Well, yes, obviously

More children die unnecessarily in Britain than in any of 14 other western European countries, according to a study which found that thousands of lives could be saved each year.

For the NHS performs badly on the one health care measurement that matters: deaths amenable to medical treatment.

That there are excess treatable deaths in one section of the population when there are excess treatable deaths in all sections of the population is hardly a surprise.

45 thoughts on “Well, yes, obviously”

  1. Tim, “avoidable deaths” generally have got not much to do with the NHS and a lot to do with lifestyle – the nanny state measures you hate would be what’s needed to reduce them.

    The Lancet paper behind this report seems not yet to be available online, but one cause of the UK’s high child mortality is asthma. The NHS could do better (with more nannying of asthma sufferers) but the main reason the UK does worse than other countries is that it has a high incidence of asthma. Which is not the fault of the NHS.

  2. have to say I prefer the term avoidable deaths

    unnecessary deaths raises the question of why it was that the other children had to die?

  3. Thanks Unity. Correcting what I wrote earlier: the paper shows that UK mortality from asthma is high even relative to the incidence.

    Here’s what we need to do to improve things:

    If all countries in the EU15 could reduce their child mortality to that of Sweden (the best-performing country), more than 6000 excess deaths could have been prevented in 2010 (table). This goal is achievable. Many aspects of child health are affected by government policies, especially policies that affect the distribution of resources, employment, housing, education, and health care. Thus, countries with high spending on social protection for families generally have low rates of child death

  4. Many aspects of child health are affected by government policies, especially policies that affect the distribution of resources, employment, housing, education, and health care. Thus, countries with high spending on social protection for families generally have low rates of child death

    This isn’t medical science, it’s political campaigning.

  5. It’s not political campaigning, it’s epidemiology.

    The study finds that the UK’s model for delivering paediatric care is one of the major factors associated with excess child mortality; and that the UK’s distribution of resources is the other.

    Political campaigning would be to seize on the first finding and say “THE NHS IS SHIT” while ignoring the point about equality; or to seize on the second finding and say “POLLY IS RIGHT” while ignoring the point about healthcare organisation.

  6. The study finds that the UK’s model for delivering paediatric care is one of the major factors associated with excess child mortality; and that the UK’s distribution of resources is the other.

    I’m sorry, without even bothering to look at it I know that this study would fail under the most basic of scientific scrutiny: where was the control group?

    The fact they need to insert weasel words such as “associated” tells you that. It’s speculation, nothing more, aimed at supporting a preconceived political goal.

  7. PaulB,

    If all countries in the EU15 could reduce their child mortality to that of Sweden (the best-performing country), more than 6000 excess deaths could have been prevented in 2010 (table). This goal is achievable. Many aspects of child health are affected by government policies, especially policies that affect the distribution of resources, employment, housing, education, and health care. Thus, countries with high spending on social protection for families generally have low rates of child death

    What’s any of that got to do with asthma? How does redistributing resources or spending more money on education reduce it?

  8. TimA: That’s an interesting question. I don’t know the answer, but I can make some suggestions.

    This paper reports that the highest childhood asthma mortality rates are in Singapore, Panama, Thailand, UK, and USA. Which I think makes it pretty hard to make a case that the healthcare model is the primary factor.

    Plausibly, the following measures would decrease mortality:
    – reduce exposure to asthma triggers, including cigarette smoke, traffic fumes, and moulds.
    – educate patients and their carers in the importance of using prophylactic corticosteroids to reduce the frequency of attacks.
    – help patients and carers to recognize potentially serious attacks and seek medical attention urgently when they occur.

  9. “Where’s the control group?”

    For comparative purpose, Sweden.

    “weasel words such as ‘associated'”

    No, ‘associated’ is perfectly correct as we’re looking at epidemiological data comparing primary health indicators across multiple domains, hence correlations.

    This is hardly controversial stuff, if you can be bothered to pull your head out of your arse and look at the evidence. Associations between poverty and poor health have been well documented for more than a century.

    “What’s any of that got to do with asthma? How does redistributing resources or spending more money on education reduce it?”

    As questions go that’s pretty much on the level of asking what the prevalence of cholera has to do with people shitting in the local water supply, but as Paul B has pointed out reduction of exposure to asthma triggers such as moulds is a relevant factor and an increased risk of exposure to moulds is associated with poor quality housing stock which is, of course, lived in by people with not much money, etc.

    It’s called the social model of health and it works on a very simple principle – if you can stop people getting sick in the first place, by addressing the many non-communicable causes of poor health, then you’ll reduce the overall cost of healthcare services.

    Prevention is not just better than a cure, it’s also a damn sight cheaper in the long run.

  10. “Paul B has pointed out reduction of exposure to asthma triggers such as moulds is a relevant factor and an increased risk of exposure to moulds is associated with poor quality housing stock which is, of course, lived in by people with not much money, etc.”

    That’s a very interesting connection you’re making there.
    Now one thing I’ve learnt since I started messing about with Spanish properties is that there’s hardy any of them without serious mould problems. For some reason, the Spanish builder just doesn’t get the concept of ventilation. And the idea this country is permanently arid disappears if you live here. This is the driest part & we’ve had a foot of rain in two weeks.
    So you’ve poorly constructed, leaking roofs, almost total absence of proper damp courses & the widespread use of bottle gas heaters which produce a litre of water for every litre of gas burned. From luxury villas to village cortijos, they’re wringing wet from autumn until spring. Various moulds positively thriving everywhere you look. Worse than anything I’ve ever seen in the UK. And from what I’ve seen, Portugal’s no better.
    So the Iberian peninsular must, by rights, be a hotbed of asthma. But doesn’t appear on your list.

  11. Oh, & just to confound you cause lists, everybody including the family dog, smokes here & the traffic fumes in the narrow city streets, surrounded by high rise apartment blocks, can be eye stinging.

  12. For comparative purpose, Sweden.

    So how are other factors compensated for? Answer: they’re not.

    No, ‘associated’ is perfectly correct as we’re looking at epidemiological data comparing primary health indicators across multiple domains, hence correlations.

    I bet you can’t find me a single graph or set of data which shows a correlation between child mortality and model of pediatric healthcare delivery.

    Associations between poverty and poor health have been well documented for more than a century.

    Nobody is arguing otherwise.

  13. Paul B has pointed out reduction of exposure to asthma triggers such as moulds is a relevant factor and an increased risk of exposure to moulds is associated with poor quality housing stock which is, of course, lived in by people with not much money, etc.

    Right, so point to the data which shows a clear correlation between those who live in damp houses and those who suffer from asthma, instead of assuming – rightly or wrongly – that damp houses cause asthma and then leaping to another assumption – which is probably wrong* – that it is mainly the poor who live in damp houses, and then lurch into a conclusion that it is therefore the poor who suffer from asthma.

    *If this were the case, you’d expect to see people living in old houses – especially coastal farmhouses – suffering from asthma.

  14. “It’s not political campaigning, it’s epidemiology.”

    It’s not cheese, m’lud, it’s cheddar.

  15. so point to the data which shows a clear correlation between those who live in damp houses and those who suffer from asthma

    Here you are.

    But what I wrote is not that mould causes asthma, but that mould can trigger asthma attacks. That’s well established – google it.

  16. @ PaulB
    To quote your own link
    “”These finding strengthen evidence that exposure to moulds increases the risk of developing asthma in childhood…”

    So they think it’s causative

    “He adds: “The results of this study are of interest in every country where housing stock is prone to damp, and add to previous studies linking asthma with chemicals and cigarette smoke. Simple ways to protect children against developing asthma include keeping damp and mould at bay, exposing children to fresh air, and never letting them breathe second hand cigarette smoke”.

    But hang on. Asthma rates in children are rising. Yet exposure to second hand smoke has been falling as less people smoke

    So like much of the stuff you quote, this is yet another load of bollocks.

  17. But what I wrote is not that mould causes asthma, but that mould can trigger asthma attacks. That’s well established – google it.

    I wasn’t addressing you, I was addressing Unity – which is probably why you’ve missed the point by a mile and a half.

  18. bis: Right. The number of cars on uk roads has gone up fairly consistently for the last forty years. and the road accident mortality rate has gone down fairly consistently. That proves that cars don’t cause road traffic accidents. Or perhaps there’s something wrong with your logic.

    However, I offered the links just to be helpful. My point stands even in the vanishingly unlikely event that you understand asthma aetiology better than asthma researchers do.

  19. If smoking causes asthma in children why has the frequency of asthma in children risen as smoking has declined in the UK. Why doesn’t China feature in the list of nations with high childhood asthma rates?
    If it’s traffic fumes exactly the same question applies – traffic fumes in the UK are far lower than 40-50 years ago while Beijing’s smog is almost as notorious as London’s was in the early ’50s.

  20. @ #22 Paul B
    That link doesn’t actually take me to any data, just an article saying that if you are allergic to a particular mould then breathing in spores of that mould can trigger an allergic reaction. I don’t think I would want to dispute that, but I haven’t learned anything I didn’t already know.

  21. Tim (Newman)

    You want to know where the data is?

    Pubmed – big fuck off online database of articles from reputable medical journals where people who actually want to try an understand things rather than wave their dick around go to find published journal papers.

    As of about 2 minutes ago, a search for “Asthma Environmental Factors” returns 5724 papers published between 1950 and 2013 of which the three most recent are – guess what – by Chinese researchers – well there’s a fucking surprise given what we know about levels of atmospheric pollution in China these days.

  22. PaulB had a mate once who took some drugs and fell off some scaffolding – help me out here, Paul, this is right yes? – and on that basis he thinks he should get to decide drugs policy. I think the same logic applies elsewhere. We’re in safe hands with this one!

  23. No, it’s wrong. If you care at all about the truth, which I doubt, you can use an internet search engine to find out what I wrote. But, if it’s any help, I’m sorry I wrote it, and wouldn’t have done if it had occurred to me that people like you (that’s a term of disrespect) might want to bring it up as some sort of commentary on the question of whether the NHS is responsible for childhood asthma deaths.

  24. You want to know where the data is?

    No, I already know. I have no problem with scientific data which demonstrates X is caused by Y. Indeed, my own profession depends on it.

    But I have serious problem with political campaigning which attempts to extrapolate a politically desired solution from scientific data, with the whole mess appearing in scientific journals and being presented as sound science.

  25. “bis: Right. The number of cars on uk roads has gone up fairly consistently for the last forty years. and the road accident mortality rate has gone down fairly consistently. That proves that cars don

  26. “bis: Right. The number of cars on uk roads has gone up fairly consistently for the last forty years. and the road accident mortality rate has gone down fairly consistently. That proves that cars don t cause road traffic accidents. Or perhaps there’s something wrong with your logic.”
    The logic of that statement would be cars have become safer in 40 years.
    Attributing a rising rate of asthma to a falling rate of smoking would either imply cigarettes are becoming more dangerous. Or passive smoking is efficacious in the treatment of asthma.
    But that s logic for you.

    Paul. I grew up in a London where smoking was regarded as good for the health, houses were heated by smoky paraffin heaters equivalent to sharing the room with an operating diesel engine & fogs so thick you could get lost trying to cross a street. By your experts reckoning I died in 1955.
    Have some respect for the deceased

  27. bis: No one is attributing a rising rate of asthma to a falling rate of smoking. Scientists who’ve studied the question agree that smoking is a causative factor in asthma, but there are many other factors: presumably it’s some of those other factors which are responsible for the increase.

    Whatever the circumstances of your childhood, they created a risk of various diseases, not a certainty. Evidently most children survived. The Lancet paper gives a calculation of just under 2,000 excess child deaths in the UK compared with rates in Sweden. That’s an excess of 18 deaths per 100,000 children, which is not a risk you’d want to subject your child to, but a long way from certain death. If you care about these statistics you need to recognize that we are talking about very small differences in risk affecting large populations.

    Respect for the deceased, certainly. But not for the reasoning powers of a corpse.

  28. If you care about these statistics you need to recognize that we are talking about very small differences in risk affecting large populations.

    Indeed. But this doesn’t stop people using it as justification for new levels of government-directed “resource distribution” on a national scale (with seemingly no understanding of the concept of trade-offs).

    Note: I am not disputing the study’s findings, nor would I dispute recommendations which target the *precise* cause of the problems. It is the enormous jump from the study’s findings to calls for greater “resource distribution” that I object to.

  29. @Cane – broadly speaking, that is what he said, yes. It doesn’t tell us much about Paul’s view on the NHS/mortality rates, but it does give us an insight into his thinking, which is sometimes muddled.

  30. Paul
    The thing I’m disputing is studies that attribute causes to oh so convenient issues that suit other agendas. Would I accept a risk of 18/100,000 deaths of a child of mine? Bloody right I would, if it meant not having the levels of redistributive taxes Sweden has. As Tim Newman says above, it s all about trade offs. I d imagine, raising a child where I was living a while ago would raise the risk by more like 180/100,000. But a fantastic place for a kid to grow up.
    But you still haven t addressed the thing I disputed, have you? If you re making a case for mould infested housing as being causative of asthma, why aren t Spanish kids, growing up in mould infested houses, suffering high rates of asthma & showing up on your list? Could, of course, be the Spanish mortality rates are lower because Spain has a health system doesn t let kids die with the regularity of the NHS. Which, after all, does have form for inadequacy in lots of other areas.

  31. Oh & if you d ever gotten out from behind a desk & had the task of curing damp in British housing, you d find that the overwhelming cause is lack of ventilation, resulting in condensation on cold surfaces. Now a lot of this is the result of retrofitting old houses with double glazing & the high cost of heating, encouraging occupants to block what little ventilations left & turn down heating when the house isn t occupied . You ll note that all of these things are encouraged by government policy. Very clever.

  32. “Would I accept a risk of 18/100,000 deaths of a child of mine? Bloody right I would, if it meant not having the levels of redistributive taxes Sweden has.”

    I’m glad I’m not a child of yours.

  33. bis: I’m not particularly interested in making the case that mould is a cause for asthma, but as it happens the scientific evidence strongly suggests that it is. If you want to dispute the evidence, you could start by reading some of it.

    There are a lot of factors involved in the development of asthma, one of which is respiratory irritants such as mould spores. But that’s far from being the only factor; apparently other factors are less prevalent in Spain than in the UK.

    It really doesn’t make sense to blame the NHS for UK asthma mortality. Unless you want to condemn the health services in Singapore and the USA also.

  34. “bis: Im not particularly interested in making the case that mould is a cause for asthma, but as it happens the scientific evidence strongly suggests that it is.”

    PaulB @6
    “Correcting what I wrote earlier: the paper shows that UK mortality from asthma is high even relative to the incidence.

    Here

  35. 3rd time lucky?
    “bis: Im not particularly interested in making the case that mould is a cause for asthma, but as it happens the scientific evidence strongly suggests that it is.”

    PaulB @6
    “Correcting what I wrote earlier: the paper shows that UK mortality from asthma is high even relative to the incidence.

    Here is what we need to do to improve things:”
    And you quote
    “Many aspects of child health are affected by government policies, especially policies that affect the distribution of resources, employment, >housingmoulds<."

    Now, reading those I d say it was a logical conclusion to think you were advocating spending public money on reducing mould in British homes. You were the one to bring up the subject of moulds. No-one else mentioned them. But now you're not particularly interested in them.

    And Luke. The local paper from the area recently carried a story about a child fell into a river & drowned. That sort of thing is quite common up there. The kids ride their motos around the steep cobbled streets without crash helmets as well. And fall off of horses, no doubt. But they're not scared of being robbed on the way to school. Or in school. The teenage, unmarried, pregnancy rates minimal. And thats with an AoC of 13. They have few drug problems, despite cannabis growing wild.
    As Tim Newman said. Its about trade offs. Its one I would make.

  36. bis: What I wrote is:

    Plausibly, the following measures would decrease mortality:
    – reduce exposure to asthma triggers, including cigarette smoke, traffic fumes, and moulds…

    It’s beyond dispute that moulds can trigger asthma attacks. And if we reduce the number of asthma attacks, we’ll reduce mortality.

    It’s very likely that moulds are a factor in the development of asthma too. But I was talking about triggers, so that’s not directly relevant to what I said.

    At to whether it’s worth spending public money to save these lies, that is, as you say, a matter of trade offs. But it’s stupid to decline to spend the money then blame the NHS for the consequences.

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