For Goodness Sake

Another day and another terrorist attack, this time some guys in a hired van driving through crowds then picking up knives to go for a rampage. 7 dead according to the latest news.

And the thing that really winds me up (and millions of Brits posting on twitter) is the shameless tweeting of the American president, posting and mis-quoting our mayor Sadiq Khan yet again. WTF.

What is his problem? Does he really think that the situation would have been better if those guys had access to semi-automatic guns rather than carving knives? Is he a total nut job? Does he think it is right or reasonable to try to make political gain from peoples dead relatives?

Why did the American newspapers feel a need to describe the UK as “reeling” (thank you NYT) when we’re basically getting on with the show?

To be lectured on violent crime by Americans is just gob-smackingly unreasonable. In the 3 months to March 2017, 6,000 Americans died as a result of gun crime. In the 12 months to March 2017, around 500 Brits died from any crime, including terrorism. Our streets are significantly safer than most. Maybe Americans should consider relocating over here to improve their life expectancy?

To be told we need to arm up our police force when their excellent response meant the whole incident was over almost before it began is just ridiculous. We have no appetite for routinely armed police. No appetite for the kind of routine shooting of civilians by the police that seems to happen in the States. It’s bad enough that the BAME community is stopped and searched disproportionately; no one wants to add guns into the mix.

To be told that we need to close our borders when inevitably the guys involved will turn out to be home-grown British boys disaffected and cut-off from their families and communities just beggars belief.

There is no other way to say this: Donald Trump is a twat, a dick of the first order and by that I mean small and mean-minded.

Too Late

I’m committed. It’s too late to change my mind. The flower bed will have to be extended, dug out some time in August ready for planting.

I’ve ordered the iris for a new bed, germanica yosemite star.

It’s said to be strongly remontant, which I take to mean will give me a second flush of flowers in late summer providing I remember to cut back the first flush of flowers in May/June.

The new bed will be roughly 5m by 1.5 m and the iris need 45cm to spread. Apparently they hate being crowded so I’ll plant a row at the front (10 bare root plants) plus a second sparse row offset (4-5 plants) to give plenty of space to grow and spread. If they like the space, they should spread happily. If not it will be a waste of time and effort.

Ho hum – gardening.

The mathematical amongst you will have worked out that with two rows and a spread of 45cm, I will still have space in the bed backing onto the fritelaria and alliums.

I considered peony plants but they seem to take an awful lot of space for a very beautiful but very transient flower. I’ve decided on more roses, a white David Austin called Susan Williams.

According to the catalogue it flowers repeatedly, is strong and disease resistant with an excellent scent. Given the background of green and brown wooden sleepers, the white should stand out better than a pink or darker colour. It’s a bit tasteful but you can’t have everything. Maybe I’m mellowing out of the vulgar in my old age. I’ve ordered 6 bare root plants that will have to be dug in late in the year.

The roses will need mulching whilst the iris will have to be kept clear – they like the sun on their bare bones.

Next stop the on-line hire shop for a suitable digger. The sun is shining and all is well with the world.

 

Populism

Populism works. It works as a method of gaining and sometimes holding power.

The recipe is universal. Find a wound common to many, someone to blame for it and a good story to tell. Mix it all together. Tell the wounded you know how they feel. That you found the bad guys. Label them: the minorities, the politicians, the businessmen, the media. Cartoon them. As vermin, evil masterminds, flavourless bureaucrats, you name it. Then paint yourself as the saviour. Capture their imagination. Forget about policies and plans, just enrapture them with a good story. One that starts in anger and ends in vengeance. A vengeance they can participate in.

That’s how it becomes a movement. There’s something soothing in all that anger. Though full of hatred, it promises redemption. Populism can’t cure your suffering, but it can do something almost as good—better in some ways: it can build a satisfying narrative around it. A fictionalized account of your misery. A promise to make sense of your hurt. It’s not your fault. It is them. It’s been them all along.

But if you want to be part of the solution, the road ahead is clear: Recognize you’re the enemy they need; show concern, not contempt, for the wounds of those that brought the populist to power;  be patient with democracy and struggle relentlessly to free yourself from the caricature the populists have drawn of you.

Travel

What does a good travel photo look like?

Big Sky Namibia
Ely Coast, Scotland
Crossing to Vancouver, Canada

We can do sunsets, especially African easily enough.

African Sunset I
African Sunset II

Is it all about the place, outstanding scenery maybe?

Namibia
Yosemite
Namibia Naukluft Namibia
Etosha Namibia
Namibia Naukluft Namibia
Highland, Scotland
Etosha Namibia

Or maybe it’s better if we stick a building into the picture somewhere

Highland castle
Highland castle, Scotland
Highlands castle
Varanasi boats
 Or maybe a boat or two.
Tonle Sap, Cambodia
Thimupu Bhutan
Seville cathedral

Does a picture of human intervention in a beautiful place, add or lose interest in the photo?

Mekong Houseboats, Laos
Bhutanese Prayer Flags

Maybe if it’s alien enough, the photo could just be the detail, the hint of a thing.

Bangkok Temple Detail
Bangkok Temple
Bangkok Temple Detail

Delhi Detail
Mezquita, Cordoba
Alhambra Arches
Jerusalem, Israel

Does a good travel need to be human, with people and children?

Chill, Thailand
Burma Refugee, Thailand
Whirling Dancer, Egypt
Strontium Games, Scotland

Does it have interesting people doing interesting things?

Delhi Cleaning
Delhi Sikh temple
Second Thoughts Kathmandu
Seriously Dad?, Varanasi

Because I have a few of those.

Varanasi Holy man and Acolyte
Fishing, Tonle Sap

Or maybe we could just think about animals, local of foreign, cute or not so much.

Zebra Etosha
Cheetah Lunch, Namibia
Cheetah II, Namibia
Baby Elephant, Namibia

We live in an astonishing world.

Changing the Story

Power is something we are often uncomfortable naming and talking about explicitly. In our everyday talk, power has a negative moral vibe: power-mad, power-hungry, power trip. But power is no more inherently good or evil than fire or physics. It just is. The only question is whether we will try to understand and harness it. In the culture and mythology of democracy, power is supposed to reside with the people.

Here’s a simple definition of power — it’s the capacity to ensure that others do as you would want them to do. Civic power is that capacity exercised by citizens in public, whether in elections or government or in social and economic arenas. Power in civic life takes many forms: force, wealth, state action, ideas, social norms, numbers. And it flows through many conduits: institutions, organizations, networks, laws and rules, narratives and ideologies. Map these forms and conduits against each other, and you get what we think of as “the power structure.”

Story is the catalytic agent for changing the status quo.

The problem today is that too many people aren’t able to draw, read or follow such a map. Too many people are profoundly illiterate in power (TED Talk: Why ordinary people need to understand power). As a result, it’s become easier for those who do understand how power operates in civic life to wield a disproportionate influence and fill the void created by the ignorance of the majority.

The powerful tell tales about why they deserve their status, so that they can feel better about it. So do the powerless. Together, these two sets of stories form an unseen prison of the imagination that shrinks everyone’s scope of possibility about alternative arrangements and allocations of power.

When you want to challenge the powerful, you must change the story. You can use story to organize people and then allow them to organize themselves into the story. Your narratives have to offer an alternative to the dominant story line of why things are the way they are. You have to stir up a new sense of “us”; provide an overarching explanation for who has what and why; and awaken the hero’s spirit in every citizen. Story is the bonding agent in social cohesion. It is the catalytic agent for changing the status quo.

Organizing people centers on telling three nested narratives: the story of self, the story of us, and the story of now.

Marshall Ganz,  learned his art as a civil rights worker in Mississippi in the 1960s, then went on to organize migrant farmworkers with Cesar Chavez. He developed the organizing tools and strategies used by the first Obama presidential campaign and has mentored countless social-justice organizers around the planet. He teaches now at Harvard, where, 28 years after dropping out of college, he returned to finish his degree and get a doctorate. He is the quintessential teacher-as-learner.

Everywhere he goes, Ganz uses a method for organizing that centers on three nested narratives: the story of self, the story of us, and the story of nowHe teaches organizers entering into any setting to start not with policy proposals or high concepts like justice but with biographies — their own, and those of the people they hope to mobilize.

What are the stories you tell about yourself? Why do you tell them that way? How can we find connections across our stories of origin that build trust and common cause? That work then flows into the story of us: the collective narratives of challenge, choice and purpose that emerge from any community — that, in fact, help define it.

This is how in a place like New Orleans after the flood or Detroit after the crash, residents can develop a shared identity of resilience and reinvention. It’s how a political party is able to motivate and mobilise for change.

Once that shared narrative is activated, the organizer can connect it to the fierce urgency of now: a story about why this is the “movement moment,” when individual and collective motivations converge, and when action is needed and possible. Why this and no other time is the time for change. This is how “Yes We Can” became more than a slogan in 2008, as “Morning in America” did in 1980. Or “Make America Great Again” did in 2016.

Stories are weapons in an endless contest for legitimacy.

Of these three stories, the middle one — about us — is crucial. Any effort to exercise citizen power depends on creating new answers to the question: Who is “us”? During the campaign for a $15 minimum wage in Seattle, one of the most potent speeches was from a woman named Evelyn, a sixty-something Filipina immigrant who cleans rooms at a Sea-Tac Airport hotel.

It was a fund-raising event for the campaign, and this was her first public speech. And though she’d never heard of Marshall Ganz before, in her short and blunt remarks she intuitively hit each of his marks. She talked about how a higher wage would enable her to catch up on her bills (self). She talked about why this was a unique opportunity to make gains for working people (now). But she was at her most effective when she talked about what kind of Seattle we wanted to be, and why the city would be stronger if the people who do the thankless work could afford to live there, too. In short, she redefined us. She redrew the circles of identity, not as low-wage workers versus high-wage workers but as people who hold true Seattle values of inclusion versus those who don’t.

This redrawing of the circles is also how “deep canvassing” — intensive face-to-face front-porch conversations based on personal storytelling — can change minds and win adherents on contentious issues like gay and transgender rights. 

Two young political scientists, Joshua Kalla of Berkeley and David Broockman of Stanford, have conducted pioneering field experiments on deep canvassing. One of the strategies that they found most effective was “analogic perspective taking,” in which canvassers would invite citizens to talk about times when they’d been treated unfairly for seeming “different.” From there, the canvasser could pivot to what those citizens had in common with gay or transgender people, and could often awaken enough empathy to reduce bias.

This is more than stepping into someone else’s shoes — it’s stepping into the story of how someone else came to be wearing those shoes. 

If you are trying to convince your neighbors that a nearby church should be allowed to host a temporary homeless encampment, how do you deploy story? Sometimes, it might be by deriding the selfishness of those who resist. More often, it will be by appealing to the better angels of all, so that even resisters can join without losing face.

Either way, you are crafting an imagined us in order to create a real majority. In a town with excellent schools that attracts young families, how do you deal with the divide between the newcomers who are driving up property values and the old-timers who don’t have school-age kids and want lower taxes? Again, you create a story of us, of common interest, that will either transcend that divide or sharpen it in a way that isolates the holdouts.

Such stories are weapons in an endless contest for legitimacy. 

The forthcoming General Election is already over, not won by the Conservatives so much as lost by Labour who have allowed the Tory narrative to prevail.

“We can do better. We can be better. Now.” Is essentially the Labour narrative. It is now and always has been the same story and Labour needs to stick to it rather than [playing the fear blame game that the Tories prefer.

We can do better by our elderly, better healthcare, better social care. Because my nan deserves better and so does yours.

We can do better by our children, better schools and universities. because my children got to university and so should yours, or maybe to an apprenticeship scheme, or straight into a job because that’s what was right for them.

We can do better by our friends and neighbours. We don’t have to be aggressive and nasty to our neighbours, our trading partners in the EU. We can be kind, gentle and generous to the newly arrived amongst us because we are better than the alternative.

We are better than mean and nasty.

Dark

There’s a photo participation being organised by the Guardian newspaper on the subject “Dark” which led to e looking through the various albums.

There are the obvious pictures of sunsets, most obviously from Africa.

Namibia Sunset
Namibia Sunset
Namibia Sunset

But also from Wales.

Sunset, Wales
Sunset, Wales

Turns out there’s not a bad sunset picture to be taken in a desert.

Negev Desert, Israel

And there are the endless pictures through windows or window screens from the dark into the light.

Window Screen, India
Agra Window, India
Cambodia Temple Window

Saville cathedral
Science Museum London

There are the shots taken in dark places, usually more about the light than the dark surroundings.

Pantheon, Rome
View through Alhambra Arches
Mezquita Cordoba
Reflections, Bangkok
Fireworks, London

 Egyptian Show dancer
St Andrews

There are the pictures with dark subjects or topics, whether emotional (the cremations by the side of the Varanasi) physical (the gorging on a recently dead gazelle) or scary childhood toys.

Morning Cremation, Varanasi
Children’s Theatre Toy, Glasgow
Lunch, Namibia
 And finally there are just pictures of dark coloured things, from tulips to a bit a black and white shade and shadow.
Dark Parrot Tulip
Black Parrot Tulip
Toy Dolls, Glasgow Museum
Shadows on the Heath, London

Turns out Spanish catholic churches can be especially morbid with their monuments.

Lady Chapel, Granada Church
Dead Jesus, Granada
head of John the Baptist, Seville Cathedral

Retirement

He says that at the end of the year when this contract comes to an end, he plans to retire. Hmm.

Economist James Banks of the University of Manchester says retirement can be good or bad for your health depending on what you have come from and what you are going to.

If you have had a highly paid, high-status job but little time or inclination to cultivate social activities or friends outside work, then retirement could be a negative step even if you have a huge pension pot. “You may walk all day and do sudokus all night once retired, but still miss the social and intellectual stimulation of the workplace,” he says. However, if you have given up a physically demanding and hazardous manual job, or one with little control and lots of stress, then retirement may be a positive step.

UK, European, US and international studies show a mixed picture; it depends on an individual’s change of status when they leave the workplace. And it is possible it may not even change your life much; if you can maintain your standard of living, interactions and sense of purpose, then retirement may not have an impact on your quality of life.

Academic Gill Mein, at St George’s, University of London, worked on the Whitehall II study, which looked at the social determinants of health among British civil servants. She has two tips for a “good retirement”. One is to develop a hobby or interest while still employed, which you can build on when you leave work. The other is to involve your partner/spouse in your change in role at home once you retire. “I met some couples where one person was used to being at home all alone day and found it difficult to adjust to both being at home and with each other 24/7.”

Professor Deborah Schofield, of the University of Sydney, says: “Moving into a planned retirement from choice is very different from having to leave because of illness. Control over your plans – such as paying off the mortgage, building up some savings and waiting for kids to leave home – are thrown into disarray, you may have less income and also fewer plans. You can find yourself at a loose end without companionship.”

There is a relationship between income and reported satisfaction with life; money may not make you happy, but it helps to be able to afford the necessities of life and a few luxuries. Schofield adds that divorce can hit women particularly hard as they often have lower savings than men. And the three main causes of early retirement because of ill health – pain, arthritis and mental illness – are poorly treated and resourced compared with other conditions such as cancer.

So since he has relatively good health, certainly none of the above issues, it bodes well. Since, between us, we have good pension provision and good levels of savings, plus the house bought and paid for, we should be well placed financially which always gives people choices.

There are said to be three stages to retirement: SAGA. AGA and GAGA that is, an adventurous start, a phase where home is best and a quieter life, followed by the decline into dementia and care homes. In my family experience, whatever age we live to, the last two years will be tough. The average life expectancy for my generation is around 80, but there are serious variations by geography, a fairly obvious proxy for wealth in the UK.

Geriatrician Dr Jeremy Jacobs, of the Hebrew University of Jerusalem, says research into a cohort of Jerusalem residents has suggested old people who rate their health as being poor are more likely to be lonely, depressed, poor, obese or have back pain. “Loneliness is common, but it doesn’t kill you,” he says. Once you take financial security out of the equation, culture, country of origin and ethnicity seem to play a very minor role in how you age.

People over 90 stop reporting pain as a problem; no one knows exactly why.

To live longer and with good quality of life you need to sort out vision and hearing problems (cataract surgery and a hearing aid), take measures to prevent falls (nail down the carpet), avoid taking siestas, eat a decent amount and range of food (not vitamin supplements – they may increase mortality) and, above all, keep moving and stay engaged.

“Adverse life events don’t affect longevity, but if you sit at home all day doing nothing, you will deteriorate. You need to leave the house every day even if you’re in a wheelchair. And keep mentally, socially and physically active at whatever level you can manage. You don’t have to stay in paid work; volunteering is fine too,” says Jacobs.

 

 

Hard Choices

Some jobs nobody wants.

Telling a parent that their child is dying has to be up there with the worst jobs in the world, the flip side perhaps to telling them that you can save their child’s life. Telling parents that their very sick child cannot be helped, and worse still, you believe that keeping them alive is pointless and possibly damaging, telling them you’d like to switch off the machines keeping their child alive, must be amongst the most soul-destroying jobs in the world.

Recent newspapers have been full of the difficult case of the British boy Charlie Gard, the latest in a series of court cases in the UK when parents and doctors have disagreed about medical treatment for a child. Charlie Gard is a 9-month-old boy with the rare neurodegenerative disorder severe encephalomyopathic mitochondrial DNA depletion syndrome.

He is dependent on life support and has been in intensive care at Great Ormond Street Hospital for Children in London, UK, since October, 2016. In such disputes, typically, doctors regard life support treatment as “futile” or “potentially inappropriate”.

Parents, by contrast, want treatment to continue. In the current case, High Court Judge Mr Justice Francis has recently rejected the request of Charlie Gard’s parents for him to travel to the USA for an experimental medical treatment, nucleoside therapy. On April 11, 2017, Justice Francis ruled that it would be lawful and in Charlie Gard’s best interests to withdraw artificial ventilation and provide palliative care. Charlie Gard’s parents have appealed this ruling.

When doctors and the courts consider cases like this one, they often focus exclusively on the best interests of the patient. In some cases, however, it is uncertain whether or not treatment would be in the interests of the patient. Indeed, there could be stronger and clearer arguments to limit treatment on the basis of finite and scarce medical resources. Although it feels brutal, keeping this little boy alive inevitably means less money to spend on keeping other children alive.

The different ethical reasons that justify a decision not to provide treatment might come together, or they might come apart. If treatment would be both affordable and in the child’s interests, it should unquestionably be provided. If it is neither affordable, nor in the child’s interests, treatment should not be started or should be stopped.

Where there is uncertainty about the benefits and costs of treatment, parents’ views are crucial. But sometimes the picture is more mixed. Perhaps treatment is in the interests of the patient, but unaffordable within a public health system. In the case of Charlie Gard, the parents have raised money over the internet through crowdsourcing to enable him to be taken to the USA for medical treatment. That would mean that the resource issue is not relevant. Perhaps for him treatment would be affordable, but contrary to Charlie Gard’s best interests?

One way of thinking about what would be in someone’s best interests is to imagine a set of scales. On the right side of the scales are the reasons in favour of a course of action, on the left are the reasons against. If it were a question of weighing a small chance of a positive outcome against an empty scale, the balance would be tipped in favour of treatment, even if the chance (or magnitude) of benefit were tiny.

But there are often substantial negatives in the balance.

Although health professionals do their best to provide pain relief, sedation, care, and comfort to severely ill children and babies, that ability is finite and imperfect. Children on long-term ventilation often seem uncomfortable at least part of the time, they endure needles and invasive procedures, and might be distressed and unable to communicate the source of their distress.

It is possible to argue that the small chance (perhaps one in 10 000) of benefit would outweigh the negatives of treatment in intensive care. However, a shift in perspective casts that argument into doubt. Charlie Gard’s condition is extremely rare, but imagine that there were a sudden epidemic of mitochondrial DNA depletion syndrome affecting thousands of newborn babies. Would it be ethical to artificially ventilate for months thousands of infants to achieve some measure of improvement in one infant? Setting aside any consideration of resources, it seems wrong to subject thousands of infants to invasive and unpleasant life-support treatment to benefit one child. That implies that this chance of recovery is too slim to make treatment plausibly in the current child’s interests.

The reason why these decisions come to the court at all is because parents do not have an absolute right to make medical decisions for their children. Parents are given broad discretion about how to raise their children, for example, how to feed them, how to educate them, and whether or not to immunise them. Parents will not always make the best choices, but for the most part the state will not interfere or intervene. However, where parents’ decisions run a substantial risk of causing serious harm to their child, their decisions must be challenged, if necessary in a court.

When it comes to experimental treatment, there can be different reasonable views among health professionals about how to weigh up the chance of benefit against the burdens of the treatment. In the face of such disagreement, the decision properly belongs to the parents. Assuming the treatment is affordable, and the parents want it, it should be provided. However, when no health professionals think that the experimental treatment is worth pursuing, parents’ request for treatment should not be granted.

In the case of Charlie Gard, just one expert in the USA was prepared to provide experimental treatment. However, the expert admitted that the treatment had never been tried in a child with established encephalopathy and that benefit was “unlikely”; in his ruling, the judge clearly thought that this possibility did not represent a reasonable treatment option.

Decisions about life-sustaining treatment for critically ill children are fraught and difficult for all involved. Parents are, rightly, at the heart of the decisions that are made in intensive care. Their views about treatment are important, and their wishes are usually followed. However, there are limits. Sadly, reluctantly, doctors and judges do sometimes conclude—and are justified in concluding—that slim chances of life are not always better than dying. Providing comfort, avoiding painful and unhelpful medical treatments, supporting the child and family for their remaining time: sometimes that is the best that medicine can do, and the only ethical course.

Pending appeal Charlie Gard continues to be kept alive.

STOP

Throughout history, humanity has been blighted by epidemics of communicable diseases that medical science and public policy have, to varying degrees, been able to control. Sanitation, immunisation, mosquito nets, and antimicrobial agents are examples of developments that have helped to generate substantial reductions in cholera, dysentery, smallpox, measles, HIV, tuberculosis, and many other infectious diseases.

More people die in the developing world from non-communicable disease than communicable, though it can be tricky to raise funds for heart attacks over diphtheria. Non-communicable diseases are now emerging as major burdens in low-income and middle-income countries. This is especially true of the epidemics of lung cancer, chronic obstructive pulmonary disease (COPD), cardiovascular disease, and other disorders that are caused by tobacco smoking.

We know it’s bad for us to smoke, but maybe not quite ho bad.

A new report in The Lancet using data from the Global Burden of Disease Study provide comprehensive estimates of death and disability caused by smoking at the country level. The findings are sobering. In 2015, smoking caused more than one in ten deaths worldwide, killing more than 6 million people with a global loss of nearly 150 million disability-adjusted life-years.

Smoking prevalence and consequent morbidity and mortality are now falling in most (but not all) rich countries, but future mortality in low-income and middle-income countries is likely to be huge.

Worldwide, one in four men, and a total of 933 million people, are estimated to be current daily smokers, and 80% of these smokers live in low-income and middle-income countries. Half of these, or half a billion people alive today, can be expected to be killed prematurely by their smoking unless they quit.

At present, smoking prevalence is still low in countries with a low socio-demographic index, but, on past experience in richer countries, it is only a matter of time before men and then women in all countries take up smoking, and in due course die from lung cancer, COPD, and other diseases caused by smoking, as has happened in the richer world. Even though the prevalence of smoking is decreasing in many low-income and middle-income countries, including many of those with the most smokers (eg, China and India), population growth means that the number of smokers, and hence the burden of harm from smoking, continues to rise.

Responsibility for this global health disaster lies mainly with the transnational tobacco companies, which clearly hold the value of human life in very different regard to most of the rest of humanity.

For example, the latest annual report from British American Tobacco (BAT), historically the most global of today’s five transnational companies, details with apparent pride their geographical diversity, strong earnings and market share growth, market leadership in more than 55 countries, and manufacturing facilities in 42 of them.

In 2016, BAT sold 665 billion cigarettes, making £5·2 billion in profit; and recorded rising profits across most of the world. Countering the heft and influence of commercial behemoths such as this demands human resources, governance, expertise, and financial backing that few rich countries have yet to fully establish, let alone those countries at the lower end of the development spectrum.

The WHO Framework Convention Alliance provides detailed guidance to support implementation of a growing range of effective tobacco control policies, including taxation, advertising bans, smoke-free policies, and protection against the vested interests of the tobacco industry, but, in most parts of the world, translating this guidance into effective legislation has a long way to go.

Like in many rich countries, tobacco control legislation too often becomes mired in procedure and delayed or otherwise undermined by tobacco industry misrepresentation of science, fearmongering over tax revenue and illicit supply, corporate social responsibility activities, offers of help drafting tobacco laws, threatened or real legal action, and, in some countries, economic dependence on tobacco growing, and conflicts of interest.

The persistence of smoking in the countries first affected by the tobacco epidemic reflects decades of failure first to recognise smoking as a health problem, and second to take decisive action to implement the policies currently promoted by the WHO Framework Convention on Tobacco Control, but articulated long ago in the Royal College of Physicians’ report of 1962

Today, the smoking epidemic is being exported from the rich world to low-income and middle-income countries, slipping under the radar while apparently more immediate priorities occupy and absorb scarce available human and financial resources. The epidemic of tobacco deaths will progress inexorably throughout the world until and unless tobacco control is recognised as an immediate priority for development, investment, and research.

Rich-world experience also teaches that where the tobacco industry leads and succeeds today, so the alcohol and food industries follow tomorrow