New Thoughts in Public Health and Head for the Hills...

PROTECTING HEALTH: 

IMPROVING WELL-BEING?

Last Friday 24th February the Centre for Public Health at MMU hosted a talk by Dr Ruth Hussey OBE, entitled Public Health England: A New Approach to 21st Century Public Health Challenges. It was a significant and interesting presentation as it is a critical time in public health development in the UK, and her work entails the smooth transition from the existing model to an emerging, and as yet, not fully formed vision.

Citing the work of mid Victorian physician, John Snow, and his emerging understanding of cholera, Dr Hussey illustrated how, over 100 years later, we are still learning from these experiences, as she explained the Fifth Wave in public health, where we adapt to societal and political changes that impact on population and individual health.

Expanding on the importance of telling the emerging public health story, and generating a shared vision through new relationships, it was clear that there was an emerging role in the public health lexicon for the arts. In the search for new ways of tackling old problems and engaging with communities in ways that are relevant to them, creative approaches should be central to our shared future. Describing her own experience of working with diverse communities, she hit the nail on the head when she reflected that one community member commented, ‘We’ve all got knowledge, but it’s different kinds of knowledge.’

In the drive to understand the impact and reach of public health interventions, the arts/health community is increasingly defining itself in similar language. Similarities can be drawn both in the need to have new ways of understanding our value and our impact through models like Social Return On Investment, and the understanding that focusing on assets over deficits, enables the co-design of practice. This is very much an arts/health model, and the move from illness to wellness is emphasised in the NHS Confederation publication of the same name, which illustrates the place of culture and the arts in the ‘wellness’ movement.

Significantly, Arts for Health at MMU featured explicitly a couple of times during her presentation, which she astutely described as a growing movement, and I would suggest that by engaging at a national and local level, and embedding thinking around the impact of creativity, culture and the arts alongside the scientific model, we will develop a robust approach to 21st Century public health that moves away from narrow reductivism and embraces a more genuinely holistic approach to health and well-being.

NHS REFORM AND FREEDOM OF SPEECH

Professor John Ashton CBE is Joint Director of Public Health for Cumbria Primary Care Trust and Cumbria County Council. John is well known for his work on planned parenthood, Healthy Cities and for his personal advocacy of public health.  He was also a member of the British delegation to Macedonia during the Kosovo emergency and played a prominent role in resolving the fuel dispute. He has played an active part in developing government policies for public health and under his leadership, the North West became regarded as a centre for pioneering initiatives, including his consistent support of Arts for Health, and whilst he was Regional Director of Public Health, he was the Department of Health sponsor for the Invest to Save Arts in Health Project. He has been instrumental in the development of part one of the manifesto for arts and health.

Earlier this month, Prof John Ashton co-signed a letter in the Independent defending the Royal College of GPs' chair, who opposes reform in the NHS. NHS Cumbria said in a letter to Prof Ashton that he should not express his personal views and told him his actions were ‘inappropriate’’ asking him to attend a meeting planned for last Friday.

John featured prominently in the broadcast media and printed press last week, commenting, “As a public health director and as the advisor for public health to the county of Cumbria... I have the freedom to speak out on matters of interest...I am not acting politically, I am acting professionally, drawing on the evidence of what will happen if we go down the road to private health insurance.”

Whilst John wasn’t acting politically, this is a critical agenda for us all to be engaged in, and regardless of our political allegiances, our health is political and the arts are political too.


Please click on John's photograph to go to his article in the Lancet: The Art of Medicine, Defending Democracy and the National Health Service.

COMMUNICATING SCENARIOS AROUND PANDEMIC PLANNING

For the last couple of years I have had some engagement with the Asia Europe Foundation (ASEF) and have actively worked with them on Scenario Planning around possible future pandemics. The work is gathering momentum and ASEF have produced a number of films to tell the story. They are also developing strategy for delivering this work. More information and short films can be found by clicking on the logo above.


And, purely for ironic entertainment...

ARTS FOR HEALTH ARCHIVE at 

Manchester Histories Festival 

Arts for Health’s Archive goes public for the first time this weekend with a small exhibition and a talk by Dr Langley Brown at the Manchester Histories Festival’s Celebration Day on Saturday, 3 March.

The Arts for Health exhibition is one of 80 displays on local histories that will take place in the Main Hall of Manchester’s magnificent Town Hall. It will introduce the Archive, and present ‘work-in-progress’ towards a larger exhibition that is to be a centrepiece of celebrations this April of the 80th anniversary of the Kinder Scout Mass Trespass, an event which helped pave the way towards the formation of the British National Parks and the steady growth of public access to wild countryside.  

This ‘work-in-progress’ previews Head for the Hills, a small-scale replica of a mosaic mural that was opened in 1986 by countryside access campaigner the late Benny Rothman. The mural was designed and made by users and staff of Manchester’s mental health services with artists of Hospital Arts (now Lime), but demolished in 2006 during rebuilding at Manchester Royal Infirmary. It was envisaged as celebration of and a lasting monument to the shared experiences, in wild landscapes, of a disparate group of people embodying a kaleidoscope of experience and skills who had only come together through the adverse circumstances of mental distress.

This project is not just the overdue resuscitation of a monument to a kaleidoscope of shared experiences from over a quarter of a century ago; it is also a potential catalyst for innovative approaches in art, wellbeing and ecology that will draw on lessons learnt from history.

The original Head for the Hills project ran during the time that the arts and mental health organisation START in Manchester evolved from Hospital Arts. START went on to inspire further developments including START in Salford, ARC in Stockport, and Connected in Oldham.

The completed replica, made by a group of Manchester Metropolitan University History of Art and Design students led by Langley Brown, will be accompanied by additional documentation on the original project and texts on topics arising concerning art, activism, environment, walking, wilderness and wellbeing, and will feature at the Edale Moorland Centre as part of the celebrations of the 80th Anniversary of the Kinder Trespass in April.

Events on Saturday 3 March:

Arts for Health Archive: Head for the Hills ‘work-in-progress’: 10am-5.30pm, Main Hall, Manchester Town Hall

Talk by Dr Langley Brown: 3.30pm, Friends Meeting House, 6 Mount St, Manchester M2 5NS 

KInder Trespass 80th anniversary events 20-29 April 

Head for the Hills exhibition: Moorland Centre, Edale (exact dates/times to be announced)

For more information email: langley.brown@mmu.ac.uk

Head for the Hills is supported by Derbyshire County Council.

Gaining muscle and losing fat at the same time: If I can do it, anyone can

The idea of gaining muscle and losing fat at the same time seems impossible because of three widely held misconceptions: (a) to gain muscle you need a calorie surplus; (b) to lose fat you need a calorie deficit; and (c) you cannot achieve a calorie surplus and deficit at the same time.

Not too long ago, unfortunately I was in the right position to do some self-experiments in order to try to gain muscle and concurrently lose fat, without steroids, keeping my weight essentially constant (within a range of a few lbs). This was because I was obese, and then reached a point in the fat loss stage where I could stop losing weight while attempting to lose fat. This is indeed difficult and slow, as muscle gain itself is slow, and it apparently becomes slower as one tries to restrict fat gain. Compounding that is the fact that self-experimentation invariably leads to some mistakes.

The photos below show how I looked toward the end of my transformation from obese to relatively lean (right), and then about 1.5 years after that (left). During this time I gained muscle and lost fat, in equal amounts. How do I know that? It is because my weight is the same in both photos, even though on the left my body fat percentage is approximately 5 points lower. I estimate it to be slightly over 12 percent (on the left). This translates into a difference of about 7.5 lbs, of “fat turning into muscle”, so to speak.

A previous post on my transformation from obese to relatively lean has more measurement details (). Interestingly, I am very close to being overweight, technically speaking, in both photos above! That is, in both photos I have a body mass index that is close to 25. In fact, after putting on even a small amount of muscle, like I did, it is very easy for someone to reach a body mass index of 25. See the table below, from the body mass index article on Wikipedia ().

As someone gains more muscle and remains lean, approaching his or her maximum natural muscular potential, that person will approach the limit between the overweight and obese areas on the figure above. This will happen even though the person may be fairly lean, say with a body fat percentage in the single digits for men and around 14-18 percent for women. This applies primarily to the 5’7’’ – 5’11’’ range; things get somewhat distorted toward the extremes.

Contrast this with true obesity, as in the photo below. This photo was taken when I was obese, at the beach. If I recall it properly, it was taken on the Atlantic City seashore, or a beach nearby. I was holding a bottle of regular soda, which is emblematic of the situation in which many people find themselves in today’s urban societies. It reminds me of a passage in Gary Taubes’s book “Good Calories, Bad Calories” (), where someone who had recently discovered the deliciousness of water sweetened with sugar wondered why anyone “of means” would drink plain water ever again.

Now, you may rightfully say that a body composition change of about 7.5 lbs in 1.5 years is pitiful. Indeed, there are some people, typically young men, who will achieve this in a few months without steroids. But they are relatively rare; Scooby has a good summary of muscle gain expectations (). As for me, I am almost 50 years old, an age where muscle gain is not supposed to happen at all. I tend to gain fat very easily, but not muscle. And I was obese not too long ago. My results should be at the very low end of the scale of accomplishment for most people doing the right things.

By the way, the idea that muscle gain cannot happen after 40 years of age or so is another misconception; even though aging seems to promote muscle loss and fat gain, in part due to natural hormonal changes. There is evidence that many men may experience of low point (i.e., a trough) in their growth hormone and testosterone levels in their mid-40s, possibly due to a combination of modern diet and lifestyle factors. Still, many men in their 50s and 60s have higher levels ().

And what are the right things to do if one wants to gain muscle and lose fat at the same time? In my next post I will discuss the misconceptions mentioned at the beginning of this post, and a simple approach for concurrently gaining muscle and losing fat. The discussion will be based on my own experience and that of several HCE () users. The approach relies heavily on individual customization; so it will probably be easier to understand than to implement. Strength training is part of this simple strategy.

One puzzling aspect of strength training, from an evolutionary perspective, is that people tend to be able to do a lot more of it than is optimal for them. And, when they do even a bit more than they should, muscle gain stalls or even regresses. The minimalists frequently have the best results.

Deller and New Evaluation...

Short and Sweet this week, but two things of interest to keep us ticking over...C.P.

Be Creative Be Well: arts, wellbeing and local communities, an evaluation

Over three and a half years, the Well London programme empowered some of the capital’s most deprived communities to take a proactive role in enhancing their health and wellbeing. Within this programme, there were a number of strands of work with Be Creative Be Well representing the importance of art and creativity in health agendas.

This report is an independent evaluation of Be Creative Be Well, looking at the impact that the quality of the arts and cultural activity can have in community engagement and in improving health and wellbeing.

JOY IN PEOPLE

The Hayward Gallery will be holding a retrospective of Jeremy Deller, which starts on Wednesday and runs until 13th May, titled Jeremy Deller: Joy in People, it will bring together documents of past collaborative events, films, books and banners.

The “pork paradox”? National pork consumption and obesity

In my previous post () I discussed some country data linking pork consumption and health, analyzed with WarpPLS (). One of the datasets used, the most complete, contained data from Nationmaster.com () for the following countries: Australia, Brazil, Canada, China, Denmark, France, Germany, Hong Kong, Hungary, Japan, Mexico, Poland, Russia, Singapore, Spain, Sweden, United Kingdom, and United States. That previous post also addressed a study by Bridges (), based on country-level data, suggesting that pork consumption may cause liver disease.

In this post we continue that analysis, but with a much more complex model containing the following country variables: wealth (PPP-adjusted GNP/person), pork consumption (lbs/person/year), alcohol consumption (liters/person/year), obesity (% of population), and life expectancy (years). The model and results, generated by WarpPLS, are shown on the figure below. (See notes at the end of this post.) These results are only for direct effects.

WarpPLS also calculates total effects, which are the effects of each variable on any other variable to which it is linked directly and/or indirectly. Two variables may be linked indirectly, through various paths, even if they are not linked directly (i.e., have an arrow directly connecting them). Another set of outputs generated by the software are effect sizes, which are calculated as Cohen’s f-squared coefficients. The figure below shows the total effects table. The values underlined in red are for total effects that are both statistically significant and also above the effect size threshold recommended by Cohen to be considered relevant (f-squared > 0.02).

As I predicted in my previous post, wealth is positively associated with pork consumption. So is alcohol consumption, and more strongly than wealth; which is consistent with a study by Jeanneret and colleagues showing a strong association between alcohol consumption and protein rich diets (). The inclusion of wealth in the model, compared with the model without wealth in the previous post, renders the direct and total effects of alcohol and pork consumption on life expectancy statistically indistinguishable from zero. (This often happens when a confounder is added to a model.)

Pork consumption is negatively associated with obesity, which is interesting. So is alcohol consumption, but much less strongly than pork consumption. This does not mean that if you eat 20 doughnuts every day, together with 1 lb of pork, you are not going to become obese. What this does suggest is that maybe countries where pork is consumed more heavily are somewhat more resistant to obesity. Here it should be noted that pork is very popular in Asian countries, which are becoming increasingly wealthy, but without the widespread obesity that we see in the USA.

But it is not the inclusion of Asian countries in the dataset that paints such a positive picture for pork consumption vis-à-vis obesity, and even weakens the association between wealth and obesity so much as to make it statistically non-significant. Denmark is a wealthy country that has very low levels of obesity. And it happens to have the highest level of pork consumption in the whole dataset: 142.6 lbs/person/year. So we are not talking about an “Asian paradox” here.

More like a “pork paradox”.

Finally, as far as life expectancy is concerned, the key factors seem to be wealth and obesity. Wealth has a major positive effect on life expectancy, while obesity has a much weaker negative effect. Well, access to sanitation, medical services, and other amenities of civilization, still trumps obesity in terms of prolonging life; however miserable life may turn out to be. The competing effects of these two variables (i.e., wealth and obesity) were taken into consideration, or controlled for, in the calculation of total effects and effect sizes.

The fact that pork consumption is negatively associated with obesity goes somewhat against the idea that pork is inherently unhealthy; even though pork certainly can cause disease if not properly prepared and/or cooked, which is true for many other plant and animal foods. The possible connection with liver problems, alluded to in the previous post, is particularly suspicious in light of these results. Liver diseases often impair that organ’s ability to make glycogen based on carbohydrates and protein; that is, liver diseases frequently lead to liver insulin resistance. And obesity frequently follows from liver insulin resistance.

Given that pork consumption appears to be negatively associated with obesity, it would be surprising if it was causing widespread liver disease, unless its relationship with liver disease was found to be nonlinear. (Alcohol consumption seems to be nonlinearly associated with liver disease.) Still, most studies that suggest the existence of a causal link between pork consumption and liver disease, like Bridges’s (), hint at a linear and dose-dependent relationship.

Notes

- Country-level data is inherently problematic, particularly when simple models are used (e.g., a model with only two variables). There are just too many possible confounders that may lead to the appearance of causal associations.

- More complex models ameliorate the above situation somewhat, but bump into another problem associated with country-level data – small sample sizes. We used data from 18 countries in this analysis, which is more than in the Bridges study. Still, the effective sample size here (N=18) is awfully small.

- There were some missing values in this dataset, which were handled by WarpPLS employing the most widely used approach in these cases – i.e., by replacing the missing values with the mean of each column. The percentages of missing values per variable (i.e., column) were: alcohol consumption: 27.78%; life expectancy: 5.56%; and obesity: 33.33%.

One Tomato at a Time: Feeding the World with Controlled Environment Agriculture

Tomatoes grown with controlled environment agriculture

A simple insalata caprese served to bring about a possible, worldwide agricultural revolution in Tucson, Ariz.

Each tomato in the Capri-style dish was a product of gardening perfection, grown within a precise range of "Goldilocks" (not too hot, not too cold) temperatures with a steady supply of light, carbon dioxide, water, and nutrients. Each bite and burst of fresh-off-the-vine tang only reminds, "Yes, food can and should taste this good."

The lucky few who enjoyed the salad—along with grilled eggplant, squash, fruit, and watermelon juice—were University of Arizona scientists attending the Research and Reports Retreat on Aug. 19 hosted by the Controlled Environment Agriculture Center (CEAC). Nina Fedoroff, professor of biology at Penn State and AAAS president, gave the keynote address.
By 2050, Fedoroff warned, world population would reach nine billion. Scientists must figure out how to squeeze every ounce of agricultural productivity to double the food supply. All this, she said, while simultaneously facing climate change, new biofuel demands, and pressure to reduce agriculture’s ecological footprint if the planet is to preserve what’s left of its biodiversity.

"The amount of arable land hasn’t changed in more than half a century. This means that the amount of arable land per person will decrease by half," she said. "I think we need to think of new ways. We need to think of the entire system. We have to think about the water, the energy, and the land."

Shaping up to be one of those "new ways" is controlled environment agriculture, said Gene Giacomelli, a horticultural engineer. As director of CEAC, he’s seen the center grow from its roots as a project to improve the living standards of communities in the Arizona desert to changing the way scientists view the future of farming.

Already, however, CEAC-designed high-tech greenhouses are producing nearly 10 times more produce—tomatoes, for example—as conventional farms with only a tenth or less of the resources. What’s more, it’s a feat that can be accomplished anywhere.

"It's providing food in places when and where we want it," Giacomelli said. "It's Biology 101: Everything is based on the plant. The plant provides you oxygen, purifies the water, and gives you the food."


Consider the work of soon-finished agricultural graduate student Lane Patterson on the South Pole Food Growth Chamber, a CEAC-designed greenhouse that has operated for six years providing fresh produce including cucumbers, melons, and a variety of tomatoes to researchers at the South Pole research station.

Patterson maintains control of the chamber from a computer station in Tucson. Based on hydroponics, the chamber is a closed system that recycles a high percentage of its materials. Sensors tightly control air temperature, humidity, and carbon dioxide. Special water-cooled lights provide the energy for plant growth.
When operating at peak capacity, the chamber can provide each researcher three salads a day year-round, an incredible feat for a greenhouse at the bottom of the world (and that could one day feed astronauts on the moon). Unfortunately, Patterson said, the chamber only has its lights on a third of the time to save on electricity costs.

These costs, however, may be a thing of the past with new advances in CEAC research coming from the labs of Mirat Kacira and Cheri Kabota.

Kacira's greenhouse systems and plant sensory monitoring technology simulates any weather condition, computes airflow, and monitors growth of all the plants. Through use of thermal imaging, for example, his system can detect the onset of a nutrient deficiency well before the naked human eye. By improving efficiency of resources, he sees huge potential in savings.

CEAC Faculty, Students, Staff, Guests (me on the right)

Savings may also come from introduction of light-emitting diode (LED) lamps. Kabota studies just how much LED light and what kind—red light, blue light, or both—is needed to stimulate growth of plants. Working with other universities, the plan is to grow plants with the least amount of LED light possible.

Eventually, Giacomelli says, CEAC advances will be welcome news for investors who are bringing controlled environment agriculture to urbanized areas such as New York or Montreal, but whose operating costs are also hampered mainly by electricity usage.

One of these companies is owned and run by Fedoroff’s own daughter and her boyfriend. Lufa Farms of Montreal is covered in photovoltaic panels, re-circulates all its water, and is sealed to exclude insects and eliminate need for pesticides and herbicides.

"It's a pretty high tech, high-intensity facility, and it grows lovely vegetables," Fedoroff said. These urban farms, she said, could be the answer (along with genetic engineering) needed to feed the world of the future.  

She added, "What it does that I think is extremely important to be mindful of is it brings agriculture back to the city. We've separated it. It's important psychologically and brings the value."

As if the promise of fresh, flavorful, garden-variety tomatoes for available year-round for salads and sandwiches wasn’t enough!

Note: This report was written in August 2011, but had not been published.

Can We Prevent a Food Crisis while Preserving Biodiversity?

Nina Fedoroff

To feed a crowded planet and avoid further loss of species, Nina Fedoroff, professor of biology at Penn State University and president of the American Association for the Advancement of Science (AAAS), argues for more focus on biotechnology and controlled environment agriculture. 

"Time is not on our side," she said in a keynote address at a research reports and retreat in Tucson, Ariz., hosted Aug. 19 by The University of Arizona's Controlled Environment Agriculture Center.

Thomas Malthus reasoned in 1798 that exponential population growth would eventually bring on worldwide famine and devastation, but he couldn’t have foreseen the advent of the most sophisticated agricultural production in human history. If he’d had a crystal ball, he would have witnessed plant science take hold—the introduction of post-Mendelian breeding practices, mechanization, intensive propagation and chemical fertilization.

These technologies among others and the expansion of agriculture making use of arable land across the globe, has permitted a tripling of the world’s population since Malthus’s time. However, this remarkable story of modern agriculture hasn’t been all good news.

  

Modern agriculture, Fedoroff said, has led to the boundless human encroachment into wild areas followed by deforestation and replacement with agricultural monocultures that has caused the catastrophic loss of species and ecological systems. In addition, the loss is not confined to land. Continued intensive use of fertilizers has led to eutrophication, or runoff into lakes and oceans creating dead zones, areas where feasting phytoplankton suffocate all other kinds of marine life.

She notes that if it hadn’t been for the Green Revolution, the situation may have even been worse. The revolution introduced technology and high-yield crops to third-world countries like India, Mexico, and Africa mid-century. Fedoroff told me that, indeed, the revolution is largely credited for not only providing food to millions, but also saving species like the tiger from extinction. 

As the world’s population passes seven billion and with predictions of world population reaching nine billion by 2050, the pressure is on for another revolution to feed the hungry mouths of the world’s future. Bring on the threats of biofuels, increasing water scarcity, and climate change driving up food prices and a Malthusian nightmare appears ever nearer.

What’s more is that "the amount of arable land hasn’t changed for more than half a century," Fedoroff warned. "This means that the amount of arable land per person will decrease by half."

When asked if it possible to double the food supply while preserving what’s left of biodiversity, Fedoroff responded by noting that this seemingly impossible feat depends on reducing agriculture’s ecological footprint while simultaneously adapting crops to a hotter, drier world. And there is hope.

"In the nick of time, we've had another revolution in the 20th century," Fedoroff said. "It's the molecular revolution."

The molecular revolution involves genetic engineering, the topic of Fedoroff's recent editorial in the New York Times. In it she blasts the Environmental Protection Agency (EPA) for overregulation of genetically modified crops. The focus of EPA’s regulation is ironically in part to protect biodiversity from relative risks of cross-pollination and new “gene-flow” in the environment.

On the contrary, Fedoroff argued, genetic engineering is a natural consequence to plant breeding and its crops are among the most well studied for human and environmental safety. They also offer the clearest way to avoiding more destruction to what’s left of biodiversity.

"We've come to regulate these modifications as if they're dangerous," Fedoroff said. "The evidence is pretty clear now that there isn’t any damaging or particular risks that are new."

Genetically engineered crops can protect the environment are two-fold, Fedoroff told me: First, because crops genetically engineered to produce more food reduces habitat destruction; and second, because crops genetically engineered to be pest- and disease-resistant reduce overall pesticide and herbicide use, which harm biodiversity by killing both harmful and beneficial insects and plants. 

Apart from genetically engineering, Fedoroff also said that it’s time to consider new methods to maximize crop yields. For example, Fertigation is a combination of irrigation and fertilization using a drip system with pressurized hoses underground that can preserve water. In addition, rooftop greenhouses using hydroponics or aquaponics or controlled environment agriculture facilities have a yield per unit area per year that can range anywhere between five to 10 times what can be produced on a conventional field.

"I think we need to think of new ways. We need to think of the entire system. We have to think about the water, the energy, and the land," Fedoroff said.

One of a growing number of urban facilities to make use of controlled environment agriculture is Lufa Farms of Montreal, which a family member introduced to Fedoroff. The high-tech urban gardening company is sealed to exclude insects and decrease chemical use. It is covered in photovoltaic panels, for continual light and recirculates all its water.

"It's a pretty high tech, high intensity facility, and it grows lovely vegetables," she said. "What it does that I think is extremely important to be mindful of is it brings agriculture back to the city. We've separated it. It's important psychologically and brings the value."

Will the EPA cooperate and put measures in place to encourage agricultural productivity through a combination of genetic engineering and controlled environment agriculture? Only time will tell, and, according to Fedoroff, it's time we need and don't have.

Note: This article was written August 2011, but was never published. 

Where is the VISION in Politics? - Artists in the NHS, Yayoi Kusama, Cultural Champions and more...

WHERE IS THE VISION IN POLITICS?
Dementia is a burgeoning health issue, here in the UK and globally. We’re all familiar with the bullet-point ‘facts’, as peddled by the media and more recently by the reporting of neglect by the Patients Association and Care Quality Commission (amongst others). The National Dementia Strategy highlighted the pressing need to address the over-prescribing of anti-psychotic medication and the value of non-pharmacological approaches to dementia care services.

This agenda should be central to the public outrage at NHS reform! This is not just a health issue, this is a political issue. We should expect politicians from all parties to demand cultural change in the way our elders are cared for, particularly the most vulnerable. Where are the politicians who have vision? Where are the politicians who don’t just wait to defend the next policy, or react to media baiting? Where is the dynamic vision in 21st century politics? Step forward and engage. We are your allies and can help create change. Culture and the arts will be central to innovation across society, enabling 21st century well-being that is so much more than a passive acceptance of an intolerable future.

This is a call for a generational shift in the way we think about aging, and plan and deliver care for those who have been the bedrock of our country, its workers, families and free-thinkers.

I am thrilled to announce that Arts for Health will be working with colleagues from around the UK on understanding the impact and reach of the arts on Dementia and the Imagination, with funding from the Arts and Humanities Research Council. More details of this will be available very shortly.

ARTISTS IN THE NHS - in pictures
To raise awareness of the devastating NHS reforms proposed by the health and social care bill, writer Niru Ratnam and Frieze Art Fair curator Sarah McCrory set up a new blog, Artists for the NHS, and have asked artists to make thought-provoking posters. Click on the Alistair Frost poster above.



THE MANIFESTO BEGINS ITS METAMORPHOSIS
And as the manifesto transforms from a pupa to a butterfly, here are a few reminders of part one’s content. (available in plain old black and white too)

YAYOI KUSAMA @ Tate Modern
The Japanese artist Yayoi Kusama has a retrospective at Tate Modern until 5th June. She’s an interesting person and there’s lots to read in the national press. For this blog, its her honest account of her mental ill-health that is interesting, which began in childhood when she started hallucinating the dots, nets and flowers which frequently appear in her paintings and sculptures. She voluntarily resides in a mental institution in Japan. An interesting interview with her from 1999 can be found at Bombsite, and here is a sample to whet your appetite.

Grady Turner There has been so much interest in your life story as a result of your retrospective at the Museum of Modern Art. Do you ever fear people may be interested in your biography at the expense of your art?

Yayoi Kusama No, I have no such fear. My artwork is an expression of my life, particularly of my mental disease.

GT We are conducting this interview by fax because you live in a mental institution in Tokyo. Is it true you committed yourself?

YK I was hospitalized at the mental hospital in Tokyo in 1975 where I have resided ever since. I chose to live here on the advice of a psychiatrist. He suggested I paint pictures in the hospital while undergoing medical treatment. This happened after I had been traveling through Europe, staging my fashion shows in Rome, Paris, Belgium and Germany.

GT Even though you are institutionalized, you are a prolific writer and artist. Where do you work?

YK I work at my condominium-turned-studio near the hospital as well as at a studio I’ve been renting for some years, which is just a few minutes walk from the hospital. I also created a large sculpture in the big yard of the hospital—a store-bought rowboat completely covered with stuffed canvas protuberances. I have made about five or six hundred large sculptures so far.

GT Do you still work around the clock for days at a time, as you did in the 1960s? Or is your work routine different now?

YK I work very hard even now, but probably not as hard as I did when I was in New York.

GT You say your art is an expression of your mental illness. How so?

YK My art originates from hallucinations only I can see. I translate the hallucinations and obsessional images that plague me into sculptures and paintings. All my works in pastels are the products of obsessional neurosis and are therefore inextricably connected to my disease. I create pieces even when I don’t see hallucinations, though...

Continued on Bombsite.



WHO IS YOUR CULTURAL CHAMPION
Arts and Business are inviting you to consider who you would like as a Cultural Champion. Below you’ll find advice as to what a Cultural Champion is and the types of support they are celebrating. If you would like to nominate someone, then please do go to http://artsandbusiness.org.uk  or email peter.collins@artsandbusiness.org.uk or call 0121 248 1200 for further details.

A POEM for VALENTINES DAY
Looking at poetry in relation to the manifesto and stumbled upon work by Harold Pinter, who I naively only knew as a playwright. How blind! Writing an essay for another piece of work about how we die, I was exposed to the blistering piece by Pinter called, American Football (Please don't click on this link to this poem if your easily offened, or blind to the violence of war). For those of you who are interested in how artists respond to the politics of war, and where work is not embraced by the mainstream media, I recommend it to you. You can read it hear. American Football.
To celebrate all things valentine however, here is a short and sublime piece of writing by Pinter

It Is Here

What sound was that?

I turn away, into the shaking room.

What was that sound that came in from the dark?
What is this maze of light it leaves us in?
What is this stance we take,
To turn away and then turn back?
What did we hear?

It was the breath we took when we first met.

Listen. It is here.

Does pork consumption cause cirrhosis? Perhaps, if people become obese from eating pork

The idea that pork consumption may cause cirrhosis has been around for a while. A fairly widely cited 1985 study by Nanji and French () provides one of the strongest indictments of pork: “In countries with low alcohol consumption, no correlation was obtained between alcohol consumption and cirrhosis. However, a significant correlation was obtained between cirrhosis and pork.”

Recently Paul Jaminet wrote a blog post on the possible link between pork consumption and cirrhosis (). Paul should be commended for bringing this topic to the fore, as the implications are far-reaching and very serious. One of the key studies mentioned in Paul’s post is a 2009 article by Bridges (), from which the graphs below were taken.

The graphs above show a correlation between cirrhosis and alcohol consumption of 0.71, and a correlation between cirrhosis and pork consumption of 0.83. That is, the correlation between cirrhosis and pork consumption is the stronger of the two! Combining this with the Nanji and French study, we have evidence that: (a) in countries with low alcohol consumption we can find a significant correlation between cirrhosis and pork consumption; and (b) in countries where both alcohol and pork are consumed, pork consumption has the strongest correlation with cirrhosis.

Do we need anything else to ban pork from our diets? Yes, we do, as there is more to this story.

Clearly alcohol and pork consumption are correlated as well, as we can see from the graphs above. That is, countries where alcohol is consumed more heavily also tend to have higher levels of pork consumption. If alcohol and pork consumption are correlated, then a multivariate analysis of their effects should be conducted, as one of the hypothesized effects (of alcohol or pork) on cirrhosis may even disappear after controlling for the other effect.

I created a dataset, as best as I could, based on the graphs from the Bridges article. (I could not get the data online.) I then entered it into WarpPLS (). I wanted to run a moderating effect analysis, which is a form of nonlinear multivariate analysis. This is important, because the association between alcohol consumption and disease in general is well known to be nonlinear.

In fact, the relationship between alcohol consumption and disease is often used as a classic example of hormesis (), and its characteristic J-curve shape. Since correlation is a measure of linear association, the lower correlation between alcohol consumption and cirrhosis, when compared with pork consumption, may be just a “mirage of linearity”. In multivariate analyses, this mirage of linearity may lead to what are known as type I and II errors, at the same time ().

I should note that the Bridges study did something akin to a moderating effect analysis; through an analysis of the interaction between alcohol and pork consumption. However, in that analysis the values of the variables that were multiplied to create a “dummy” interaction variable were on their original scales, which can be a major source of bias. A more advisable way to conduct an interaction effect analysis is to first make the variables dimensionless, by standardizing them, and then creating a dummy interaction variable as a product of the two variables. That is what WarpPLS does for moderating effects’ estimation.

One more detour, leading to an important implication, and then we will get to the results. In a 1988 article, Jeanneret and colleagues show evidence of a strong and possibly causal association between alcohol consumption and protein-rich diets (). One possible implication of this is that in countries where pork is a dietary staple, like Denmark and Germany, alcohol consumption should be strongly and causally associated with pork consumption. (I guess Anthony Bordain would agree with this eh?)

Below are the results of a multivariate analysis on a model that incorporates the above implication, by including a link between alcohol and pork consumption. The model also explores the role of pork consumption as a moderator of the relationship between alcohol and cirrhosis, as well as the direct effect of pork consumption on cirrhosis. Finally, the total effects of alcohol and pork consumption on cirrhosis are also investigated; they are shown on the left.

The total effects are both statistically significant, with the total effect of alcohol consumption being 94 percent stronger than the total effect of pork consumption on cirrhosis. Looking at the model, alcohol consumption is strongly associated with pork consumption (which is consistent with Jeanneret and colleagues’s study). Alcohol consumption is also strongly associated with cirrhosis, through a direct effect; much more so than pork. Finally, pork consumption seems to strengthen the relationship between alcohol consumption and cirrhosis (the moderating effect).

As we can see the relationship between pork consumption and cirrhosis is still there, in moderating and direct effects, even though it seems to be a lot weaker than that between alcohol consumption and cirrhosis. Why does pork seem to influence cirrhosis at all in this dataset?

Well, there is another factor that is strongly associated with cirrhosis, and that is obesity (). In fact, obesity is associated with just about any major disease, including various types of cancer ().

And in countries where pork is a dietary staple, isn’t it reasonable to assume that pork consumption will play a role in obesity? Often folks who consume a lot of addictive industrial foods (e.g., bread, candy, regular sodas) also eat plenty of foods with saturated fat; and the latter end up showing up in disease statistics, misleadingly supporting the lipid hypothesis. The phenomenon involving pork and cirrhosis may well be similar.

But you may find the above results and argument not convincing enough. Maybe you want to see some evidence that pork is actually good for one’s health. The results above suggest that it may not be bad at all, if you buy into the obesity angle, but not that it can be good.

So I downloaded the most recent data from Nationmaster.com () on the following variables: pork consumption, alcohol consumption, and life expectancy. The list of countries was a bit larger than and different from that in the Bridges study; the following countries were included: Australia, Brazil, Canada, China, Denmark, France, Germany, Hong Kong, Hungary, Japan, Mexico, Poland, Russia, Singapore, Spain, Sweden, United Kingdom, and United States. Below are the results of a simple multivariate analysis with WarpPLS.

As with the Bridges dataset, there is a strong multivariate association between alcohol and pork consumption (0.43). The multivariate association between alcohol consumption and life expectancy is negative (-0.14). The multivariate association between pork consumption and life expectancy is positive (0.36). Neither association is statistically significant, although the association involving pork consumption gets close to significance with a P=0.11 (a confidence level of 89 percent; calculated through jackknifing, a nonparametric technique). The graphs show the plots for the associations and the best-fitting lines; the blue dashed arrows indicate the multivariate associations to which the graphs refer. So, in this second dataset from Nationmaster.com, the more pork is consumed in a country, the longer is the life expectancy in that country.

In other words, for each 1 standard deviation variation in pork consumption, there is a 0.36 standard deviation variation in life expectancy, after we control for alcohol consumption. The standard deviation for pork consumption is 36.281 lbs/person/year, or 45.087 g/person/day; for life expectancy, it is 4.677 years. Working the numbers a bit more, the results above suggest that each extra gram of pork consumed per person per day is associated with approximately 13 additional days of overall life expectancy in a country! This is calculated as: 4.677/45.087*0.36*365 = 13.630.

Does this prove that eating pork will make you live longer? No single study will “prove” something like that. Pork consumption is also likely a marker for wealth in a country; and wealth is strongly and positively associated with life expectancy at the country level. Moreover, when you aggregate dietary and disease incidence data by country, often the statistical effects are caused by those people in the dietary extremes (e.g., alcohol abuse, not moderate consumption). Finally, if people avoid death from certain diseases, they will die in higher quantities from other diseases, which may bias statistical results toward what may look like a higher incidence of those other diseases.

What the results summarized in this post do suggest is that pork consumption may not be a problem at all, unless you become obese from eating it. How do you get obese from eating pork? Eating it together with industrial foods that are addictive would probably help.