On diabetes, mental health and on risk management

On his Facebook page Bernard Jenkins (mp) – who I greatly respect – added a post. It was raising an important point, for those affected. In some ways it was and is a good thing, a right thing to do. But, yer, well, this is me. I tend to look and things from several angles and think, “Well, about that…” and go off on a tangent.

Thus, Sir Bernard wrote:

I’m backing calls from leading charity Diabetes UK to create new national standards for diabetes emotional and mental health support, and to increase support available locally to people living with diabetes in the area.

The findings, published in the report “Too often missing: Making emotional and psychological support routine in diabetes care”, show that diabetes is much more than a physical condition. I joined Diabetes UK at a parliamentary event, as the charity launched its campaign to make the emotional and psychological demands of living with diabetes recognised and provide the right support to everyone who needs it.

Diabetes UK is urgently calling on the NHS to create national standards for diabetes emotional and mental health services. These should ensure that everyone receives joined up care, that they are asked how they are feeling as part of every diabetes appointment, and that a mental health professional with knowledge of diabetes is part of every diabetes care team!

… and I threw in… :

Two thoughts here, Bernard, one callous sounding, but nonetheless true, the other negative, but equally true. Not trolling here, just facts of life.

Firstly, in terms of numbers, in a lot cases of diabetes {of type 2} it is, to be blunt, self-inflicted. Not intentionally, but it is established that obesity can lead to type-2 diabetes, and that the obesity problem in this country is so bad that we are looking at a rise of up to a million new cases over the next two decades as a result. [e.g. Diabetes UK ]. There are plenty of counter arguments, often valid, (e.g. it’s my hormones, it’s in my genes), sometimes questionable (e.g. it’s poverty, I can’t afford to eat healthily / I’m too busy to cook healthy food). No, it’s a life choice. You can have smaller portions, you can do light exercise daily, you can cut out sugars and too much fatty food, you can shop at the end of the day and pick up bargains from the ‘reduced to sell’ shelves most supermarkets have.

The point here isn’t to be being rude, it’s that greater awareness is needed. Not a soft, whiny “don’t do that, Thomas”, message, but an IN-YOUR-FACE, cigarette packet style, home-hitting warning. People are too soft these days, and media and the government pamper to them. It’s the worst kind of nannying. “Don’t offend them, we need to count on their votes in a few years.” Ah, I see. Understood.

Forgetting all the other health risks of obesity, even seen from the outside, diabetes is just nasty. It’s not simply “watch your sugars,” “take your injections”, unmonitored, or undetected, it’s things like losing feeling in your feet so you only aware you sliced your toe open because someone pointed out the trail of blood you are leaving. It’s kidney failure. It’s … a long list.

“Sir, I’m going to have to ask you to put down that bag and step away from the donuts.”

As snarky as that sounds – and is – when you see a young person, one so obese that they don’t stroll they lumber ponderously, walking around town with a pie in each hand. Or you are in hospital, waiting for your own ambulance, and the person beside you is so morbidly obese they need a wheelchair because they are too fat to walk – and are stuffing their face with pies and a litre of coffee. Those are choices. In the genuine examples given the choice was gluttony.

This too, in a way, is a problem of government, of all sitting governments. Too much, it seems, you compartmentalise, you look to the short term, at grand vote-winning gestures and lofty goals, at ‘meaningful’ sound byes, at charts and statistics, (plus the odd trophy piece of tat, like HS2). The focus is ever on getting elected again, it is not on what’s best for the country, not for the future, but what’s best for the party, and for your seat in particular. (‘Your’ being each and every one of the 650 seats in the HoC, rather that finger-pointing).

Do the maths. Outpatient costs for diabetes are put around £240 a year. Inpatient around £2,250. Multiply that by a million. Dialysis patients cost over £30,000 a year, each. Add that. ICU beds, which diabetes patients sometimes end up in, cost over £2,000 a day. Cardiovascular… add that. Plus the 100-odd other potential co-morbidity complications.

Basically, drink, drugs, smoking – and obesity – are crippling the NHS. (And ruining lives and communities). And instead of spending money educating people – starting in school – you throw tens of millions, tens of billions at vanity projects.

I’ll throw you a curved ball, Bernard. To do with Brexit, and politics, but also related to healthcare, and thus to diabetes. There is a body of thought – well researched – that suggests ignorance (or “moronic stupidity”) is government policy! Not a wild conspiracy theory, not simply the Tories, or the UK, but a global intention that the masses – even the educated to degree level masses – basically should not think to much. Because thinking leads to awkward questions, and governments, media, and big business do NOT like savvy customers.

As I say, this isn’t a tinfoil hat conspiracy, it’s think tank stuff from the world renowned Max Planck Institute, in Germany. In particular by Gerd Gigerenzer. Stuff like this should be taught as standard in schools:

Before you comment, if you are feeling like trolling, watch the linked TEDx talk, and look up the credentials of Gerd Gigerenzer.

The Brexit divide – is down to this omission. Lack of awareness to risk literacy to health issues – is down to this omission. Even at university level, where you are (or should be) taught critical thinking, the focus is on the right answers to grade the paper, not on looking at the box and going, “OYE!”

Which is better – and cheaper – an education policy taught even an hour a week in the first years of high school, or tens of billions in healthcare costs decades down the line?

Now to the second point, that of emotional and mental health services. Besides the fact that the services are already there, if you ask, there is a bigger problem. A MUCH bigger problem, that of logistics. Of base numbers. We do not have the doctors. psychiatrists, psychologists, or the trained counsellors for it. If we quadrupled the number of clinical psychologists in the country, we still wouldn’t have enough to meet the general needs. Rinse and repeat globally.

I put it down to explosively population and tech growth. In 1972 the planet housed 3.85bn, it is now home to over 7.7bn. It has doubled in less than two generations, increasing at the rate more than 2 billion a generation.

Big numbers, mind boggling numbers, so to simplify it, slightly: It takes roughly 12 years of higher education, from college, through degrees and masters to post doctorate specialisation to become a clinical psychologist. In that time another billion people will be born. 25% more than the entire population of Europe combined.

Psychology, with the focus on cognitive biases, behaviour, emotional welfare needs to be core curriculum in schools. Mandatory.

Yes, absolutely, there is a need for such help for diabetes patient, but also for cardiac, renal, for teachers and bus drivers… If you give to one, you delay or deny another. Just how it is.

There is no short term answer, that answer is – at best – 12 to 15 years away. What is needed is a very long term solution.

Just my opinion, though one shared my many; the problem isn’t simply diabetes, or obesity, or politics, it’s the world, and it is education, and the glaring lack thereof. The problem is that school and education does not prepare you for life, it prepares you for a job. For fodder for factories and hospitals and corporations. It prepares you to make money for others! A bit contentious, I agree, but bear me out. Younger people won’t get this, but the older you are, the more you understand.

At high school I studied – I suffered – Jane Eyre in English. And Wuthering Heights. It did not help my literacy. It taught me that there in a genre of books I never want to see again in my lifetime. As a grammarian I firmly believe good English matters, but this…

Full on, 100%, I am for STEM and English to high standards, that said, for most people, knowing what an isosceles triangle actually is, quoting Boyle’s Law, reciting Jane Austin, you are just never going to use that in your life. It’s useless.

Pre-college is not actually used to “educate”, that happens in college and university, it is used to push you along a path. That is wrong. The time should be used to prepare you for life, to introduce you to arts and sciences etc etc so you can see what interests you. School doesn’t prepare you for mortgages, or depression caused by stress etc, it prepares you to fill a role. That failing is government policy. Supported by education systems that are frankly ignorant.

On that note, I’ll leave you with this TED talk by Sir Ken Robinson: Do schools kill creativity?

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