Tuesday, November 27, 2007


University College London offers a free lunchtime lecture series that take place, literally, a stone's throw from our flat. Some of them have been very interesting - here are some highlights. A warning - these highlights are a little heavy on the facts and figures.

Today's lecture: Fair Health? Health Inequities within and between countries: a global challenge by Michael Marmot, UCL.
  • Women in Botswana live, on average, to the age of 34, while women in Japan live to 86.
  • Men from the most deprived areas of Glasgow, Scotland have a life expectancy of 54, while those from the most affluent areas have a life expectancy of 82.
  • Even in the poorest countries, a social gradient for life expectancy exists. It is not just a problem of the very poorest people. This argues for universalist approaches rather than just policies aimed at the poorest.
  • The % probability of dying between the ages of 15 and 60 for men is:
    - 8.2% in Sweden
    - 48.5% in Russia
    - 84.5% in Lesotho
  • Have to look at social determinants of health. Not just the causes of ill health, but the causes of the causes. We need to create the social conditions for health.
  • The only area of the world for which life expectancy dropped between the early 1970s and early 2000s was the former Soviet states (69 to 68.1). But while life expectancy increased from 52.1 to 66.9 in Arab states and 50.1 to 63.2 in south Asia, it increased only from 45.8 to 46.1 in sub-Saharan Africa.
  • The United States spends $5,274 per capita on medical care (15% GDP). The U.K. spends $2,164. Yet for white men between the ages of 55 and 64, even the wealthiest Americans have more cancer and diabetes than the poorest citizens of the U.K., and the wealthiest Americans have more heart disease than all but the poorest citizens of the U.K. (Wealthiest Americans have, by far, better health than middle-income or poor Americans).
  • Compared to other nations, the United States ranks 33rd for men and 36th for women in the probability at birth of surviving to age 65.
  • In nutrition, from 1985-2000, prices for fresh fruits and vegetables increased by 40% (according to the USDA) while prices for soft drinks dropped by 30%.
  • If you haven’t yet seen the CDC map of obesity in America, take a look.

Too Many Men – a time bomb for China? by Therese Hesketh
(speaker is a pediatrician who has worked and lived in China for 20 years)

  • At birth, normal sex ratio is 103-107 males/100 females, with a median of 105.9. This number has been stable across populations and time.
  • The population sex ratio is 98-102 males/100 females, with a median of 100.
  • The population sex ratio is influenced by the sex ratio at birth (which favors males), differential mortality at different ages (which favors females), and migration.
  • Deviations from normal sex ratios result from a strong tradition of preferences for males. Before birth, this is largely accomplished through selective abortion. After birth, it is accomplished through infanticide, neglect, abandonment.
  • The numbers:
    - 112 males/100 females in India
    - 120 males/100 females in China.
    - China & India have 1/3 of all births globally, nearly 40% of the world population. As a result, the global sex ratio is becoming skewed.
  • At the time of the implementation of the one child policy in China, and before abortion for purposes of sex selection was readily available, the sex ratio was 106 males/100 females – a bit high, but in the normal range.
  • The one child policy is not uniform across China. It applies to urban areas. In rural areas, families are allowed 2, but the second may be allowed only if the first is a girl. Some ethnic groups are allowed more.
  • For families having their second child, the sex ratio is normal (103 boys for every 100 girls) if the first child was a boy. If the first child was a girl, there are 156 boys born for every 100 girls, indicating that sex selection is common.
  • Sex selection in China is not just a rural problem:
    First child: 111 boys/100 girls urban 106 boys/100 girls rural
    Second child: 130 boys/100 girls urban 123 boys/100 girls rural
    Third child: 130 boys/100 girls urban 145 boys/100 girls rural
  • By 2020, up to 15% of adult men in China will be single and childless, most of whom are poor and uneducated. This may lead to societal problems, such as an increase in the sex industry, increased trafficking of women, increased violence. Some speculate there could be potential for large-scale domestic or even international violence.
  • For men who are married, they tend to be more monogamous, have more stable families, and have a low divorce rate.
  • In China, few obvious problems have surfaced so far. Crime rates are relatively low, migrants are generally well absorbed.
  • Short-term solutions being seriously discussed in China include greater recruitment into the armed forces, sending unmarried men to remote border areas, and employing them on dangerous projects. (Another Great Wall, anyone?)
  • Long term solutions include enforcing the existing legislation on sex-selective technologies, giving women equal rights in inheritance & income, providing supportive measures for elderly people without sons, and increasing public awareness about the value of daughters.
  • South Korea has already grappled with this problem. In 1992, the sex ratio of 3rd births was 212 boys for every 100 girls. After enforcement of laws on sex selection techniques, the rates have dropped so that 3rd births are 124 boys for every 100 girls. (It’s 106 for first children and 108 for second.)

Shell Shock (a history of public health lecture at the London School for Hygiene and Tropical Medicine)

  • The number of psychiatric casualties in war is closely related to total casualties. The mediators are morale, training, food, leadership.
  • In WWI, many psychiatrists believed that war was only a trigger of shell shock, but that the general degeneration of society was the cause.
  • In WWI, only 16.9% of soldiers treated at forward psychiatric units were able to return to duty.
  • In Iraq, we seem to have forgotten the lessons of the last century. We are still looking for a physical cause for shell shock (what the U.S. is calling Minor Traumatic Brain Injury), while we learned in WWI that a debate between physical and psychological explanations is not helpful to treatment or recovery.

Sunday, November 25, 2007


On Thursday, Erin & Christine (pictured here), two of Wayne's students, joined me in bringing Thanksgiving to Abby's kindergarten class.
Most of the kids are pictured here with the headbands we made. We sure managed to trash the classroom.
The kids were all willing to try pumpkin pie, and many of them even asked for seconds. I was surprised, since it was almost certainly a new food for most of them.
I made plenty - enough for Abby's class and for our Thanksgiving potluck with Wayne's students. The potluck was great - the only thing you see missing from this plate is the turkey, but it was beautiful.

Wednesday, November 21, 2007

Tuesday, November 20, 2007

Turkey quest

We're getting ready to host a Thanksgiving potluck for 13 or so in our flat. We've been scouring the local grocery stores for turkeys with no luck. Today I managed to locate one - no mean feat in a country where turkey is strictly for Christmas, and where turkey flocks were hit last week with avian flu. When I took it to the till, the clerk asked me why I was buying a turkey in November, and then asked me what Thanksgiving is, so checking out took a little longer than expected. I then dragged this poor bird up 6 floors of escalators and back down (we were in John Lewis, and I'd promised Abby we'd ride the escalators, not really expecting that we'd have a Thanksgiving turkey in tow along with all of our library books and her school bag), then outside, up to the upper level of the bus, through rush hour traffic, and then the two block walk to our flat. Luckily we ran into some of the students around the corner and Johnathan was kind enough to carry it the rest of the way. Then we had to clear out our dorm-sized refrigerator to make room for it, which meant I was practically force-feeding Abby cold food items. I did my part with the ice cream. Oops, we didn't really need freezer space, did we?

Monday, November 19, 2007

Transition to Germany

Great news - we have a place to live in Wiesbaden! Wayne has been apartment hunting and has found a flat. It has 2 bedrooms, which will be a welcome change from our studio apartment here, and is in a great location between Abby's school and the downtown pedestrian zone. It also means we can have houseguests, which has been impossible in London. We move on December 7.

Saturday, November 17, 2007

Catching up!

I've fallen a little behind in the blog, for the two of you who may be reading it! Autumn is definitely here - it has gotten much colder, somewhat rainier (though not bad), and the sun is now setting a few minutes after 4 p.m. (and getting earlier by the day). Abby misses having piles of leaves to jump in - Wayne does not miss raking up all those leaves! She's a been a bit homesick the last week or so. She doesn't want to go home, exactly, but she wants her friends to magically appear here. I know what she means.

Today was a banner day - another parent actually spoke to me at a playground! Turns out he'd lived in the States for 7 years, which probably explains it. He lived next door to Madeline Albright. This has been something I find difficult about London - it is tough to strike up conversations with other parents at playgrounds or waiting outside school to pick up kids. I don't know how much of that is a cultural difference (the famous British reserve), how much is a language barrier (many, many people in this part of London don't speak English as their first language), and how much I would also find if I were in a new community in the U.S. Every time I travel for an extended period of time I'm filled with new resolve to reach out to people when I'm home. One English person I know joked that if an English person starts a conversation with a stranger they always begin with, "I'm sorry, but . . . " Perhaps this is why I am stopped nearly daily on the street for directions.

This week I went with Wayne's students to see King Lear at the New London Theatre. It was a great production, very well done. My complaints are the same as the last production of Lear I saw - Lear can be very hard to understand as his world disintegrates around him, and I wish Cordelia wasn't such a wimp. The production was 3 hours and 45 minutes, and walking home in the cold rain through dark streets at 11 p.m. fit the ending of the play perfectly (Death! Destruction! Despair!)

Also this week I had lunch with one of my classmates who is from Uganda. She is a social worker, interested in creating services for grandparents raising their grandchildren. In her town of about 2000, she could only think of three families where parents are raising their children. Most children are orphaned - a combination of accidents, AIDS, and death in childbirth taking their parents. We also talked about the difference in social work between Uganda and the U.K.

Another classmate is from Bangladesh - I don't know yet whether any of his family/friends have been directly affected by the cyclone there. The last numbers I heard were 1,700, but it sounds like it's going to go even higher.

On a brighter note, last weekend was the Lord Mayor's Show. The Lord Mayor of London is the leader of the City of London, a fairly small area home to the U.K. financial community. Every year they have a big parade, and pull out the Lord Mayor's coach (below) from the Museum of London. Abby & I went down for the parade, which was full of marching bands and floats, fancy coaches, and people in odd wigs. Since we won't see any Thanksgiving parades, this will have to do.
And, of course, no event in England is complete without fireworks! These were over the Thames - we stood on Blackfriar's Bridge to watch. This is one advantage of the fall - the fireworks started a few minutes after 5. Nothing like being able to see a fireworks show and make it home in time for dinner!
There was even a carnival. This is the view from the ferris wheel Abby & I rode right next to St. Paul's Cathedral. This week we'll be hosting a Thanksgiving dinner for the students and also doing some special Thanksgiving activities with Abby's class. Hand turkeys, anyone?

Sunday, November 4, 2007

Happy Guy Fawkes Day!

We celebrated Guy Fawkes day with a trip to Battersea Park, in south London, to see the bonfire & fireworks. The fireworks were quite good.
The bonfire, though, gets right to the heart of the holiday, which is often called Bonfire Night. There was one major disappointment here - not an effigy of Guy Fawkes to be seen! The tradition is that kids make Guy Fawkes effigies and then throw them into the bonfire. In some towns, they even throw effigies of the pope into the fire, since one of Guy Fawkes's goals was to turn the nation away from Anglican back to the Catholic faith.

The crowd, as you can get an inkling of in this photo, was huge, but amazingly well behaved. The only obvious drunk I saw had an American accent. Even though this is the quintessential English holiday, there was no patriotism on display. The only person I heard singing "God Save the Queen" was the aforementioned American drunk. People just came politely, watched the bonfire, stood in amazingly long "queues" for the port-a-potties (port-a-loos?), food tents, and beer tent, watched the fireworks, and left.

This is the Albert Bridge, just because it's so pretty at night. Abby fell sound asleep on the bus on the way home and we ended up carrying her from the bus stop back to the flat - we won't be able to do that much longer!