Toilet shortage 'is health risk'

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19 January 2012 Last updated at 16:17 GMT Local authorities do not have legal duty to provide toilets A lack of public toilets puts vulnerable people at greater risk of strokes and heart attacks, assembly members have been told.

A cross-party committee also heard a shortage of toilets interfered with police work as officers had to return to their stations to use the toilet.

AMs took evidence on the public health implications of inadequate facilities in Wales.

They heard of a 40% decline in public toilets across the UK in 10 years.

Karen Logan, a nurse consultant and head of the continence service at Aneurin Bevan Health Board, told AMs about the severe consequences for someone forced to hold their bladder because a toilet is not available.

'Full bladder'

She said: "Holding on to a full bladder or bowel increases the heart rate, it increases blood pressure.

"For very old, ill, vulnerable people this could cause a stroke, a heart attack and other health implications."

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For very old, ill, vulnerable people this could cause a stroke, a heart attack and other health implications”

End Quote Karen Logan Nurse consultant She added: "I don't think it is quantified. It's probable, it's supposition really. There's no evidence there to say how many that could occur to or how many it has.

"It's just a physiological effect of holding on to a full bladder or bowel."

AMs heard evidence from British Toilet Association director Mike Bone that the number of toilets across the UK has decreased by some 40% over the last 10 years.

He said people working in vehicles - such as truck drivers, road maintenance workers, taxi drivers and police officers - were greatly affected.

Mr Bone said: "There are reports that, for example, police have been told that they must go back to the station... if they can't find a toilet and you can imagine a cost in terms of their time and the fact that they're not available to deal with crime while they're doing that.

"We've already heard about lorry drivers who've been fined for using a lay-by as a toilet when they've tried in five different towns to (find) a toilet.

"So this is a really big issue."

Gillian Kemp, of the Irritable Bowel Syndrome Network, said: "I have come across an incident where a police constabulary were told not to drink too much so they don't keep coming back to the police station, which is totally unacceptable."

Figures indicating the decline in toilet numbers in Wales are not available. It was suggested to members that this is because there is no requirement on councils to provide them.

Local authorities are not under a legal duty to provide toilets.

Source BBC

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Health trust in Army medics plan

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19 January 2012 Last updated at 22:31 GMT Pontefract Hospital's A&E department has been closed overnight since 1 November A health trust which shut its A&E unit in Pontefract overnight due to doctor shortages is considering using Army medics in a bid to solve the problem.

The department has been closed from 22:00 to 08:00 each day since November following the move by the Mid Yorkshire Hospitals NHS Trust.

The trust said it was looking at how Army medical staff could provide support on a temporary basis.

The night-time closure has drawn criticism from residents and MPs.

Wakefield Council's social care and health scrutiny committee met earlier to look at how the closure has affected people.

Councillor Betty Rhodes, chair of the committee, said members were "surprised" when the trust informed them of its approach to the Army.

"We found out for the first time that in order to look to reduce the gap, the trust had approached the Army to bring some medical staff in and they told us they haven't had a reply from the Army."

She added: "I actually asked them to reiterate the word in terms of the Army coming in."

Committee 'sceptical'

Ms Rhodes said the committee was "sceptical" of the trust's attempts to try to recruit doctors to enable the unit to reopen fully.

"The trust told us... they were finding it very difficult to find the middle management doctors that were necessary to provide the overnight service.

"Today we were very sceptical... because we have seen evidence other trusts, such as Mid Staffordshire, have actually resulted in their recruitment drive with a shortlist of 14 for their middle management."

In a statement, the trust said: "We have made contact with the Army and had early exploratory conversations."

A spokesperson for the trust said earlier it would reopen the unit as soon as enough doctors could be recruited to staff it safely.

The spokesperson said it was looking at a range of options based on the experience of other trusts.

"One of these options was to look at how medical staff who have been trained by the Army could provide some support on a temporary basis.

"We are in the early stages of looking at the viability of this as one of several possible options and there are no confirmed plans."

However, a Department of Health spokeswoman said there was no doctor shortage issue at Pontefract and that the MoD had told her it had received no approach from the Mid Yorkshire Hospitals NHS Trust.

'Very unusual'

Yvette Cooper, Labour MP for Pontefract and Castleford, said she welcomed any action which would mean additional doctors at the hospital, but she believed it was not a long-term solution.

"Clearly, the Army's priority is to be able to support their wounded soldiers and their personnel," she said.

"And while we want to do everything possible to get Pontefract A&E open, I think the government also needs to answer how it has come to this and why hospitals are now reliant on the Army."

Dr Richard Vautrey, deputy chairman of the British Medical Association's GPs Committee, said a hospital calling for help from Army doctors was "very, very unusual".

"We need to ask why doctors are not seeking to work at Pontefract Hospital or responding to the recruitment drive they have initiated," he said.

"There simply aren't that many Army-trained doctors sitting twiddling their thumbs," he added.

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Apple juice can pose a health risk _ from calories

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FILE - In this Sept. 15, 2011 photo, an apple and a pitcher of apple juice are posed together in Moreland Hills, Ohio. Despite the government's consideration of new arsenic limits on the juice, the real danger, nutrition experts say, is to waistlines and teeth. Apple juice and other juice-based beverages have relatively few natural nutrients, many calories and more sugar, in many cases, than a can of soda. (AP Photo/Amy Sancetta) FILE - In this Sept. 15, 2011 photo, an apple and a pitcher of apple juice are posed together in Moreland Hills, Ohio. Despite the government's consideration of new arsenic limits on the juice, the real danger, nutrition experts say, is to waistlines and teeth. Apple juice and other juice-based beverages have relatively few natural nutrients, many calories and more sugar, in many cases, than a can of soda. (AP Photo/Amy Sancetta) Chart shows per capita consumption of juiceeval("var currentItemd57851005a80479aaeeb90a12c70b9ff = 1;");eval("var nextd57851005a80479aaeeb90a12c70b9ff = 0;");eval("var previousd57851005a80479aaeeb90a12c70b9ff = 0;"); It's true — apple juice can pose a risk to your health. But not necessarily from the trace amounts of arsenic that people are arguing about.

Despite the government's consideration of new limits on arsenic, nutrition experts say apple juice's real danger is to waistlines and children's teeth. Apple juice has few natural nutrients, lots of calories and, in some cases, more sugar than soda has. It trains a child to like very sweet things, displaces better beverages and foods, and adds to the obesity problem, its critics say.

"It's like sugar water," said Judith Stern, a nutrition professor at the University of California, Davis, who has consulted for candy makers as well as for Weight Watchers. "I won't let my 3-year-old grandson drink apple juice."

Many juices are fortified with vitamins, so they're not just empty calories. But that doesn't appease some nutritionists.

"If it wasn't healthy in the first place, adding vitamins doesn't make it into a health food," and if it causes weight gain, it's not a healthy choice, said Karen Ansel, a registered dietitian in New York and spokeswoman for the American Dietetic Association.

The American Academy of Pediatrics says juice can be part of a healthy diet, but its policy is blunt: "Fruit juice offers no nutritional benefit for infants younger than 6 months" and no benefits over whole fruit for older kids.

Kids under 12 consume 28 percent of all juice and juice drinks, according to the academy. Nationwide, apple juice is second only to orange juice in popularity. Americans slurp 267 ounces of apple juice on average each year, according to the Food Institute's Almanac of Juice Products and the Juice Products Association, a trade group. Lots more is consumed as an ingredient in juice drinks and various foods.

Only 17 percent of the apple juice sold in the U.S. is produced here. The rest comes from other countries, mostly China, Argentina, Chile and Brazil, the association says.

Television's Dr. Mehmet Oz made that a key point a few months ago when he raised an alarm — some say a false alarm — over arsenic in apple juice, based on tests his show commissioned by a private lab. The Food and Drug Administration said that its own tests disagreed and that apple juice is safe.

However, on Wednesday, after Consumer Reports did its own tests on several juice brands and called along with other consumer groups for stricter standards, the FDA said it will examine whether its restrictions on the amount of arsenic allowed in apple juice are stringent enough.

Some forms of arsenic, such as the type found in pesticides, can be toxic and may pose a cancer risk if consumed at high levels or over a long period.

All juice sold in the United States must be safe and meet U.S. standards, said Pat Faison, technical director for the juice association. As for making good nutrition choices, "a lot of the information that people need about fruit juices is on the label," she said.

So what's on those labels?

Carbohydrates, mostly sugars, in a much higher concentration than in milk. Juice has a small amount of protein and minerals and lacks the fiber in whole fruit, the pediatrics academy notes.

Drinking juice delivers a lot of calories quickly so you don't realize how much you've consumed, whereas you would have to eat a lot of apples to get the same amount, and "you would feel much, much more full from the apples," Ansel said.

"Whole fruits are much better for you," said Dr. Frank Greer, a University of Wisconsin, Madison, professor and former head of the pediatrics academy's nutrition committee.

He noted that the WIC program — the U.S. Department of Agriculture's nutrition program for Women, Infants and Children — revised its rules in 2005 to replace juice with baby food fruits and vegetables for children over 6 months. More than half of all infants born in the U.S. are eligible for WIC, and the government "really cut back severely on the ability of mothers to get fruit juices" through the program, Greer said.

If you or your family drinks juice, here is some advice from nutrition experts:

—Choose a juice fortified with calcium and vitamin D-3.

—Give children only pasteurized juice — that's the only type safe from germs that can cause serious disease.

—Don't give juice before 6 months of age, and never put it in bottles or covered cups that allow babies and children to consume it throughout the day, which can cause tooth decay. For the same reason, don't give infants juice at bedtime.

—Limit juice to 4 to 6 ounces per day for children ages 1 to 6, and 8 to 12 ounces for those ages 7 to 18.

—Encourage kids to eat fruit.

—Don't be swayed by healthy-sounding label claims. "No sugar added" doesn't mean it isn't full of naturally occurring sugar. And "cholesterol-free" is silly — only animal products contain cholesterol.

___

Marilynn Marchione can be followed on Twitter at http://twitter.com/MMarchioneAP

___

Online:

Academy of Pediatrics on juice: http://tinyurl.com/qtkls

FDA: http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm271394.htm

WIC program advice: http://bit.ly/sYXqAi

Industry: http://www.fruitjuicefacts.org

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Wal-Mart's Health Plans for 2012 to Increase Premiums for Smokers

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Penalty per pay period that Wal-Mart's health insurance plans will require of employees who smoke in 2012. The cost will amount to $260 to $2,340 extra per year for those who want health coverage. According to the benefits consulting firm Mercer, several other large employers also charge higher premiums to workers who smoke; among the largest employers, about 28% adjust their premiums based on workers' tobacco use. [via The New York Times]

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Study: Living in poor neighborhood can hurt health

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Annie Ricks, 55, poses in her public housing apartment Wednesday, Oct. 19, 2011, in Chicago. Local housing authorities paid for her to relocate to the South Side last year as part of its demolition plans for high-rise tenements, but Ricks says her new neighborhood is worse. According to a study released Wednesday, Oct. 19, 2011, poor women in big city public housing given a chance to live in more affluent neighborhoods had lower rates of diabetes and extreme obesity. Ricks was not part of the study, but says such efforts should be expanded. (AP Photo/M. Spencer Green) Annie Ricks, 55, poses in her public housing apartment Wednesday, Oct. 19, 2011, in Chicago. Local housing authorities paid for her to relocate to the South Side last year as part of its demolition plans for high-rise tenements, but Ricks says her new neighborhood is worse. According to a study released Wednesday, Oct. 19, 2011, poor women in big city public housing given a chance to live in more affluent neighborhoods had lower rates of diabetes and extreme obesity. Ricks was not part of the study, but says such efforts should be expanded. (AP Photo/M. Spencer Green) Annie Ricks, 55, poses in her public housing apartment Wednesday, Oct. 19, 2011, in Chicago. Local housing authorities paid for her to relocate to the South Side last year as part of its demolition plans for high-rise tenements, but Ricks says her new neighborhood is worse. According to a study released Wednesday, Oct. 19, 2011, poor women in big city public housing given a chance to live in more affluent neighborhoods had lower rates of diabetes and extreme obesity. Ricks was not part of the study, but says such efforts should be expanded. (AP Photo/M. Spencer Green) Vickie Webb poses for a photograph at her apartment in Durham, N.C., Wednesday, Oct. 19, 2011. Webb, 43, lived in the projects in Durham, N.C. for several years before a housing agency helped relocate her and her husband to a better neighborhood. According to a study released Wednesday, Oct. 19, 2011, poor women in big city public housing a chance to live in more affluent neighborhoods. had lower rates of diabetes and extreme obesity. Webb was not part of the study. (AP Photo/Jim R. Bounds) Vickie Webb checks her blood pressure in her apartment in Durham, N.C., Wednesday, Oct. 19, 2011. Webb, 43, lived in the projects in Durham, N.C. for several years before a housing agency helped relocate her and her husband to a better neighborhood. According to a study released Wednesday, Oct. 19, 2011, poor women in big city public housing a chance to live in more affluent neighborhoods. had lower rates of diabetes and extreme obesity. Webb was not part of the study. (AP Photo/Jim R. Bounds) Vickie Webb stands in the door way of her apartment after checking her blood pressure in Durham, N.C., Wednesday, Oct. 19, 2011. Webb, 43, lived in the projects in Durham, N.C. for several years before a housing agency helped relocate her and her husband to a better neighborhood. According to a study released Wednesday, Oct. 19, 2011, poor women in big city public housing a chance to live in more affluent neighborhoods. had lower rates of diabetes and extreme obesity. Webb was not part of the study. (AP Photo/Jim R. Bounds)eval("var currentItemd57851005a80479aaeeb90a12c70b9ff = 1;");eval("var nextd57851005a80479aaeeb90a12c70b9ff = 0;");eval("var previousd57851005a80479aaeeb90a12c70b9ff = 0;"); ATLANTA (AP) — Back in the 1990s, the federal government tried an unusual social experiment: It offered thousands of poor women in big-city public housing a chance to live in more affluent neighborhoods.

A decade later, the women who relocated had lower rates of diabetes and extreme obesity — differences that are being hailed as compelling evidence that where you live can determine your health.

The experiment was initially aimed at researching whether moving impoverished families to more prosperous areas could improve employment or schooling. But according to a study released Wednesday, the most interesting effect may have been on the women's physical condition.

About 16 percent of the women who moved had diabetes, compared with about 20 percent of women who stayed in public housing. And about 14 percent of those who left the projects were extremely obese, compared with nearly 18 percent of the other women.

The small-but-significant differences offered some of the strongest support yet for the idea that where you live can significantly affect your overall health, especially if your home is in a low-income area with few safe places to exercise, limited food options and meager medical services.

"This study proves that concentrated poverty is not only bad policy, it's bad for your health," Shaun Donovan, secretary of the Department of Housing and Urban Development.

But no one believes the deficit-plagued federal government is going to expand the program and start moving low-income women to better neighborhoods en masse.

"It's not enough to simply move families into different neighborhoods," Donovan said. Instead, new ways must be found to help families "break the cycle of poverty that can quite literally make them sick." He did not mention specific proposals.

Public health experts have long thought that living in poor neighborhoods could ruin a person's health, but this study put the idea to a rigorous test.

Here's how it worked: Women believed to be about the same in most respects were randomly assigned to one group or another and then followed through time, in a model customarily seen in pharmaceutical studies. That makes it more scientifically rigorous than most research linking health problems to a social environment.

The study's good design "provides a basis to infer cause and effect" between poverty and bad health, said Dr. Robert Califf, a noted Duke University cardiologist who is leading a massive study on neighborhoods and health outcomes.

The research was led by Jens Ludwig, a University of Chicago professor of public policy. It was published in Wednesday's New England Journal of Medicine.

The experiment started as a $70 million HUD project in Baltimore, Boston, Chicago, Los Angeles and New York. It morphed into a health study after a variety of other government agencies and private foundations pitched in with an additional $17 million more.

"In terms of scale, it's not soon or ever to be repeated," said Dr. Robert Whitaker, a Temple University pediatrician who was a study co-author.

The study involved women living in public housing in neighborhoods where 40 percent or more of residents were poor — areas like many of those on the South Side of Chicago or in the Bronx in New York City. The women all had children and were considered heads of households.

From 1994 to 1998, nearly 1,800 of them were offered vouchers to subsidize private housing, but the vouchers were only good in higher-income neighborhoods where fewer than 10 percent of the people were considered poor. They were required to live there at least a year.

The rest of the women were divided into two groups. One group got vouchers they could use in any neighborhood. The other women did not receive vouchers, with the expectation that they would stay put.

Ten years later, women in the study were weighed and gave a blood sample to check for diabetes.

The women who moved to richer areas had the lowest rates of extreme obesity and diabetes. The difference suggests that moving to a better neighborhood could help at least 1 in 25 women. Or, in other terms, a person's risk of diabetes or extreme obesity dropped by about 20 percent by moving to a higher-income neighborhood.

(However, even the women who moved were not exactly models of health. About 14 percent of them were extremely obese, which is twice the national average for women.)

The study has some notable flaws.

Because it did not start out looking at health, the women's medical condition and weight were not checked at the outset. The researchers believe the women in the different groups were about the same, because they matched up on more than 50 other indicators, such as age, race, employment and education. But that is an assumption.

Also, only about half the women offered a chance to move to a more prosperous zip code did so. And many who did move left after a year.

What's more, the study was not designed to answer what it is about more affluent neighborhoods that would cause someone to be healthier. But the authors listed four theories:

— The availability of healthier food is worse in lower-income neighborhoods.

— Opportunities for physical exercise are scarcer, and fear of crime can make people afraid to jog or play in parks.

— There may be fewer doctors' offices and other medical services.

— The long-term stress of living in such an environment may alter the hormones that control weight.

Some of those theories were supported by some women who live in the kind of situation targeted in the study.

Vickie Webb lived in the projects in Durham, N.C., for several years before a housing agency helped relocate her and her husband to a better neighborhood.

"There was too much violence, too much going on in the 'hood. It wasn't safe," said Webb, who was not part of the study.

Annie Ricks, who lives with her 14-year-old son and two grandchildren in a public housing unit on Chicago's South Side, was not involved in the study either. But she said efforts like the HUD experiment should be expanded.

Local housing authorities paid for her to relocate to the South Side last year as part of its demolition plans for high-rise tenements. But Ricks lost her child-care job after the move, and says her new neighborhood is worse.

At her old building, Ricks could walk across the street to a supermarket. In her new neighborhood, without a car, she has to take public transportation to get groceries or go to the doctor, and Ricks says there's more crime.

"I feel like it would be a blessing" to be able to move to a wealthier area, she said.

___

Associated Press writers Alicia Chang in Los Angeles and Lindsey Tanner in Chicago contributed to this report.

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Do EU summits need a health warning?

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Greece's Prime Minister George Papandreou (C) arrives at a news conference at the end of a euro zone summit in Brussels, October 27, 2011.

Credit: Reuters/Yves Herman

By Dina Kyriakidou

ATHENS | Thu Oct 27, 2011 4:22pm EDT

ATHENS (Reuters) - In the small hours of Thursday, George Papandreou thanked his aides for helping clinch a second bailout deal for debt-ridden Greece, and admitted the strain had almost killed one of them.

"Some were under such pressure that they needed medical attention. I see George Zanias, thankfully with us. But George Glynos was unable to join us after suffering a heart attack," Papandreou told a news conference in Brussels after an 11-hour EU summit.

Like many of their EU counterparts, Greek officials have worked punishing hours under enormous stress for months. The debt crisis has taken its toll not only on their country and the euro, but on their health.

Government officials said Greece's chief economic adviser, Zanias, developed very high blood pressure during Sunday's summit and was ordered to stay in his room all day Monday. Papandreou's aide Glynos suffered a heart attack in Athens after Sunday's summit and missed Wednesday's meeting.

"Your body revolts. You go from a plane to meeting after meeting with little sleep, you drink too much coffee and you are forced to eat bad food. It's an unnatural life and there comes a point when we'll all pay for it," said a Greek Finance Ministry official who did not want to be named.

While leaders dined on giant shrimp with aubergines followed by roast turbot and a trio of sorbets, for the delegations, usually waiting anxiously to be briefed on a different floor, the dining is not as exciting.

"The food is terrible. You eat sandwiches and junk food all day. I got really sick from it Sunday," said one Greek delegate who declined to be named.

MARATHON MEETINGS

But even after a meal of roast turbot, the tension is just as high for the leaders meeting in a vast, windowless conference room in the upper reaches of the European Council's headquarters in Brussels.

They entered the building at around 5 p.m. Wednesday, and were still bargaining over a deal to rescue the euro zone from its debt crisis almost 11 hours later.

At around 2 a.m., when negotiations were at their peak, a team of around 15 medics gathered in the lobby of the brown marble-fronted Justus Lipsius building, although the reason was not immediately clear.

EU officials said the talks were extremely intense, with hard-nosed negotiation over very specific numbers before leaders would agree on the outline of a plan to reduce Greek debt and convince banks to take losses.

They knew their decisions had to reassure edgy financial markets, but could also cause big losses for financial institutions and perhaps lead to the nationalization of Greek banks.

One senior EU official said the talks progressed extremely slowly.

In the early hours of Thursday, French President Nicolas Sarkozy, German Chancellor Angela Merkel and the IMF's Christine Lagarde entered into direct negotiations with representatives of private sector banks and insurers to persuade them voluntarily to accept heavy losses on Greek debt.

At one point, euro zone negotiators said it might be necessary to force the banks and insurers to take losses if they didn't accept at least a 50 percent loss on their investments -- a move that would constitute an immediate default on Greek debt, with unpredictable fallout for Greece and the European economy.

Such a threat is likely to have caused enormous stress to the Greek team, which repeatedly said ahead of the summit that it wanted to do everything to avoid defaulting on its 210 billion euros of private sector debt.

HUGELY TIRING

"It is hugely tiring. You have to stay mentally focused, and it helps to be physically fit. You go to bed at maybe two in the morning and are up early. There's a huge amount of information you have to be able to process," said Michael Denison, special adviser to David Miliband when he was Britain's foreign secretary, and now research director for the London-based consultancy Control Risks.

EU summits are frequently high-pressure events. The leaders gather on the restricted upper floors of the building and barely move from the negotiating room until agreements are reached.

"It's a very unhealthy room, with no fresh air, and you don't know if it's day or night outside," the Greek delegate said. "During 11 hours of talks, the leaders took two half-hour breaks -- and that was not to rest, but to brief delegations."

The leaders usually sit around a vast oval table in the low-ceilinged wood-paneled room. Behind them is a separate table for aides and advisers, and on one side of the room a wall of glass booths contains the interpreters.

Summits are frequently heated and exhausting, with diplomats telling of heads of state who lose their temper or even fall asleep at critical moments. Not infrequently, they may go to change a shirt or freshen up when the strain begins to show.

One official half-jokingly said that supplies of fresh bottles of water to the meeting room are sometimes halted in order to add extra pressure on the negotiators to wrap it up.

"Part of the trick is to be able to move on from a topic immediately once a decision has been made," Denison said.

"But, however you do it, you need ministers who can keep the pace at these kind of meetings."

(Additional reporting by Luke Baker and Justyna Pawlak in Brussels, Peter Apps in London; Editing by Kevin Liffey)

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Obama and Romney health plans borrowed from Nixon

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Mitt Romney, shown at a CNN debate, contends the Massachusetts health care plan differs greatly from the Obama planRomney promises to repeal Obama health care plan, yet critics find links between twoStuart Altman says both plans had their basis in Richard Nixon's health care planAll three plans built on private, employer sponsored health insuranceRomney, Obama plans don't significantly restrain costs, he saysEditor's note: Stuart Altman, Chaiken Professor of National Health Policy at Brandeis University's Heller School for Social Policy and Management, is co-author of a new book, "Power, Politics and Universal Healthcare".

Waltham, Massachusetts (CNN) -- Mitt Romney has pledged to repeal President Obama's universal health care law if he is elected president. Critics find his position rather strange, arguing that the plan he helped develop when he was governor of Massachusetts is quite similar in design to the Obama plan. Romney disputes his critics, saying there are important and fundamental differences between the plans. Who is correct?

In actuality, both plans draw extensively from legislation offered by President Nixon in January 1974. In a book just published, "Power, Politics, and Universal Health Care," David Shactman and I explain how Romney and Obama used the same approach as Nixon to lower the number of uninsured.

All three built their system on private, employer-sponsored insurance in which all but the smallest employers had to provide insurance to their workers or pay a penalty. All utilized Medicare to insure the elderly and an expanded Medicaid-type program to insure the poor. All provided subsidies to low-income individuals and small employers. The Romney and Obama plans created state-based private insurance exchanges to make insurance more accessible and affordable to small business and individuals.

President Obama has been heavily criticized by conservatives because his plan includes a mandate for all individuals to have insurance or pay a penalty. Romney, too, has joined those criticizing the president, yet his plan in Massachusetts included just such a mandate. This idea was originally proposed by conservative groups as a measure of personal responsibility and an alternative to a single-payer system advocated by many progressive organizations. Romney believes it is alright to have a state require all to have coverage but that it cannot be mandated by the federal government.

Romney contends the Massachusetts plan required no new funding, whereas the Obama law calls for nearly a trillion dollars in increased taxes and cuts in projected Medicare spending over 10 years.

What Romney doesn't say is that the Massachusetts plan is partly funded with earmarked federal dollars and partly with state funds generated by a tax increase previously enacted to pay for a universal coverage plan that was never implemented. Unfortunately for Obama, there was no larger entity to support his plan. He had to pay for his plan with new federal monies and cuts in future federal spending. Although the federal government will assume a greater proportion of health spending, total health spending in the United States is projected to increase only 2% more by 2019 under the Obama plan than it would have otherwise.

As with the Nixon proposal, neither Romney nor Obama decided to include significant measures to reduce health care costs. Although both were criticized, I believe that was a sound political decision that allowed all the major health groups to support both plans. President Clinton's health plan drew strong opposition from many stakeholders because it included a tight spending budget. Under Obama's plan, hospitals, insurers and drug companies agreed to modest cuts in future revenues or rate increases, because all expected increased revenues from the millions of newly insured Americans. Both Obama and Romney expected that constraining health costs would be necessary in future years.

A complete review of the two plans should acknowledge that the Obama plan includes many components not in the Massachusetts legislation. The most controversial are a board appointed to control Medicare spending and a requirement that insurance companies spend a minimum percentage of their revenues on direct patient care.

The plan also includes a number of provisions to reform Medicare and Medicaid, and an extensive list of new delivery system approaches to be tested with federal pilot and demonstration programs. Important as these components may be, they are not part of the basic framework of the plan.

After comparing the Romney and Obama plans, it is clear that the similarities far outweigh the differences. Romney could argue, however, that Obama didn't use the Massachusetts plan as a model but rather drew on the proposal put forth by Richard Nixon almost 40 years earlier.

Romney's plan worked for Massachusetts, reducing its uninsured rate to the lowest in the country. Although the legislation did not put a brake on rising health care costs, there is some evidence it did reduce its rate of growth compared to other parts of the country. Health insurance premiums have traditionally been higher in Massachusetts than in the rest of the United States. The gap, however, has narrowed somewhat as premium growth between 2006 and 2010 in the United States grew by an average yearly rate of 5.1% while in Massachusetts the average growth was 4.4%.

The opinions expressed in this commentary are solely those of Stuart Altman.

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Most in Massachusetts want state push on health costs

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By Ros Krasny

BOSTON | Fri Oct 21, 2011 6:00pm EDT

BOSTON (Reuters) - Most Massachusetts residents want their state government to take action to reduce high healthcare costs that they blame on drug and insurance companies charging too much, a survey showed on Friday.

Massachusetts has almost universal healthcare insurance coverage thanks to a 2006 law driven by current Republican presidential candidate Mitt Romney when he was state governor.

Romney's rivals for the party's 2012 nomination have criticized the law as a government overreach that served as a pattern for the 2010 national healthcare law championed by Democratic President Barack Obama.

Eighty-eight percent of the 1,000 Massachusetts residents questioned in the poll in September said the state government should take "major action" to address rising costs.

Only 48 percent expressed confidence that the state government could take steps to reduce future healthcare costs, with Democrats more confident than Republicans.

Asked for reasons why costs are so high, survey respondents cited drug companies and insurance companies charging too much money, as well as waste and fraud in the healthcare system, hospitals charging too much, and people not taking good care of their health.

The poll, conducted by the Harvard School of Public Health for the Blue Cross Blue Shield of Massachusetts Foundation, found that 78 percent of respondents viewed the high cost of healthcare as either a crisis (25 percent) or a major problem (53 percent).

The Massachusetts law, popular in the state, did little to curb rising costs. That effort is now under way in the state legislature and by current Governor Deval Patrick, a Democrat.

"There is clear, overwhelming and bipartisan support to control healthcare costs in Massachusetts," said Nancy Turnbull, Harvard School of Public Health's associate dean.

"People ... support government taking big action, but are skeptical that it's going to work," added Robert Blendon, professor of social policy at Harvard School of Public Health, lead author of a report on the survey.

(Reporting by Ros Krasny; Editing by Will Dunham)

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Dental care in big demand at free LA health clinic

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Patients receive free dental care at a free health clinic sponsored by CareNow at the Los Angeles Sports Arena Thursday, Oct. 20, 2011, in Los Angeles. More than 800 health care professionals are volunteering their time Thursday through Sunday to provide medical, dental and eye care. (AP Photo/Damian Dovarganes). Patients receive free dental care at a free health clinic sponsored by CareNow at the Los Angeles Sports Arena Thursday, Oct. 20, 2011, in Los Angeles. More than 800 health care professionals are volunteering their time Thursday through Sunday to provide medical, dental and eye care. (AP Photo/Damian Dovarganes). Corey Bowers, 9, left, comforts his mother Deborah Dawson, 49, as she gets ready for a dental extraction at a free health clinic sponsored by CareNow at the Los Angeles Sports Arena Thursday, Oct. 20, 2011, in Los Angeles. More than 800 health care professionals are volunteering their time Thursday through Sunday to provide medical, dental and eye care. (AP Photo/Damian Dovarganes). Patients receive free dental care at a free health clinic sponsored by CareNow at the Los Angeles Sports Arena Thursday, Oct. 20, 2011, in Los Angeles. More than 800 health care professionals are volunteering their time Thursday through Sunday to provide medical, dental and eye care. (AP Photo/Damian Dovarganes).eval("var currentItemd57851005a80479aaeeb90a12c70b9ff = 1;");eval("var nextd57851005a80479aaeeb90a12c70b9ff = 0;");eval("var previousd57851005a80479aaeeb90a12c70b9ff = 0;"); LOS ANGELES (AP) — Avery Shapiro has had tooth pain for several years. Pat Morris' dental insurance wouldn't cover the tab for a filling. Chenell Bass had to stop driving because her eyesight got so weak.

Such stories were typical among the first 1,200 people filing into a huge free medical clinic that opened Thursday at the Los Angeles Sports Arena.

The four-day clinic, organized by Los Angeles-based nonprofit CareNow, is expected to draw 5,000 uninsured and underinsured patients who spent hours in line Monday to obtain wristbands to enter the event. Some even camped out overnight.

It's the fourth such event that CareNow has organized around Los Angeles County with the help of 800 medical professionals volunteering their services, and supplies and equipment donated by manufacturers.

"We hope to keep doing these until we're obsolete," said CareNow President Don Manelli. "There are 2 million uninsured in L.A. County. We're doing what we can do."

At all the clinics, dental treatment is the overwhelming request followed by vision care. "If you have a toothache, there's no ER to go to," Manelli said. "About 60 percent ask for dental care."

The buzz of dental drills cut above the hum of voices on the floor of the arena where dozens of dentists worked on patients in makeshift dental chairs in assembly line fashion. Their instruments sat on rows of folding tables behind them.

For 26-year-old Shapiro, who had to move into a homeless shelter after losing her job as a nanny three years ago, getting her tooth fixed was worth standing in line for almost seven hours earlier this week to receive a wristband to enter the clinic.

"It's a lot of waiting but I'm grateful they have this," she said. "I just don't have the money to pay for it."

Others said they had minimal dental insurance or health insurance that didn't cover dental or vision care.

Pat Morris, a 60-year-old retired phone company worker, said she can get cleanings and X-rays under her health benefits, but that's it. When her dentist found a cavity, she couldn't afford the $300 to fill it. "That's just for one tooth," she said. "I'm on a fixed income."

For Dr. Lillian Gelberg, a family medicine professor at University of California Los Angeles, the mass clinic demonstrates the cracks in the medical system. "We need to get everybody insured," she said.

Physicians attended to patients in curtained cubicles that served as consulting rooms. Many people were there for symptoms of chronic diseases, such as diabetes and hypertension. Foot ills were another big complaint.

Many poor people find ways of coping with maladies until they worsen to a point when they are in pain or can no longer compensate, said internist Monya De, who was volunteering her services. "Treatment doesn't seem like an option to them," she said.

This year, CareNow has lined up about 40 clinics to provide free follow-up care to the patients. "Our goal is to make sure people in line this year don't have to be in line next year," Manelli said. "Now there's continuity of care."

The organization is also pushing prevention harder this year. Booths offered preventive procedures such as mammograms, Pap smears and vaccinations, as well as information on smoking cessation, nutrition, and government assistance programs.

On the other side of the arena, patients waited for their number to be called for eye exams and free glasses. After queuing up six hours to get a wristband on Monday, Chenell Bass took two buses to get her eyes examined on Thursday.

The waits of hours were nothing — she's been waiting to get glasses for five years because she can't afford them.

"Not being able to see is terrible. I can't read anymore, and I love to read. I can't drive," said the 52-year-old former housecleaner who lives on disability for a bad back. "This is a blessing."

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Most in Massachusetts want state push on health costs

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By Ros Krasny

BOSTON | Fri Oct 21, 2011 6:00pm EDT

BOSTON (Reuters) - Most Massachusetts residents want their state government to take action to reduce high healthcare costs that they blame on drug and insurance companies charging too much, a survey showed on Friday.

Massachusetts has almost universal healthcare insurance coverage thanks to a 2006 law driven by current Republican presidential candidate Mitt Romney when he was state governor.

Romney's rivals for the party's 2012 nomination have criticized the law as a government overreach that served as a pattern for the 2010 national healthcare law championed by Democratic President Barack Obama.

Eighty-eight percent of the 1,000 Massachusetts residents questioned in the poll in September said the state government should take "major action" to address rising costs.

Only 48 percent expressed confidence that the state government could take steps to reduce future healthcare costs, with Democrats more confident than Republicans.

Asked for reasons why costs are so high, survey respondents cited drug companies and insurance companies charging too much money, as well as waste and fraud in the healthcare system, hospitals charging too much, and people not taking good care of their health.

The poll, conducted by the Harvard School of Public Health for the Blue Cross Blue Shield of Massachusetts Foundation, found that 78 percent of respondents viewed the high cost of healthcare as either a crisis (25 percent) or a major problem (53 percent).

The Massachusetts law, popular in the state, did little to curb rising costs. That effort is now under way in the state legislature and by current Governor Deval Patrick, a Democrat.

"There is clear, overwhelming and bipartisan support to control healthcare costs in Massachusetts," said Nancy Turnbull, Harvard School of Public Health's associate dean.

"People ... support government taking big action, but are skeptical that it's going to work," added Robert Blendon, professor of social policy at Harvard School of Public Health, lead author of a report on the survey.

(Reporting by Ros Krasny; Editing by Will Dunham)

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Study: Living in poor neighborhood can hurt health

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Annie Ricks, 55, poses in her public housing apartment Wednesday, Oct. 19, 2011, in Chicago. Local housing authorities paid for her to relocate to the South Side last year as part of its demolition plans for high-rise tenements, but Ricks says her new neighborhood is worse. According to a study released Wednesday, Oct. 19, 2011, poor women in big city public housing given a chance to live in more affluent neighborhoods had lower rates of diabetes and extreme obesity. Ricks was not part of the study, but says such efforts should be expanded. (AP Photo/M. Spencer Green) Annie Ricks, 55, poses in her public housing apartment Wednesday, Oct. 19, 2011, in Chicago. Local housing authorities paid for her to relocate to the South Side last year as part of its demolition plans for high-rise tenements, but Ricks says her new neighborhood is worse. According to a study released Wednesday, Oct. 19, 2011, poor women in big city public housing given a chance to live in more affluent neighborhoods had lower rates of diabetes and extreme obesity. Ricks was not part of the study, but says such efforts should be expanded. (AP Photo/M. Spencer Green) Annie Ricks, 55, poses in her public housing apartment Wednesday, Oct. 19, 2011, in Chicago. Local housing authorities paid for her to relocate to the South Side last year as part of its demolition plans for high-rise tenements, but Ricks says her new neighborhood is worse. According to a study released Wednesday, Oct. 19, 2011, poor women in big city public housing given a chance to live in more affluent neighborhoods had lower rates of diabetes and extreme obesity. Ricks was not part of the study, but says such efforts should be expanded. (AP Photo/M. Spencer Green) Vickie Webb poses for a photograph at her apartment in Durham, N.C., Wednesday, Oct. 19, 2011. Webb, 43, lived in the projects in Durham, N.C. for several years before a housing agency helped relocate her and her husband to a better neighborhood. According to a study released Wednesday, Oct. 19, 2011, poor women in big city public housing a chance to live in more affluent neighborhoods. had lower rates of diabetes and extreme obesity. Webb was not part of the study. (AP Photo/Jim R. Bounds) Vickie Webb checks her blood pressure in her apartment in Durham, N.C., Wednesday, Oct. 19, 2011. Webb, 43, lived in the projects in Durham, N.C. for several years before a housing agency helped relocate her and her husband to a better neighborhood. According to a study released Wednesday, Oct. 19, 2011, poor women in big city public housing a chance to live in more affluent neighborhoods. had lower rates of diabetes and extreme obesity. Webb was not part of the study. (AP Photo/Jim R. Bounds) Vickie Webb stands in the door way of her apartment after checking her blood pressure in Durham, N.C., Wednesday, Oct. 19, 2011. Webb, 43, lived in the projects in Durham, N.C. for several years before a housing agency helped relocate her and her husband to a better neighborhood. According to a study released Wednesday, Oct. 19, 2011, poor women in big city public housing a chance to live in more affluent neighborhoods. had lower rates of diabetes and extreme obesity. Webb was not part of the study. (AP Photo/Jim R. Bounds)eval("var currentItemd57851005a80479aaeeb90a12c70b9ff = 1;");eval("var nextd57851005a80479aaeeb90a12c70b9ff = 0;");eval("var previousd57851005a80479aaeeb90a12c70b9ff = 0;"); ATLANTA (AP) — Back in the 1990s, the federal government tried an unusual social experiment: It offered thousands of poor women in big-city public housing a chance to live in more affluent neighborhoods.

A decade later, the women who relocated had lower rates of diabetes and extreme obesity — differences that are being hailed as compelling evidence that where you live can determine your health.

The experiment was initially aimed at researching whether moving impoverished families to more prosperous areas could improve employment or schooling. But according to a study released Wednesday, the most interesting effect may have been on the women's physical condition.

About 16 percent of the women who moved had diabetes, compared with about 20 percent of women who stayed in public housing. And about 14 percent of those who left the projects were extremely obese, compared with nearly 18 percent of the other women.

The small-but-significant differences offered some of the strongest support yet for the idea that where you live can significantly affect your overall health, especially if your home is in a low-income area with few safe places to exercise, limited food options and meager medical services.

"This study proves that concentrated poverty is not only bad policy, it's bad for your health," Shaun Donovan, secretary of the Department of Housing and Urban Development.

But no one believes the deficit-plagued federal government is going to expand the program and start moving low-income women to better neighborhoods en masse.

"It's not enough to simply move families into different neighborhoods," Donovan said. Instead, new ways must be found to help families "break the cycle of poverty that can quite literally make them sick." He did not mention specific proposals.

Public health experts have long thought that living in poor neighborhoods could ruin a person's health, but this study put the idea to a rigorous test.

Here's how it worked: Women believed to be about the same in most respects were randomly assigned to one group or another and then followed through time, in a model customarily seen in pharmaceutical studies. That makes it more scientifically rigorous than most research linking health problems to a social environment.

The study's good design "provides a basis to infer cause and effect" between poverty and bad health, said Dr. Robert Califf, a noted Duke University cardiologist who is leading a massive study on neighborhoods and health outcomes.

The research was led by Jens Ludwig, a University of Chicago professor of public policy. It was published in Wednesday's New England Journal of Medicine.

The experiment started as a $70 million HUD project in Baltimore, Boston, Chicago, Los Angeles and New York. It morphed into a health study after a variety of other government agencies and private foundations pitched in with an additional $17 million more.

"In terms of scale, it's not soon or ever to be repeated," said Dr. Robert Whitaker, a Temple University pediatrician who was a study co-author.

The study involved women living in public housing in neighborhoods where 40 percent or more of residents were poor — areas like many of those on the South Side of Chicago or in the Bronx in New York City. The women all had children and were considered heads of households.

From 1994 to 1998, nearly 1,800 of them were offered vouchers to subsidize private housing, but the vouchers were only good in higher-income neighborhoods where fewer than 10 percent of the people were considered poor. They were required to live there at least a year.

The rest of the women were divided into two groups. One group got vouchers they could use in any neighborhood. The other women did not receive vouchers, with the expectation that they would stay put.

Ten years later, women in the study were weighed and gave a blood sample to check for diabetes.

The women who moved to richer areas had the lowest rates of extreme obesity and diabetes. The difference suggests that moving to a better neighborhood could help at least 1 in 25 women. Or, in other terms, a person's risk of diabetes or extreme obesity dropped by about 20 percent by moving to a higher-income neighborhood.

(However, even the women who moved were not exactly models of health. About 14 percent of them were extremely obese, which is twice the national average for women.)

The study has some notable flaws.

Because it did not start out looking at health, the women's medical condition and weight were not checked at the outset. The researchers believe the women in the different groups were about the same, because they matched up on more than 50 other indicators, such as age, race, employment and education. But that is an assumption.

Also, only about half the women offered a chance to move to a more prosperous zip code did so. And many who did move left after a year.

What's more, the study was not designed to answer what it is about more affluent neighborhoods that would cause someone to be healthier. But the authors listed four theories:

— The availability of healthier food is worse in lower-income neighborhoods.

— Opportunities for physical exercise are scarcer, and fear of crime can make people afraid to jog or play in parks.

— There may be fewer doctors' offices and other medical services.

— The long-term stress of living in such an environment may alter the hormones that control weight.

Some of those theories were supported by some women who live in the kind of situation targeted in the study.

Vickie Webb lived in the projects in Durham, N.C., for several years before a housing agency helped relocate her and her husband to a better neighborhood.

"There was too much violence, too much going on in the 'hood. It wasn't safe," said Webb, who was not part of the study.

Annie Ricks, who lives with her 14-year-old son and two grandchildren in a public housing unit on Chicago's South Side, was not involved in the study either. But she said efforts like the HUD experiment should be expanded.

Local housing authorities paid for her to relocate to the South Side last year as part of its demolition plans for high-rise tenements. But Ricks lost her child-care job after the move, and says her new neighborhood is worse.

At her old building, Ricks could walk across the street to a supermarket. In her new neighborhood, without a car, she has to take public transportation to get groceries or go to the doctor, and Ricks says there's more crime.

"I feel like it would be a blessing" to be able to move to a wealthier area, she said.

___

Associated Press writers Alicia Chang in Los Angeles and Lindsey Tanner in Chicago contributed to this report.

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Wal-Mart trims some U.S. health coverage

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By Jessica Wohl

Fri Oct 21, 2011 5:01pm EDT

n">(Reuters) - Wal-Mart Stores Inc will no longer offer health insurance to new part-time U.S. employees who work fewer than 24 hours a week and will charge workers who use tobacco more for coverage as healthcare costs rise, the company said on Friday.

Wal-Mart, the largest U.S. retailer and the nation's largest private employer, is also slashing the amount that it puts in employees' healthcare expense accounts by 50 percent.

The changes, which affect U.S. associates who work for Walmart and Sam's Club, are being explained during the current fall enrollment period before they take effect in January.

Preventive care such as annual checkups remains fully covered. Wal-Mart will now provide $250 for associates to use for healthcare expenses that are not covered, down from $500, and will provide $500 for families, down from $1,000.

Those who use tobacco products will also pay more, with rates varying by the type of plan someone chooses.

"The current healthcare system is unsustainable for everyone and like other businesses we've had to make choices we wish we didn't have to make," said Wal-Mart spokesman Greg Rossiter. "Our country needs to find a way to reduce the cost of healthcare, particularly in this economy."

Wal-Mart said that it will continue to pay the majority of costs for its employees' healthcare.

Not all of the company's 1.4 million U.S. employees sign up for its healthcare plans. Wal-Mart said it currently insures more than 1 million people, including workers' family members.

Wal-Mart is not alone in looking for ways to cut spending on healthcare. Starting next year, Wells Fargo & Co will ask employees to fund their own medical expense accounts or choose to pay higher insurance premiums and have the company fund them, following the lead of companies such as General Electric that offer account-based healthcare plans.

A study last month by the Kaiser Family Foundation found that the average annual premium for family coverage through an employer increased 9 percent to $15,073 in 2011 from the year before. Since 2000, premiums have risen 134 percent.

Employers pay nearly three-quarters of that premium, a rate that has held fairly steady for the last 10 years, according to the foundation's data.

A Mercer survey found that health benefits costs on average will rise 5.4 percent in 2012, the smallest increase since 1997, because employers have been so aggressive about cutting these expenses.

WAL-MART'S CHANGING PLANS

At Wal-Mart, part-time associates become eligible for healthcare coverage after working for the chain for one year.

One of Wal-Mart's basic plans for an associate costs $15 per two-week pay period, or just over $1 per day. A tobacco user will now be charged an additional $10 per pay period.

Associates will use an honor system to say whether they use tobacco products.

Wal-Mart has offered part-time workers the option of signing up for healthcare coverage since 1996, regardless of how many hours per week worked. Now, part-time associates who work less than an average of 24 hours per week will no longer be eligible for the company's health insurance plans.

Those who were already eligible may still participate, even if they work fewer than 24 hours per week.

The changes were met with disappointment from some who have spoken out against Wal-Mart in the past.

"(Wal-Mart) may get away with these attacks on workers' rights in other parts of the country, but we won't stand for it in New York City," said New York City Council Speaker Christine Quinn, who has pushed to keep the chain out of New York City.

Those who work about 24 hours to 33 hours a week can still sign up for coverage for themselves and for their children.

Wal-Mart has not said what percentage of its U.S. associates work fewer than 24 hours a week. Those who work 34 hours a week or more are considered full-time associates.

Changes to the company's healthcare plans were first reported by the New York Times.

Shares of Wal-Mart were up 1.1 percent at $56.98 in afternoon trading on Friday.

(Corrects to show that part-time employees become eligible for healthcare coverage after working for one year, paragraph 13; also adds dropped word "in" to quote in paragraph 19, adds "of" instead of "on" in paragraph 19)

(Reporting by Maneesha Tiwari in Bangalore and Jessica Wohl in Chicago. Additional reporting by Rick Rothacker in Charlotte, North Carolina; Editing by Steve Orlofsky)

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The digested Health Bill debate

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One hundred peers lined up to speak in this week's two-day debate on the government's plans to reform the NHS in England. If for some reason you were unable to find time to watch it all, fear not: Democracy Live has compiled this selection of highlights.

Watch the unedited first part of the Health and Social Care Bill debate above or click on the links in the text below to go directly to each peer's speech

Opening the debate, Lord Howe sought to pre-empt criticism that the responsibility of the secretary of state for health for the NHS would be watered down by the bill.

"Managing the range of healthcare needs for our diverse population is now so complex that no one would argue that it is a task best carried out from Whitehall," he argued.

The bill sought to bring about a "fundamental shift in the balance of power" from politicians to patients and doctors, the minister asserted, which would raise standards.

"The case for change is clear and compelling, and I am personally in no doubt that the changes set out in this bill are right for our NHS and, more importantly, right for patients," he concluded.

Labour peer and former GP Lord Rea

But the government's staunchest critic in the Lords was not soothed. Labour's Lord Rea set out to persuade his colleagues that the government had no democratic mandate to introduce the reforms and back his amendment to throw them out altogether - a highly unusual move for legislation that has already been approved by MPs.

Former Labour cabinet minister and founder of the SDP Lord Owen, who now sits as an independent peer, did not want to block the bill but he argued that the changes in it were so significant that a special committee should be established to look at them in detail.

After the health secretary's role had changed, he wondered, who would be in charge during a pandemic? "Adversarial debates across the floor of this House" were not the right medium for making judgements of such profound importance, he averred.

Labour frontbencher Baroness Thornton

Opposition health minister, Baroness Thornton, declared: "People did not expect, did not vote for and do not want these changes."

Focusing on the structural changes to NHS administration, she claimed that the new NHS Commissioning Board would be the "biggest quango in the world" and complained that Monitor was being transformed into a "huge bureaucratic economic regulator".

"The Liberal Party was in at the birth of the NHS," she noted, pleading with Lib Dem peers not to put that "legacy... in jeopardy".

Senior Lib Dem peer Baroness Williams

Baroness Williams told peers that extremely high levels of satisfaction with the current system were being overlooked, and that there was a pervasive fear that the NHS would be "essentially market based" under the changes.

She warned of the "frightening" consequences of mixing medicine and profit, suggesting that some US doctors were reluctant to cut down on carrying out lucrative prostate cancer tests despite warnings that they might cause incontinence and impotence.

Former Conservative Health Secretary Baroness Bottomley

Lady Bottomley suggested that some campaigning material she had received prior to the debate had been wide of the mark.

It exhorted her to "ensure my grandchildren can have the same benefits that you and I have received from the NHS since 1948", she revealed.

"I do not want my grandchildren to have the same benefits; my grandchildren have high standards. Like everybody else in this House, I want my grandchildren to have a better, more responsive, more effective and cost-effective NHS. Only through this bill will we achieve that."

Surgeon and former Labour health minister Lord Darzi

Lord Darzi, who conducted his own review of the NHS three years ago, said the "right competition for the right reasons" could drive up standards by "sparking creativity and lighting the fire of innovation" among clinicians.

But he criticised the complexity of the proposed new lines of accountability in the NHS.

Historian and broadcaster Lord Hennessy

Crossbencher Lord Hennessy, a co-signatory to Lord Owen's amendment, said the day the NHS was created was the "closest we have ever come to institutionalising altruism".

A way had to be found that did not involve the health secretary "abandoning" his role as the guarantor of a comprehensive service, free at the point of delivery, he said, and the special committee envisaged by his amendment would be able to do just that.

Fertility expert and broadcaster Lord Winston

Labour's Lord Winston spelled out why he believed "the legacy of the previous government which we keep hearing about might be a bit better than has been suggested by the present government".

The changes were "unnecessary" and "irresponsible", he lamented.

Lady Hussein Ece agreed the legislation was not perfect.

But she added: "I think most of us would agree that the status quo is not really an option." The bill could improve patient care and accountability, she predicted, if amended appropriately during its passage through the upper chamber.

Conservative former Health Secretary Lord Fowler

Lord Fowler lambasted a "dreary" misconception: "The use of the private sector does not mean that one is privatising the service."

He also dismissed the Owen-Hennessy bid to refer the bill to a special committee, telling peers that "the normal committee processes of the House would be sufficient" scrutiny for the legislation.

Finally, Lord Howe faced the daunting task of responding to the marathon debate. Peers agreed to give the bill a second reading, and then let it proceed with normal committee-stage scrutiny without establishing the special committee envisaged by Lord Owen and Lord Hennessy.

Compiled by Democracy Live's Ed Lowther

democracylive@bbc.co.uk

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Greece health warning after cuts

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10 October 2011 Last updated at 00:23 GMT By James Gallagher Health reporter, BBC News Will cuts affect the long-term health of Greeks? Researchers have issued a warning about the health of people in Greece in the wake of the financial crisis.

Writing in The Lancet, they said cuts to hospitals' budgets meant they were being overstretched.

More people were reporting "bad health" and HIV infections were on the increase, the authors warned.

While public health experts said the picture was "concerning" they said it could take several years for the true health implications to fully emerge.

Greece has been at the centre of the economic turmoil in Europe and researchers say the austerity measures have taken a toll on health services.

"There were about 40% cuts in hospital budgets, understaffing, reported occasional shortage of medical supplies, and bribes given to medical staff to jump queues in overstretched hospitals," they wrote.

At the same time there was a 24% increase in public hospital admissions, partly fuelled by fewer patients using private hospitals.

An analysis of data from EU Statistics on Income and Living Conditions, comparing 2007 and 2009, showed a 15% increase in people not going to a doctor or dentist, mostly due "to long waiting times".

The researchers said: "We noted a significant rise [14%] in the prevalence of people reporting that their health was bad or very bad."

They also reported a decline in the number of people eligible for sickness benefit.

New infections of HIV were expected to increase by 52% in 2011, with half due to intravenous drug use.

Their report concludes: "Ordinary people are paying the ultimate price: losing access to care and preventative services.

"Greater attention to health and healthcare access is needed."

However, there is no data on the actual health of Greek citizens.

Dr Alexander Kentikelenis, of the University of Cambridge, told the BBC: "Many implications will take longer to show. In the Great Depression it took five-plus years for the effects to show in health in the US."

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Sentamu warning on health reforms

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8 October 2011 Last updated at 09:58 GMT Dr Sentamu wants a national debate on the future of health care provision The Archbishop of York has warned of the dangers of introducing a more commercial culture into the National Health Service.

Dr John Sentamu, who had his appendix removed in May, said an NHS hospital could not be compared to a supermarket.

The archbishop said he was calling for a national debate on healthcare provision as politicians debate the Health and Social Care Bill.

The Department of Health said it "welcomed" the archbishop's comments.

Dr Sentamu was speaking after a meeting of the Archbishop of York's symposium, which brings together academics and practitioners to discuss a range of issues.

He said: "We must never allow health provision in this country to become exclusive.

"Decent healthcare should not solely be the preserve of those that can afford to purchase it."

Health inequalities

"Whilst we may strive to deliver value for money, we cannot allow care to be market-led or commercialised to the point where patient safety is put at risk."

Dr Sentamu said he was also concerned about social inequalities in healthcare provision and that problems could not be solved by "simply throwing money" at the system.

Calling for a national debate on the future of the NHS, the archbishop said: "We all want to see investment spent appropriately to provide the best care possible to as many people as possible.

"We all want to see a system that is compassionate and responsive. The challenge is how do we achieve that?"

A Department of Health spokesman said: "Our bill puts clear safeguards in place against any abuse from the private sector and ensures that all provision of services to NHS patients will be based on the quality of the service to patients, not the cost."

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Sick Greek economy takes heavy toll on health

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High-school students clash with riot police during a protest march against economic austerity and planned education reforms in Athens October 3, 2011.

Credit: Reuters/John Kolesidis

By Kate Kelland

LONDON | Sun Oct 9, 2011 7:09pm EDT

LONDON (Reuters) - Greece's debt crisis is hitting the health of the nation hard, with the number of suicides increasing, more people turning to drugs and prostitution and rapidly rising rates of HIV infections, researchers said on Monday.

Swingeing budget cuts and growing unemployment are pushing more people into severe depression and drug-dependence, and cutbacks in hospital budgets and healthcare services mean fewer people can see their doctors or access help.

"The picture of health in Greece is concerning," said David Stuckler, a sociologist at Britain's University of Cambridge who reported his findings in the Lancet medical journal.

"We're seeing ... worrisome trends -- a doubling of suicides, rising homicides, a 50 percent rise in HIV infections and people reporting that their health has got worse but they're not going to the doctor even though they felt they needed to."

In the past two years, the Greek government has imposed harsh austerity measures to deal with a debt mountain as the country plummeted into its deepest recession in 40 years and was forced to accept an EU-IMF bailout.

Greece is expected to run out of cash as soon as mid-November. Inspectors from the European Union, the International Monetary Fund and the European Central Bank -- the so-called "troika" -- are currently assessing whether Athens has fulfilled the criteria for more aid.

In the meantime, businesses are shutting down, the public sector is shrinking and unemployment is running at more than 16 percent. Health budget cuts have also led Greece to slash the prices it will pay for medicines, triggering supply concerns.

Stuckler's team found that suicides rose by 17 percent in 2009 from 2007 and said unofficial data quoted in Greece's parliament point to even greater rises, of 25 to 40 percent.

The data mirror grim local news reports.

In tales that have shocked Athenians, a former businessman was reported to have jumped to his death leaving a note saying the financial crisis drove him to it, and the owner of a small retail firm was found hanging from rope tied to a bridge. His suicide note said simply: "Don't look for other reasons. The economic crisis led me to this."

LESSON TO OTHERS

Martin McKee of the London School of Hygiene and Tropical Medicine, who worked with Stuckler on the Lancet paper, said other struggling European nations should take note.

"The experience of Greece is a warning of what can happen if there are major cuts to healthcare in the face of a recession," he said in a telephone interview.

A previous study by McKee, Stuckler and others in July found suicide rates across Europe rose sharply in the two years to 2009 as the financial crisis drove unemployment up and squeezed incomes. Greece and Ireland were worst hit.

In Monday's paper, the researchers also found a significant increase in HIV infections in Greece in late 2010 and said data suggest that new infections with the virus that causes AIDS will rise by 52 percent this year compared to last.

Rates of heroin use rose by 20 percent in 2009, and at the same time, budget cuts in 2009 and 2010 meant a loss of a third of the country's street-work programs designed to help drug addicts and provide them with HIV prevention services.

Stuckler said there were reports of some drug users deliberately infecting themselves with HIV, or human immunodeficiency virus, to get access to welfare benefits of 700 euros ($940) a month and faster admission into drug substitution programs. "It's really alarming," he said.

Greece has had a rocky relationship with pharmaceutical companies as a result of the crisis, imposing some of the most draconian price cuts for medicines of any European country, with unpaid bills a further burden for pharmaceutical companies.

Swiss group Roche has stopped delivering cancer drugs to some state-funded Greek hospitals that have not paid their bills, with patients being told to collect medicines from privately run pharmacies as they are more reliable payers.

Roche and other drugmakers have also been forced to accept Greek government bonds instead of cash for some outstanding debts -- a move that is expected to increase bad debt provisions, although Greece accounts for only around 1 percent of the global pharmaceuticals market.

(Additional reporting by Simon Roach and Ben Hirschler; Editing by Janet Lawrence)

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Clearer idea on health spending

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4 October 2011 Last updated at 09:37 GMT Andrew Lansley's figures have been further examined

I make no apologies for returning to government spending on health.

The Tory promise in the election to ring-fence health spending and increase it in real terms every year even during a period of public spending cuts was distinctive and much-touted during the 2010 election campaign.

A quick recap: during my extended interview with Health Secretary Andrew Lansley which went out live on the BBC News Channel on Sunday evening, I suggested that higher inflation than anticipated when the health spending promise was given would make it more difficult to meet the Tory promise of real annual rises.

Indeed I put to him a projection for real health spending which showed it would decline. Mr Lansley disputed these figures and said that, because of an earlier underspend, health spending would still rise in real terms despite the higher inflation.

I said I would post my figures on this blog, which I duly did. And I invited the Department of Health to respond, which it has.

As a consequence of this process I have a clearer idea of what is happening. The Department is right that an underspend in 2010 helps health spending to rise in real terms through to 2015.

But it is important to understand what happened: the 2010-11underspend happened during the coalition's first year. It meant there was a 0.9% fall in spending, in real terms, compared with 2009-10, Labour's last year.

Using this new lower spending base for 2010-11 and applying the official Treasury deflators, spending will be back just above the 2009-10 level in 2014-15 - but by only a 0.1% real increase.

'Essentially static'

In other words, even allowing for the underspend and using the existing deflator, spending will be, effectively, no more than it was in Labour's last year in real terms.

But the official Treasury deflator does not take into account the recent surge in inflation.

Using the average of the independent forecasts for the deflator which the Treasury published in August, health spending will fall by 0.8% in real terms between 2009-10 and 2014-15. The cut is masked starting from the lower baseline of 2010-11.

So there we have it. Comparing Labour's last year (2009-10) with the coalition's last year (2014-15) before the next election, health spending will be essentially static in real terms, using the Treasury's original GDP deflator.

Using a newer deflator that takes into account the reality of recent higher inflation, and real spending on health falls by almost 1%. Either way, it is hard for Mr Lansley to claim that he is keeping his promise.

But these are complicated matters and, as always, I stand ready to be corrected.

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Child health 'contrast' concerns

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2 October 2011 Last updated at 10:54 GMT 'Prioritisation of community child health services is vital,' says Andrew Jones, public health official The contrast between the health of babies born in poor and more affluent areas of north Wales has been branded as "unacceptable" by a public health chief.

A report from Betsi Cadwaladr University Health Board (BCUHB) shows people born in deprived parts of Rhyl can expect to die seven years earlier than those in areas like nearby Conwy.

It also shows a "stark" variation in the number of babies born with low birth weights, linked to poverty.

The report author is calling for action to end the "health inequalities" to create a "fairer society".

Rates of stillbirth, admissions to neonatal units, infant and child mortality, injuries and teenage pregnancy are higher in areas with high levels of deprivation, according to Andrew Jones.

He is the executive director of public health for Betsi Cadwaladr University Health Board (BCUHB) which manages the region's health services.

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Giving every child the best start in life is the highest priority. This is the key to reducing health inequalities and creating a fairer society.”

End Quote Andrew Jones Executive director of public health for Betsi Cadwaladr University Health Board He says the annual report focuses on the early years because scientific evidence shows influencing the development of children to maximise their health is most effective when done as early as possible.

'Vital'

"There is also a strong economic case as return on investment in the early years is higher than at any other stage," he says.

Mr Jones says current financial challenges highlight the importance of using resources wisely.

"Whilst there is a risk that we may wish to focus on the short term, the simple fact is that we cannot afford to ignore the evidence and the opportunity to improve health outcomes now and into the future," he said.

His report highlights 11 key areas to reduce the "inequity" across the region.

These include:

More support for vulnerable familiesReduce smoking in pregnancyReduce maternal obesity.

While the percentage of babies born with low birth weight in north Wales is slightly lower (5.5%) than the average for Wales (5.8%), the report says there is "considerable variation" across the region and a "stark geographical variation".

The highest percentage of low birth weights in north Wales is in Rhyl south west in Denbighshire, at 8.2%, compared to the lowest, 2.9%, found in Llandrillo yn Rhos, Conwy.

"Giving every child the best start in life is the highest priority," says Mr Jones.

"This is the key to reducing health inequalities and creating a fairer society. Prioritisation of community child health services is vital."

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New health phone number to launch

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1 October 2011 Last updated at 15:36 GMT Currently, around 14,000 people a day call NHS Direct for medical advice A non-emergency telephone number for NHS services is to launch across England, the Department of Health says.

The 111 number, which has been tested in four areas, will be available nationally by April 2013.

The service will replace NHS Direct, which the government announced it was scrapping last year.

It will give health advice and information about services such as out-of-hours GPs, walk-in centres, emergency dentists and pharmacies.

The government says it will reduce confusion and effectively abolish the concept of "out-of-hours" in the NHS.

After pilot schemes in County Durham, Nottingham, Lincolnshire and Luton, the service will be extended to the Isle of Wight and Chesterfield before Christmas.

The government says NHS Direct is expected to "retain a role" in its the delivery, staffed by call advisers supported by nurses.

'Simple number'

Currently, around 14,000 people a day call NHS Direct for medical advice, with the service costing £123m a year to run.

Health Secretary Andrew Lansley said: "The new 111 service will mean patients can access the whole of the NHS through just one simple number.

"This marks another important step in modernising the NHS and giving patients greater control and choice over their healthcare."

Dr Clare Gerada, chairwoman of the Royal College of General Practitioners, said: "Not only will callers to the service be advised on what to do but also to be directed to the appropriate local service to address their need consistently.

"However, patients should be aware that this is not a replacement for the current system and that they can continue to call their GP practice as normal."

The change will not affect existing NHS helpline services in Scotland and Wales.

Critics claimed the decision to scrap NHS Direct would undermine the quality of the service by reducing the number of qualified nurses answering calls.

And shadow health secretary Andy Burnham said last year that the service saved the NHS £200m a year and played a key role in taking pressure off the health service.

But last June the British Medical Association said MPs should consider scrapping the telephone service, saying it was not cost-effective.

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Students' mental health 'at risk'

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29 September 2011 Last updated at 23:55 GMT By Branwen Jeffreys Health correspondent, BBC News Students face greater pressures on mental health Doctors are warning that the current generation of students has a greater risk of anxiety and depression than previous ones.

The Royal College of Psychiatrists says there are now many more students from less privileged backgrounds who are less prepared for university life.

Students also face rising debt and uncertain job prospects, it warns.

It is concerned universities may see counselling and support services as an easy target for cuts.

In a report seen exclusively by the BBC, the college says the massive expansion in the numbers of young people going into higher education has had a significant impact.

Universities are now educating a different type of student from the privileged minority of 20 years ago. Changes in wider society are also being seen on campus, with an increase in students from fractured families. At the same time, the financial cost of going to university has increased.

Dr John Callender, one of the report authors, said: "Many are having to work long hours in paid work on top of full-time academic studies. Many are less well-supported by their families than was the case in years gone by.

"The reasons for this are things like increased rates of marital breakdown and students being drawn from poorer social backgrounds."

He said there are also intense social pressures for many young people, living away from home and trying to live up to the expectation that these years should be a happy and sociable time.

Dropping out

During their years at university, it is thought about 4% of students will turn to counselling services for support. Recent research has suggested that these services are facing increasing demands for their advice.

For Liam Bore, being able to talk to someone made the difference between staying at university and dropping out.

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Sometimes there is a lot of pressure on them to succeed. They can be carrying the hopes of a whole family”

End Quote Eileen Smith Report joint author He found himself struggling to maintain his studies after the death of two school friends was followed only a year later by the loss of his mother.

"My concentration wasn't good, I couldn't take on what was going on in the lessons, and that had a big impact on my grades."

With support from the counselling service at the University of Hertfordshire, Liam has negotiated extra time to complete his final assignments and now hopes to leave with a good degree.

Some universities are investing more in support services, in recognition that if students leave their course, it can damage their prospects and lead to the university losing their fees.

Eileen Smith, the head of counselling at the University of Hertfordshire and a joint author of the report, has been advising first-year students about the help available as part of their freshers' week.

She agrees this is a generation for whom the pressures are greater, as many are the first in their family to reach university.

"They might find it harder to negotiate with tutors, they're less sure what to expect, and less confident about asking for help.

"Sometimes there is a lot of pressure on them to succeed. They can be carrying the hopes of a whole family."

The report warns that despite the growing demands, there are concerns for the future of some welfare services, with reports of some universities in England already freezing posts as a result of the financial pressures on higher education.

The RCPsych says this is a crucial time in the lives of young people, whether for temporary support, or early diagnosis of major mental illnesses.

It wants academic staff to receive more training, and greater incentives for GPs interested in running dedicated health services for students.

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