Tag Archives: lead

Saving the NHS means forcing us to change the way we lead our lives | Nick Cohen

If you imagine a healthy future for Britain, or any other country that has put the hunger of millennia behind it, you see a kind of dictatorship. Not a tyranny, but a society that ruthlessly restricts free choice. It is a future that views the mass of people as base creatures jerked around by desires they cannot control. Expert authority must engineer their lives from above for their own good and the common good.

That we need to change radically was shown by a mass study of the health of 300,000 people that was at once entirely shocking and wholly predictable. Newcastle University found obesity and the lack of exercise (the two go together, of course) in the middle aged mean two-thirds will have more than one chronic illness when they reach 65. These bleakly titled “multiple morbidities” will afflict them simultaneously. (For in the future, illnesses will not come as single spies but in battalions.) Most are the natural consequence of our high calorie/low exercise world: arthritis, cancer, diabetes, dementia and strokes.

Here’s my partial sketch of how Britain would have to change to limit the costs to the NHS that stunted lives and avoidable pain will bring. Pedestrians and cyclists would have priority on the roads. If the roads are too narrow to take cars, cycle lanes and a pavement wide enough to allow pedestrians to walk or run in comfort, then cars will have to go. School runs will become history as heads refuse to admit any able-bodied child who arrives at school in a car.

It will not necessarily be illegal to drive in towns and cities, just pointless. Motorists would inch along because cycle and bus lanes would take up road space and pelican crossings would be reset so pedestrians never had to wait more than a minute to cross a road. Even when they reached their destinations, drivers would search forever for a space because car parks would have been demolished and replaced with public parks.

No fast-food outlet would be allowed within a one-mile radius of a school. Agricultural subsidies for fat and sugar would be abolished. Rapeseed oil and sugar beet cultivation would stop as new subsidies for public transport began. Meanwhile, the manufacturers of processed food high in sugar, salt and fat would face advertising bans and punitive taxes. (If food manufacturers want to dump prematurely sick patients on the NHS, we will say, they can damn well pay for the privilege.)

Water fountains would everywhere provide an alternative to drowning in the calories of fizzy drinks. Wardens would patrol parks, so the elderly would not fear walking in them and the young fear playing in them.

It may seem a less practical measure but I would hope to see a vigorous challenge to the paradox of our culture’s celebration of thinness and athleticism in an overweight world. The idealisation of film stars and athletes raises impossible expectations. Because 99% of people do not have the genes – or the time and money for training – to even think of imitating them, we simply don’t try. A small blow could be struck if UK Sport were forced to stop sponsoring elite Olympic athletes and spend its millions on sports facilities for all instead.

The above may sound utopian or dystopian, according to your point of view, but more radical ideas are circulating. In 2006, Tim Lang and Geof Rayner from the Food Policy Centre said the vast forces in the modern economy delivering calories on a scale humans did not evolve to digest required an equally sweeping response. Everything from our attitude to nature, our bodies and food production needed to change. The Brazilian nutritionist Carlos Monteiro coined the concept of “ultra-processed” food: ready-to-eat or ready-to-heat dishes, snacks and drinks that are energy-dense, depleted of nutrients, fatty, sugary or salty.

Included among them I must warn you were not only Big Macs, but the middle-class wares of Marks & Spencer and Waitrose. As for the notion of living in an “obesogenic environment”, which combines the cheap calories of fast food with the inertia office work and the car brings, it was first described and denounced in the mid-1990s.

One day all this could be a thing of the past.


One day all this could be a thing of the past. Photograph: Martin Godwin for the Guardian

Ever since, nutritionists have hoped for a moment of public enlightenment. They consoled themselves with the thought that it took decades for the link between smoking and lung cancer to turn from a medical fact into an effective public health campaign. But the years have passed and in Britain little has been done. Councils have built the odd cycle lane and a modest sugar tax is due in April. The real work, however, has yet to begin.

I can feel the force of the objections. When we imagine a healthier future we are also imagining a more authoritarian state. Individual choice will be constrained and wisdom of the crowd rejected. Women will wonder who will chop the vegetables and cook the dinners when ultra-processed food is taxed to the point of extinction.

Beyond gender lies an undoubted class element in public health campaigns. Sugar and fat addiction, like all addictions, provide a temporary respite for the poor, the depressed and the disappointed. Perhaps we should offer them better lives rather than snatch away the few comforts they enjoy. This sounds a stirring counter-argument. But as any reader who has been an addict will know, addiction prevents you finding a better life. For when you suffer the multiple morbidities of diabetes, arthritis, cancer and strokes, your sicknesses are your life. You do not have the freedom to choose to change it.

God knows, there are good reasons to mistrust experts re-engineering societies from above. But as with tobacco, freedom of choice in the food and car markets has left us with no choice but to trust them.

Saving the NHS means forcing us to change the way we lead our lives | Nick Cohen

If you imagine a healthy future for Britain, or any other country that has put the hunger of millennia behind it, you see a kind of dictatorship. Not a tyranny, but a society that ruthlessly restricts free choice. It is a future that views the mass of people as base creatures jerked around by desires they cannot control. Expert authority must engineer their lives from above for their own good and the common good.

That we need to change radically was shown by a mass study of the health of 300,000 people that was at once entirely shocking and wholly predictable. Newcastle University found obesity and the lack of exercise (the two go together, of course) in the middle aged mean two-thirds will have more than one chronic illness when they reach 65. These bleakly titled “multiple morbidities” will afflict them simultaneously. (For in the future, illnesses will not come as single spies but in battalions.) Most are the natural consequence of our high calorie/low exercise world: arthritis, cancer, diabetes, dementia and strokes.

Here’s my partial sketch of how Britain would have to change to limit the costs to the NHS that stunted lives and avoidable pain will bring. Pedestrians and cyclists would have priority on the roads. If the roads are too narrow to take cars, cycle lanes and a pavement wide enough to allow pedestrians to walk or run in comfort, then cars will have to go. School runs will become history as heads refuse to admit any able-bodied child who arrives at school in a car.

It will not necessarily be illegal to drive in towns and cities, just pointless. Motorists would inch along because cycle and bus lanes would take up road space and pelican crossings would be reset so pedestrians never had to wait more than a minute to cross a road. Even when they reached their destinations, drivers would search forever for a space because car parks would have been demolished and replaced with public parks.

No fast-food outlet would be allowed within a one-mile radius of a school. Agricultural subsidies for fat and sugar would be abolished. Rapeseed oil and sugar beet cultivation would stop as new subsidies for public transport began. Meanwhile, the manufacturers of processed food high in sugar, salt and fat would face advertising bans and punitive taxes. (If food manufacturers want to dump prematurely sick patients on the NHS, we will say, they can damn well pay for the privilege.)

Water fountains would everywhere provide an alternative to drowning in the calories of fizzy drinks. Wardens would patrol parks, so the elderly would not fear walking in them and the young fear playing in them.

It may seem a less practical measure but I would hope to see a vigorous challenge to the paradox of our culture’s celebration of thinness and athleticism in an overweight world. The idealisation of film stars and athletes raises impossible expectations. Because 99% of people do not have the genes – or the time and money for training – to even think of imitating them, we simply don’t try. A small blow could be struck if UK Sport were forced to stop sponsoring elite Olympic athletes and spend its millions on sports facilities for all instead.

The above may sound utopian or dystopian, according to your point of view, but more radical ideas are circulating. In 2006, Tim Lang and Geof Rayner from the Food Policy Centre said the vast forces in the modern economy delivering calories on a scale humans did not evolve to digest required an equally sweeping response. Everything from our attitude to nature, our bodies and food production needed to change. The Brazilian nutritionist Carlos Monteiro coined the concept of “ultra-processed” food: ready-to-eat or ready-to-heat dishes, snacks and drinks that are energy-dense, depleted of nutrients, fatty, sugary or salty.

Included among them I must warn you were not only Big Macs, but the middle-class wares of Marks & Spencer and Waitrose. As for the notion of living in an “obesogenic environment”, which combines the cheap calories of fast food with the inertia office work and the car brings, it was first described and denounced in the mid-1990s.

One day all this could be a thing of the past.


One day all this could be a thing of the past. Photograph: Martin Godwin for the Guardian

Ever since, nutritionists have hoped for a moment of public enlightenment. They consoled themselves with the thought that it took decades for the link between smoking and lung cancer to turn from a medical fact into an effective public health campaign. But the years have passed and in Britain little has been done. Councils have built the odd cycle lane and a modest sugar tax is due in April. The real work, however, has yet to begin.

I can feel the force of the objections. When we imagine a healthier future we are also imagining a more authoritarian state. Individual choice will be constrained and wisdom of the crowd rejected. Women will wonder who will chop the vegetables and cook the dinners when ultra-processed food is taxed to the point of extinction.

Beyond gender lies an undoubted class element in public health campaigns. Sugar and fat addiction, like all addictions, provide a temporary respite for the poor, the depressed and the disappointed. Perhaps we should offer them better lives rather than snatch away the few comforts they enjoy. This sounds a stirring counter-argument. But as any reader who has been an addict will know, addiction prevents you finding a better life. For when you suffer the multiple morbidities of diabetes, arthritis, cancer and strokes, your sicknesses are your life. You do not have the freedom to choose to change it.

God knows, there are good reasons to mistrust experts re-engineering societies from above. But as with tobacco, freedom of choice in the food and car markets has left us with no choice but to trust them.

Saving the NHS means forcing us to change the way we lead our lives | Nick Cohen

If you imagine a healthy future for Britain, or any other country that has put the hunger of millennia behind it, you see a kind of dictatorship. Not a tyranny, but a society that ruthlessly restricts free choice. It is a future that views the mass of people as base creatures jerked around by desires they cannot control. Expert authority must engineer their lives from above for their own good and the common good.

That we need to change radically was shown by a mass study of the health of 300,000 people that was at once entirely shocking and wholly predictable. Newcastle University found obesity and the lack of exercise (the two go together, of course) in the middle aged mean two-thirds will have more than one chronic illness when they reach 65. These bleakly titled “multiple morbidities” will afflict them simultaneously. (For in the future, illnesses will not come as single spies but in battalions.) Most are the natural consequence of our high calorie/low exercise world: arthritis, cancer, diabetes, dementia and strokes.

Here’s my partial sketch of how Britain would have to change to limit the costs to the NHS that stunted lives and avoidable pain will bring. Pedestrians and cyclists would have priority on the roads. If the roads are too narrow to take cars, cycle lanes and a pavement wide enough to allow pedestrians to walk or run in comfort, then cars will have to go. School runs will become history as heads refuse to admit any able-bodied child who arrives at school in a car.

It will not necessarily be illegal to drive in towns and cities, just pointless. Motorists would inch along because cycle and bus lanes would take up road space and pelican crossings would be reset so pedestrians never had to wait more than a minute to cross a road. Even when they reached their destinations, drivers would search forever for a space because car parks would have been demolished and replaced with public parks.

No fast-food outlet would be allowed within a one-mile radius of a school. Agricultural subsidies for fat and sugar would be abolished. Rapeseed oil and sugar beet cultivation would stop as new subsidies for public transport began. Meanwhile, the manufacturers of processed food high in sugar, salt and fat would face advertising bans and punitive taxes. (If food manufacturers want to dump prematurely sick patients on the NHS, we will say, they can damn well pay for the privilege.)

Water fountains would everywhere provide an alternative to drowning in the calories of fizzy drinks. Wardens would patrol parks, so the elderly would not fear walking in them and the young fear playing in them.

It may seem a less practical measure but I would hope to see a vigorous challenge to the paradox of our culture’s celebration of thinness and athleticism in an overweight world. The idealisation of film stars and athletes raises impossible expectations. Because 99% of people do not have the genes – or the time and money for training – to even think of imitating them, we simply don’t try. A small blow could be struck if UK Sport were forced to stop sponsoring elite Olympic athletes and spend its millions on sports facilities for all instead.

The above may sound utopian or dystopian, according to your point of view, but more radical ideas are circulating. In 2006, Tim Lang and Geof Rayner from the Food Policy Centre said the vast forces in the modern economy delivering calories on a scale humans did not evolve to digest required an equally sweeping response. Everything from our attitude to nature, our bodies and food production needed to change. The Brazilian nutritionist Carlos Monteiro coined the concept of “ultra-processed” food: ready-to-eat or ready-to-heat dishes, snacks and drinks that are energy-dense, depleted of nutrients, fatty, sugary or salty.

Included among them I must warn you were not only Big Macs, but the middle-class wares of Marks & Spencer and Waitrose. As for the notion of living in an “obesogenic environment”, which combines the cheap calories of fast food with the inertia office work and the car brings, it was first described and denounced in the mid-1990s.

One day all this could be a thing of the past.


One day all this could be a thing of the past. Photograph: Martin Godwin for the Guardian

Ever since, nutritionists have hoped for a moment of public enlightenment. They consoled themselves with the thought that it took decades for the link between smoking and lung cancer to turn from a medical fact into an effective public health campaign. But the years have passed and in Britain little has been done. Councils have built the odd cycle lane and a modest sugar tax is due in April. The real work, however, has yet to begin.

I can feel the force of the objections. When we imagine a healthier future we are also imagining a more authoritarian state. Individual choice will be constrained and wisdom of the crowd rejected. Women will wonder who will chop the vegetables and cook the dinners when ultra-processed food is taxed to the point of extinction.

Beyond gender lies an undoubted class element in public health campaigns. Sugar and fat addiction, like all addictions, provide a temporary respite for the poor, the depressed and the disappointed. Perhaps we should offer them better lives rather than snatch away the few comforts they enjoy. This sounds a stirring counter-argument. But as any reader who has been an addict will know, addiction prevents you finding a better life. For when you suffer the multiple morbidities of diabetes, arthritis, cancer and strokes, your sicknesses are your life. You do not have the freedom to choose to change it.

God knows, there are good reasons to mistrust experts re-engineering societies from above. But as with tobacco, freedom of choice in the food and car markets has left us with no choice but to trust them.

Saving the NHS means forcing us to change the way we lead our lives | Nick Cohen

If you imagine a healthy future for Britain, or any other country that has put the hunger of millennia behind it, you see a kind of dictatorship. Not a tyranny, but a society that ruthlessly restricts free choice. It is a future that views the mass of people as base creatures jerked around by desires they cannot control. Expert authority must engineer their lives from above for their own good and the common good.

That we need to change radically was shown by a mass study of the health of 300,000 people that was at once entirely shocking and wholly predictable. Newcastle University found obesity and the lack of exercise (the two go together, of course) in the middle aged mean two-thirds will have more than one chronic illness when they reach 65. These bleakly titled “multiple morbidities” will afflict them simultaneously. (For in the future, illnesses will not come as single spies but in battalions.) Most are the natural consequence of our high calorie/low exercise world: arthritis, cancer, diabetes, dementia and strokes.

Here’s my partial sketch of how Britain would have to change to limit the costs to the NHS that stunted lives and avoidable pain will bring. Pedestrians and cyclists would have priority on the roads. If the roads are too narrow to take cars, cycle lanes and a pavement wide enough to allow pedestrians to walk or run in comfort, then cars will have to go. School runs will become history as heads refuse to admit any able-bodied child who arrives at school in a car.

It will not necessarily be illegal to drive in towns and cities, just pointless. Motorists would inch along because cycle and bus lanes would take up road space and pelican crossings would be reset so pedestrians never had to wait more than a minute to cross a road. Even when they reached their destinations, drivers would search forever for a space because car parks would have been demolished and replaced with public parks.

No fast-food outlet would be allowed within a one-mile radius of a school. Agricultural subsidies for fat and sugar would be abolished. Rapeseed oil and sugar beet cultivation would stop as new subsidies for public transport began. Meanwhile, the manufacturers of processed food high in sugar, salt and fat would face advertising bans and punitive taxes. (If food manufacturers want to dump prematurely sick patients on the NHS, we will say, they can damn well pay for the privilege.)

Water fountains would everywhere provide an alternative to drowning in the calories of fizzy drinks. Wardens would patrol parks, so the elderly would not fear walking in them and the young fear playing in them.

It may seem a less practical measure but I would hope to see a vigorous challenge to the paradox of our culture’s celebration of thinness and athleticism in an overweight world. The idealisation of film stars and athletes raises impossible expectations. Because 99% of people do not have the genes – or the time and money for training – to even think of imitating them, we simply don’t try. A small blow could be struck if UK Sport were forced to stop sponsoring elite Olympic athletes and spend its millions on sports facilities for all instead.

The above may sound utopian or dystopian, according to your point of view, but more radical ideas are circulating. In 2006, Tim Lang and Geof Rayner from the Food Policy Centre said the vast forces in the modern economy delivering calories on a scale humans did not evolve to digest required an equally sweeping response. Everything from our attitude to nature, our bodies and food production needed to change. The Brazilian nutritionist Carlos Monteiro coined the concept of “ultra-processed” food: ready-to-eat or ready-to-heat dishes, snacks and drinks that are energy-dense, depleted of nutrients, fatty, sugary or salty.

Included among them I must warn you were not only Big Macs, but the middle-class wares of Marks & Spencer and Waitrose. As for the notion of living in an “obesogenic environment”, which combines the cheap calories of fast food with the inertia office work and the car brings, it was first described and denounced in the mid-1990s.

One day all this could be a thing of the past.


One day all this could be a thing of the past. Photograph: Martin Godwin for the Guardian

Ever since, nutritionists have hoped for a moment of public enlightenment. They consoled themselves with the thought that it took decades for the link between smoking and lung cancer to turn from a medical fact into an effective public health campaign. But the years have passed and in Britain little has been done. Councils have built the odd cycle lane and a modest sugar tax is due in April. The real work, however, has yet to begin.

I can feel the force of the objections. When we imagine a healthier future we are also imagining a more authoritarian state. Individual choice will be constrained and wisdom of the crowd rejected. Women will wonder who will chop the vegetables and cook the dinners when ultra-processed food is taxed to the point of extinction.

Beyond gender lies an undoubted class element in public health campaigns. Sugar and fat addiction, like all addictions, provide a temporary respite for the poor, the depressed and the disappointed. Perhaps we should offer them better lives rather than snatch away the few comforts they enjoy. This sounds a stirring counter-argument. But as any reader who has been an addict will know, addiction prevents you finding a better life. For when you suffer the multiple morbidities of diabetes, arthritis, cancer and strokes, your sicknesses are your life. You do not have the freedom to choose to change it.

God knows, there are good reasons to mistrust experts re-engineering societies from above. But as with tobacco, freedom of choice in the food and car markets has left us with no choice but to trust them.

One cigarette ‘may lead to habit for more than two-thirds of people’

More than two-thirds of people who try just one cigarette may go on to become regular smokers, new research suggests.

Researchers found that just over 60% of adults said they had tried a cigarette at some point in their lives, with almost 69% of those noting that they had, at least for a period, gone on to smoke cigarettes daily.

“[This shows] prevention, providing [fewer] opportunities or reasons for young people to try a cigarette, is a good idea,” said Peter Hajek, co-author of the research, from Queen Mary University of London.

The research, published in the journal Nicotine and Tobacco Research, is based on data pooled from eight surveys conducted since the year 2000, including three each from the UK and USA, and a further two studies from Australia and New Zealand.

Together, the surveys included more than 216,000 respondents, with between 50% and 82% saying that, after trying a cigarette, they had gone on to smoke on a daily basis – at least temporarily. Further analysis showed that, taken together, an estimated 68.9% of individuals smoked daily for a period after trying a cigarette.

The team also looked at whether the results were likely to be skewed by smokers being less likely to respond in surveys than non-smokers, but no strong effect was found. However, the authors note that the study also has other limitations, including that the findings are based on respondents self-reporting information, meaning the resulting figures are only an estimate.

“It is possible that somebody who is a lifetime non-smoker did try a cigarette when they were a kid but it didn’t make any impression on them, and they forgot it or don’t see that it is important enough to report,” said Hajek. But, he added, “I think even if you assume there is a recall issue and other things, you are talking about more than a 50% [conversion rate from trying a cigarette to daily smoking].”

Decline in British smoking since 1974

Hajek added that declining rates of smoking among younger people suggested that measures such as restrictions on sales and a shift away from portraying it as glamorous were having a positive effect. But, he noted, the influence of e-cigarettes should also be explored, since the decline in smoking rates in England has accelerated since the devices came onto the market.

Linda Bauld, professor of health policy at the University of Stirling, said the study highlighted the importance of preventing smoking in the first place.

“Tobacco use starts in childhood for two-thirds of smokers in the UK, and this study suggests that even trying a cigarette becomes regular use in most cases,” she said.

“Fortunately, in the UK, youth smoking rates continue to decline – but we shouldn’t be complacent,” she added, noting that according to recent figures every year approximately 200,000 children in the UK try cigarettes for the first time. According to recent reports, there were almost one billion smokers worldwide in 2015, with numbers expected to rise – despite a drop in prevalence – as the global population grows.

Global smoking prevalence

Bauld also agreed that the role of e-cigarettes merited further study, pointing out that while it had been assumed that experimentation with e-cigarettes would also lead to regular use, that does not appear to be the case. “

While rates of e-cigarette experimentation amongst young people have risen in recent years, rates of regular use in teenagers who have never smoked remain at well below 1%, she said. “We need to be clear about this distinction and keep our focus on doing everything we can to prevent smoking, which we know is deadly, rather than demonising vaping, which all the evidence suggests is a hugely less harmful behaviour.”

One cigarette ‘may lead to habit for more than two-thirds of people’

More than two-thirds of people who try just one cigarette may go on to become regular smokers, new research suggests.

Researchers found that just over 60% of adults said they had tried a cigarette at some point in their lives, with almost 69% of those noting that they had, at least for a period, gone on to smoke cigarettes daily.

“[This shows] prevention, providing [fewer] opportunities or reasons for young people to try a cigarette, is a good idea,” said Peter Hajek, co-author of the research, from Queen Mary University of London.

The research, published in the journal Nicotine and Tobacco Research, is based on data pooled from eight surveys conducted since the year 2000, including three each from the UK and USA, and a further two studies from Australia and New Zealand.

Together, the surveys included more than 216,000 respondents, with between 50% and 82% saying that, after trying a cigarette, they had gone on to smoke on a daily basis – at least temporarily. Further analysis showed that, taken together, an estimated 68.9% of individuals smoked daily for a period after trying a cigarette.

The team also looked at whether the results were likely to be skewed by smokers being less likely to respond in surveys than non-smokers, but no strong effect was found. However, the authors note that the study also has other limitations, including that the findings are based on respondents self-reporting information, meaning the resulting figures are only an estimate.

“It is possible that somebody who is a lifetime non-smoker did try a cigarette when they were a kid but it didn’t make any impression on them, and they forgot it or don’t see that it is important enough to report,” said Hajek. But, he added, “I think even if you assume there is a recall issue and other things, you are talking about more than a 50% [conversion rate from trying a cigarette to daily smoking].”

Decline in British smoking since 1974

Hajek added that declining rates of smoking among younger people suggested that measures such as restrictions on sales and a shift away from portraying it as glamorous were having a positive effect. But, he noted, the influence of e-cigarettes should also be explored, since the decline in smoking rates in England has accelerated since the devices came onto the market.

Linda Bauld, professor of health policy at the University of Stirling, said the study highlighted the importance of preventing smoking in the first place.

“Tobacco use starts in childhood for two-thirds of smokers in the UK, and this study suggests that even trying a cigarette becomes regular use in most cases,” she said.

“Fortunately, in the UK, youth smoking rates continue to decline – but we shouldn’t be complacent,” she added, noting that according to recent figures every year approximately 200,000 children in the UK try cigarettes for the first time. According to recent reports, there were almost one billion smokers worldwide in 2015, with numbers expected to rise – despite a drop in prevalence – as the global population grows.

Global smoking prevalence

Bauld also agreed that the role of e-cigarettes merited further study, pointing out that while it had been assumed that experimentation with e-cigarettes would also lead to regular use, that does not appear to be the case. “

While rates of e-cigarette experimentation amongst young people have risen in recent years, rates of regular use in teenagers who have never smoked remain at well below 1%, she said. “We need to be clear about this distinction and keep our focus on doing everything we can to prevent smoking, which we know is deadly, rather than demonising vaping, which all the evidence suggests is a hugely less harmful behaviour.”

One cigarette ‘may lead to habit for more than two-thirds of people’

More than two-thirds of people who try just one cigarette may go on to become regular smokers, new research suggests.

Researchers found that just over 60% of adults said they had tried a cigarette at some point in their lives, with almost 69% of those noting that they had, at least for a period, gone on to smoke cigarettes daily.

“[This shows] prevention, providing [fewer] opportunities or reasons for young people to try a cigarette, is a good idea,” said Peter Hajek, co-author of the research, from Queen Mary University of London.

The research, published in the journal Nicotine and Tobacco Research, is based on data pooled from eight surveys conducted since the year 2000, including three each from the UK and USA, and a further two studies from Australia and New Zealand.

Together, the surveys included more than 216,000 respondents, with between 50% and 82% saying that, after trying a cigarette, they had gone on to smoke on a daily basis – at least temporarily. Further analysis showed that, taken together, an estimated 68.9% of individuals smoked daily for a period after trying a cigarette.

The team also looked at whether the results were likely to be skewed by smokers being less likely to respond in surveys than non-smokers, but no strong effect was found. However, the authors note that the study also has other limitations, including that the findings are based on respondents self-reporting information, meaning the resulting figures are only an estimate.

“It is possible that somebody who is a lifetime non-smoker did try a cigarette when they were a kid but it didn’t make any impression on them, and they forgot it or don’t see that it is important enough to report,” said Hajek. But, he added, “I think even if you assume there is a recall issue and other things, you are talking about more than a 50% [conversion rate from trying a cigarette to daily smoking].”

Decline in British smoking since 1974

Hajek added that declining rates of smoking among younger people suggested that measures such as restrictions on sales and a shift away from portraying it as glamorous were having a positive effect. But, he noted, the influence of e-cigarettes should also be explored, since the decline in smoking rates in England has accelerated since the devices came onto the market.

Linda Bauld, professor of health policy at the University of Stirling, said the study highlighted the importance of preventing smoking in the first place.

“Tobacco use starts in childhood for two-thirds of smokers in the UK, and this study suggests that even trying a cigarette becomes regular use in most cases,” she said.

“Fortunately, in the UK, youth smoking rates continue to decline – but we shouldn’t be complacent,” she added, noting that according to recent figures every year approximately 200,000 children in the UK try cigarettes for the first time. According to recent reports, there were almost one billion smokers worldwide in 2015, with numbers expected to rise – despite a drop in prevalence – as the global population grows.

Global smoking prevalence

Bauld also agreed that the role of e-cigarettes merited further study, pointing out that while it had been assumed that experimentation with e-cigarettes would also lead to regular use, that does not appear to be the case. “

While rates of e-cigarette experimentation amongst young people have risen in recent years, rates of regular use in teenagers who have never smoked remain at well below 1%, she said. “We need to be clear about this distinction and keep our focus on doing everything we can to prevent smoking, which we know is deadly, rather than demonising vaping, which all the evidence suggests is a hugely less harmful behaviour.”

The world’s most toxic town: the terrible legacy of Zambia’s lead mines

“I’d like to be a doctor,” says seven-year-old Martin, sitting quietly in his modest home in Kabwe, Zambia. But the truth is that Martin struggles with his schoolwork, and his dream seems unlikely to become a reality.

Kabwe is the world’s most toxic town, according to pollution experts, where mass lead poisoning has almost certainly damaged the brains and other organs of generations of children – and where children continue to be poisoned every day.

Almost a century of lead mining and smelting has left a truly toxic legacy in the once-thriving town of 220,000 people in central Africa’s Copperbelt, 100km north of the capital Lusaka. But the real impact on Kabwe’s people is yet to be fully revealed and, while the first steps towards a clean-up have begun, new dangers are emerging as desperately poor people scavenge in the vast slag heap known as Black Mountain.

“Having been to probably 20 toxic hotspots throughout the world, and seeing mercury, chromium and many contaminated lead sites, [I can say] the scale in Kabwe is unprecedented,” says Prof Jack Caravanos, an environmental health expert at New York University, on his fourth visit to the town. “There are thousands of people affected here, not hundreds as in other places.”

The fumes from the giant state-owned smelter, which closed in 1994, has left the dusty soil in the surrounding area with extreme levels of lead. The metal, still used around the world in car batteries, is a potent neurotoxin and is particularly damaging to children. But it is youngsters who swallow the most, especially as infants when they start to play outside and frequently put their hands in their mouths.

Martin Cilufya and his brother Gift Chilufya in Kabwe


Martin (left) and his brother Gift live in former miner’s housing, next to the giant spoil heaps of the Kabwe mine and smelter. Photograph: Larry C Price for the Guardian

It was at that age that Martin’s mother, Annie Kabwe, first noticed her children getting stomach pains and fevers, and losing weight. “I thought it might be HIV, but the tests were negative,” she says. Then blood tests revealed very high levels of lead.

“I thought they would die,” Kabwe says. After learning about the toxicity of the dust in her neighbourhood and reducing her children’s lead exposure, through frequent washing of hands and clothes, the worst has not happened. “The problem is they are not really learning well in school, so the lead is still affecting them,” she says.

Caravanos says lead poisoning stays with you for the rest of your life – it can’t be reversed. Having seen the extreme lead levels measured in children in several townships, he says severe and widespread health impacts are highly likely, including brain damage, palsy and ultimately fatalities. “I am concerned kids are dying here,” he says.

Barry Mulimba, who as a volunteer community facilitator has seen many affected children, says: “I feel very, very sad, especially for the children, because we consider the children our future leaders and if they do not get a good education, they will not be capable.”

The slow, insidious nature of lead poisoning means careful epidemiological work is needed to distinguish its effects from other causes and reveal the true extent of the crisis. But that work has barely begun. “It is shocking to think that we are here in 2017 and that problem we have known about for decades is still here,” says Caravanos.

Lead poisoning remains a highly sensitive issue in Kabwe and people from several organisations refused to speak to the Guardian, while those trying to tackle the problem complain that data gathered by officials is not made public.

Children playing with bottle tops in the dust in Chowa township in Kabwe


Children playing with bottle tops in the dust in Chowa township in Kabwe. The dust is highly contaminated with lead, which is extremely toxic. Photograph: Larry C Price for the Guardian

One local source reports that there are children with brain damage, paralysis and blindness – all classic symptoms of lead poisoning – who have not been tested for lead, and that some children with disabilities are hidden away by families fearing stigma. A second source says that the children in Chowa, the township that once housed the mines and smelter workers, are markedly different from those in less polluted townships: “I do notice a slowness in them and they take much longer to catch on to ideas.”

What is clear in Kabwe is the extreme levels of contamination. A large World Bank project that ended in 2011 revealed the problem, though it achieved little in remediating the pollution. In affected townships, the lead in soils is about 10 times the US safety limit and far higher in hotspots.

One such hotspot turns out to be the dusty yard of the only medical clinic in Chowa, which serves 14,000 people. Caravanos uses a handheld detector to reveal extreme lead levels in the sun-baked mud, frequently over 10,000 parts per million (ppm), far above the 400ppm limit in the US. The clinic’s head declined to be interviewed by the Guardian.

The blood levels of lead in children in Kabwe are also known to be very high – a recent study revealed that every one of 246 children tested were above the safety limit of 5 micrograms per decilitre of blood. The vast majority were over 45 micrograms per decilitre, which causes brain, liver and hearing damage, and eight were over 150 micrograms per decilitre, at which point death is the likely outcome.

However, in 2015, 113 years after the smelter first opened, NGOs began to clean up the first homes, funded by Germany’s Terrre des Hommes and delivered by Environment Africa and Pure Earth, using workers from the community. More than 120 homes have had the soil in their yards replaced with clean soil from elsewhere.

“It is a drop in the ocean, but we are happy that we have targeted the most polluted homes first,” says Namo Chuma, Environment Africa’s director in Zambia. But Chuma believes that official recognition of the problem is at least finally starting to be seen: “The government does now acknowledge there is a problem.”

Women and children crush rocks to sell as gravel in Kabwe, Zambia


Women and children crush rocks to sell as gravel among the highly contaminated spoil heaps of the former mine. Photograph: Larry C Price for the Guardian

Paul Mukuka, director of public health at Kabwe Municipal Council, says: “The government, like any other government, is concerned for the health of its people.” He says there is a now a fund of 16m kwacha (about $ 1.7m) that will be spent on cleaning up Kabwe’s toxic pollution, providing the drug therapies that have been absent so far and repairing the clogged canal that is supposed to channel away the run-off from the mine site.

Wilford Chipeta, whose grandson has been poisoned, remains to be convinced: “We were promised that drugs were coming [before], but nothing came. They always talk but we get nothing.”

Mukuka was confronted by the lead crisis personally when he arrived in Kabwe a year ago looking for a clean neighbourhood for his family: “I have three beautiful girls at home – where are they going to be playing?” He says the new plan also promises new livelihoods, to draw people away from scavenging among the mine’s dumps.

On Black Mountain, bare-foot and ragged-clothed men dig out lead from the huge slag heap, often in long, unsupported tunnels, dug with hand tools and lit only by candles.

“When you don’t make them properly, you find they just bury someone,” says Provost Musonda, a young father of three, and people have died in the scarred hellscape of Black Mountain. He earns about 80 kwacha ($ 8.50) a day, unless his chest pains prevent him working. “If I could get another job, I would go there. But there is no way of sustaining our lives otherwise.”

Caravanos uses a portable detector to measure the lead levels on Black Mountain: they are sky high at 30,000-60,000 ppm. “Kids playing here is really unbelievable,” he says, noting the youngsters nearby.

black mountain slag heap Kabwe


Illegal miners scavenge for lead on Black Mountain, a huge slag heap, exposing themselves to extreme levels of lead. Photograph: Larry C Price for the Guardian

In another part of the mine waste dump, beyond a long breeze block wall emblazoned with large signs reading “Danger keep away!”, people sit in the dust breaking stones to sell as building materials.

At one spot, a young woman, Debola Kunda, toils away, with two of her young children lending a hand. The dust sparkles with the metallic glint of galena – pure lead sulphide – and the soil right next to her four-year-old son, Acili, measures an astronomical 37,900ppm – 100 times above the danger level.

She is concerned about the health of her children, who have not been tested for blood lead. “But what can we do when there are no others at home to take care of the children? How will we eat if we stay at home?” she says.

A new $ 65m project for Kabwe and three other copperbelt mining areas was approved by the World Bank in December but the Zambian government has yet to give the go-ahead. It could be transformative – but it has yet to happen.

“A programme of more than 3,000 children and citizens of Kabwe would be subjected to constant medical surveillance and treatment programmes and anyone who showed a high blood lead level would be subjected to treatment as well,” says Sanjay Srivastava, at the World Bank, who is optimistic the crisis will be at last tackled. “The government finally recognises there is an issue and and they have to address it.”

Caravanos, who is also senior science advisor to Pure Earth, says the solution to Kabwe’s toxic trouble is clear: “We have the knowledge – we just have to get the kids away from the exposure. Will Kabwe ever be a lead-free town? No, but it can be a lead safe town.”

Photographer Larry C Price is supported by the Pulitzer Center on Crisis Reporting

Lead pollution in Kabwe


A canal drains the huge spoil heaps for the former lead mine but often floods after wet weather. Photograph: Larry C Price for the Guardian

How Britain plans to lead the global science race to treat dementia

Early next year, Professor Bart De Strooper will sit down in an empty office in University College London and start to plan a project that aims to revolutionise our understanding and treatment of dementia. Dozens of leading researchers will be appointed to his £250m project which has been set up to create a national network of dementia research centres – with UCL at its hub.

The establishment of the UK Dementia Research Institute – which was announced last week – follows the pledge, made in 2012 by former prime minister David Cameron, to tackle the disease at a national level and comes as evidence points to its increasing impact on the nation. Earlier this year, it was disclosed that dementia is now the leading cause of death in England and Wales. At the same time, pharmaceutical companies have reported poor results from trials of drugs designed to slow down the progress of Alzheimer’s disease, the most common form of dementia.

“Humans have truly wonderful brains that can cope with terrible diseases like Alzheimer’s for decades and can find all sorts of ways to get around defects that are growing inside,” said De Strooper, who is currently based at the University of Leuven in Belgium. “Eventually individuals succumb to the condition and start to display memory loss and other symptoms – but usually only after decades have passed and their brains have gone through considerable changes. This makes it very difficult to treat the disease. That is the challenge that we need to tackle.”

Current understanding of Alzheimer’s suggests the disease is triggered when beta amyloid, a protein in nerve cell membranes, starts to clump together. Slowly the brain undergoes metabolic changes as amyloid clumping continues. In particular, a protein known as tau, which is involved in memory storage, is affected. It starts to form tangles inside the brain’s neurons and these die off. Eventually, symptoms – such as severe memory loss – manifest themselves.

To date, most attempts at drug interventions have focused on medicines that could prevent beta amyloid from forming clumps, the most recent being Solanezumab, developed by the pharmaceutical company Eli Lilly. However, results of clinical trials of the drug – revealed last month – indicated that it had no significant effect on the thinking abilities of people with mild Alzheimer’s. Solanezumab had also failed in people with more advanced versions of the disease in earlier trials.

This double failure has led some scientists to argue that amyloid clumping is not a cause of the disease but is merely a symptom. By targeting it, scientists are wasting time, it is argued. Professor John Hardy, a geneticist based at UCL – who has played a key role in setting up the college’s Dementia Research Institute – does not agree. “All the evidence we have from families affected by early onset dementia indicates that the disease begins with the deposition of amyloid plaques in the brain,” he said. “The trouble is that this buildup starts 15 to 20 years before dementia’s symptoms appear. The drugs we have developed so far offer treatments that are, in effect, too little and too late.”

Hardy drew a parallel between cholesterol buildup in blood vessels that eventually leads to cardiac disease and the buildup of amyloid plaques in the brain and the onset of Alzheimer’s. “Unfortunately, we have no equivalent of a cholesterol test to assess how much amyloid is clumping in a person’s brain,” he added. “However, that could change in the near future.”

Research suggests between 20 and 30 genes are involved in predisposing people to Alzheimer’s.


Research suggests between 20 and 30 genes are involved in predisposing people to Alzheimer’s. Photograph: Getty

Recent research has pinpointed a group of around 20 to 30 genes that are involved in predisposing individuals to Alzheimer’s. These genes come in different variants. Some variants of a gene predispose individuals to dementia more than other variants of that gene. If a person inherits a package of genes made up of variants that particularly predispose to dementia, they are very likely to develop Alzheimer’s.

“We are now within five years of developing a chip that will be able to tell – from a blood test – whether a person is likely to have amyloid plaques forming inside their brains in middle age,” added Hardy. “This would then be followed up by a brain scan to confirm if this is true or not.”

This would be dementia’s equivalent of a cholesterol test. The problem is that there is, as yet, no equivalent of drugs which would halt this amyloid buildup in a way that parallels the use of statins to block buildups of cholesterol, once detected, and so head off cardiac illness. For their part, researchers argue that the use of drugs like Solanezumab – although seemingly ineffective on patients in whom amyloid plaques have become established – could be far more effective in the early stage of the condition.

Many other issues complicate our understanding of dementia, however. “A good example is provided by the immune system,” said David Reynolds, chief scientific officer of Alzheimer’s Research UK. “There is a lot of evidence now that the immune system is involved in the development of Alzheimer’s after beta amyloid clumps appear.”

However, the nature of that immune response is still not fully understood. “We do not know whether the immune system tends to overreact – as with conditions like rheumatoid arthritis in which the body’s own tissue is attacked by its own immune defences – or react weakly and allow amyloid clumps to develop when they could be stopped,” added Reynolds. “Certainly it would be unwise to wade in with drugs until we know exactly what it is we want to achieve.”

And this is where the distributed nature of the Dementia Research Institute network could prove important. Based in different university cities (Edinburgh, Oxford and Cambridge are all candidates for units), these outlying centres will focus on different aspects of the disease: environmental factors, care of dementia patients – and immunology. “The creation and direction of these centres will depend on existing expertise at that university,” added Reynolds. “A centre that focuses on immunology and dementia would be particularly useful in finding new ways to tackle the condition.”

The Dementia Research Institute network is to be supported, over the next 10 years, by £150m funding from the Medical Research Council – with further inputs of £50m each being made by Alzheimer’s Research UK and by the Alzheimer’s Society. This commitment marks a significant increase in dementia research in the UK, which had already raised its annual funding from £50m in 2008 to £90m in 2012 and is now a world leader in the field.

“It is good news but we need to put it in perspective,” said James Pickett, of the Alzheimer’s Society. “In 2012 we spent more than £500m on cancer research; there are five times more researchers working on cancer in the UK; while the number of clinical trials of dementia drugs is less than 1% of those of cancer drugs.”

At the same time, the need for some form of treatment to tackle dementia is becoming increasingly urgent. More and more people are living to their 80s and 90s when their chances of getting dementia increase markedly. There are currently 850,000 people with dementia in the UK, a figure that will rise to one million by 2025 and two million by 2051.

“We are going to have to be very nuanced in understanding all the risk factors involved in dementia – and in appreciating why factors like education and general health provide some protection against its onset,” said Professor Carol Brayne, of Cambridge. “That is going to be the strength of the institute. It offers us the opportunity, for the first time, to follow so many different avenues and approaches to dealing with and understanding the dementia.”

GROWING THREAT

Dementia overtook heart disease as the leading cause of death in England and Wales last year. More than 61,000 people died of the condition in 2015, 11.6% of all recorded deaths.

The Office for National Statistics said the increase had occurred because people were living for longer while deaths from other causes, including heart disease, had gone down. In addition, doctors are now better at diagnosing dementia, and it is appearing more often on death certificates.

The bulk of dementia deaths last year were among women: 41,283, compared to 20,403 in men.

According to the Alzheimer’s Society, dementia is the only one of the top 10 causes of death that we cannot prevent or even slow down.

The leading cause of dementia is Alzheimer’s disease, which accounts for 62% of all cases in the UK: 520,000 of the 850,000 people living with dementia in the UK today. Other forms of the disease include vascular dementia and Lewy Body dementia.

Dementia costs the UK economy approximately £26bn per year, according to the Alzheimer’s Society.

If a drug could be found to slow cognitive decline in dementia, that would delay the need for paid care and reduce the financial burden on families, the NHS and social care.

Why Washing Dishes by Hand May Lead to Fewer Allergies

TIME-logo.jpg Households worldwide now have extra incentive for getting family members to do the dishes: It could prevent the development of allergies. A new and preliminary study, published in the journalPediatrics, adds to an increasing body of evidence that suggests getting a little dirty does the immune system some good. That thinking is known as the “hygiene hypothesis,” which speculates that the reason kids develop so many allergies today is because their environments are just too clean. Without exposure to bacteria early in life, children’s immune systems don’t become as hardy as they could be. Research over the years has linked a variety of early lifestyle factors, like having pets, eating fish, and living on a farm to a significantly lower risk of developing allergies. Now this new study suggests that hand washing dishes might be the next behavior to add to the list. “If you are exposed to microbes, especially early in life, you stimulate the immune system in various ways and it becomes tolerant,” says study author Dr. Bill Hesselmar of Queen Silvia Children’s Hospital in Gothenburg, Sweden. “We thought [hand washing dishes] might be important, but we didn’t know, so we asked that question.” Hesselmar and his team surveyed the parents and guardians of 1,029 Swedish children ages 7 to 8. They discovered that children in homes where the family hand-washed the dishes instead of using a machine were less likely to have allergies. Only 23% of children whose parents used hand dishwashing had a history of eczema, compared with 38% of kids whose families mainly used machine dishwashing. The researchers also found that the result was amplified when kids ate fermented food or food bought directly from farms. Though the study is only observational and can’t confirm causality, Hesselmar and his team have a few speculations. It’s not necessarily that the kids are washing the dishes themselves and becoming exposed to bacteria. That might be one form of exposure, but as Hesselmar notes, some of the kids might be too young for that chore. Instead, it could be that long-term use of hand-washed dishes does the trick. Prior research comparing the cleanliness of dishes washed by hand to those washed by machine has shown that machine washing is more efficient and leaves fewer bacteria behind. Living in a household that hand-washes means family members are eating off of plates and cutlery that have more bacteria, and therefore more microbial exposure. Families who hand-wash may also have other lifestyle factors that contribute to a lower allergy risk. The researchers note that overcrowded housing, low socioeconomic status and immigration status can also be linked to fewer allergies, as well as possibly different modes of dish washing.

“The study was really well done and caveated well, while simultaneously suggesting new areas of research and interesting models,” says Jonathan A. Eisen, a professor at the University of California at Davis. Eisen, who was not involved in the study, is an expert on exposure to microbial communities.

The study still leaves a few questions unanswered, like why hand washing was only associated with a lower likelihood of eczema and not other allergy-related symptoms like asthma, or why the effect was so significant even though dish washing requires the use of soaps, possibly even antibacterial products. Hesselmar says they are asking the same questions and hope to continue looking into the link.

Read next: This ‘Peanut Patch’ Could Protect Against Peanut Allergies

This story originally appeared on Time.com.