Smoking. Photo: Pascal Le Segretain/Getty Images
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Doom-laden ads put healthy people in a panic – but some need to worry a bit more

It's hard to draw the line between inciting fear, and giving a fair warning - as Colin and Mary's story proves.

An advert on a bus shelter caught my eye recently. The gist was: if you’re over 60 and you feel the slightest bit peaky, you’d best get yourself along to the doctor, because illness can be so much more serious at that kind of age. It filled me with gloom. There seems no room for common sense any more; everything must be devolved to a professional. The logic – encourage people to seek help at the first hint of trouble and you’ll catch anything major at an early stage – is seductive yet flawed. Waves of the worried well suck vast amounts of time out of the health service, to the detriment of those with serious disease. Even important diseases can be vague and undifferentiated in the initial phases, making it hard to diagnose them. And then there’s the psychological downside of continually sapping people’s confidence in their own judgement.

Having said that, the folk who devise these awareness-raising campaigns mean well, and there is certainly another side to the coin. The advert put me in mind of Colin and Mary. They were an unusual couple, she in her late seventies, he about 15 years her junior, and they were devoted to each other. They’d never had children, and kept themselves to themselves, rarely bothering with doctors – perhaps in part because Colin was tired of being nagged about his inveterate smoking. It was highly unusual to be asked to visit Mary.

She was sitting in their somewhat dingy lounge when I arrived. And that was the problem, Colin explained: Mary had been “right as rain” the previous day but now he couldn’t get her off the sofa. I asked her various questions, but she denied pain or any other symptoms. She just couldn’t move.

Although this wasn’t typical, I wondered about a stroke – her speech was halting and unclear, and her limbs were markedly stiff – but she firmly declined hospital admission. I set about getting urgent home care for them, and sent off a battery of investigations to try to get to the bottom of it.

Ultimately, the only condition that seemed to explain Mary’s presentation was Parkinson’s disease, in which the area of the brain responsible for executing voluntary movements, the substantia nigra, slowly degenerates. The problem was, Parkinson’s takes years to develop and Mary had succumbed overnight. The only time I’d come across such an acute onset was once, when a drug had caused Parkinson’s-like side effects. But Mary hadn’t been prescribed anything new for ages.

I cross-examined Colin in detail. It turned out his “right as rain” had been hideously misleading. Mary had been becoming ever less mobile for a long time, which they’d been putting down to old age. In the weeks before her final seizing-up, Colin had been having literally to manhandle her across the room. Trying to get her upstairs had involved putting her over his shoulder and shoving with Herculean determination. It was an eye-wateringly scary picture.

Mary soon improved with treatment – there are certain drugs that supplement the neurotransmitter dopamine, which becomes depleted with the degeneration of the substantia nigra. But the whole episode raised an altogether more delicate question: what to do when a patient or their carer seems to lack the kind of common sense that would prompt most people to seek professional help? We had to evaluate carefully Mary’s competence to make decisions about her care, and the degree to which Colin’s disregard for the medical profession might be exerting an undue influence. In the end, we had to move her to a nursing home. Some months later, Colin succumbed at home to a smoking-related cancer, declining all but the minimum help right to the end. His was an almost pathological stoicism, and I can imagine the disdain he would have felt for that bus-shelter advert. That was his right, but the tragedy was that, in the end, Mary had needed protection from his very particular brand of loving care.

This article first appeared in the 27 February 2015 issue of the New Statesman, Russia vs the west

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The rise of the green mayor – Sadiq Khan and the politics of clean energy

At an event at Tate Modern, Sadiq Khan pledged to clean up London's act.

On Thursday night, deep in the bowls of Tate Modern’s turbine hall, London Mayor Sadiq Khan renewed his promise to make the capital a world leader in clean energy and air. Yet his focus was as much on people as power plants – in particular, the need for local authorities to lead where central governments will not.

Khan was there to introduce the screening of a new documentary, From the Ashes, about the demise of the American coal industry. As he noted, Britain continues to battle against the legacy of fossil fuels: “In London today we burn very little coal but we are facing new air pollution challenges brought about for different reasons." 

At a time when the world's leaders are struggling to keep international agreements on climate change afloat, what can mayors do? Khan has pledged to buy only hybrid and zero-emissions buses from next year, and is working towards London becoming a zero carbon city.

Khan has, of course, also gained heroic status for being a bête noire of climate-change-denier-in-chief Donald Trump. On the US president's withdrawal from the Paris Agreement, Khan quipped: “If only he had withdrawn from Twitter.” He had more favourable things to say about the former mayor of New York and climate change activist Michael Bloomberg, who Khan said hailed from “the second greatest city in the world.”

Yet behind his humour was a serious point. Local authorities are having to pick up where both countries' central governments are leaving a void – in improving our air and supporting renewable technology and jobs. Most concerning of all, perhaps, is the way that interest groups representing business are slashing away at the regulations which protect public health, and claiming it as a virtue.

In the UK, documents leaked to Greenpeace’s energy desk show that a government-backed initiative considered proposals for reducing EU rules on fire-safety on the very day of the Grenfell Tower fire. The director of this Red Tape Initiative, Nick Tyrone, told the Guardian that these proposals were rejected. Yet government attempts to water down other EU regulations, such as the energy efficiency directive, still stand.

In America, this blame-game is even more highly charged. Republicans have sworn to replace what they describe as Obama’s “war on coal” with a war on regulation. “I am taking historic steps to lift the restrictions on American energy, to reverse government intrusion, and to cancel job-killing regulations,” Trump announced in March. While he has vowed “to promote clean air and clear water,” he has almost simultaneously signed an order to unravel the Clean Water Rule.

This rhetoric is hurting the very people it claims to protect: miners. From the Ashes shows the many ways that the industry harms wider public health, from water contamination, to air pollution. It also makes a strong case that the American coal industry is in terminal decline, regardless of possibile interventions from government or carbon capture.

Charities like Bloomberg can only do so much to pick up the pieces. The foundation, which helped fund the film, now not only helps support job training programs in coal communities after the Trump administration pulled their funding, but in recent weeks it also promised $15m to UN efforts to tackle climate change – again to help cover Trump's withdrawal from Paris Agreement. “I'm a bit worried about how many cards we're going to have to keep adding to the end of the film”, joked Antha Williams, a Bloomberg representative at the screening, with gallows humour.

Hope also lies with local governments and mayors. The publication of the mayor’s own environment strategy is coming “soon”. Speaking in panel discussion after the film, his deputy mayor for environment and energy, Shirley Rodrigues, described the move to a cleaner future as "an inevitable transition".

Confronting the troubled legacies of our fossil fuel past will not be easy. "We have our own experiences here of our coal mining communities being devastated by the closure of their mines," said Khan. But clean air begins with clean politics; maintaining old ways at the price of health is not one any government must pay. 

'From The Ashes' will premiere on National Geograhpic in the United Kingdom at 9pm on Tuesday, June 27th.

India Bourke is an environment writer and editorial assistant at the New Statesman.

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