.com

‘Our society is broken’: what can stop Canada’s First Nations suicide epidemic?

“… And I hope that we will not have to bury one more innocent child – the future of our communities and the future of our nation.”

Sheila North Wilson, grand chief and representative of more than 75,000 indigenous people living across northern Canada, was in Ottawa last February to discuss the many issues plaguing First Nations communities. The memory of the conference speech she made there is now etched on her mind.

“Throughout the speech, my phone wouldn’t stop buzzing,” she recalls. “I didn’t think much of it.” But what she read next brought her to the floor.

“The text said my cousin Gabe had died – he had committed suicide that morning. I just went numb. Here I was giving a speech about the detrimental impact suicide had on our communities – and in the cruellest irony, my cousin had taken his life that morning.”

This was not the first time suicide had impacted Wilson’s family. “Gabe was 33, had three kids and so much life to offer. The only way I could come to terms with it was to say to myself that at least he wasn’t a teenager.” Four years ago, Wilson’s teenage nephew also killed himself.

The suicide epidemic affecting First Nations communities across Canada has been a national crisis for decades, but it attracted international headlines after three indigenous communities were moved to declare a state of emergency in response to a series of deaths.

A candlelight vigil in the Attawapiskat First Nation reserve marks a shocking series of suicide attempts.


A candlelight vigil in the Attawapiskat First Nation reserve marks a shocking series of suicide attempts. Photograph: Chris Wattie/Reuters

In the spring of 2016, Attawapiskat First Nation reserve in Ontario declared a state of emergency after 11 young people tried to commit suicide in one night – adding to the estimated 100 attempts made over 10 months among this community of 2,000 people.

Not long after, it was revealed that six people, including a 14-year-old girl, had killed themselves over a period of three months in the Pimicikamak Cree Nation community of northern Manitoba. In the aftermath, more than 150 youths in this remote community of 6,000 were put on suicide watch.

Then in June this year, another First Nations reserve in Ontario lost three 12-year-old girls who had reportedly agreed a suicide pact. This string of tragic events has seen media and government turn the spotlight on an issue too often ignored in Canada.


People call us freeloaders. They call us dirty Indians. I am judged because of my culture and heritage

Across the country, suicide and self-inflicted injury is the leading cause of death for First Nations people below the age of 44. Studies show young indigenous males are 10 times more likely to kill themselves than their non-indigenous male counterparts, while young indigenous females are 21 times more likely than young non-indigenous females.

Katrina, 16, lives on a reserve in central British Columbia with her family. She recently confided to a counsellor that she had contemplated suicide, and had even made a detailed plan on how she was going to carry it out.

“I felt like I had no other option; I felt hopeless,” Katrina recalls, adding that the stigma attached to being an aboriginal youth played a huge role in her contemplating suicide. “People call us freeloaders. They call us dirty Indians. I am judged because of my culture and heritage.”

Accounts of such prejudice are prevalent across the country. The government has been criticised for its lack of support and funding for First Nations communities, which total 1.4 million people – just under 4.3% of Canada’s population.

“We call that injustice,” says Roderick McCormick, an expert in indigenous health and suicide at Thompson Rivers University in Kamloops BC. He suggests a complex web of severe poverty plus lack of education and basic necessities underpins the rise in suicides among indigenous youths.

“In terms of educational opportunities, healthcare and child welfare, the government is doing an injustice by not adequately funding our communities,” McCormick says. “When these remote reserves compare themselves to other communities across Canada, there is a huge gap that has become really evident.”

Recent research has found more than 100 reserves still lack housing, electricity or running water – with almost 90 of them being advised to boil their drinking water. Another study by the Canadian Centre for Policy Alternatives found that 60% of children on these reserves are living in poverty.

“The communities I represent are living in abject poverty,” Wilson says. “My people are the poorest in this country, and that’s not right.”

Health and educational services on First Nations reserves are also far below the national averages. “Secondary schools on reserves are about two grades behind urban schools,” Wilson says. “So when you tell young people to go to college, they are so behind in the curriculum they get overwhelmed. Youth are expected to succeed, but it is setting them up to fail.”

A youth panel meeting to discuss suicide attempts in Attawapiskat First Nation reserve.


Canada’s minister of crown-indigenous relations Carolyn Bennett, left, and former chief Bruce Shisheesh, right, at a youth panel meeting to discuss suicide attempts in Attawapiskat First Nation reserve. Photograph: Nathan Denette/AP

Experts say all of these factors are contributing to the lack of hope indigenous youths have about their futures – and that this creates a perfect breeding ground for mental health and addiction issues.

“When I fly into these isolated communities, all I do is contain the situation,” says Hilda Green, a psychotherapist who specalises in mental health and wellbeing in indigenous communities. “I am temporarily putting out fires – but if the community does not have full-time mental health experts to help them after I leave, those fires will ignite again.”

Green, who grew up on a First Nations reserve in central British Columbia, lost both her boyfriend and her brother to suicide as young adults. She believes there needs to be a shift in how the government handles mental health issues within indigenous communities. Instead of responding to crises after they have occurred, she says, funding needs to be allocated towards prevention.

“I have a client who has been through so much trauma,” Green explains. “All five of my client’s siblings committed suicide, leaving them as the only one left in their family. Yet I am expected to help them and so many others within a few hours and with little-to-no resources. That is not right. More needs to be done to prevent this from happening.”

Horrifying stories

Many regard the suicide epidemic as a symptom of a much bigger and deeper-rooted issue: Canada’s systemic, long-standing neglect of its indigenous people. This is encapsulated in the ongoing impact of the country’s residential school system, which saw more than 150,000 indigenous children taken from their homes in an attempt to forcibly assimilate them into Canadian society.

Amber, 23, whose grandmother was a survivor of the residential school system, recalls horrifying stories her grandmother would share with her of sexual and physical abuse. “She would tell me about the teachers who would come into her room in the middle of the night and take her away and rape her. She was only nine years old.”


Our society is broken – we are failing our future generations. This is unacceptable, and it is time for change

Stacy Wormell-Street

Rife with neglect and abuse, at least 6,000 residential schoolchildren are documented to have died as a result of their school experiences. In 2008, the Canadian government finally acknowledged this system as a dark chapter in the country’s history – but the effects of the schools can still be felt among First Nations communities today.

Amber says the lack of affection and guidance her grandmother received as a child prevented her from being a good mother herself. “The only thing my grandma knew was abuse,” she says, “so that’s what she did to my mother.”

This cycle of abuse, combined with deplorable living conditions, often made Amber contemplate suicide herself. She says she first attempted suicide at the age of 12: “It’s just a reality we live with. It’s easier to end [your life] than to get help in most cases.”

Stacy Wormell-Street, director of operations at ASK Wellness Society (a non-profit helping indigenous communities struggling with addiction) agrees the impact of residential schools – the last of which closed its doors in 1996 – still permeates indigenous communities today.

“The deep-rooted trauma which Canada’s aboriginal people suffered through the assimilation of their culture by the Canadian government has been carried on through generations,” she says. “Today we continue to see a drastic and tragic rise in death by suicide within our aboriginal youth.”

According to Wormell-Street, many children are being lost into the child welfare system because mothers and fathers do not have the supports necessary to make good decisions. “Our society is broken,” she says. “We are failing our future generations – this is unacceptable and it is time for change.”

Katrina, who received help from counsellors and went through an outreach programme aimed at helping youth struggling with depression and anxiety, feels lucky to have been given another opportunity at life.

“I know so many kids who never got this kind of help – it’s sad,” she says. “I understand why [they kill themselves]. I felt ashamed of who I was. And I felt like I had nothing to live for.”

While the prime minister, Justin Trudeau, has pledged to dedicate more resources and funding to grassroots organisations and programs, Wilson says much more must be done to combat the high rates of suicide.

“We need to empower our communities to be prosperous and independent, and the only way to do that is create programmes where we all benefit from the resources,” she says. “[Our young people] need stable housing and running water before they can make the most of any opportunity afforded to them.”

McCormick agrees: “Before we can address this crisis, we need to solve the underlying issues so other communities do not go through the same things. We are putting a Band-Aid over the symptoms, and not getting to the root causes of why this is happening.”

In the meantime, for Wilson and countless families like her’s, burying loved ones who die too young is set to remain a tragic part of life among Canada’s indigenous communities.

“When I was going through the grieving process for Gabe in Ottawa,” she recalls, “an elder who was with me said this is just typical of our communities. We are always in a constant state of crisis, so we are constantly grieving … It should not come to the point where nine-year-olds are killing themselves for our voices to be heard.”

  • Some names in this article have been changed at the request of the interviewees
  • Kids Help Phone, Canada’s leading counselling service for young people, is available at any time at 1 800 668 6868. The Canadian Association for Suicide Prevention gives a list of crisis centres here
  • Follow the Guardian’s Inequality Project on Twitter here, or email us at inequality.project@theguardian.com

‘Our society is broken’: what can stop Canada’s First Nations suicide epidemic?

“… And I hope that we will not have to bury one more innocent child – the future of our communities and the future of our nation.”

Sheila North Wilson, grand chief and representative of more than 75,000 indigenous people living across northern Canada, was in Ottawa last February to discuss the many issues plaguing First Nations communities. The memory of the conference speech she made there is now etched on her mind.

“Throughout the speech, my phone wouldn’t stop buzzing,” she recalls. “I didn’t think much of it.” But what she read next brought her to the floor.

“The text said my cousin Gabe had died – he had committed suicide that morning. I just went numb. Here I was giving a speech about the detrimental impact suicide had on our communities – and in the cruellest irony, my cousin had taken his life that morning.”

This was not the first time suicide had impacted Wilson’s family. “Gabe was 33, had three kids and so much life to offer. The only way I could come to terms with it was to say to myself that at least he wasn’t a teenager.” Four years ago, Wilson’s teenage nephew also killed himself.

The suicide epidemic affecting First Nations communities across Canada has been a national crisis for decades, but it attracted international headlines after three indigenous communities were moved to declare a state of emergency in response to a series of deaths.

A candlelight vigil in the Attawapiskat First Nation reserve marks a shocking series of suicide attempts.


A candlelight vigil in the Attawapiskat First Nation reserve marks a shocking series of suicide attempts. Photograph: Chris Wattie/Reuters

In the spring of 2016, Attawapiskat First Nation reserve in Ontario declared a state of emergency after 11 young people tried to commit suicide in one night – adding to the estimated 100 attempts made over 10 months among this community of 2,000 people.

Not long after, it was revealed that six people, including a 14-year-old girl, had killed themselves over a period of three months in the Pimicikamak Cree Nation community of northern Manitoba. In the aftermath, more than 150 youths in this remote community of 6,000 were put on suicide watch.

Then in June this year, another indigenous reservation in Ontario lost three 12-year-old girls who had reportedly agreed a suicide pact. This string of tragic events has seen media and government turn the spotlight on an issue too often ignored in Canada.


People call us freeloaders. They call us dirty Indians. I am judged because of my culture and heritage

Across the country, suicide and self-inflicted injury is the leading cause of death for First Nations people below the age of 44. Studies show young indigenous males are 10 times more likely to kill themselves than their non-indigenous male counterparts, while young indigenous females are 21 times more likely than young non-indigenous females.

Katrina, 16, lives on an indigenous reservation in central British Columbia with her family. She recently confided to a counsellor that she had contemplated suicide, and had even made a detailed plan on how she was going to carry it out.

“I felt like I had no other option; I felt hopeless,” Katrina recalls, adding that the stigma attached to being an aboriginal youth played a huge role in her contemplating suicide. “People call us freeloaders. They call us dirty Indians. I am judged because of my culture and heritage.”

Accounts of such prejudice are prevalent across the country. The government has been criticised for its lack of support and funding for First Nations communities, which total 1.4 million people – just under 4.3% of Canada’s population.

“We call that injustice,” says Roderick McCormick, an expert in indigenous health and suicide at Thompson Rivers University in Kamloops BC. He suggests a complex web of severe poverty plus lack of education and basic necessities underpins the rise in suicides among indigenous youths.

“In terms of educational opportunities, healthcare and child welfare, the government is doing an injustice by not adequately funding our communities,” McCormick says. “When these remote reservations compare themselves to other communities across Canada, there is a huge gap that has become really evident.”

Recent research has found more than 100 reservations still lack housing, electricity or running water – with almost 90 of them being advised to boil their drinking water. Another study by the Canadian Centre for Policy Alternatives found that 60% of children on these reservations are living in poverty.

“The communities I represent are living in abject poverty,” Wilson says. “My people are the poorest in this country, and that’s not right.”

Health and educational services on First Nations reservations are also far below the national averages. “Secondary schools on reservations are about two grades behind urban schools,” Wilson says. “So when you tell young people to go to college, they are so behind in the curriculum they get overwhelmed. Youth are expected to succeed, but it is setting them up to fail.”

A youth panel meeting to discuss suicide attempts in Attawapiskat First Nation reserve.


Canada’s minister of crown-indigenous relations Carolyn Bennett, left, and former chief Bruce Shisheesh, right, at a youth panel meeting to discuss suicide attempts in Attawapiskat First Nation reserve. Photograph: Nathan Denette/AP

Experts say all of these factors are contributing to the lack of hope indigenous youths have about their futures – and that this creates a perfect breeding ground for mental health and addiction issues.

“When I fly into these isolated communities, all I do is contain the situation,” says Hilda Green, a psychotherapist who specalises in mental health and wellbeing in indigenous communities. “I am temporarily putting out fires – but if the community does not have full-time mental health experts to help them after I leave, those fires will ignite again.”

Green, who grew up on a First Nations reservation in central British Columbia, lost both her boyfriend and her brother to suicide as young adults. She believes there needs to be a shift in how the government handles mental health issues within indigenous communities. Instead of responding to crises after they have occurred, she says, funding needs to be allocated towards prevention.

“I have a client who has been through so much trauma,” Green explains. “All five of my client’s siblings committed suicide, leaving them as the only one left in their family. Yet I am expected to help them and so many others within a few hours and with little-to-no resources. That is not right. More needs to be done to prevent this from happening.”

Horrifying stories

Many regard the suicide epidemic as a symptom of a much bigger and deeper-rooted issue: Canada’s systemic, long-standing neglect of its indigenous people. This is encapsulated in the ongoing impact of the country’s residential school system, which saw more than 150,000 indigenous children taken from their homes in an attempt to forcibly assimilate them into Canadian society.

Amber, 23, whose grandmother was a survivor of the residential school system, recalls horrifying stories her grandmother would share with her of sexual and physical abuse. “She would tell me about the teachers who would come into her room in the middle of the night and take her away and rape her. She was only nine years old.”


Our society is broken – we are failing our future generations. This is unacceptable, and it is time for change

Stacy Wormell-Street

Rife with neglect and abuse, at least 6,000 residential schoolchildren are documented to have died as a result of their school experiences. In 2008, the Canadian government finally acknowledged this system as a dark chapter in the country’s history – but the effects of the schools can still be felt among First Nations communities today.

Amber says the lack of affection and guidance her grandmother received as a child prevented her from being a good mother herself. “The only thing my grandma knew was abuse,” she says, “so that’s what she did to my mother.”

This cycle of abuse, combined with deplorable living conditions, often made Amber contemplate suicide herself. She says she first attempted suicide at the age of 12: “It’s just a reality we live with. It’s easier to end [your life] than to get help in most cases.”

Stacy Wormell-Street, director of operations at ASK Wellness Society (a non-profit helping indigenous communities struggling with addiction) agrees the impact of residential schools – the last of which closed its doors in 1996 – still permeates indigenous communities today.

“The deep-rooted trauma which Canada’s aboriginal people suffered through the assimilation of their culture by the Canadian government has been carried on through generations,” she says. “Today we continue to see a drastic and tragic rise in death by suicide within our aboriginal youth.”

According to Wormell-Street, many children are being lost into the child welfare system because mothers and fathers do not have the supports necessary to make good decisions. “Our society is broken,” she says. “We are failing our future generations – this is unacceptable and it is time for change.”

Katrina, who received help from counsellors and went through an outreach programme aimed at helping youth struggling with depression and anxiety, feels lucky to have been given another opportunity at life.

“I know so many kids who never got this kind of help – it’s sad,” she says. “I understand why [they kill themselves]. I felt ashamed of who I was. And I felt like I had nothing to live for.”

While the prime minister, Justin Trudeau, has pledged to dedicate more resources and funding to grassroots organisations and programs, Wilson says much more must be done to combat the high rates of suicide.

“We need to empower our communities to be prosperous and independent, and the only way to do that is create programmes where we all benefit from the resources,” she says. “[Our young people] need stable housing and running water before they can make the most of any opportunity afforded to them.”

McCormick agrees: “Before we can address this crisis, we need to solve the underlying issues so other communities do not go through the same things. We are putting a Band-Aid over the symptoms, and not getting to the root causes of why this is happening.”

In the meantime, for Wilson and countless families like her’s, burying loved ones who die too young is set to remain a tragic part of life among Canada’s indigenous communities.

“When I was going through the grieving process for Gabe in Ottawa,” she recalls, “an elder who was with me said this is just typical of our communities. We are always in a constant state of crisis, so we are constantly grieving … It should not come to the point where nine-year-olds are killing themselves for our voices to be heard.”

  • Some names in this article have been changed at the request of the interviewees
  • Kids Help Phone, Canada’s leading counselling service for young people, is available at any time at 1 800 668 6868. The Canadian Association for Suicide Prevention gives a list of crisis centres here

‘Cholera is everywhere’: Yemen epidemic spiralling out of control

Ali Muhammad’s entire family are sick. In the months since his home district of Abs in northern Yemen was hit by a cholera outbreak, he has lost both parents and all six of his children have fallen ill.

“Cholera is everywhere,” he said, according to a testimony provided by Médecins Sans Frontières, who are caring for his eldest daughter at a cholera treatment centre in Abs. “The water is contaminated and I don’t drink it. We have tanks, but we don’t get water regularly. The situation cannot be worse.”

As the area grapples with both the cholera epidemic, which began to spread in April, and the impact of the country’s civil war, the life of the qat harvester has become harder and harder. “Everybody is sick and in rough shape, and their poor financial condition does not enable them to move from one health centre to another.

“My father got sick and although we hospitalised him, he passed away. My mother died as well. And I am just like many others.”

The Abs district was the scene of a deadly airstrike by the Saudi-led coalition last August that demolished a hospital supported by MSF, killing 19 people, including one of the aid agency’s staff members, and injuring 24.

Less than a year later, as the ongoing conflict hits an stalemate, creating the largest humanitarian crisis in the world, the MSF cholera treatment centre in Abs town alone is receiving more than 460 patients daily, which is more than anywhere else in the country.

A girl drinks water from a well that is allegedly contaminated with cholera.


A girl drinks water from a well that is allegedly contaminated with cholera. Photograph: Hani Mohammed/AP

The International Committee of the Red Cross warned on Monday that the cholera epidemic in Yemen was spiralling out of control, reaching a milestone of over 300,000 suspected cases. More than 1,600 people have died. Children account for nearly half of all suspected cholera cases in the country, according to the UN’s children agency.

Sana’a-based Taha Yaseen, from the Mwatana Organisation for Human Rights, said obstacles that stand in the way of controlling and containing cholera today in Yemen, include but are not limited to the ongoing war.

“During [the war] almost all health facilities and healthcare services reached a point of thorough collapse and thus are unable to respond to the increasing need to address fatal diseases and civilian victims. Many hospitals [have] shut down and many others were hit either by air or ground strikes, occupied by militias or used as military barracks,” he told the Guardian.

“Most [people] cannot afford even the transportation from their countryside areas or displacements communities to the nearest medical centres to treat them for cholera,” he added.

MSF’s Roger Gutiérrez, who has just returned from a seven-month service in Abs, said the wards in the hospital there, the only public hospital in the area, “are bursting at the seams … what’s happening in Abs sums up the current state of Yemen.”

The district hosts more internally displaced people than anywhere else in the country but most health facilities are not functioning; there is a lack of staff and medical supplies are running short.

“When a plane flies overhead, many patients and staff feel that fear, that vulnerability. For seconds everything stops,” he said, according to a testimony provided by MSF. “You see mothers disconnecting their children’s feeding tubes so they can run out of the hospital’s nutrition ward.”

Ayed Ali, a Yemeni caretaker based in al-Sharq district of Hajjah governorate, said most people in the area drink from exposed wells and tanks, “no matter the water is clean or not”. “There are no salaries and no services,” he said, according to MSF. “Even public hospitals are down. There are no drugs. If you have money, you get treatment. Otherwise, you’ll die.”

The conflict in Yemen is between Houthi rebels controlling the capital Sana’a, who are allied with former president Ali Abdullah Saleh, who led the country from 1990 to 2012, and forces loyal to the ousted president, Abd-Rabbu Mansour Hadi. Since March 2015, Saudi Arabia has led a US-backed military intervention in Yemen, aimed at reinstating Hadi, who lives in exile in the Saudi capital, Riyadh, and countering advances of Iran-backed Houthis.

Yemen expert Adam Baron, speaking to the Guardian, said “the key thing to remember is that while combat deaths continue to get more attention, it is the indirect results of the conflict – things like the cholera outbreak, the hunger crisis and the rise of deaths from preventable disease – that remain the largest killers.”

While Houthis have taken some significant losses this year, Baron said the conflict has largely seen a continued stalemate on most key fronts. “By and large, the war in Yemen continues to flare,” he said. “Airstrikes and shelling continue as civilians continue to get caught in the crossfire. But even as the conflict proves to be the catalyst for the collapse of Yemen’s already weakened healthcare system, the country continues to get little attention. The worry is that this won’t change until it’s far too late.”

According to the World Health Organization, suspected cholera cases have been reported in 95.6% of Yemen governorates. Apart from Hajjah, the other three affected areas are Amanat al-Asimah, al-Hudaydah and Amran. Only 45% of health facilities in Yemen remain with limited functionality, the UN has said.

Drugs alone won’t cure the epidemic of depression. We need strategy | Mark Rice-Oxley

It’s become as inevitable as the rise and rise of global temperatures or the perennial high-water mark of examination grades: another year, another record number of antidepressants dispensed by doctors up and down the country. This is one of those trends that should be both celebrated and castigated in equal measure. Celebrated, because at last we found something that can help some people deal with an insidious, depleting, often ruinous clinical condition. Castigated because if antidepressants are the answer, we’re not asking the right question.

First, the good bit. Contrary to what detractors may say, antidepressants are not addictive and there is no tolerance effect. They are not like benzodiazapines or opioids – you don’t need more and more of them to obtain the same level of relief. Theoretically, you can sit quite comfortably on the same dose for ever, though it should also be noted that there is little research into long-term usage of these medicines. And while it’s true that science still doesn’t quite know how they work, it is clear that they have helped a great number of people, and certainly saved lives.

But, but, but … They are also overprescribed, the first and often only resort of the busy healthcare professional to deal with the bewildered person sitting in front of them. They don’t work for everyone. They take weeks, even months, to kick in – and the early side-effects can be awful. They should be reserved for cases of moderate to severe depression, but seem to enjoy an ever wider distribution list. And most crucially they treat symptoms, not causes, meaning that sufferers may never properly confront what has made them unwell in the first place – a vital step in order to achieve sustainable recovery.

So what are the alternatives? In my own odyssey through this valley of shadows I have mulled over three approaches.

Pals, not pills

In the dismal, early reaches of clinical depression, the sufferer wants reassurance. They may actually relish the first meetings with the GP, because they think there will be answers. There are none. Even GPs who know plenty about clinical depression have no idea how it will pan out.

The people who do are the ones who’ve been there before. Fellow travellers.


If a register could be established, GPs could prescribe hour-long buddy sessions, rather than pills, where appropriate

When children go to new schools, they are often paired up with a “buddy”, someone senior who can show them the ropes, tell them what to expect, how to play it all, the dos and don’ts. We need this for newcomers to the dark underworld of depression. We should build, perhaps in partnership with Mind or the Samaritans, a nationwide volunteer system of “buddies”, available, say, for one hour a week to coach new victims through the worst stretches, reassure them that, yes, most people recover, but that it will be very up and down.

That face to face contact, that reassurance, that human interaction would be hugely beneficial to both parties. If a functional register could be established, GPs could prescribe hour-long buddy sessions, rather than pills, where appropriate. I’d be the first to sign up.

Prevention, not cure

We make the case of prevention not cure with other illnesses: don’t smoke, you’ll get cancer. Keep fit – it will do your heart good. Eat well, don’t drink too much, wrap up warm, it’s cold outside, take your coat off, you won’t feel the benefit.

But we’re only starting to realise that the same precautions can work for mental illness. People need to know there is a serious epidemic out there, but that there are a handful of things you can do to mitigate risk: don’t try so hard, lower expectations a little, stop judging yourself, change your relationship with your thoughts. Take proper holidays, nurture your friendships, try not to worry so much about things beyond your control.

Fledgling prevention strategies have popped up in the City and in some schools, but like so much else the UK, it’s piecemeal, ad hoc, patchwork. There is no strategy, no roll-out, no universality – and there is unlikely to be a cohesive plan now that our short-termist political class is preoccupied with problems of their own making.

Back to school

I can’t help but think that this new depression epidemic is partly down to inflated expectations, to untrammelled individualism and the culture of winner takes all. The pressure to “succeed”, the urgency to validate our short lives with obvious and unambiguous “achievement”: show me a good loser and I’ll show you a loser, they say. No, how about show me a winner and I’ll show you someone on the verge of cracking up.


Show me a winner and I’ll show you someone on the verge of cracking up

Of course it starts in schools, in homes, where instead of teaching our children to be flexible easygoing people, agreeable and comfortable in their own skin, we urge them to outperform, to qualify, to succeed, intoxicated by the notion of their future glory, terrified of what “failure” might mean, ignorant that overachievement brings with it very considerable risks too. Instead, we should value effort not achievement, attitude not outcome. So why not add that as a qualitative mark to a set of exam results? Instead of expending huge effort changing them from letters to different letters to numbers. After all, psychological flexibility is the best qualification a young adult could leave school with.

Of course, mental illness takes many forms and there will always be a place for medication (declaration of interest: I have taken antidepressants for several years). But the current “system” clearly doesn’t work, the drugs are just an expensive way of treading water and the costs of properly facing our mental health crisis would bankrupt the NHS several times over. We need new approaches.

Drugs alone won’t cure the epidemic of depression. We need strategy | Mark Rice-Oxley

It’s become as inevitable as the rise and rise of global temperatures or the perennial high-water mark of examination grades: another year, another record number of antidepressants dispensed by doctors up and down the country. This is one of those trends that should be both celebrated and castigated in equal measure. Celebrated, because at last we found something that can help some people deal with an insidious, depleting, often ruinous clinical condition. Castigated because if antidepressants are the answer, we’re not asking the right question.

First, the good bit. Contrary to what detractors may say, antidepressants are not addictive and there is no tolerance effect. They are not like benzodiazapines or opioids – you don’t need more and more of them to obtain the same level of relief. Theoretically, you can sit quite comfortably on the same dose for ever, though it should also be noted that there is little research into long-term usage of these medicines. And while it’s true that science still doesn’t quite know how they work, it is clear that they have helped a great number of people, and certainly saved lives.

But, but, but … They are also overprescribed, the first and often only resort of the busy healthcare professional to deal with the bewildered person sitting in front of them. They don’t work for everyone. They take weeks, even months, to kick in – and the early side-effects can be awful. They should be reserved for cases of moderate to severe depression, but seem to enjoy an ever wider distribution list. And most crucially they treat symptoms, not causes, meaning that sufferers may never properly confront what has made them unwell in the first place – a vital step in order to achieve sustainable recovery.

So what are the alternatives? In my own odyssey through this valley of shadows I have mulled over three approaches.

Pals, not pills

In the dismal, early reaches of clinical depression, the sufferer wants reassurance. They may actually relish the first meetings with the GP, because they think there will be answers. There are none. Even GPs who know plenty about clinical depression have no idea how it will pan out.

The people who do are the ones who’ve been there before. Fellow travellers.


If a register could be established, GPs could prescribe hour-long buddy sessions, rather than pills, where appropriate

When children go to new schools, they are often paired up with a “buddy”, someone senior who can show them the ropes, tell them what to expect, how to play it all, the dos and don’ts. We need this for newcomers to the dark underworld of depression. We should build, perhaps in partnership with Mind or the Samaritans, a nationwide volunteer system of “buddies”, available, say, for one hour a week to coach new victims through the worst stretches, reassure them that, yes, most people recover, but that it will be very up and down.

That face to face contact, that reassurance, that human interaction would be hugely beneficial to both parties. If a functional register could be established, GPs could prescribe hour-long buddy sessions, rather than pills, where appropriate. I’d be the first to sign up.

Prevention, not cure

We make the case of prevention not cure with other illnesses: don’t smoke, you’ll get cancer. Keep fit – it will do your heart good. Eat well, don’t drink too much, wrap up warm, it’s cold outside, take your coat off, you won’t feel the benefit.

But we’re only starting to realise that the same precautions can work for mental illness. People need to know there is a serious epidemic out there, but that there are a handful of things you can do to mitigate risk: don’t try so hard, lower expectations a little, stop judging yourself, change your relationship with your thoughts. Take proper holidays, nurture your friendships, try not to worry so much about things beyond your control.

Fledgling prevention strategies have popped up in the City and in some schools, but like so much else the UK, it’s piecemeal, ad hoc, patchwork. There is no strategy, no roll-out, no universality – and there is unlikely to be a cohesive plan now that our short-termist political class is preoccupied with problems of their own making.

Back to school

I can’t help but think that this new depression epidemic is partly down to inflated expectations, to untrammelled individualism and the culture of winner takes all. The pressure to “succeed”, the urgency to validate our short lives with obvious and unambiguous “achievement”: show me a good loser and I’ll show you a loser, they say. No, how about show me a winner and I’ll show you someone on the verge of cracking up.


Show me a winner and I’ll show you someone on the verge of cracking up

Of course it starts in schools, in homes, where instead of teaching our children to be flexible easygoing people, agreeable and comfortable in their own skin, we urge them to outperform, to qualify, to succeed, intoxicated by the notion of their future glory, terrified of what “failure” might mean, ignorant that overachievement brings with it very considerable risks too. Instead, we should value effort not achievement, attitude not outcome. So why not add that as a qualitative mark to a set of exam results? Instead of expending huge effort changing them from letters to different letters to numbers. After all, psychological flexibility is the best qualification a young adult could leave school with.

Of course, mental illness takes many forms and there will always be a place for medication (declaration of interest: I have taken antidepressants for several years). But the current “system” clearly doesn’t work, the drugs are just an expensive way of treading water and the costs of properly facing our mental health crisis would bankrupt the NHS several times over. We need new approaches.

Obesity is a health epidemic. But doctors can’t solve it alone | Ranjana Srivastava

“Why don’t doctors do something about obesity?” This is the puzzled question from a friend that plays on my mind after a recent encounter with a patient that proves unpredictably upsetting.

The patient needs chemotherapy for her newly diagnosed cancer and is understandably terrified. We have spoken at length and now that she is more settled, I tell her I’ll do her paperwork.

“What’s your weight?” I ask, staring at my computer.

Chemotherapy prescribing is based on weight and height unless the patient is morbidly obese, in which case modifications are needed to mitigate toxicity. Accepting the temporary silence, I check the guidelines. I make a mental note that one day, I will need to talk to her about safe and gradual weight loss that will have an impact on not only cancer but also multiple health outcomes.

The silence persists, so I repeat,

“Do you know your weight?”

I turn to her and am startled to see her dissolving in tears.

“Please don’t be angry but in the 30 years of our marriage, my husband has never known my weight, and he has loved me just the way I am. I’m not afraid that he will leave, but I can’t bear to tell him how much I weigh.”

He blinks and nods. And I am mortified. Totally stumped that a mere chemotherapy prescription order, the most automatic thing I do, could unravel the very things my new patient will need to rely on to tackle cancer – love and trust and marriage. Amazed (and knowing I shouldn’t be) that amid all the pacts we make with our spouse and all the secrets we keep, one could be the reading on the bathroom scales. Feeling like I have a split second of grace, I say, “That’s really sweet, and I am sorry to have put you on the spot. But you and I can take a walk to the scales and he can stay here.”

Her grateful grasp of my extended hand says it all. Needless to add, all my good intentions about discussing her weight perish right there. Better an obese patient, I console myself, than an unhappy one.

When she leaves, I find myself musing about the ubiquitous problem of weight. Once a problem of the rich world, the epidemic now sweeps the globe and takes over countries better known for their food shortage. More than two-thirds of Australians, British and Americans have long been overweight or obese but as new data shows Latin America, Indonesia, India and China are catching up. So are Saudi Arabia, Bhutan, Mali, Algeria and Egypt and scores of other nations you wouldn’t guess. Which country has the fastest growing rate of adult obesity in the world? Burkina Faso. (The lowest is Vietnam.) Not only are we getting heavier, we are leading our children into danger even as we know that the best way of maintaining a healthy weight is to prevent excessive gain in the first place.

Obesity is associated with an expanding list of chronic health problems, disability and early mortality so it goes to reason that doctors should work harder at preventing obesity instead of just battling its consequences. But the problem is patients don’t put on weight in the doctor’s office. Unlike, say, the opioid epidemic, where our prescribing habits warrant scrutiny, we are largely powerless over the easy availability of cheap junk foods, the free soft-drink refills, intense advertising to children, increased urbanisation encroaching on open spaces and the daily changing myths about the “best” way to lose weight.

It’s sobering to note that while some governments have intervened to alter the food environment, no country has yet achieved population level success.


Overweight doctors are much less likely to discuss weight loss with patients because they feel hypocritical doing so.

The wealthy obese can (partly) mitigate their burden of disease with better drugs for cardiovascular disease but not so their counterparts in the developing world. As with other global epidemics, poorer countries are worse off. The warnings keep piling in but no one is listening. And amid all the noise, the simple message of “eat less, move more”, seems, well, too simple.

But I confess there is another reason why doctors may not want to touch the thorny matter of weight. Our patients are overweight but so are we. It has been shown that doctors judge their obese patients as awkward or unattractive but in fact, our patients are judging us too, which is hardly a surprising revelation about human nature.

Overweight doctors are much less likely to discuss weight loss with patients because they feel hypocritical doing so. Defensive patients tell doctors to heed their own advice before seeking to untangle their problems and indeed, there are doctors who have done just that. Some have been successful and have felt more confident discussing the issue with patients. Some have not been so unsuccessful but have turned the experience into a talking point with their patients.

Yes, the problem of obesity stares me, and my colleagues, in the eye. But what we also get to see up close is that weight is so deeply entwined with food, emotion and identity that it’s impossible to tackle it from a purely medical angle. We will need a multipronged approach that starts with basic health literacy and we don’t have this at present.

Another patient is a retiree who has her hair done and wears her pearls before her annual visit with me.

“And darling, was it a boy or a girl? I was so excited by that tiny bump last year.”

There was a time when such misassumptions irked me but now, I have lost count, so I am happy to use humour.

“The baby actually came out many years ago. But before he reaches high school, you and I must talk about how I lost the bump.”

You can hear a pin drop in the room.

“I guess,” she winces. “If you will still be my doctor.”

Obesity is a health epidemic. But doctors can’t solve it alone | Ranjana Srivastava

“Why don’t doctors do something about obesity?” This is the puzzled question from a friend that plays on my mind after a recent encounter with a patient that proves unpredictably upsetting.

The patient needs chemotherapy for her newly diagnosed cancer and is understandably terrified. We have spoken at length and now that she is more settled, I tell her I’ll do her paperwork.

“What’s your weight?” I ask, staring at my computer.

Chemotherapy prescribing is based on weight and height unless the patient is morbidly obese, in which case modifications are needed to mitigate toxicity. Accepting the temporary silence, I check the guidelines. I make a mental note that one day, I will need to talk to her about safe and gradual weight loss that will have an impact on not only cancer but also multiple health outcomes.

The silence persists, so I repeat,

“Do you know your weight?”

I turn to her and am startled to see her dissolving in tears.

“Please don’t be angry but in the 30 years of our marriage, my husband has never known my weight, and he has loved me just the way I am. I’m not afraid that he will leave, but I can’t bear to tell him how much I weigh.”

He blinks and nods. And I am mortified. Totally stumped that a mere chemotherapy prescription order, the most automatic thing I do, could unravel the very things my new patient will need to rely on to tackle cancer – love and trust and marriage. Amazed (and knowing I shouldn’t be) that amid all the pacts we make with our spouse and all the secrets we keep, one could be the reading on the bathroom scales. Feeling like I have a split second of grace, I say, “That’s really sweet, and I am sorry to have put you on the spot. But you and I can take a walk to the scales and he can stay here.”

Her grateful grasp of my extended hand says it all. Needless to add, all my good intentions about discussing her weight perish right there. Better an obese patient, I console myself, than an unhappy one.

When she leaves, I find myself musing about the ubiquitous problem of weight. Once a problem of the rich world, the epidemic now sweeps the globe and takes over countries better known for their food shortage. More than two-thirds of Australians, British and Americans have long been overweight or obese but as new data shows Latin America, Indonesia, India and China are catching up. So are Saudi Arabia, Bhutan, Mali, Algeria and Egypt and scores of other nations you wouldn’t guess. Which country has the fastest growing rate of adult obesity in the world? Burkina Faso. (The lowest is Vietnam.) Not only are we getting heavier, we are leading our children into danger even as we know that the best way of maintaining a healthy weight is to prevent excessive gain in the first place.

Obesity is associated with an expanding list of chronic health problems, disability and early mortality so it goes to reason that doctors should work harder at preventing obesity instead of just battling its consequences. But the problem is patients don’t put on weight in the doctor’s office. Unlike, say, the opioid epidemic, where our prescribing habits warrant scrutiny, we are largely powerless over the easy availability of cheap junk foods, the free soft-drink refills, intense advertising to children, increased urbanisation encroaching on open spaces and the daily changing myths about the “best” way to lose weight.

It’s sobering to note that while some governments have intervened to alter the food environment, no country has yet achieved population level success.


Overweight doctors are much less likely to discuss weight loss with patients because they feel hypocritical doing so.

The wealthy obese can (partly) mitigate their burden of disease with better drugs for cardiovascular disease but not so their counterparts in the developing world. As with other global epidemics, poorer countries are worse off. The warnings keep piling in but no one is listening. And amid all the noise, the simple message of “eat less, move more”, seems, well, too simple.

But I confess there is another reason why doctors may not want to touch the thorny matter of weight. Our patients are overweight but so are we. It has been shown that doctors judge their obese patients as awkward or unattractive but in fact, our patients are judging us too, which is hardly a surprising revelation about human nature.

Overweight doctors are much less likely to discuss weight loss with patients because they feel hypocritical doing so. Defensive patients tell doctors to heed their own advice before seeking to untangle their problems and indeed, there are doctors who have done just that. Some have been successful and have felt more confident discussing the issue with patients. Some have not been so unsuccessful but have turned the experience into a talking point with their patients.

Yes, the problem of obesity stares me, and my colleagues, in the eye. But what we also get to see up close is that weight is so deeply entwined with food, emotion and identity that it’s impossible to tackle it from a purely medical angle. We will need a multipronged approach that starts with basic health literacy and we don’t have this at present.

Another patient is a retiree who has her hair done and wears her pearls before her annual visit with me.

“And darling, was it a boy or a girl? I was so excited by that tiny bump last year.”

There was a time when such misassumptions irked me but now, I have lost count, so I am happy to use humour.

“The baby actually came out many years ago. But before he reaches high school, you and I must talk about how I lost the bump.”

You can hear a pin drop in the room.

“I guess,” she winces. “If you will still be my doctor.”