Making yourself ill

The idea is regularly mooted in the UK that people shouldn't get free medical treatment - or any medical treatment at all - if they've "made themselves ill". It's only a small minority who take this line, but they always get plenty of media attention, as if it's a wonderful idea.

If people drink too much, take drugs, smoke, engage in risky activities, or become enormously fat, goes the argument, then they shouldn't qualify for NHS treatment and they should be left to their own devices. If their behaviour leads to severe medical conditions, they should be left to seek treatment at their own expense and not expect the taxpayer to step in and sort them out.

Well, apart from the fact that the NHS has always pledged to be free at the point of use, regardless of personal circumstances and regardless of financial status, deciding that certain people shouldn't qualify for NHS treatment would be the start of a slippery slope. Once you begin turning away certain individuals, where would it end? The exemptions would proliferate until whole swathes of people could no longer use the NHS.

Furthermore, if people happen to have engrained psychological weaknesses that have led to illness - lack of self-control, recklessness, impulsiveness, whatever - why should be penalised for it? They may have tried many times to change their behaviour and failed. Or their behaviour might be a response to distressing personal circumstances they find it hard to cope with. People don't simply "make themselves ill".

Another case of engaging mouth without engaging brain.

NB: Of course all this only applies to the NHS because health care is organised quite differently in the States.

Fancy a chat?

The growing problem of loneliness has prompted a new initiative you might call "opportun-ities to chat". Coffee shops have introduced "chat areas" and train companies are experimenting with "chat carriages".

The idea is that people who want some social contact can head for these chat areas and strike up conversation with others in the same boat.

Alexandra Hoskyn was 33 when she started the Chatty Café Scheme three years ago. Her son, Henry, was four months old and she felt isolated and deprived of adult company. So she encouraged coffee shops to set up chat areas where lonely people could meet and talk.

Now more than 1,000 cafés, hospitals, council offices, supermarkets and other venues have set up chat tables and the trend is catching on.

It seems like a great idea to me. You can chat to someone knowing they also want to chat, instead of risking a brush-off or just keeping yourself to yourself.

I don't know of any such "chat areas" in Northern Ireland, although Costa Coffee and Sainsbury's have introduced them elsewhere. Mind you, the Northern Irish are naturally chatty and will natter away to anyone anywhere. Sit next to someone on the bus and you could very well hear their entire life story by the end of the journey.

Loneliness has been linked to many medical conditions such as dementia, obesity, high blood pressure and mental disorders, so it seems a no-brainer that anything that makes it easier to link up with other people can only be a good thing.

I'd like to give it a try. Just as long as I'm not landed with some gung-ho political nerd who wants to discuss the finer details of Brexit for at least half an hour....

The other 9/11 victims

With the tenth anniversary of 9/11 coming up, there's the usual focus on the almost 3,000 people who died, but little is said about the 20,000 with serious illnesses caused by exposure to toxic dust and debris.

The health hazards of two massive skyscrapers collapsing and poisonous material spewing all over the surrounding area should have been obvious, yet thousands of emergency workers, volunteers, local residents, cleaners and other tradespeople went about their business for weeks with very little protection.

Now thousands are suffering from a range of disabling illnesses including asthma, sinusitis, muscular and intestinal conditions, lung diseases and memory problems. Many are unable to work or live a normal life.

Up to 80,000 people were present in the aftermath and new patients are coming forward all the time with previously undiagnosed disorders. People are expected to fall sick for at least another 20 years.

In hindsight, it seems obvious that everyone should have been evacuated from the area and proper decontamination teams sent in to remove all the toxic residue. Yet the dust and debris - which included asbestos, lead and mercury - was generally treated as a mere nuisance rather than a major health emergency.

Alex Sanchez is just one example of this peculiar oversight. He helped clean dust from numerous buildings in Lower Manhattan. In only two buildings was he given even a face mask. Now he has severe breathing difficulties, headaches, gastric problems and is no longer able to work. His life has been wrecked just as much as for the families of the dead.

The government has set up a $2.9 billion fund for monitoring, treatment and compensation for the 20,000 plus "other" victims. But the question remains - why was this serious health hazard not clearly recognised in the first place?

PS: Some first responders get help, some don't. Ralph and Barbara Geidel have spent close to $100,000 on his medical treatment since 2003, when the former fireman and first responder was diagnosed with tongue and neck cancer. The Zadroga Act, which set up the compensation fund, doesn't cover cancer. Yet a study in The Lancet says firefighters at Ground Zero are 19% more likely to get cancer than those who weren't there. Ralph's brother Gary died in the World Trade Center attack.

Pic: Alex Sanchez

Go treat yourself

Every so often some bright spark suggests that the NHS shouldn't treat people with "self-inflicted" ailments. Things like alcoholism, drug addiction, obesity, anorexia.

It sounds good on paper, for about five minutes. It would save the NHS millions of pounds, we would all pay less tax, and it would encourage people to take more care of their health.

But in reality the idea just doesn't stack up. For a start, how do you decide that something is self-inflicted? If someone is overweight, they may be over-eating or they might have faulty genes or a hormone imbalance. They might say they've genuinely tried to lose weight but nothing has worked.

If you refuse to treat a "self-inflicted" illness it could get worse, meaning far more expense farther down the line as the illness becomes terminal or the person loses their job or becomes a burden on others.

Also, any ailment can be seen as self-inflicted if you so choose. The hill-walker who breaks a leg on a mountain-top. The gym enthusiast who has a heart attack during a workout. The rock musician with hearing loss. If they hadn't been doing those things in the first place, they would be fine....

And who exactly would make the fateful decision? A doctor? A petty official? Your right to medical treatment would be subject either to someone's personal whim or some baffling set of guidelines. You sometimes use the lift and not the stairs? Sorry, mate, we can't help you.

Not to mention the awful choice for someone who's hard-up whether to scrape the money together for private treatment or somehow live with the illness.

In the end, it's just an attempt to blame the victim for their problem instead of giving them what they need. Of course we all try to avoid getting ill. Nobody wants to be swallowing a load of medicines or languishing in a hospital ward. But despite our best efforts, we can still succumb to ill health and it's up to the NHS to help us.

This half-baked idea belongs in the dustbin.

Unsung heroines (4)

Georgina Downs of Chichester, West Sussex, has spent the last ten years trying to ban pesticide-spraying near homes, schools and workplaces. She is sure it causes serious health problems.

She herself has suffered sore throats, blistering, muscle wastage and other ailments that have stopped her doing what she wanted with her life.

They have led to her not having a partner or children and not pursuing her chosen career in musical theatre. Instead she started the UK Pesticides Campaign to force the government to restrict pesticide spraying.

How can it be right, she says, that chemicals labelled "very toxic by inhalation" can be pumped out yards from people's homes? How come the sprayers themselves have to be properly protected against the chemicals but householders can breathe them in regardless?

In November 2008 the High Court ruled she had produced "solid evidence" that rural dwellers facing repeated exposure had suffered harm, and that the government "must think again" about the use of pesticides.

But eight months later the Appeal Court ruled the government was doing enough to protect its citizens.

Now Georgina is planning to take her case to the European Court of Human Rights and write a book on the subject.

She has researched the harmful effects of pesticides exhaustively and is convinced indiscriminate spraying can cause any number of severe conditions including cancer and Parkinson's Disease.

She says the government's claims that people are properly safeguarded aren't backed up by the evidence and they have misled and misinformed the public.

It's tremendous that people like Georgina won't be fobbed off by government reassurances about their health but are determined to get to the bottom of the matter and fight every inch of the way for better protection and more responsible attitudes. We could do with more people like her.

Unsung heroines 3: Salome Mbugua
Unsung heroines 2: Camila Batmanghelidjh
Unsung heroines 1: Gareth Peirce