The TTIP and healthy public policy

If multinational companies have the power to restrict the ability of governments to legislate, what will be the implications for the development of healthy public policy? This is the fear raised by the inclusion of investor-state dispute settlement (ISDS) in the Transatlantic Trade and Investment Partnership (TTIP).  There are already some smaller trade treaties that have ISDS inserted into their conditions, and it is these that are enabling for example, Phillip Morris, the tobacco company, to sue the Australian and Uruguayan governments for affecting their profits by encouraging people to stop smoking. There are many other examples – the government in El Salvador is being sued by an Australian company as the government has refused permission for a goldmine as it fears it will pollute drinking water. Friends of the Earth have argued that lower standards of environmental protection will occur if further ISDS clauses are written in to these treaties. The new TTIP (between the USA and Europe) seemed relatively benign until people started to realize the effect of the ISDS within it. Public concern grew to an extent that the European Commission started a public consultation on the issue in March 2014, which closed in July 2014. Its report is due this month. Over 149,399 individuals and organizations participated in the consultation.

In short, not only would the development of healthy public policy – already a battle – be severely affected, but also the ISDS would result in massive bias towards the interests of the business sector. Even The Economist, a magazine that is hardly left wing, and which reports on business matters, has recently come out against the TTIP. It has said that ISDS is “a way to let multinational companies get rich at the expense of ordinary people”. Others, both critics and those corporate lawyers who are involved in the process and stand to gain from ISDS, have expressed amazement that governments have agreed to these investor-state dispute settlements. One submission to the EC consultation was a group of professors from a range of European universities, who stated:

“The system involves a shift in sovereign priorities toward the interests of foreign owners of major assets and away from those of other actors whose direct representation and participation is limited to democratic processes and judicial institutions.”

This quote is from this blog, which provides an overview of the consultation:

http://kluwerarbitrationblog.com/blog/2014/10/03/isds-which-way-will-the-scales-ttip/

For the full response from the Professors’ group, see also: http://conflictoflaws.net/News/2014/10/20140711_MuirWatt.pdf

There’s also some useful comments at: http://conflictoflaws.net/2014/isds-in-the-ttip/

The French government has already said that it will not sign the TTIP if the ISDS is included: http://www.euractiv.com/sections/trade-society/french-government-will-not-sign-ttip-agreement-2015-310037

Now, I’m not an expert on this at all, but it seems that the EC hasn’t yet published its report on the consultation. There was, earlier in November, a discussion with the most senior EC leaders about the inclusion of ISDS in the TTIP, which seemed to indicate that the tide is turning against ISDS: https://www.youtube.com/watch?v=OfBXhtdBnSg

I guess what this shows is that the corporate sector has huge ability to shift the balance of power in its favour, pushing ahead terms of trade that contain all sorts of hidden aspects that float past a public that has limited understanding of what they will mean in practice. The fact that there has at least been a pause, and possibly even a reversal of the TTIP shows that public resistance does work. The 38 degrees campaigning group has amassed 910,000 signatures against the TTIP http://www.38degrees.org.uk/ and http://ttipaction.38degrees.org.uk/

In October there were protests across 24 of the EU member states and the Stop TTIP petition has now been signed by 750,000 people. The Stop TTIP campaign calls itself a self organized European Citizens’ Initiative:

https://stop-ttip.org/

The site documents other attempts to overrule democracy and to allow corporate interests to trump national sovereignty.

Developing healthy public policy, to me, is the cornerstone of the Ottawa Charter, which in turn is the foundation of modern health promotion. Certainly the other four ‘planks’ are essential, but healthy public policy facilitates and enables the others. It firmly makes the move from victim blaming and from a reliance on health education alone. Ever since the Ottawa Conference in 1986, governments have squirmed and wriggled out of their obligations to use policy to promote and protect people’s health and tackle health inequalities. Michael Sparks spoke of the battle to keep building healthy public policy on the right track:

Sparks, M. (2011) Building Healthy Public Policy: don’t believe the misdirection, Health Promotion International, 26(3), 259-262

The initiative ‘Health in All Policies’, started in 2006 under the Finnish Presidency of the EU, was given impetus by the Adelaide conference on the same theme in 2010:

http://www.who.int/social_determinants/hiap_statement_who_sa_final.pdf

And also by the 8^th International Health Promotion conference in Helsinki in 2013:

http://www.healthpromotion2013.org/health-promotion/health-in-all-policies

The values and principles of Health in all Policies are diametrically opposed to the direction of travel represented by ISDS in the TTIP. Health impact assessment – where the impacts on health of any action or policy are properly assessed – has obviously not been considered in relation to the TTIP. If the TTIP, with its current ISDS, is agreed to by the governments involved, there will be an utter undermining of those policy efforts to improve health. The power of the food industry, tobacco and alcohol industries will be further enhanced – the very industries that have to date, resisted attempts to move their activities in any meaningful way to increase health. There will be consequences for health and the environment from other parts of the corporate world that will use the ISDS to challenge any policies that they regard as eroding their profits. If you do nothing else, at least read the information about the ISDS and the TTIP and decide to join in the debate.

Ebola and the Global response

Our hearts go out to our students, colleagues and everyone else in those countries affected by Ebola. There’s very little we can do except to say that we are thinking of you, and to put pressure on our government to offer more help. David Cameron yesterday pledged a further £80 million to Sierra Leone, meaning that the UK has pledged £205 million. This is more than 19 other EU countries combined. The company IKEA has donated 5 million Euros, more than 18 EU countries have.  What Cameron didn’t say when he announced the monies pledged, was that his government cut aid to Sierra Leone by 20% last year. Some might argue that donating money isn’t the answer, but it must surely help. Sadly though, of the new £80 million donated by the UK, £10 million of that will go to burying the dead and paying for their funerals. There surely never was a more poignant case of too little, too late.

The  run-down and poorly resourced WHO has said that it needs $260 million to combat Ebola; the UN has said it will take $1 billion to bring the outbreak under control in the next six months. The WHO communications officer, Fadela Chaib has said that 3.3 million items of high quality personal protective equipment is needed.  So far only two countries, Cuba and Timor-Leste have ‘punched above their weight’, according to Samantha Power, the US Ambassador to the UN, in that they have actually put in place their aid efforts and given far more than what would be expected from relatively poor countries. Clearly we are seeing an emergency response that is late, and also doesn’t take into account the capacity of the countries most affected by Ebola to actually spend the extra resources  - it also needs logistics, personnel, and a whole host of infrastructure in order to be able to use the funding effectively.

It looks as though there are about 1,000 new infections each week, and the capital cities of Freetown, Conakry and Monrovia are especially affected. Today there’s the first case in Mali.  Another estimate says that we will soon be seeing 10,000 cases each week, and the WHO has given out very different estimates of how many could be dead by Christmas.

Ebola is a test of the strength and resilience of communities but it’s also a test of the strength of the global contract that asserts that our health is all interconnected. We cannot be healthy – morally and socially – whilst others do not enjoy health. This is a fundamental principle of health promotion and is behind its commitment to tackling health inequalities. That ‘there can be no health without that of my brother or sister’ may seem trite and it certainly trips off the tongue. The global North only seems to remember that health is interconnected when its people’s health is physically threatened rather than being merely morally threatened. There has been as much coverage in the western media of the few cases in Spain, the USA and the UK as there has of the thousands of cases in Africa. Ebola fuels the fears of those in the global North that Africa is a source of disease and that it threatens our own wellbeing.

Africa remains the Dark Continent in so many people’s minds; when people knew I was travelling there recently, they asked whether I was worried about Ebola. They had no idea that they were almost as near the epicenter here in the UK as I would be below the Tropic of Capricorn. The continued use of the Mercator projection of the globe gives no clue of the vast space that is Africa. Few people would know where the countries affected are. They would also perhaps be unaware that these countries are among the poorest in the world. The latest Human Development Index Report shows that out of 187 countries, Sierra Leone is ranked at 183, Guinea Conakry 179, Guinea Bissau 177 and Liberia 175. These are fragile states even before the rise of Ebola, but it is precisely because they are fragile states that Ebola has been able to gain such a grip. To prevent occurrences of Ebola becoming major disasters needs either the more usual type of outbreak – such as in the Congo where outbreaks are more common and occur in remote forest communities and tend to die out fairly quickly – or it needs strong public health systems, where medicine is free or subsidized, and it needs strong national government, a well-resourced local government structure and a strong public sector. These aspects of good governance do not exist in many poorer countries.

In response to the Ebola crisis, the global North has adopted its usual siege mentality. The UK has put in place a screening process at a cost of £9 million, though again, experts say that it won’t pick up those who have the virus but who are not yet symptomatic. Travelling in various parts of Africa recently, I’ve seen the measures put in place to try to stop the virus entering new countries. At Gaborone airport I was asked to fill in a questionnaire asking if I had certain symptoms. Of course this is completely ineffectual, especially when Ebola takes 21 days to show symptoms. But what steps can a country take? Dr. Stella Ameyo Adadevoh has just been recognized in Nigeria’s National Honours award list. She was the person credited with stopping a disastrous outbreak in Nigeria – Africa’s most populous country – by taking swift action in the case of Dr. Patrick Sawyer, who brought Ebola to Nigeria from Liberia. Sadly she and seven others died after being in contact with Sawyer. There is a plan to rename the Infectious Diseases Hospital in Lagos after her. It highlights the danger to front line health workers and indeed many have given their lives to this virus. Front line health workers are those working way downstream; what is clear is that the global community has failed to work upstream to do something about all those states that have languished for decades at the bottom of any index of poverty or development.

Sierra Leone is still reconstructing after its civil war; communities and infrastructure were just beginning to recover from its systems and institutions being destabilized. It’s noticeable that of the handful of European victims of Ebola, many have survived – when your body is well nourished and you received excellent health care, you obviously stand much more chance, let alone having access to experimental treatments. Where people do not have enough food anyway, where immune systems are under threat simply from day to day living and where there are not hygienic conditions, those infected are so much less likely to survive. People in Sierra Leone already spend between 60 and 70% of their income on food; with the effect on the food supply chain and a breakdown in other services, families are now going without food. I cannot imagine the impact on the normal routines of hospitals – what’s happening to all the usual cases of illness that would be treated in those hospitals that have now been overwhelmed by Ebola?

Margaret Chan, director general of the WHO has said of Ebola, “I have never seen a health event threaten the very survival of societies and governments in already poor countries. I have never seen an infectious disease contribute so strongly to potential state failure”. Ellen Johnson Sirleaf’s letter to the world is an extraordinary dignified and passionate appeal to the world to help. I urge you to listen to it. It can be seen at:

http://search.yahoo.com/search?ei=utf-8&fr=aaplw&p=you+tube+Ellen+Johnson+Sirleaf+letter+to+the+world.

And the text can be found at:

http://infotainmentnaija.blogspot.co.uk/2014/10/liberia-president-johnson-sirleaf.html

It would be good to think that this disaster will show the world the true conditions of life in Guinea, Liberia and Sierra Leone, will help to bring about the realization that global health really is interconnected, and that our ethical responsibility is to improve the health of the unhealthiest – not just when it threatens our health, not just when it suits us, and not just in an emergency, but as an ongoing commitment. 

Health Promotion and the World Cup?

When my colleague and graduate of Leeds Met,  Ebenezer Owusu-Addo,

read my last blog post, he emailed me and said “what will your next blog be on – health promotion and the world cup?!” Eben is Assistant Research Fellow at the Bureau of Integrated Rural Development, Kwame Nkrumah University of Science & Technology in Kumasi, Ghana, and like many of us, is a football fan.  So this one’s for you, Eben!

Initially I thought that the world cup doesn’t have much to do with health promotion, but I like a challenge, so I've been thinking about it. And of course, the world cup is important and I’m writing this on the same glorious day in 1966 that England beat Germany 4-2. I watched it alone as a child, in a cavernous room in a castle whilst on holiday with my family and it remains one of the best sporting events of my life, and that of many other people. This was only 21 years after the end of the Second World War and victory over Germany is always sweeter than that over any other nation. Here start the problems – what’s the line between national pride in achievement, and nationalism?

Now, in my view there are lots more important and pertinent issues than football and the world cup. I’d like to mention a few before returning to the main theme. To start with, over 1000 Palestinians have been killed in the last three weeks by the action against Hamas by Israel. Children and women have been the largest part of these deaths; about 50 Israelis have lost their lives, mainly military personnel. There seems to be no end to the violence there and no solutions; I wept again at seeing the images of children in hospital in Gaza, aware that they would become the next generation of angry young people. And there’s the downing of Malaysia Airlines flight MH17, again bringing heart-rending scenes of parents who have lost their children. Right now we are commemorating a random act of violence a hundred years ago that led to the First World War; even if flight MH17 was accidently shot down, it’s the kind of thing that has the potential to shatter peace on a global scale. How many times have we heard “Never Again”?

From a professional point of view, (and knowing that all lives are of equal worth), one death that struck me, of those killed on flight MH17, was Professor Joep Lange. He was the Dutch doctor and specialist in infectious disease whose work developed antiretroviral therapy. ARTs are now saving millions of lives throughout the world, making HIV a manageable disease as long as these drugs remain available. He worked tirelessly to make sure the drugs were available throughout poorer countries from the 1990s. He was a founder of the Amsterdam Institute for Global Health and Development, and had started to take on a series of other major issues, such as health care financing. He has been described as having a heart of gold and a strong sense of humour, a highly intelligent and cultured man. He was 59 and surely had many more years of life to enjoy and many more ways to contribute to improving health. One senseless death among so many.

Back to football. Yes I enjoyed the world cup. Yes of course I wanted Ghana to win. Being an academic, where our job is to be critical, it’s often the case that you feel split – you can simply enjoy an amazing spectacle, young men showing extraordinary skill, the excitement of a competition, plus the feeling that you are joining in with everyone else. On the other hand, you are aware of the deeper level of analysis that’s required, aware that along with everyone else, you are watching a spectacle that has something to do with ‘bread and circuses’. There are of course, many who ignore it all completely, and there are those who live and breathe football. We know that heart attacks rise during important televised matches (and there were a few points in the world cup where one might have been concerned about the state of Angela Merkel’s arteries) – there are fans and there are ‘fanatics’.  Seeing the anguish and tears on Brazilian faces as they were thrashed 7-1 by Germany; the frenzied fist pumping from managers, the breakdowns (such as Neymar’s) at having to retire injured all would lead anyone to ponder on how healthy this was. To be so overwrought – is it healthy that it matters this much?  China has reported a number of deaths related to nervous exhaustion due to so many people rearranging their sleep and work around the awkward time differences of Brazil. The fouls, let alone Luis Suarez’s use of his teeth show how important it is to win at any cost, and it’s one of the reasons why one of the matches I enjoyed most was that between the USA and Belgium – played impeccably, with good grace and hardly any nasty physical contact. There were of course lots of great moments too. Columbia’s team dance was a joy. At the end, the crown went to a country with not only the best team – which they were – but also to a country that can afford the resources and have a well organized machine to produce such a team.  Could a resource-poor country such as Costa Rica or Ghana ever get to the final? Does football demonstrate the global inequalities that are so evident in every other aspect of life?

All this leads to the question of whether football is real life or whether it mimics real life. Is football a mirror on the world or a parallel universe? In my view it’s the former, which is why the campaigns to stamp out racism, homophobia and sexism in sport are so important. Health promotion is first and foremost about all people being able to live freely as themselves and to achieve their potential.  There are still no openly gay male players at the top levels. Football is all about looking at young men – the women’s game gets little TV coverage.  The football world seems to be deeply sexist and homophobic and whilst black people and other minorities are becoming well represented on the pitch, they are not at more senior management levels. There’s been controversy recently in scientific and media discussions trying to understand why so many black people make great athletes, particular Jamaicans, with a theory regarding the genetic selection caused by the Atlantic slave trade. I don’t know enough about the details to discuss it, but it’s plausible. My colleague at Leeds Met, Professor Kevin Hylton, has used critical race theory to explore racism and sport, the subject of his inaugural lecture. See:

https://www.leedsmet.ac.uk/news/lecture-to-examine-racism-in-sport-leisure-and-society28102013.htm

In Iran, women are banned from watching football alongside men, so they have been watching it in defiance of the authorities, in mixed cafes.

So the football pitch demonstrates ‘personal politics’ as well as politics at the highest level.  Football is a means of demonstrating ‘soft power’; Germany certainly is the dominant European power, and you have to hand it to them – they are such an accomplished nation. There’s a reason why I drive a German-made car! And of course it’s great to see those countries that are not party to the seats of power doing well in such a tournament, and in so doing, challenging the global order, even if in a not very significant way.

Globalization has led to increasing diasporas, meaning that the followers of particular nations may be found all over the globe – Mexico’s victory against Croatia was celebrated wildly in Californian streets and that of Algeria moving into the second round was cheered on city streets all over France. The fact that so many players from all around the world play in the English premier league has been linked to the poor performance of the England team, as it means that not enough English players get exposure at these highest levels, undermining the formation of a solid national team, and also the dominance of the premier league has led some clubs to want to limit players’ involvement (and potential for injury) outside club games. These seem to be excuses to me, but certainly if we want examples of globalization, we need look no further than football.

I use the example of the obscene level of footballers’ salaries to demonstrate the huge inequity in income in the UK; I’m saddened by the takeover of what started as a working class game by big business. This has happened to such an extent that many now feel that the beautiful game has been poisoned – by corruption, political interference, bribery and fixing – whether that is of the location for future world cups or of individual matches. I’ve written in this blog before about the appalling conditions facing the migrant labourers working on the stadia in Qatar, and since then there have of course been widespread allegations of corruption in how Qatar was awarded the world cup.  The international body, FIFA increasingly looks like a corrupt oligarchy operating in a secret world.

As in football, as in life – the world cup illustrates key health promotion values in that we can use it to point out inequalities, power, oppression and discrimination. Sport of course is often used to promote health, in encouraging individuals to become more active. We can see the Tour de France effect on cycling in Britain, and even before that, the number of people cycling once a week in the last six months in the UK had grown to 2.1 million. Whilst the figures for people getting involved in sport are generally on the increase, the numbers playing football once a week have fallen in the last 12 months, and falls are particularly prominent in working class areas. See:

http://www.theguardian.com/sport/2014/jun/12/sport-england-figures-15m-adults-play-sport

Sport is also implicated in social capital; locally organized football and other sports clubs are often used as one measure of this important concept.  See the book Nicholson, M. and Hoye, R (2008) Sport and Social Capital, Taylor and Francis for a thorough overview of the role of sport in participation, social engagement and social capital.

The World Cup in Brazil cost $11 billion. It led to all sorts of protests from ‘ordinary’ Brazilians when so many in Brazil live in poverty.  Peaceful protest and social action are part of our repertoire of activities to create meaningful social change for a healthier world – but sometimes I’m not optimistic.

Health Promotion and 'British values'

Health promotion is based on a clear set of values. There’s been a lot of debate about its ability to provide evidence of effectiveness and to be ‘evidence-based’ and evidence-driven. BUT – having said that, health promotion as an activity and as a discipline is really values-driven, and we have discussed these in depth in our book and in our teaching. Health promotion is concerned with social justice, with tackling health inequities, with fairness, redistributing power, creating strong cohesive communities, and helping all people everywhere to reach their full potential without having to worry about their wellbeing, pain, disability and disadvantage. An ethical thread thus runs deeply through our whole endeavour. We know a lot about values! It was therefore interesting to see our government over the last few weeks talk so much about British values, and to assert how important they are.

These values, according to street interviews with the British public, are about ‘fairness’, ‘fair play’, cheeriness, stoicism, everyone pulling together in a crisis. I do agree that these are to be found in communities around me. It’s when I look at those who run the country, the decision makers and powerful, that I despair. Here are some examples over the same few weeks that show to me that Britain does not demonstrate those values.

Firstly, the number of British households falling below minimum living standards has more than doubled in the last 30 years. This has just been revealed at the third annual Peter Townsend conference. (http://www.poverty.ac.uk/take-part/events/final-conference)

For those of you unaware of the contribution of the great Peter Townsend, he was the chief architect behind the Black Report of 1979 that showed so clearly how health inequalities are linked to poverty and deprivation. He was one of the key thinkers who developed clear measures of disadvantage and his work had a huge impact on people like me, grappling with how to understand just why so much relative deprivation could exist in an affluent country.  As his Wikipedia entry says, Townsend was dedicated to studying "very carefully the life of the poorest and most handicapped members of society". See: http://en.wikipedia.org/wiki/Peter_Townsend_(sociologist)

He co-founded Child Poverty Action and also the Disability Alliance. (If you Google him of course, you’re likely first to find Pete Townsend from The Who, so try Peter Townsend, sociologist).

The new research, described as the most detailed study ever of poverty in the UK shows that 18 million Britons live in inadequate housing, 2.5 million children live in damp homes, and that 12 million are too poor to take part in basic social activities. The report shows that one in three people cannot afford to heat their homes properly and 4 million adults and children are not able to eat healthily. One in five adults have to borrow money to fund basic day-to-day needs. The Townsend Centre for International Poverty Research led the research, funded by the ESRC. Professor David Gordon from the Townsend Centre has said, “The coalition government aimed to eradicate poverty by tackling the causes of poverty. Their strategy has clearly failed. The available high quality scientific evidence shows that poverty and deprivation have increased. The poor are suffering from deeper poverty and the gap between the rich and poor is widening.”

All in all, the message is that over the last thirty years, the proportion of households having to cope in ‘below-par’ living conditions has risen from 14% in the early 1980s to 33% now. What’s fair about that?

A key message from this new research is that poverty is not especially caused by lack of paid employment, as the majority of children suffering poverty are in households where at least one parent is employed. These findings echo those reported a week earlier by the Social Mobility and Child Poverty Commission, whose recent report has concluded that this will be the first decade since 1960 not to see a fall in absolute child poverty. The Child Poverty Act, one of the last acts passed by the previous Labour Government, set targets to get relative child poverty below 10% by 2020. (Relative child poverty is the proportion of children living in households on below 60% median income). The Commission has said there’s not a chance of meeting these targets, as 3.5 million children are expected to be in absolute poverty in 2020 – five times the target.

The government keeps talking about the way out of poverty being employment, and that child poverty can be addressed by getting more parents into work. The Commission though has said that addressing poverty through the labour market “does not look remotely realistic”, and now the latest Townsend Centre research confirms that employment is not a sufficient protection against poverty.

We know that poverty is the key cause of ill health. It came as no surprise therefore that another report, from the Office of National Statistics last month, showed that about a quarter of people are dying prematurely from preventable causes. The report showed that 23% of deaths registered in 2012 were “caused by certain conditions which should not occur in the presence of timely and effective healthcare or through wider public health interventions”.

This statement seems to imply that public health and health promotion has somehow failed and in my view, it’s being blamed for not ‘saving lives’. But given the well known links between social status and health inequalities, dating back to the Black Report and Townsend’s seminal work, and the recent dramatic increase in poverty, it’s not at all surprising that people are dying from preventable causes. Moreover, the rise in poverty is happening alongside the cutting of funding on public health, the dismantling of health promotion and community health projects and wider cuts such as in Sure Start or Children’s Centres. It’s also happening at a time of huge change in the NHS. So even if we did accept that more “timely and effective health care or wider public health interventions” could effectively tackle health inequalities, these services are under threat.

Official figures also show how people’s chances of not dying from preventable causes such as certain cancers, are being threatened by what’s happening in the NHS. NHS performance data show increasing delays in carrying out vital tests – the number of people waiting more than six weeks for a scan is now at its highest level since 2008. In April 2014, 17,000 people with suspected cancer had to wait more than six weeks for tests, which is twice the total in the same month last year. In the same week, the Royal College of Nurses said that by 2025, district nurses, the backbone of community nurses may ‘face extinction’. The decline in their numbers comes despite the increase in the need for them, given the increase in lifestyle-related diseases such as type-2 diabetes. (Another recent piece of research from the University of Leicester, analyzing data from the Health Survey for England, and published in the BMJ Open, shows that the number of people with pre-diabetes has risen from 11.6% in 2003 to 35.3% in 2011.)

On the 5^th of June, Harry Leslie wrote a moving piece in the Guardian, from his new book, “Harry’s Last Stand”.  In his lifetime, (he was born in 1923) he saw the birth of the NHS and knew what it meant for working class people like him and his family. See: http://www.theguardian.com/society/2014/jun/04/coalition-attacks-nhs-return-britain-age-workhouse

His sister Marion, paralyzed by TB that spread to her spine, died aged 10 in the 1920s, in a workhouse infirmary, her life dominated by having to live in a ‘disease-ridden mining slum’. He concludes the piece with this:

“It ends where I began my life – in a Britain that believed health care depended on your social status. So if you were rich and insured you received timely medical treatment, while the rest of the country got the drippings. One-fifth of the lords who voted in the controversial act – which provides a gateway to privatize our health care system – were found to have connections to private health care companies. If that doesn’t make you angry, nothing will.

Sometimes I try to think how I might explain to Marion how we built these beautiful structures in our society – which protected the poor, which kept them safe at work, healthy in their lives, supported them when they were down on their luck – only to watch them be destroyed within a few short generations. But I cannot find the words”.

Indeed.

British values?

I cannot find the words.