An important intervention in the aid debate

A new report by the ONE campaign shows how the UK aid budget will make a difference.

A new report by the ONE campaign shows how the UK aid budget will make a difference.

Today the ONE campaign has published a report that calculates what the UK international aid budget will actually be able to achieve between now and the next election. It is an incredibly important but also very clever interjection into the debate on overseas aid which continues to rage, despite the political consensus at the last election.

All three parties committed to meet the UN target of 0.7 per cent by 2013 in their manifestos, but the Conservatives went even further. Following Gordon Brown's announcement at Labour's 2009 party conference that Labour would legislate to make the commitment a legally binding target, the Conservative manifesto raised the stakes, declaring, on page 117:

A new Conservative government will be fully committed to achieving, by 2013, the UN target of spending 0.7% of national income as aid. We will stick to the rules laid down by the OECD about what spending counts as aid. We will legislate in the first session of a new Parliament to lock in this level of spending for every year from 2013.

Despite this being one of the longest ever sessions of Parliament, International Development Secretary Andrew Mitchell has told journalists that there is no time for the legislation. So the ONE campaign has cleverly turned the debate from input - £8.6bn of your taxes - into outputs.

On the same day as the former Security Minister Lord West tells the Daily Telegraph that our aid budget should be cut in order to reinvest in the Royal Navy, the ONE campaign show us what your taxes can achieve. Lord West says he is "horrified our naval flotilla now comprises only 19 frigates and destroyers". But ONE's report reminds us of the horrifying fact that 50 million women around the world give birth outside of a health facility and without the support of a midwife or health worker.

On the same day we learn of a £2bn aircraft carrier procurement error, Lord West says our ability to recapture the Falkland Islands is at stake. But the ONE report reminds us that this year 358,000 mothers will die in unaided child birth and that 2.6 million stillbirths will result and a further 2.8 million children will die in their first week of life. As I argued when Liam Fox's letter on the 0.7 per cent aid commitment leaked, there is no trade off between body armour and bednets. We can have both.

Mitchell made clear in the Sunday Times (£) yesterday, that development is a process and that aid is just a step on the developing world's journey to self-sufficiency. The UK taxpayer should be proud that their country spends their taxes through a development department (DFID) and not an aid agency (like the State Department's USAid).

Mitchell has decided that DFID will leave India in time for the next UK election because the country will be rich enough to deal with its own poverty. But there will still be around 400 million people living on less than 80p ($1.25) a day in India, more than in the 51 countries of sub-Saharan Africa put together. The £280m a year that the DFID saves will be reinvested not in warships but in water sanitation. Let's just hope that India makes poverty reduction a priority but also be proud that the UK taxpayer made one big difference to the lives of the 1.2 million Indian children who have gone to primary school since 2003 thanks to us.

Richard Darlington was Special Adviser at DFID 2009-2010 and is now Head of News at IPPR - follow him on Twitter: @RDarlo

Richard Darlington is Head of News at IPPR. Follow him on Twitter @RDarlo.

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The surprising truth about ingrowing toenails (and other medical myths)

Medicine is littered with myths. For years we doled out antibiotics for minor infections, thinking we were speeding recovery.

From time to time, I remove patients’ ingrowing toenails. This is done to help – the condition can be intractably painful – but it would be barbaric were it not for anaesthesia. A toe or finger can be rendered completely numb by a ring block – local anaesthetic injected either side of the base of the digit, knocking out the nerves that supply sensation.

The local anaesthetic I use for most surgical procedures is ready-mixed with adrenalin, which constricts the arteries and thereby reduces bleeding in the surgical field, but ever since medical school I’ve had it drummed into me that using adrenalin is a complete no-no when it comes to ring blocks. The adrenalin cuts off the blood supply to the end of the digit (so the story goes), resulting in tissue death and gangrene.

So, before performing any ring block, my practice nurse and I go through an elaborate double-check procedure to ensure that the injection I’m about to use is “plain” local anaesthetic with no adrenalin. This same ritual is observed in hospitals and doctors’ surgeries around the world.

So, imagine my surprise to learn recently that this is a myth. The idea dates back at least a century, to when doctors frequently found digits turning gangrenous after ring blocks. The obvious conclusion – that artery-constricting adrenalin was responsible – dictates practice to this day. In recent years, however, the dogma has been questioned. The effect of adrenalin is partial and short-lived; could it really be causing such catastrophic outcomes?

Retrospective studies of digital gangrene after ring block identified that adrenalin was actually used in less than half of the cases. Rather, other factors, including the drastic measures employed to try to prevent infection in the pre-antibiotic era, seem likely to have been the culprits. Emboldened by these findings, surgeons in America undertook cautious trials to investigate using adrenalin in ring blocks. They found that it caused no tissue damage, and made surgery technically easier.

Those trials date back 15 years yet they’ve only just filtered through, which illustrates how long it takes for new thinking to become disseminated. So far, a few doctors, mainly those in the field of plastic surgery, have changed their practice, but most of us continue to eschew adrenalin.

Medicine is littered with such myths. For years we doled out antibiotics for minor infections, thinking we were speeding recovery. Until the mid-1970s, breast cancer was routinely treated with radical mastectomy, a disfiguring operation that removed huge quantities of tissue, in the belief that this produced the greatest chance of cure. These days, we know that conservative surgery is at least as effective, and causes far less psychological trauma. Seizures can happen in young children with feverish illnesses, so for decades we placed great emphasis on keeping the patient’s temperature down. We now know that controlling fever makes no difference: the fits are caused by other chemicals released during an infection.

Myths arise when something appears to make sense according to the best understanding we have at the time. In all cases, practice has run far ahead of objective, repeatable science. It is only years after a myth has taken hold that scientific evaluation shows us to have charged off down a blind alley.

Myths are powerful and hard to uproot, even once the science is established. I operated on a toenail just the other week and still baulked at using adrenalin – partly my own superstition, and partly to save my practice nurse from a heart attack. What would it have been like as a pioneering surgeon in the 1970s, treating breast cancer with a simple lumpectomy while most of your colleagues believed you were being reckless with your patients’ future health? Decades of dire warnings create a hefty weight to overturn.

Only once a good proportion of the medical herd has changed course do most of us feel confident to follow suit. 

This article first appeared in the 20 April 2017 issue of the New Statesman, May's gamble

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