Homes and mirrors
Would you commit a crime to avoid loneliness?
Middle-aged and older women in Japan are now committing crimes to ensure imprisonment. The overwhelming majority were in jail for shoplifting. Prisoners would rather face prison rather than society itself. In prison, there is companionship, access to regular meals and healthcare escaping loneliness and poverty. The Japanese government are trying to combat through community support centres, housing initiatives and prison rehabilitation programs to stop re-offending. In a country with a growing aging population, and low birth rates, there are no easy solutions.
Such a situation is a warning to most industrialised countries and asks us the big question: how do we ensure that our elderly are looked after. Singapore give tax breaks of up to £8000 per older dependent, e.g. parent or grandparent, that is looked after by a child or grandchild. Caring in itself is emotionally and physically draining and caring could be paid for by an outside agency. The British government have set a cap on the total care costs at £86000. Another initiative is ‘homesharing’ is a way for older adults to have ‘informal care’ and companionship by younger adults who are looking for a place to rent. Whilst this solved 2 problems with 1 solution, intergenerational communication is often a challenge as well as privacy. Other ideas would be to create social structures to ensure healthy long lives such as a community settings, balance and strength classes and opportunities for social interaction.
What great ideas have you heard of to combat elder loneliness?
Do we still need therapists when we have AI?
The waiting list for talking therapy from my GP practice is months. Only one type of talking therapy is cognitive behavioural therapy (CBT) is offered. Sometimes when my patients have had one or several courses of talking therapy they do not feel better. Even when I refer to the mental health team for advice or psychotherapy, they do have the resources to help. Overall getting help for mental health is difficult in the NHS.
Imagine if we could have a digital intervention that would personalise treatment like a therapist. As we enter a new technological revolution, generative AI could provide the answer. A recent randomised control trial including 210 participants found that scores for depression, anxiety and eating disorders significantly decreased over a with use of the chatbot over an 8 week period. Users used the chatbot for about 6 hours on average.
Getting instant mental health treatment would be fantastic but I wonder if there are risks. Would the chatbot know it own limits and how to manage increased clinical risk to a person or others? Could it safetynet appropriately?
Lots of unknowns but an exciting development which could surely be of benefit in resource-depleted healthcare systems globally.
How can we regulate the food industry?
I find myself in clinic saying 2 things on repeat to almost all my patients: drink water and eat more fruit and vegetables. This is not a cure-all to all disease but perhaps a way we can really improve our individual health. Often our individual habits are tied to symptoms which sometimes indicate something we do something about. Dehydration can often cause headaches and diet is linked to a whole host of illnesses but perhaps has not been studied in huge details. Why would a farmer or grocer do a randomised trial to see if a vegetable could improve health? As well as generic nagging, I often ask people to start small and increase from there upwards and tailor it to their circumstances, e.g. if money is short then frozen vegetables are fine.
Knowing what I know about our food system, I stand on shaky ground. We are continuously pummelled by advertisements about food system. How can I expect everyone to make changes? A recent review of policy changes for our food system focused on individual behaviour change rather than big changes. Perhaps multi-targeted interventions such controls on advertising, minimum standards in schools, and taxes could be a way forward.
It’s hard to make big changes individually, even from healthcare, but maybe if enough of us raise our voices then can cause a cultural generational change.
Why should we sort out the housing crisis?
As a society, we often look to medicine to provide cures for common physical and mental health conditions. One example is depression. Very rarely do these ‘cures’ come around, except perhaps for recent weight loss injections but even they are not perfect. Similarly as rare is depression with no cause. Discussion about bigger issues that drive poor health almost never happens in society but something community healthcare staff see everyday. The worries created by having nowhere to live have clear knock-on effects on health, especially mental health. In clinic, we sometimes have housing advisors or social prescribers, but they cannot build houses.
A recent policy brief from the charity, Shelter, suggested that building social houses would require initial investment from the government but would have benefits for society as a whole. For every £1 invested, there would be a £2.63 return on investment. Just 90,000 new social rent homes for one year could:
“add £51.2bn to the economy over 30 years”
“support more than 350,000 jobs and, unlike the one-off impact of private housing construction”
“lead to overall savings of £2.7 billion in education and £3.1bn in lower crime.”
“save £250m a year as households in expensive private rentals move into lower-rent social homes”
“save councils £245m a year on homelessness services – over 10% of total spending last year – and result in £4.5bn in savings over the next 30 years”
As well as this there could be benefits for productivity as temporary housing is associated with decreasing working rates. There has been an investment promise of £2 billion for 18,000 homes but this falls far short of the 300,000 homes needed annually. I wonder why there is not big investment in social housing. Is it that most voters are older who tend to own property so building more houses would be unpopular. As well as that older voters have pensions, rely on investment from private equity firms in property rents which might be another reason not to invest.
Lots more housing investment is needed if we are going to improve human health and the economy for future generations.
Why could looking in the mirror could improve your health?
When I say looking in the mirror could improve your health, I mean figuratively of course - ‘introspection’: looking inwards. Our relationships with ourselves impact on our social relationships which has a knock-on effect on health. This was noted by Dr Gabor Maté who suggested that women had an increased burden of autoimmune disease where the body attacks itself. This is thought to be due to held back emotions, causing internal stress and increased risk of disease. In Dr Maté’s book, “When the Body Says No: The Cost of Hidden Stress” highlights the impact of this in autoimmune diseases, cancer and neurological conditions such as motor neurone disease. Sadly in clinic, we see this play out in real time, where it can be difficult to intervene. Understanding ourselves and relationships really is one of the unwritten rules in life.
Reading Dr Ayan Panja’s blog reminds us about the challenges in knowing ourselves and taking a check when navigating our changing relationships with different people. Understanding that it’s ok to say “no” to others is actually saying “yes” to yourself.
Highlighted Video: Engaging with views you may not agree with
Gary Stevenson debates Daniel Priestley about rising inequality and whether wealth taxation or lowering taxes to start new businesses would reverse this trend:
Double think: a quote that made me think twice
“Deep rivers run quiet.”
Haruki Murakami (writer, 1949-present)