Please help me this weekend...

HELP NEEDED THIS WEEKEND

I need the following text translated into YOUR language asap!
If you are one of the regular readers of this blog, please email me with a translation of the following, all in lower case. 

             art + culture = power

Many, many thanks and email directly to c.parkinson@mmu.ac.uk 

Health Inequalities? Choose Life...

This week the Kings Fund published its report on health inequalities citing what we probably knew in our heart-of-hearts: the poorer you are, the worse your life expectancy: the wealthier you are, the more likely you are to have followed government advice on reducing dangerous lifestyles - thus you’ll live longer. So this isn’t wind-surfing and abseiling we’re talking about, but what you eat, drink and puff on - and if you spend your days sat on the sofa soaking up daytime TV and playing on the computer. It seems that the public health messages have been driven home successfully to those already interested in their health, but people who are disengaged for whatever reason (poverty?) will statistically die earlier. 

Over this same period, we’ve had two rather tragic legal cases being played out in the media: that of Tony Nicklinson who wanted to choose how and when he died, and more importantly, he fought for the legal right to end his life and make any doctor that helped him be immune from prosecution. The other story is that of the anonymous Mr L from Greater Manchester who reportedly is in a persistent vegetative state following a series of heart attacks, and is being cared for by Pennine Acute Hospitals NHS Trust who feel that it’s in his best interest not to be resuscitated, if he succumbs to infection, further heart attack or stroke. However, his family want to prolong his life, whatever the quality, for as long as possible. What a terrible situation. These painful cases illustrate the need to discuss the manner in which we die, much earlier in our lives and as a society, we seem loath to ever discuss the manner of our deaths, until we are in a terminal health crisis. Even sadder, is that following the High Court’s rejection of Tony Nicklinson’s case, he gave up his fight and succumbed to pneumonia.

It seems a whole-life approach to talking about death and dying could be easily achieved through the introduction of something very similar to a Birth Plan, which expectant mothers routinely develop with their partner and midwives. Wouldn’t something similar in the manner of an Advanced Directive, be a simple and useful resource to develop? Could Health Visitor’s and Palliative Care Nurse’s be a more visible part of this conversation, earlier in our lives?

Admittedly, this doesn’t take into account the political and social ramifications of assisted dying, voluntary euthanasia, or more generally our right to die in a manner and at a time of our choosing, but nevertheless it introduces and normalises conversations about life and death - something to which we seem culturally divorced from.

I’m pleased to say I’ll be working with a new Arts for Health intern for 12 months alongside MA Contemporary Curating, and we’ll be exploring some of these very issues: issues which I began to discuss in relation to culture and the arts last year, in my opening paper; Towards Sentience, at the 4th International Arts and Health Conference at the National Gallery of Australia. We’ll be holding an exhibition here at The Holden Gallery in July 2013, which will be accompanied by a series of events and discussions, and is being developed under the working title of ‘Imagining Death’.

Inequalities & death - blimey, seems insurmountable doesn’t it? Well, death certainly is, but inequalities, quality of life and the manner in which we die are something we can most definitely have some control over. Whilst we struggle blindly to make sense of seemingly immovable inequalities, we miss their connection to poverty of aspiration and wide-spread disillusionment at politics; we miss the connection to apathy and blind acceptance of inequalities. The Bank of England’s Quantitative Easing has helped the wealthier citizens of the UK markedly, but has been invisible to the majority of us - unacceptable. Poorer people die earlier than wealthier people? Sorry - this is outrageous. 

Quantitative Easing is having limited impact on the austerity we’re all facing, the Kings Fund have illustrated the failure of policy to impact on the poorest in the UK, our high streets are increasingly boarded-up; grocers, bakers and butchers being replaced by fast-food outlets, betting shops, coffee chains and mobile-phone and charity shops. The banks and building societies seem to be surviving, albeit in a fortified manner, but other than the proliferation of increasing necessary charity shops, our high streets represent something of the 21st century drug peddler. There’s no shortage of plasma screens for our telephone-based talent shows; computer games to feed our short attention span; alcopops, caffeine and fried gizzards. All you can eat for £2.99 - not bad eh? Short cut to a state sponsored short life...

I worry that some of the blindingly superb work of arts/health practitioners/projects, whilst cushioning and supporting marginalised and displaced individuals, frequently fails to engage the very same people - often miraculously turned around, in engagement with the political process. What we do so unequivocally, is enable people to grow and thrive - give people a voice - but doesn’t this singular voice need to be connected to that of others? If we are meaningfully lifting people from isolation, depression or giving voice to people affected by homelessness - what next: just put them right back into a system that feeds on such divisions? How can we connect our practice and facilitate real change? Well for a start, we can acknowledge that both our health and wellbeing, and the arts, are political.

So, as an antidote to all this, and with our home-spun Olympian NHS Saviour in mind, Danny Boyle, lets remind ourselves of his interpretation of the Irvine Welsh novel Trainspotting. The following brief extract from the film, offers something of a poem to our consumer addiction. Be warned though, it is peppered with expletives that are appropriate, but that might offend. Text below and video, by clicking on the film.

Choose Life. 

Choose a job. Choose a career. Choose a family. Choose a fucking big television, choose washing machines, cars, compact disc players and electrical tin openers. Choose good health, low cholesterol, and dental insurance. Choose fixed interest mortage repayments. Choose a starter home. Choose your friends. Choose leisurewear and matching luggage. Choose a three-piece suite on hire purchase in a range of fucking fabrics. Choose DIY and wondering who the fuck you are on a Sunday morning. Choose sitting on that couch watching mind-numbing, spirit-crushing game shows, stuffing fucking junk food into your mouth. Choose rotting away at the end of it all, pishing your last in a miserable home, nothing more than an embarrassment to the selfish, fucked up brats you spawned to replace yourself.

Choose your future.

Choose life...                                     John Hodge/Irvine Welsh  

Volunteering in the Arts Toolkit Launch

You are invited to the launch of the Volunteering in the Arts Toolkit September 10th at the GMCVO centre, Ardwick Green, Manchester. Full details, including how to book can be found by clicking on the ice-cream van.

We have been working with Arts Council England and Volunteering England on the production of the Toolkit. It developed as a result of an audit of Arts Council funded organisations s who currently work with volunteers. The toolkit is aimed at professional arts organisations to support them in the recruitment, management and retention of volunteers with the aim of improving the volunteer experience for both host organisation and volunteer. This really useful resource comes with case studies, guides and a whole range of relevant information including health and safety, safeguarding, working with volunteers on benefits and advice on how to avoid using volunteers as substitutes for paid workers. The toolkit is free and will be downloadable from the Voluntary Arts website.

The State of Arts and Health in England and Further Afield...

In 2009 and alongside colleagues from the field, I contributed to the introductory essay, the State of Arts and Health in England, to Arts and Health: An International Journal for Research, Policy and Practice. Since this paper was written the face of arts/health practice and research has evolved at a fast pace. Taking into account the political landscape of the UK and the ongoing changes within the public sector, I am working with colleagues in Europe to better understand the changing field, and am revisiting this paper. I am particularly keen to hear from you in relation to mapping and research undertaken between 2009 and 2012 and am also keen to hear from international research projects. Please email me directly at artsforhealth@mmu.ac.uk 

Networking Event

BANG...out of the blue, a brand new one-off event. No agenda. No guest speaker. Just us having the opportunity to chew the fat, and perhaps hatch some plans! Thursday 27th September 6:00 - 8:00PM. So email artsforhealth@mmu.ac.uk if you want to come along, and the venue at MMU will be emailed to you the week before.

Thank you...C.P

When I won't accept a guest post

I get regular requests from people who want to guest post on my blog. Then, I got this unbelievable one yesterday. More unbelievable was that I saw it almost directly after giving a lecture on evidence-based nutrition. Thought I'd share.

The 2012 Atherosclerosis egg study: Plaque decreased as LDL increased with consumption of 2.3 eggs per week or more

A new study by David Spence and colleagues, published online in July 2012 in the journal Atherosclerosis (), has been gaining increasing media attention (e.g., ). The article is titled: “Egg yolk consumption and carotid plaque”. As the title implies, the study focuses on egg yolk consumption and its association with carotid artery plaque buildup.

The study argues that “regular consumption of egg yolk should be avoided by persons at risk of cardiovascular disease”. It hints at egg yolks being unhealthy in general, possibly even more so than cigarettes. Solid critiques have already been posted on blogs by Mark Sisson, Chris Masterjohn, and Zoe Harcombe (, , ), among others.

These critiques present valid arguments for why the key findings of the study cannot be accepted, especially the finding that eggs are more dangerous to one’s health than cigarettes. This post is a bit different. It uses the data reported in the study to show that it (the data) suggests that egg consumption is actually health-promoting.

I used the numbers in Table 2 of the article to conduct a test that is rarely if ever conducted in health studies – a moderating effect test. I left out the “egg-yolk years” variable used by the authors, and focused on weekly egg consumption (see Chris’s critique). My analysis, using WarpPLS (), had to be done only visually, because using values from Table 2 meant that I had access only to data on a few variables organized in quintiles. That is, my analysis here using aggregate data is an N=5 analysis; a small sample indeed. The full-text article is not available publicly; Zoe was kind enough to include the data from Table 2 in her critique post.

Below is the model that I used for the moderating effect test. It allowed me to look into the effect that the variable EggsWk (number of eggs consumed per week) had on the association between LDL (LDL cholesterol) and Plaque (carotid plaque). This type of effect, namely a moderating effect, is confusing to many people, because it is essentially the effect that a variable has on the effect of another variable on a third. Still, being confusing does not mean being less important. I should note that this type of effect is similar to a type of conditional association tested via Bayesian statistics – if one eats more eggs, what is the association between having a high LDL cholesterol and plaque buildup?

You can see what is happening visually on the graph below. The plot on the left side is for low weekly egg consumption. In it, the association between LDL cholesterol and plaque is positive – eating fewer eggs, plaque and LDL increase together. The plot on the right side is for high weekly egg consumption. In this second plot, the association between LDL cholesterol and plaque is negative – eating more eggs, plaque decreases as LDL increases. And what is the turning point? It is about 2.3 eggs per week.

So the “evil” particle, the LDL, is playing tricks with us; but thankfully the wonderful eggs come to the rescue, right? Well, it looks a bit like it, but maybe other foods would have a similar effect. In part because of the moderating effect discussed above, the multivariate association between LDL cholesterol and plaque was overall negative. This multivariate association was estimated controlling for the moderating effect of weekly egg consumption. You can see this on the plot below.

The highest amount of plaque is at the far left of the plot. It is associated with the lowest LDL cholesterol quintile. (So much for eggs causing plaque via LDL cholesterol eh!?) What is happening here? Maybe egg consumption above a certain level shifts the size of the LDL particles from small to large, making the potentially atherogenic ones harmless. (Saturated fat consumption, in the context of a nutritious diet in lean individuals, seems to have a similar effect.) Maybe eggs contain nutrients that promote overall health, leading LDL particles to "behave" and do what they are supposed to do. Maybe it is a combination of these and other effects.

One cannot resist an idea whose time has come...

So, two years each in prison for three women who expressed their opinion of the state through peaceful protest. Looks like impotent leadership in the face of inevitable global change to me. When French author, Victor Hugo said that "music expresses that which cannot be said, and on which it is impossible to be silent", I’m pretty sure, he couldn’t have imagined Pussy Riot - but with Les Misérables in mind, I can’t help thinking he would perhaps be a more effective vocal supporter, than Messrs. McCartney et Madonna. Surely its becoming more difficult for dubiously ‘elected’ leaders to quash the voices of the people? Then again, millions across the world took to the streets to oppose the attack on Iraq; and I’m still confused as to how the Coalition Government came into being!

'The NHS belongs to the people' 

NHS Constitution

Whilst our the Olympic Games have been and gone, the flame blown out (remember that stirring in your loins, but get ready for the bill) and we’ve had the thrill of the opening corporate celebration of our floundering NHS, (and the gibberish of the closing ceremony - what a platform for Pussy Riot this could have been): what about the Paralympic Games which start on the 29th? I sincerely hope that this won’t be an after-shock, without all the razzmatazz of the ‘main-event’. I wonder too, what mischief our elected and non-elected miscreants will have been up to, whilst our eye’s have been off (or rather on) the ball? So whilst we’re feeling pumped up and patriotic, lets not forget our dear old NHS and that by April 2013, it will have undergone some quite radical changes.

'Healthwatch England will act as a champion for those who sometimes struggle to be heard' 

Anna Bradley, Chair of Healthwatch

The new NHS Commissioning Board Special Health Authority (NHS CBA), will be playing a ‘key role in the Government’s vision to modernise the health service and secure the best possible outcomes for patients. Its role is to make all the necessary preparations for the successful establishment of the NHS Commissioning Board (NHS CB) in October 2012 before it takes on full statutory responsibilities in April 2013.’ We will shortly be seeing a flurry of activity around Health and Wellbeing Boards, Clinical Commissioning Groups and the emergence of Healthwatch, which takes over the role of independent ‘consumer champion’ for us, the public. I’d suggest that our arts/health agenda should engage at the highest level with all these groups, and of course, locally. If Healthwatch is to make sure that the views of the public and people who use services are taken into account, I can think of a variety of ways that culture and the arts will be essential to their work -  and if they genuinely want to work with people who don’t have a voice and are marginalised, this is an opportunity for the arts to facilitate dialogue. 

On 19 July 2012, champion of arts and health, Lord Howarth of Newport again raised a question about our work in the House of Lords, questioning the Government Minister Earl Howe about how we encourage commissioners to invest resources in the arts as a means of improving health. Here are the question and response.

Lord Howarth of Newport: My Lords, as Ministers review the skills needs of the health service, will they take into account the significant contribution that can be made in healthcare settings to recovery and well-being by the arts-music, poetry and reading aloud, for example? Will they signal to healthcare professionals and commissioning bodies that it is legitimate to invest certain resources in the arts and, of course, design in order to promote good health?

Earl Howe: One of the features of the reforms that we have enacted is the ability for allied health professionals, including those mentioned by the noble Lord, to have a say in the planning of services at a local level-health and well-being boards. The value of those activities, rightly emphasised by the noble Lord, will I hope in time be more greatly appreciated as the outcomes framework takes effect, and the patient experience of care becomes more prominent in the way that we assess services.

We should be very aware of the efforts Alan Howarth puts into this agenda, and he has my debt of gratitude for his consistent efforts and enthusiasm. He was in fact, an early respondent to manifesto part one. Here is a reminder of his position.

‘What is at issue is the right each one of us has to be human. To be human is to identify and liberate our own authentic and best nature. That quest will sometimes be private and sometimes be communal, and in the end the one merges into the other as we make the world we inhabit a better place. Trust, arduousness, risk, self-expression, shared work are means of moving towards individual and collective integrity. Teaching and companionship sustain us; orthodoxy and exploitation blight us. 

Politics should be predicated on these values.’

I was thrilled to listen to the soundcloud of A.L Kennedy’s wonderful lecture at the launch of the London Creativity and Wellbeing Week at TATE Modern. This is excellent and is well worth taking the time to listen to. Grab a coffee, unplug the phone, click on the image below and take an hour out.

With Kennedy, Lord Howarth and the muted voices of Pussy Riot in mind, Victor Hugo again reminds me that we are part of something bigger and regardless of individual politics, and peoples determination to suppress voices that they might not like to hear - you can’t resist an idea who’s time has come. On résiste à l'invasion des armées; on ne résiste pas à l'invasion des idées.

THREE NEW FUNDING STREAMS...

OK, so we know they’re bankers, but...

Lloyds TSB Foundation: Programme to Support Older People (England & Wales) The Lloyds TSB has announced a new £2 million funding programme to support projects aimed at improving the lives of older people living in difficult financial circumstances in England and Wales.  The funding is open to all registered charities that are currently working with older people particularly those living in financial difficulties; that can demonstrate a track record and knowledge of working with this group of people; and are particularly interested in innovative work and proactive interventions that encourage and support individual empowerment and independence.  The minimum grant that eligible organisations can apply for is £50,000 and grants will be available for up to a period of three years. The closing date for submissions is 5pm on the 20th September 2012.
Read more at: http://tinyurl.com/d7xvyax

Funding to Tackle Stigma & Discrimination Facing People with Mental Illness (England) Time to Change, a new campaign to end the stigma and discrimination that faces people with mental health problems, has announced its second funding round.  Time to Change will provide grants for projects which will change public attitudes and behaviour towards mental health problems.  The grants fund will distribute £2.7 million to approximately 75 community projects across England from May 2012-March 2015.  All applications should evidence how people with personal experience of mental health problems will be involved in shaping, delivering and managing the project. The grants available range from £10,000 through its small grants programme, to up to £100,000 through the Flagship grants programme. The closing date for applications is 2pm on the 21st September 2012. Read more at: http://www.time-to-change.org.uk/grants

The LankellyChase Foundation has announced the launch of its new grants programme. The LankellyChase Foundation works to bring about change that will transform the quality of life of people who face severe and multiple disadvantages. Through its new grants programme the Foundation wants to form a funded network of 15 to 20 organisations who are working to transform the lives of people who face severe and multiple disadvantages. Read more at: www.lankellychase.org.uk/accessing_funding/funding_opportunities. 

Deadline: 14 September 2012

Thank you for following this blog...C.P.

Ancestral Health Symposium 2012: Evolutionarily sound diets and lifestyles may revolutionize health care

The Ancestral Health Symposium 2012 was very interesting on many levels. Aaron Blaisdell and the team of volunteers really did a superb job at organizing the Symposium. Boston is a great city with an excellent public transportation system, something that is always great for meetings, and a great choice for the Symposium. Needless to say, so was Harvard. Even though the program was packed there were plenty of opportunities to meet and talk with several people during the breaks.

We had our panel “New Technologies and New Opportunities”, which Paul Jaminet moderated. The panelists were Chris Keller, Chris Kresser, Dan Pardi, and myself. The first photo below, by Bobby Gill, shows Chris Keller speaking; I am on the far left looking at the screen. The second photo, by Beth Mazur, shows all the panelists. The third photo, also by Bobby Gill, shows a group of us talking to Stephan Guyenet after his presentation.

I talked a bit toward the end of the panel about the importance of taking nonlinearity into consideration in analyses of health data, but ended up being remembered later for saying that “men are women with a few design flaws”. I said that to highlight the strong protective effect of being female in terms of health, which was clear from the model I was discussing.

There is a good evolutionary reason for the protective effect of being female. Evolution is a population phenomenon. Genes do not evolve; neither do individuals. Populations evolve through the spread or disappearance of genotypes. A healthy population with 99 men and 1 woman will probably disappear quickly, and so will its gene pool. A healthy population with 99 women and 1 man will probably thrive, even with the drag of inbreeding depression. Under harsh environmental conditions, the rate of female-to-male births goes up, in some cases quite a lot.

I was able to talk to, or at least meet briefly face-to-face with, many of the people that I have interacted with online on this blog and other blogs. Just to name a few: Miki Ben-Dor, Aaron Blaisdell, Emily Deans, Andreas Eenfeldt, Glenn Ellmers, Benjamin Gebhard, Stephan Guyenet, Dallas Hartwig, Melissa Hartwig, Paul Jaminet, Chris Keller, Chris Kresser, Mathieu Lalonde, Robert Lustig, Chris Masterjohn, Beth Mazur, Denise Minger, Jimmy Moore, Katherine Morrison, Richard Nikoley, Dan Pardi, Kamal Patel, David Pendergrass, Mark Sisson, Mary Beth Smrtic, J. Stanton, Carlos Andres Toro, and Grayson Wheatley.

It would have been nice to have Peter (from Hyperlipid) there, as I think a lot of the attendants are fans. I attended Jamie Scott’s very interesting talk, but ended up not being able to chat with him. This is a pity because we share some common experiences – e.g., I lived in New Zealand for a few years. I did have the opportunity to talk at some length with J. Stanton, who is an inspiration. It was also great to exchange some ideas with my panelists, Miki Ben-Dor, Emily Deans, Stephan Guyenet, Chris Masterjohn, Kamal Patel, and David Pendergrass. I wish I had more time to talk with Denise Minger, who is clearly a very nice person in addition to being very smart. Talking about a smart person, it was also nice chatting a bit with Richard Nikoley; a successful entrepreneur who is in the enviable position of doing what he feels like doing.

I could not help but notice a tendency among some participants (perhaps many, judging from online threads) to pay a lot of attention to how other people looked in a very judgmental way. That person is too fat, his/her face is too red, she/he looks too old etc. So was this supposed to be the Ancestral Health Pageant 2012? There is nothing wrong with looking good. But many people adopt an evolution-inspired lifestyle because they are quite unhealthy to start with. And this includes some of the presenters. It takes time to change one’s health, relapses occur, and no one is getting younger. Moreover, some of the presenters’ ideas and advice may have much more dramatic positive effects on people other than themselves, because of their own pre-existing conditions. The ideas and advice are still solid.

A message that I think this Symposium conveyed particularly well was that an evolutionarily sound diet and lifestyle can truly revolutionize our health care system. Robb Wolf’s talk in particular, based on his recent experience in Nevada with law enforcement officers, made this point very effectively. The title of the talk is “How Markets and Evolution Can Revolutionize Medicine”. One very interesting idea he put forth was that establishments like gyms could expand the range of support activities they offer their customers, officially becoming the beginning of the health care chain. There are already health insurance plans that offer premium reductions for those who go to gyms. Being part of the health care chain would be different and a significant step forward - diet and exercise are powerful "drugs".

One thing that caught me a bit off-guard was Robb’s strong advocacy of the use of a drug, namely metformin (a.k.a. glucophage); even preventively in some special cases, such as with sleep-deprived law enforcement officers. I have to listen to that talk again when it is up online, to make sure that I understood it correctly. It seems to me that changing the nature of shift work among law enforcement officers, at least partially, may be a better target; current practices appear not only to impair the officers’ health but also their effectiveness in law enforcement activities. Besides, I think we need to better understand the nature and functions of cortisol, which is viewed by many as a hormone that exists only to do us harm.

Sleep deprivation is associated with an elevation in cortisol production. Elevated cortisol levels lead over time to visceral fat accumulation, which promotes systemic inflammation. Systemic inflammation is possibly the root cause of most diseases of civilization. But cortisol itself has powerful anti-inflammatory properties, and visceral fat is generally easy to mobilize through intense exercise – probably one of the key reasons why we have visceral fat. I think we need to understand this situation a bit better before thinking about preventive uses of metformin, which nevertheless is a drug that seems to do wonders in the treatment of type 2 diabetes.

Beth Mazur was kind enough to put up a post with links to various Ancestral Health Symposium 2012 summary posts, as well as pictures. Paul Jaminet has a post with an insightful discussion of our panel at the Symposium.

Leaving the room for five minutes...

OK...it’s time that this blog took a moment to rest, to reflect on the very nature of life. There will be a short intermission whilst Arts for Health pulls down the blinds and shuts up shop for a couple of weeks. Tiaras and tears will be on plentiful display on the streets of our empty capital. 

This year has seen the highest number of hits this modest blog receives, with new friends emerging from the unlikeliest of countries. To those of you who quietly read these pages, I hope you find this work interesting and occasionally, entertaining: and for those of you who go on to get in touch, thank you. One or two of you, I feel lucky enough to call friends - so a big thank you to you. 

This field we call Arts for Health; Arts in Health or Arts and Health is expanding and contracting - evolving right before our eyes. Its flexing its muscles too. Those in the wider cultural sector are getting it - realising that if the work’s done well, it can have a profound reach and impact. And then there are those exhilarating health practitioners, who’ve always got it, and who are now seeing a window of opportunity to assert the place of culture and the arts in the very real world of health and wellbeing. Acute settings, cultural settings, prisons, schools, on the streets, in shopping centre’s and yes, in theaters and galleries too - this arts and health thing we do, is transforming itself into more diverse and engaged practice - the beating heart of civic societies, that will emerge from the wreckage of our contemporary dystopia. 

Lets re-imagine ourselves then: post olympics - post jubilee - post global economic downturn...post dystopia. Its hard, isn’t it? From Robert Montgomery’s poetic attack on consumer culture and Shamsia Hassani’s graffiti on the streets of Kabul, to Pussy Riot’s neutering by an oppressive government - the arts offer critique of the status quo and give voice to frustration and anger, offering a thousand new opportunities of possible futures. Our wellbeing is at stake if we fail to understand the relevance of culture and the arts in relation to wider social and political agendas. Goodbye for now, enjoy life...and a lovely summer song.