Health

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Prescriptions for Antidepressants Have Increased by 30% Since 2016

Published by Anonymous (not verified) on Tue, 10/05/2022 - 12:41am in

While NHS spending on antidepressants increased above inflation over four years, mental health care in England remains in crisis. Sian Norris reports with the Byline Intelligence Team

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The prescription spend on antidepressants has risen from £266 million in 2016 to £374 million in 2020 – an inflation-busting 30.06% in a four year period. 

The data analysed by the Byline Intelligence Team, revealed during Mental Health Awareness Week, is based on the NHS Prescription Cost Analysis report for England. It shows that, alongside the rising prices of heart disease treatments and diabetes drugs, some medicines are seeing above inflation cost increases that are putting pressure on NHS budgets and GP budgets in particular. 

Between January and March 2021, a total of 20.2 million antidepressant drugs were prescribed in England: a 3% increase from 19.6 million items for the same quarter in 2019/20. The majority of those prescriptions were for selective serotonin reuptake inhibitors (SSRI) medicines.

The mental health impacts of lockdowns meant that more people were seeking antidepressant prescriptions than had initially been forecast. Between March 2020 and March 2021, there were 803,000 more antidepressant prescription items issued than expected based on historical trends. The NHS Business Services Authority noted that while this was higher than expected, it was not a “significant increase for the period”. 

In 2021, 5,203 suicides were registered in England: equivalent to a provisional rate of 10.5 suicide deaths per 100,000 people. The Office for National Statistics noted that this was a small increase from 2020, but one that most likely reflected the resumption of coroner’s inquests following the initial COVID-19 lockdown periods in 2020, as opposed to a genuine increase in suicide. In 2016, the suicide rate in England was 9.5 per 100,000 people. 

Although the data analysed by the Byline Intelligence Team represents a significant rise in prescription cost of antidepressants since 2016, it’s important to note that this may not indicate a rise in the number of people diagnosed with depression. SSRIs can be offered to people living with post-traumatic stress disorder, anxiety, and even menopausal symptoms such as hot flushes.

Other reasons why prescription costs may have increased is due to doctors prescribing more frequent prescriptions for the same number of patients (e.g. providing a packet of pills that cover two weeks, rather than one month – this can be a safety measure for vulnerable patients); and could be linked to a small increase in the same number of patients needing treatment for a longer period of time. 

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Mental Health Crisis

While there may be numerous explanations for why the spending on antidepressants has increased, it remains the case that mental health care is in crisis in the UK.

People with severe mental illness are far more likely to die prematurely (before the age of 75) than their peers – and the number of people dying early has increased. 

Data for 2016 to 2018 for England showed that over the three year period, 95 people with severe mental illness died per 100,000 adults. Based on the same data set, in England people with severe mental illness are 4.5 times more likely to die prematurely than those who do not have a similar diagnosis. The inequality in life expectancy is the same for men but greater for women, who are 4.7 times more likely to die prematurely than their female peers.

Worryingly, the inequality for excess premature mortality has increased over time. For all people with severe mental illness, the increase in the excess premature mortality was 355% to 365% – or 10% – when comparing data for the periods 2015 to 2017 and 2016 to 2018. For men it was a 9% increase; for women 10%. 

Beyond prescriptions for antidepressants, people struggling with severe mental illness are facing barriers to accessing appropriate treatment.

As previously reported in this paper, the number of mental health patients receiving treatment out of area is concerningly high. The latest data for January 2022 shows that in England, 700 of 770 placements are considered to be “inappropriate”, or where “patients are sent out of area because no bed is available for them locally, which can delay their recovery”. 

The highest rate of inappropriate placements is in the North West, where 100% (215 out of 215) of placements were found to be “inappropriate”. 

There are limitations to the data, for example, only 79% of organisations providing acute mental health care participated in the collection for January 2022. The data only includes out of area placements that have started since the beginning of the collection: 17 October 2016.  

Of the patients placed out of area, 60 in England were being treated more than 300km from their homes. The majority (235 patients) were being treated 50-100km away. 

While there are some examples where treatment out of area could conceivably be helpful – for example moving people away from toxic situations – overwhelmingly it’s agreed that going through treatment away out of area creates barriers to recovery. It can be harder for loved ones to visit a patient, patients are treated away from their support networks such as family and friends, and away from local specialist services which they may have previously engaged with.

There has been a 14% fall in the number of mental health beds from 2014/15 to 2018/19. Reducing the number of mental health beds has formed part of strategic commitment to support people in the community, however as the growth in out of area care shows, not all treatment can be provided in a community setting. 

Increasingly, what mental health beds are left in the NHS are being run by private providers: it is estimated 30% of mental health hospital capacity is now in the private sector – with 98% of private facilities’ earnings coming from the health service. In Bristol, North Somerset and Gloucestershire, 95% of mental healthcare beds are owned by private providers, and three-fifths are owned by US companies. 100% of patients in the South West (65) were being treated in out of area placements in January 2022. 

Additional reporting by Iain Overton

This article was produced by the Byline Intelligence Team – a collaborative investigative project formed by Byline Times with The Citizens. If you would like to find out more about the Intelligence Team and how to fund its work, click on the button below.

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Priorities for a new health minister

Published by Anonymous (not verified) on Wed, 04/05/2022 - 4:57am in

Tags 

Health, Politics

After almost a decade of health policy stagnation, what are the three most important issues for a new health minister to address? After an election all ministers will initially be focussed on implementing commitments made during the campaign. Some of them will have long-term strategic importance, while others may not. (A new machine that goes Continue reading »

Helping Forest Firefighters Battle a Different Kind of Burnout

Published by Anonymous (not verified) on Wed, 04/05/2022 - 4:39am in

Wildfire season is back. Over the weekend, hundreds of firefighters fought to contain a wildfire in New Mexico that forced thousands of people to be evacuated and destroyed at least 166 homes. In late April, more than 700 homes were evacuated as a “wall of fire” swept across parts of Arizona. Experts say such events are an early warning sign of what’s to come in the warmer months, with the situation heavily exacerbated by human-induced climate change and set to get even worse in coming decades.

The toll uncontrolled wildfires take on communities is enormous and well documented. Less discussed is the lasting, invisible mark these fires can leave on wildland firefighters after the wildfire season is over. 

In Canada, definitions of safety for wildland firefighter crews have previously centered almost exclusively on physical safety. And mental health resources, where available, haven’t been widely known, with any support offered predominantly limited to that provided after traumatic events. But a new preventative form of peer support is helping Canadian crews address the cumulative stress of their jobs before they get to the point of mental burnout or breakdown.

“When you defuse these things properly, then you have the potential not only to mitigate negative things but to enhance positive things and growth and new directions,” according to Erik Hanson of the BC Wildfire Service, who says he has experienced first hand the difference a preventative approach can make.

BC Wildfire launched Resilient Minds with help from ​​the Canadian Mental Health Association in 2019 following two unprecedented wildfire seasons. It was adapted from a successful pilot program serving City of Vancouver firefighters in 2016. In a few days of training, peer leaders learn to recognize and talk about early signs of stress among their ranks, as well as civilians, to help prevent further harm. While similar preventative, peer-led models for mental health exist in the U.S., Resilient Minds is the first program of its kind to be offered in Canada and is slowly gaining traction across the country.

The need for mental health support is apparent. Structural firefighters – those who work in cities or towns – have been shown to experience post-traumatic stress disorder at two times the rate of the general population. In turn, wildfire fighters are at higher risk of developing mental health conditions like depression, PTSD, and anxiety than the general public, according to Patricia O’Brien, a researcher and member of the PTSD clinical team for Veterans Affairs in Portland, Oregon, who adds that these conditions are often under-treated, if detected at all.

Firefighter helmet hanging in a locker room.Firefighter helmet hanging in a locker room. Credit: Michael Gabelmann, Flickr.

Since the 1990s, wildland firefighters have used what’s called Critical Incident Stress Management (CISM), an internationally recognized standard for debriefing and mental health support in response to traumatic situations, like an injury or death of a crew member. But CISM is reactive, a form of emergency first aid. In contrast, Resilient Minds and programs like it aim to build resilience through early intervention, something Hanson and his colleagues argue is more vital than ever as climate change increases the rate and intensity of wildfires, and as communities sprawl into forested areas.

“In the not so distant past, Erik [Hanson] and I would have almost exclusively fought fire in the forest. And now we almost exclusively fight fires in and around communities,” says Steve Lemon, who works with Hanson. “This has raised the stress response significantly.” 

Adding to the stress is the transient nature of wildland firefighters’ jobs which can make it hard to connect with family, community, and healthy routines, all of which buffer mental health impacts, says O’Brien. “They’re in high risk environments for a big chunk of the year. They’re with a team of people that they may belong to… and then fire season ends and often people kind of go their separate ways.”

For wildland firefighters, there’s no avoiding potentially traumatic events. And mental and physiological responses like sleep disturbances, depression, anxiety, and substance use are normal reactions to abnormal events. What Resilient Minds seeks to do is support individuals to process stressful situations in healthier ways.

Take the 2021 wildfire season in British Columbia, which will forever be known as the year the village of Lytton burned to the ground just after the highest temperature in Canada was recorded at 49.6C. As the long season came to a close, for the first time ever, crews across the province called in help to debrief. Not to review operations, or because of one traumatic incident in particular, but because “so much crazy shit happened,” recounts Hanson. “We know that part of keeping healthy is talking about this stuff.”

As well as communication, Resilient Minds helps wildland firefighters learn ways to manage stress through measures such as better sleep habits and healthy nutrition. They also cover what services are available, like CISM, counseling, and a dedicated crisis line. When team leaders go back into the field, they’re able to help break a barrier of stigma that has contributed to so many wildland firefighters suffering in silence.

“I’ve known five people within wildfire who have chosen suicide. That has left a really profound impact on me,” says Lemon, whose career spans 26 years. Forty-six first responders died by suicide in Canada in 2017 and this does not include those who are retired or no longer on the job. 

 Fallen Firefighters' MemorialThe Last Alarm statue honors all professional and volunteer firefighters who have lost their liv​es in the line of duty within British Columbia. Credit: Province of British Columbia, Flickr.

Today, the addition of two words to Lemon’s job title reflects a culture shift across the BC Wildfire Service — head of safety and wellbeing.  

“We don’t profess to be counselors or therapists ourselves,” he says. “But if coworkers can say, ‘Hey, it looks like you’re struggling here. Can I get you some help to talk to a therapist or counselor?’ That’s what we find the biggest benefit of it is.”

While these supports are in their infancy, according to O’Brien, similar peer-based programs are on the rise. Comprehensive Wellbeing and Resilience is offered in the U.S. In Ontario, they’ve adopted a Road to Mental Readiness training, which is used by the military. The long term impacts of these types of resiliency programs are still being studied. But they hold promise, especially when widely implemented before traumatic events.

At the outset of the Resilient Minds pilot study involving roughly 400 Vancouver firefighters, 30% reported having little to no knowledge about mental health. Coming out, nearly everyone surveyed reported feeling more prepared to respond to a colleague who may be struggling.

“Most workers will seek out support from people they know and from their community, before they will go to an outside therapist or counselor,” says Lemon. Since the Resilient Minds training, he’s noticed more leaders and supervisors in the field checking in with their staff to ask if there’s anything they’re struggling with. “It really just kind of opens the door and allows people to say, ‘I am feeling stressed,’ or ‘I am feeling burnt out.’”

In the past, says Hanson, the attitude was generally “let’s just suck it up and go forward”. Today, he says, the volume of calls to their 24 hour safe reporting line has gone up dramatically. Awareness is leading to new services, like phone apps and access to a mental health retreat for first responders called Honour House, and mental health conditions are now tracked as workplace injuries like physical wounds. They aim to have one in five wildland firefighters trained with Resilient Minds across B.C., to mirror their supervisor structure. Though they have yet to reach the target in some regions, Hanson and Lemon are hopeful as they work to adapt the training for all new recruits.

“In many cases, just like if you irrigate a wound, it doesn’t get infected and you don’t have to worry about it. It just heals,” says Hanson. “Ideally, if we put enough time and energy into Resilient Minds ahead of time, then people understand and they sort of see stuff coming.”

The post Helping Forest Firefighters Battle a Different Kind of Burnout appeared first on Reasons to be Cheerful.

Attention Australia: The climate crisis is a health crisis too

Published by Anonymous (not verified) on Tue, 03/05/2022 - 4:22am in

Tags 

climate, Health

After more than two years coping with a pandemic, the last thing we want to hear about is another global health crisis. But it’s becoming increasingly clear that as we continue to heat our fragile planet, we face a threat to public health that will eclipse even COVID-19. In late 2021, as the novel coronavirus Continue reading »

Abortion Drugs Fundamental to Ancient Economies, Argues Historian

Published by Anonymous (not verified) on Sat, 30/04/2022 - 2:37am in

Tags 

Health

As women’s rights to make reproductive choices come under assault, historian John M. Riddle argues that abortion has been far more essential to human history than you might imagine.

Throughout the ages, abortion has been a crucial feature of women’s lives. So argues John M. Riddle, a distinguished specialist in the history of medicine, who has spent a long career uncovering information nearly lost in the mists of time. His work shows that people going all the way back to ancient Egypt relied on a variety of herbal abortifacients (abortion-inducing substances) and contraceptives to control fertility and continued doing so well into the Middle Ages. What’s more, he argues that contrary to what many historians and demographers have maintained, these ancient drugs actually worked.

In “Eve’s Herbs: A History of Contraception and Abortion in the West,” Riddle posits that while we may think of ancient and medieval people as superstitious and prone to rely on useless remedies, when it came to abortion, many knew what they were doing.

The historian illustrates how their methods, most commonly drugs taken orally, were developed through careful observation of nature (noticing, for example, which plants caused livestock to bear fewer offspring), experimentation, and the accumulation of botanical knowledge passed down by word-of-mouth, and also occasionally in written form, including a text by a thirteenth-century physician, Peter of Spain, who later became Pope John XXI!

These botanical substances blocked or stimulated hormones, caused contractions, or otherwise acted on the body to prevent or end pregnancies, thus enabling women and their families to make reproductive choices in their best interest. Riddle points out that it wasn’t just elites who knew the secrets of which herbs to use and how—common people knew and purposefully regulated family size for a variety of reasons, including the desire to space out children, economic pressures, and the health of the mother.

As Riddle details, the Egyptians listed abortifacients in medical texts. The Greeks were so accustomed to abortion drugs that the playwright Aristophanes joked about them, describing in Lysistrata a desirable young woman “trimmed and spruced with pennyroyal,” a well-known abortion drug. Riddle holds that the plant silphium (related to giant fennel / Ferula family) was popular with the Greeks and Romans primarily because it was used to terminate pregnancies – so much so that the city-state of Cyrene (in modern-day Libya) based its whole economy on the plant until it was overharvested to extinction. His research reveals that in the Middle Ages, abortion drugs were also integral to economies. The typical European village would have available a “wise woman” or midwife, and later, an apothecary, who knew exactly what herbal remedies to give women who did not wish to be pregnant and could produce reliable results. Through such fertility intervention, he says, family size was managed in ways that may well have impacted whole populations, causing some government officials associating large families with economic prosperity to view women who controlled fertility as potential enemies of the state.

Riddle shows that what was once widely known and tolerated came under increased scrutiny as the Middle Ages gave way to the Early Modern period. Eventually, he explains, female experts in botanicals fell under suspicion of witchcraft, and their persecution served to eliminate or dilute knowledge of herbal abortifacients. As these women were pushed out of reproductive healthcare, those remaining, along with physicians and apothecaries who competed with them for business (and often knew far less about abortion and contraception), began to deal with abortifacient drugs through circumlocutions and evasions, noting that a particular drug “brought down the courses” or “aired the womb,” expecting female clients to know what they meant. In time, Riddle argues, knowledge of effective antifertility agents was lost through centuries of laws, religious doctrine, changing social mores, and witch hunts. By the late nineteenth century, a woman in New York or London might have to rely on purchasing nostrums advertised by unknown parties in newspapers rather than going to a trusted family member or midwife for assistance. Yet before the pill and legalized abortion, and even after, Riddle describes how women in many parts of the word, including Appalachia, continued to use botanicals to control fertility.

Riddle is convinced by his research that drugs that check fertility have shaped human history in ways that are not fully appreciated. Today, as women in America and elsewhere fall under attack for trying to do what their foremothers were long able to do, some in favor of restrictions argue that they are following ancient precepts, such as the Hippocratic oath. But according to Riddle and others, they are engaging in revisionist history, often unknowingly.

Riddle recently spoke to the Institute for New Economic Thinking about what we know of abortion in ancient societies and how we know it.

Lynn Parramore: Your work shows that abortifacient plants were fundamental to ancient economies. Why were they so important? And how do we know these herbal treatments worked?

John Riddle: Why shouldn’t they be important? There’s nothing more fundamental to human society than reproduction -- or lack thereof.

How do we know they worked? Let me tell you about a sixth-century man whose Latin name was Germanus, a Gallo Roman in central France who became a saint. He became bishop of Paris and is buried at the abbey Saint-Germain-des-Prés, named after him. His biography, recorded in a life of saints, states that his mother had a number of children, and when she became pregnant again, decided that she didn’t want another one just then. It was a matter of spacing with her. So she got a “poison” and she took it. After she took it her insides were in turmoil and she had pain, which extended for a period of time. But finally Germanus was born, and seeing such a lovely baby and so forth, she said she had made a mistake. There is a question with saints that you can’t be one unless you produce miracles. Well, his miracle happened when he was a fetus – the first fetal miracle!

To me, this story of Saint Germain challenges people who have said that ancient abortions couldn’t have worked. It’s actually the reverse – it took a miracle to prevent them from working! People were accustomed to abortifacients being effective.

LP: Let’s talk about Cyrene, the Greek city-state. You have argued that its economy was based entirely on an abortifacient plant called silphium, so highly coveted that it was eventually over-harvested and went extinct. What’s the evidence, in your view, that its popularity was based on its use as an abortion-inducing drug?

JR: Silphium was very basic in its association to the city of Cyrene. After I got interested in the plant, I started researching beyond the literary accounts, of which there are a number. I found a big volume on ancient Greek coins in the British Museum, and the coins of Cyrene take up a big section. Virtually every one of them has silphium – this extended for three centuries. I found no reference to it as a food. There’s a plant that’s related to it botanically that gives Worcestershire sauce its distinctive aroma, but that’s modern.

LP: And the high demand was because so many sought to use it to manage fertility?

JR: I’m as certain of it as anything one can be certain of in the ancient world. In one play, Aristophanes talks about its high price, and much later, Pliny notes that silphium is worth its weight in silver – a span of 300 years. Others referenced its use as an abortifacient. There’s no other purpose for it. They didn’t have Worcestershire sauce, and it’s too expensive to be used as a food.

LP: Just recently, an article in the Washington Times asked if health professionals who follow the Hippocratic oath should have to perform abortions. Let’s talk about this oath, which contains a prohibition on using a pessary (a vaginal insert) to induce abortion. You observe that translators often changed the meaning to suggest a prohibition against all methods of abortion, not just pessaries, and note that in the modern era, people have misunderstood who wrote the oath and how it was used. How did the oath come to be taken by modern physicians as a moral charge not to perform abortions?

JR: I learned a lot tracing that down. The Hippocratic oath was not taken as an oath by most physicians in antiquity. There’s no reference to it and there are few copies. Copies in the Middle Ages developed the notion that ancient physicians had to abide by it. Actually, it was not until the late nineteenth century that some medical schools required it. Classical scholars then did not know that ancient people had effective birth control methods other than pessaries – that they used drugs. A friend of mine at the University of Pittsburgh and another colleague found that 100% of medical schools use the oath today; some pass around a printed copy at graduation and say that students are bound to it while others make the students stand up and take the oath. But that’s a modern development.

When Roe v. Wade was first argued, the question of the oath came up. This is where it gets intriguing to me: [Dallas County District Attorney] Wade said we can’t allow abortions because physicians are bound to the oath and the oath doesn’t allow it. But someone at the Supreme Court, directly or indirectly, asked classicist Ludwig Edelstein at Johns Hopkins if that was true. He wrote an article, which was published, arguing that it wasn’t an oath in antiquity.

LP: You note that the oath wasn’t even written by Hippocrates, nor were medical texts generally ascribed to him.

JR: Yes, we’ve given up on finding the "real" Hippocrates -- he's like Santa Claus. I think what happened, and this is conjectural, is that the librarians at Alexandria made a concerted effort to get anything that had been written in Greek. Treatises came from all over, and anything medical was ascribed to Hippocrates. So at that point, medical treatises become associated with Hippocrates.

LP: The oath referred only to a prohibition on pessaries to induce abortion, but you point out that this was not the most common way of ending a pregnancy. Does that imply that the more common form of abortion, induced by drugs, would have been permitted?

JR: Abortion by pessary was absolutely not the most common method. The part about pessaries was not stated for ethical reasons, but for medical reasons, because pessaries could cause ulcerations and didn’t work that well. Translations later change the meaning to a total ban. Even Edelstein messed up on that. He used a more general term, something like “abortative remedy,” instead of “pessary.”

LP: So we ended up with the misguided idea that the Greeks prohibited abortion, which has fueled restrictive attitudes in the present day.

JR: That’s right.

LP: You do note that the Greeks and even more so, the Romans, had some misgivings about abortion as it concerned male property rights since the fetus was assumed to be the property of the father. You show that later, Christian theologians began building on the male property-rights anxiety and adding concern about when the soul entered the fetus and promoting prohibitions against abortion after “quickening.” Physicians, lawmakers, and theologians began to demand restrictions, but what about ordinary people? How did they view it?

JR: They absolutely had a much higher degree of tolerance for contraception and abortion. Keep in mind, it all gets murky, but early-term abortion was not really considered to impact a living fetus, even among theologians. There was the concept of quickening, which was thought to occur when a woman could feel the fetus kicking.

LP: Let’s say I’m a thirteenth-century English peasant woman who is pregnant but doesn’t want to carry the pregnancy to term because I have too many kids to feed already. How do I go about this? Who do I consult?

JR: You would have talked to people you trusted—a mother, an aunt, women in the village, and above all, the midwife. The transmission of the knowledge, I think, is more oral than it is written. I found very few cases in the Middle Ages or the early modern period where they go and consult a book.

LP: And I would have a pretty high expectation that the remedies indicated would work?

JR: Yes.

LP: If, as you argue, the limiting of family size through abortion drugs was common, how do demographers view the role of abortion in populations?

JR: Therein is a swamp. Two demographers of good standing said that abortions could not have worked to the level that affected gross population. However, since then, I found two demographers with different findings. One of them wrote a long article on demography in Spain in the nineteenth and early twentieth century, when Spain’s population is going down. He goes into the reasons, one by one, as to what could have caused it. Economic depression? No, Spain was not different from other places that were reasonably prosperous, and there were no widespread famines, which will reduce populations. So he concludes that the only possible reason for a steady, century-old decline was birth control (which includes the use of abortifacients). The thing that is so logical to me is that the placebo effect just doesn’t work in the case of pregnancy. If your peasant woman in the village is given a remedy to restart her menstrual cycle so that she will not have a baby – if she has the baby, then she knows the remedy doesn’t work in a very, very real way. It’s self-correcting. The midwife giving the abortion remedy that didn’t work wouldn’t be able to stay in business -- not very long in that village. She might get by with one failure, but not two.

LP: We’ve talked about how important abortifacients were to ancient economies, what about the medieval period? How do we know they were fundamental?

JR: In the late Middle Ages, German towns forbade the growing or possession of juniper, which was used by midwives to control fertility. To have the knowledge of using juniper for that purpose would make you suspected to be a witch. I wrote to several people when I was researching juniper in the history of pharmacy and asked if they could think of any other time period where a government agency had prohibited possession of a substance, and they couldn’t. So it must have been very important.

Two German researchers published work concluding that whenever there was an area where there were virulent witch hunts, that area had big increases in population. They concluded that the burning of what were often called “wise women,” who were midwives, had something to do with this rise in population.

LP: The common wisdom was that abortion was not a criminal offense, despite theologians and the bishops sometimes pushing for it, right?

JR: That’s right. I’ve read two recent works – one is by a researcher at Ohio State who just got through studying legal assizes in England where there was an abortion case, and like me, she never found a jury that convicted a woman. The jury found all kinds of excuses. One was where the baby was born but died five days later, which was attributed to poison the mother had taken. She was up for homicide, but the jury wouldn’t do it.

LP: If you were a medieval woman operating as an herbalist, consulting on abortions and contraception, you might have a thriving business and some economic independence. In times of economic turmoil, was the persecution of women for witchcraft a convenient way to bring the economy back into the hands of men?

JR: It’s terrible to think of men doing that, but they do. Men have the notion that they have the power to reproduce, and they don’t want that power taken away from them. They associate that power with the economy and the well-being of the community.

LP: And yet prohibiting the management of fertility actually has negative consequences to the community.

JR: Yes, that is correct.

LP: Do you see the motivations of women to control fertility consistent throughout history?

JR: There’s no way to deal with it statistically. You just have to extrapolate the factors that you think would be at work, other than the occasional individual. Spacing has to account for some of it – just like Germanus’s mother. We’re dealing with human nature here. The motives should the same in antiquity, the Middle Ages, and the present.

Why is it that in the United States that it tends to become associated with politics? Some states outlawing abortion and others not? From the point of view of jurisprudence, the thing that comes into play in Roe v. Wade was that she (Roe) wanted an abortion but couldn’t get one because she couldn’t afford it. Why should one person have a right in a state and another not? The question becomes economic.

On the question of when life begins, there is so much that isn’t measurable. If you’re going to talk about life beginning at conception, well, is it when the sperm enters the egg? One of the various stages after that? Implantation? Would Queen Anne’s lace, the seeds of which women have used after coitus to control fertility, be considered an abortifacient?

LP: We know from history that women desperate to end a pregnancy will try anything. Do you see vitamin supplement hawkers and dubious vendors on the internet capitalizing on the new restrictions and the distrust of mainstream medicine to promote botanical abortions? You note that a person today would be ill-advised to try this because there are so many factors involved in the efficacy of plants for this purpose -- when they’re harvested, how extracted, the dosage, the frequency, etc., and that without precise knowledge of toxicity levels, they can be dangerous.

JR: I don’t doubt that people will try to sell herbal remedies for fertility control. A vendor in California had a website and it began with a quote, “Dr. Riddle says…” It was a quote lifted out of context which purported to show that whatever herb they were promoting worked. I’m a Ph.D. in history, not an MD. I ask legal consultants if I had any legal remedy, and they said that because the quote was accurate, I didn’t.

The first book I published was on the Greek physician Dioscorides’ herbal treatise, and I decided I’d put in the frontispiece a warning that the discussions about the medical use of plants and other substances are purely for historical examination. The same goes for my book on contraceptives and abortion in history. Some people think that they need “natural remedies,” but the body doesn’t know whether it’s natural or not. All it knows are molecules. And it doesn’t make any difference where the molecule comes from.

I don’t know if the lawmakers in Texas, or the people who support them, have thought through the implications of what they’re doing. It’s obvious to me that the educators of the general public are going to have to be journalists.

LP: Does it surprise you, given your historical perspective, where we are today on this topic? It would seem that history is not linear.

JR: Yes I am surprised. I thought Roe v. Wade was rightly decided, and I didn’t think it would be reversed. You could have a district attorney, a prosecutor responsible for a large area, marshaling a whole force of law enforcement on this.

As you say, history is not linear. We can regress, and we do, in so many different ways.

Crime and Coronavirus: PPE Fraud Now Subject of Investigation

Published by Anonymous (not verified) on Fri, 29/04/2022 - 1:57am in

The Byline Times team reports on the ever-mounting investigations into the Government’s actions during the COVID-19 crisis

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Another element of the Government’s response to the Coronavirus pandemic is now caught up in criminal investigation, after the National Crime Agency (NCA) raided homes and offices in London and the Isle of Man, investigating potential fraud in relation to personal protective equipment (PPE) contracts awarded during the pandemic.

Isle of Man Police told Sky News: “The Isle of Man Constabulary, in support of an ongoing NCA investigation, executed search warrants at four addresses in the Isle of Man. No arrests were made.”

This comes just a day after the High Court concluded that the Government acted unlawfully in discharging untested hospital patients into care homes during the early stages of the COVID-19 pandemic. The case was brought by Dr Cathy Gardner and Fay Harris whose fathers, Michael Gibson and Donald Harris, died after testing positive for Coronavirus.

It has also been judged in previous cases that former Health and Social Care Secretary Matt Hancock, who served in the role during the majority of the pandemic before resigning in June 2021, acted unlawfully in failing to publish details of multi-billion-pound Government COVID contracts within the 30-day period required by law. Justice Chamberlain ruled that the failures of Hancock and his department had breached the “vital public function” of transparency over how “vast quantities” of taxpayers’ money was spent.

In January, the High Court also ruled that the Government’s ‘VIP lane’ – which awarded personal protective equipment contracts to firms with links to ministers, MPs and officials – was unlawful.

Most prominently perhaps, dozens of fixed penalty notices have been handed out to Downing Street staff members – including the Prime Minister and the Chancellor – for their lockdown-breaking parties during the pandemic. The Metropolitan Police’s investigation is ongoing into the litany of events – dubbed 'Partygate' – held in Downing Street during periods of COVID regulations.

The Great Procurement Scandal

Byline Times has extensively covered the awarding of PPE contracts to private firms during the Coronavirus pandemic.

The National Audit Office (NAO) – the Government’s independent spending watchdog – recently released a report, revealing the full scale of waste involved in these contracts.

Indeed, the NAO reported that 3.6 billion PPE items are not currently suitable for front-line services, equivalent to 11% of all the PPE the Government has received. These unsuitable items were purchased at a cost of £2.9 billion – out of a total outlay of some £13 billion by the Government on PPE.

In evidence uncovered by Byline Times, of the £670 million of PPE procured by the Government that cannot be used at all – not just in front-line services – half (£360 million) was purchased through the VIP lane.

There are 176 contracts where the Government believes it may not achieve full value for money, with an estimated £2.7 billion at risk. Some 57 of these 176 contracts were awarded through the VIP lane, with an estimated £1.4 billion at risk (37% of the total value of all VIP lane contracts).

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In the haste to procure equipment during the early stages of the crisis, the Department of Health and Social Care eschewed normal competition rules, awarding contracts worth billions of pounds to prospective suppliers – many of which seemingly had little or no experience in supplying medical equipment.

The NCA investigation, however, has escalated the severity of this scandal – raising the prospect of fraud in the supply of some contracts.

The Government has so far defended its actions during the pandemic, and no minister has resigned as a result of unlawful behaviour or the ongoing criminal investigations. Voters are therefore rightly questioning the logic of our democratic system, whereby criminality at the top of government can go systematically unpunished.

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Crime and Punishment: Lived Reality is Now Divorced From Electoral Politics

Published by Anonymous (not verified) on Wed, 27/04/2022 - 12:46am in

Sam Bright considers why, after years of stagnating wealth and declining health in Britain, the Conservative Party hasn’t seen its support slump sooner?

An embattled Prime Minister, mass inflation, industrial strife and a stagnating economy. Labour had been in power for the majority of the period since 1964, but economic turbulence and a crisis of leadership – Harold Wilson having been replaced by his Foreign Secretary James Callaghan – brought Labour’s dominance to a halt in 1979, losing comfortably to Margaret Thatcher’s Conservative Party.

The tales of the ‘Winter of Discontent’ have been well rehearsed in popular political history. An economic-industrial crisis precipitated Labour’s demise as an electoral force in the late 1970s and created the conditions for small-state Thatcherism to thrive.

However, this political ritual – whereby the mistreatment of individuals converts to the poor performance of governments at the polling booth – is disappearing in the modern era of British politics.

Indeed, the Conservative Party is set for a battering at the local elections on 5 May, but largely due to the personal offences of the Prime Minister – breaking lockdown and lying about it – rather than the record of his Government. In fact, Johnson has been using the performance of successive Conservative regimes as a crutch. Attempting to focus political attention away from his Downing Street debauchery, the Prime Minister has repeatedly expressed his desire to “get on with the job” and to “deliver on the wishes of the British people”.

This should strike fear into most people – especially those at the bottom of the income scale. The Conservative Party has presided over 12 years of declining health outcomes, economic stagnation and raging inequality – compounded by thousands of mass, avoidable fatalities during the COVID-19. Yet its public support, until the ‘Partygate’ saga, has remained buoyant – winning four elections since 2010 and rarely trailing Labour in the polls.

Health and Wealth

The UK has suffered one of the worst health and economic responses to COVID in the Western world – second only to the United States in the fall in overall life expectancy during the pandemic, among 20 comparable countries.

The pandemic “further exposed” health inequalities in Britain and “amplified them,” according to public health expert Sir Michael Marmot, who has tracked differences in health outcomes between the richest and poorest regions and individuals for more than a decade.

In 2020, for example, Sir Michael released a new report, evaluating how the past decade of Conservative rule had impacted health inequalities. According to Sir Michael, since 2010, Government spending on the key social determinants of health had fallen, and the funding was allocated in a less equitable way.

In particular, Sir Michael ascribed declining health outcomes to the Government’s ‘austerity’ programme – which sought to radically curb state spending. “Austerity will cast a long shadow over the lives of the children born and growing up under its effects,” Marmot wrote – adding that “Austerity has taken its toll... From rising child poverty and the closure of children’s centres to declines in education funding, an increase in precarious work and zero hours contracts, to a housing affordability crisis and a rise in homelessness, to people with insufficient money to lead a healthy life and resorting to food banks in large numbers, to ignored communities with poor conditions and little reason for hope.”

The Northern Health Science Alliance confirms these findings – highlighting that from 2012-14 to 2016-18, almost half of local authorities in the north experienced a fall in life expectancy among men, women or both. Byline Times has further calculated that healthy life expectancy fell in 80% of ‘Red Wall’ areas for either men or women from 2009-11 to 2017-19. So, while men in some parts of Blackpool are expected to live for 68.3 years, the life expectancy for men in the wealthiest areas of Kensington and Chelsea in London is 95.3 years.

“Put simply, if health has stopped improving it is a sign that society has stopped improving,” Marmot wrote.

Yet, in 2019, many deprived communities voted for the Conservative Party – some for the first time in decades – effectively rewarding the Government for shortening their lives.

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Meanwhile, declining health has been accompanied by stagnating wealth. In the 15 years from 2007 to 2022, wages are expected to have risen by just 9% (the worst rate on record) – or basically nothing, if inflation is taken into account. During the previous 15 years, wages rose by 50%.

And while wages have risen notably during the early months of this year, high inflation is now consuming any growth in earnings enjoyed by workers.

This stagnation is a byproduct of sluggish increases in economic output and productivity in recent times. The UK logged “dreadful productivity performance” from 2008 to 2018, according to the Institute for Fiscal Studies. Over that period, productivity per hour grew by just 0.3% a year against a historical trend of 2%.

A similar trend materialised during the Coronavirus pandemic. While Boris Johnson now claims that the UK has the fastest growth rate in the G7, he fails to note that we had the second weakest economic performance in the group during the pandemic. In effect, the UK economy is just making up lost ground.

The Importance of Accountability

Abuses of power – either through corruption, authoritarianism or mere incompetence – must be punished at the ballot box, or else abuse is embedded in the system. If political parties are able to avoid accountability for ruining lives, causing mass deprivation and poor health, there is nothing to prevent them from repeating their abuses.

This is especially the case in the UK, where democracy is underpinned by vague, unwritten conventions that concentrate power in Downing Street and demand a sense of duty and morality from those in charge – ideals that are not common among wrongdoers.

The separation between lived experience and political outcomes is also directly witnessed in the calibre and content of our current Government – or the lack of these qualities.

Parliament is coming to the end of its session with the Government failing to pass scores of new, planned legislation. More occupied with culture wars than the finer details of public policy, Johnson’s administration is effectively incapacitated – unable or unwilling to pass any legislation that doesn’t serve its divide-and-rule agenda.

Take ‘levelling up’ – the Government’s flagship domestic policy, that promises to rebalance the economy and erode entrenched inequalities between different parts of the country. The Government released its white paper on the subject in February – more than two years after the 2019 General Election – while only four of the 12 levelling up missions contained in the document will have a measurable impact on regional inequality, according to the Institute for Government.

While cabinets throughout history have been sculpted by political considerations – rewarding the loyal and satisfying internal party factions – Johnson’s Government does seem to be keenly suffering from a brain drain, with positions awarded to the dutiful over the deserving.

This is a symptom of our political climate, in which perception is far more important to election results than lived reality. As we have witnessed in recent years, politicians and their assets in the media are forced to concoct ever-more lurid ways to distract voters and distort the truth, in their efforts to cling on to power.

Public service has been supplanted by self-service, and the masses have toiled while the Tories continue to prosper.

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Cartoon: Highly selective health nuts

Published by Anonymous (not verified) on Tue, 26/04/2022 - 9:50pm in

It's easy to laugh at this stuff, but I actually find it more disturbing and sinister than anything. The "alpha male" bro culture of the alt-right ties directly into authoritarian "strongman" rhetoric and the strategically-contrived moral panic about gender that is reflected in the anti-LGBTQ laws sweeping the nation. Put simply, it's fascist, and many in news media don't seem to fully connect the dots or grasp the symbolic power at work here.

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Drop in Life Expectancy Due to Poor Pandemic Management ‘Chilling’, Says Sir Michael Marmot

Published by Anonymous (not verified) on Tue, 26/04/2022 - 6:45pm in

New research shows that England and Wales saw the biggest reduction in life expectancy after the US between 2019-21, while the life expectancy of the poorest continues to drop

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Overall life expectancy in England and Wales fell by 0.93 years during the height of the Coronavirus pandemic, research from the United States has found. 

The report comes as the Office for National Statistics (ONS) released its data on life expectancy inequality, with men from the most deprived areas in England living 9.7 years fewer than their wealthier peers. For women, the gap between the richest and poorest was 7.9 years.

The US research looked at the change in life expectancy between 2019 and 2021, or during the first two years of the pandemic, comparing the United States with 19 peer countries. 

While the US experienced much larger declines in life expectancy than its economic peers, England and Wales saw the second biggest decrease. Life expectancy dropped during the pandemic from 81.71 years in 2019 to 80.43 in 2020 and 80.78 in 2021.

In Northern Ireland, the drop was from 80.92 years in 2019 to 79.83 in 2020 and 79.99 in 2021. Scotland, which has the lowest life expectancy in the UK, saw a change from 79.29 years in 2019 to 78.29 in 2020 and 78.43 in 2021.

In contrast, Norway, South Korea and New Zealand saw life expectancy increase during the time period.

The authors explained that “estimates of life expectancy help one compare how different countries have experienced the COVID-19 pandemic”.

Professor Sir Michael Marmot, author of both Fair Society, Healthy Lives (The Marmot Review) and Health Equity in England: the Marmot Review 10 Years On, told Byline Times that “prior to the pandemic, health in England was in a poor state, relative to other rich countries", but after 2010, "life expectancy improvement slowed markedly, health inequalities increased, and health of people living in the most deprived areas got worse". 

“The pandemic further exposed these health inequalities and amplified them," he said. "Poor management of the pandemic meant a bigger drop in life expectancy in England, in 2020, than was seen in other countries that managed the pandemic better.”

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Life Expectancy Inequality

While the US research reveals an overall decrease in life expectancy over the pandemic, the latest Office for National Statistics data shows that the health gap between rich and poor is growing.

A report on 'Health State Life Expectancies by National Deprivation Deciles in England' exposes how those living in the poorest regions of England die far younger than their wealthier peers – and have fewer healthy years. 

The ONS found that there have been “statistically significant increases” in the inequality in life expectancy, with men and women living in the most deprived areas of England seeing a significant decrease in life expectancy between 2015 to 2017 and 2018 to 2020. 

Those living in the most deprived areas saw the largest reduction in life expectancy. 

“These latest figures from ONS are a continuation of the trends”, said Sir Michael Marmot. “Between 2015-17 and 2018-20, life expectancy did not improve for men, overall, and actually declined for the most deprived 40% of the population. Among women, similarly, life expectancy declined for the most deprived 40% of the population, but there was some improvement for those living in less deprived areas.”

Men in the most deprived areas can now expect to live 9.7 years fewer than men in the least deprived regions – 73.5 years compared to 83.2 years. Women living in the most deprived areas have a life expectancy of 78.3 years, while wealthy women can expect to live until their mid-80s (86.3 years).

The gap between healthy life expectancy is even more concerning.

While women in wealthy regions on average enjoy good health until they are 70.7 years old; for women in the most deprived areas, healthy life expectancy is 51.9 years. This means that they endure poor health for an additional 20 years than their richer peers.

For men, the gap was 52.3 years to 70.5 years. Because people living in the most deprived areas die sooner, they spend a greater proportion of their life in poor health. 

​​As such, in 2018 to 2020, women living in the most deprived areas were expected to live less than two-thirds (66.3%) of their lives in good general health, compared with more than four-fifths (82.0%) in the least deprived areas.

Across all income groups there has been a decline in disability-free life expectancy – the time spent living without disability. 

Male disability-free life expectancy at birth in the most deprived areas was 17.6 years fewer than in the least deprived areas in 2018 to 2020. There were significant decreases in female disability-free life expectancy at birth in both deprived and less deprived areas between 2015 to 2017 and 2018 to 2020.

The data, Sir Michael Marmot said, is “chilling”.

Overall, he told Byline Times, “the figures are really shocking. They are telling us a great deal about how well society is functioning. If health is getting worse, then society’s needs are not being met”.

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High CO2 Levels and Poor Ventilation Raise Concerns for Children’s Health and COVID Risk

Published by Anonymous (not verified) on Mon, 25/04/2022 - 7:15pm in

In Scotland, parents and politicians alike are calling for air filters to improve school ventilation – as classrooms show higher than recommended levels of CO2

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As children pack their schoolbags and head back to lessons after Easter, parents have expressed concern that pupils in Edinburgh are studying in classrooms where CO2 levels exceed recommended safety limits – and are therefore at risk of COVID-19 transmission, Byline Times can reveal. 

Scottish Government guidance states that CO2 concentrations in most classrooms should not exceed 1,500 parts per million (ppm) – reduced to 800ppm in music classrooms and gyms. 

The UK maximum is higher than other countries, some of which recommend 800ppm. The Lancet has published a study finding that schools are “chronically under-ventilated”, impacting children’s health and concentration.

A report commissioned by Edinburgh City Council, and undertaken by Edinburgh Napier University – titled 'COVID-19 Mitigation In Schools' – found that some classrooms had CO2 levels as high as 2,810ppm, while one music room had concentrations of 1,990ppm. 

The research took place between November 2020 and February 2021 across nine out of 123 primary schools. More widely, the Scottish Government asked local authorities across the country to assess CO2 concentrations in learning, teaching and play spaces. 

The report concluded that “from the data presented... most of the schools monitored demonstrated periods where the maximum recorded CO2 concentrations exceeded threshold values identified”, with the exception of two schools. 

All the rooms in one school had levels between 1,863 and 2,810ppm. In a second school, all but one room had levels between 1,560 and 1,862ppm, while a third school had three classrooms where the levels were 2,001ppm, 1,620ppm and 1,999ppm respectively.

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Edinburgh City Council confirmed that it has purchased portable CO2 monitors for all its schools and “is currently working on a programme to install fixed CO2 sensors across all learning and teaching spaces in schools”.

The concern is that while schools with CO2 monitors can now tell if levels are too high in the classroom, they have few options to reduce levels. The report noted that “leaving the window open all the time, even when no pupils are inside, helps keep the levels down, but is insufficient when the number of pupils in a classroom is too great”.

A local authority worker and trade union activist, who wished to remain anonymous, told Byline Times that there are “nowhere near enough CO2 monitors in schools” and the recommended responses to when levels are too high are not being followed. 

“We need to do more to protect people,” they said. “Local authorities are following the guidance, but we are still seeing outbreaks even when guidance is being followed, as it doesn’t go far enough.”

They confirmed that COVID-19 rates remain high in Edinburgh’s schools. A Freedom of Information request found that, between 21 October and 6 December last year, 3,097 pupils tested positive for the Coronavirus.

A council spokesperson told Byline Times: “The monitoring did identify the maximum CO2 levels in some classrooms exceeded the 1,500ppm upper limit and recommendations were made, including raising awareness of the importance of ventilations in classrooms, and giving guidance on the best strategies for ventilating spaces. Training and revised guidance was subsequently provided to school staff.”

The Fight for HEPA Air Filters

One Edinburgh parent, Sam Gajewski, has been advocating for schools to install HEPA Air Filters to reduce CO2 concentrations and therefore COVID-19 transmission.

More than one academic study has recommended a combination of “dilution methods” – such as opening windows – alongside “filtration methods” – such as air filters – to reduce COVID-19 transmission. A 2020 study found that “ventilation strategies associated with lower school incidence included dilution methods alone (35% lower incidence) or in combination with filtration methods (48% lower incidence)”. 

However, despite the growing body of evidence, Gajewski’s efforts have been met with resistance – with schools, local authorities and the Scottish and Westminster Governments promoting ventilation via open windows, instead of filters alongside open windows. 

In email correspondence seen by Byline Times, Gajewski's school assures him that the Scottish’s Government’s guidance is that air filters should only be used in “exceptional circumstances”. The Health and Safety Executive states that “air cleaning or filtration is not a substitute for good ventilation, but where poor ventilation cannot be improved, these systems can reduce airborne Coronavirus in a space”. 

A spokesperson for the Scottish Government told Byline Times that “expert advice is clear that air cleaning devices should not be used as a substitute for ventilation”. 

But Gajewski considers this a form of 'gaslighting' as it ignores that no one is calling for filters to replace natural ventilation. Instead, he and a range of MSPs are arguing for a combined approach.

Oliver Mundell, Conservative MSP for Dumfriesshire, told the Scottish Parliament: “There is scientific evidence for [filter's] efficacy and, therefore, we are talking about an addition to what is happening – it is a belt-and-braces approach.”

Byline Times has also seen correspondence between Gajewski and Edinburgh City Council and the Scottish Government’s curriculum unit. In response to an email to the local authority about introducing HEPA air filters into schools, Gajewski was told that the council’s “current approach is to prioritise natural ventilation” and that “there is currently limited evidence that air cleaners are an effective control measure to prevent COVID-19 spread”. 

This is disputed by Gajewski and by Scottish Liberal Democrat leader Willie Rennie who, in a debate on school ventilation, said: “Irish Government’s expert group on ventilation said that stand-alone high-efficiency particulate air filter devices might be useful in reducing airborne transmission in spaces with insufficient ventilation". Rennie also cited recommendations from Canada and Australia, questioning why filters are "discouraged in this country”.

The letter from the curriculum unit simply pointed to ​​the guidance for schools which “contains a range of mitigations, such as use of face coverings, ventilation and distancing requirements”.

Labour MSPs have raised the issue of air filters in Holyrood, with Michael Marra calling the area of school ventilation “a serious policy failure by the Scottish Government to date” and calling on the Government to “to ensure that local authorities have funding available to install at least two HEPA filters in each classroom in Scotland”. 

Marra pointed out that, in the summer of 2021, Scottish First Minister Nicola Sturgeon “announced there was to be a ventilation inspection programme, backed by £10 million of funding for remedial action”. However, Marra argued that “what happened next was not a ventilation programme but CO2 monitors being installed in some – but far from all – classrooms”.

The local authority worker told Byline Times that they have been campaigning to install HEPA air filters for 18 months, to no avail. “The Government says filters are not efficient but they are used in healthcare settings and they have long-term health benefits when it comes to respiratory disease," they said. "Opposition MPs and trade unions should be campaigning to bring these in.”

The World Health Organisation has said that HEPA air filters “can be effective in reducing/lowering concentrations of infectious aerosols in a single space” but should not replace natural ventilation. 

A spokesperson from Edinburgh City Council told this newspaper: “The outcomes from the monitoring and subsequent recommendations from Edinburgh Napier University helped inform the council’s ongoing approach to ventilation including highlighting areas for further investigation/action.

"As a direct outcome of this work, the council purchased portable CO2 monitors for all schools to support the return of schools in April 2021. This was in advance of any Scottish Government requirement for CO2 monitoring in schools.”

The monitors, the council explained, are smart and linked to a central cloud-based platform so its teams can monitor the data produced.

A Scottish Government spokesperson told Byline Times: “We have made an additional £5 million available to local authorities to improve ventilation in schools and early years settings. This funding is helping councils to work towards having a CO2 monitor in every learning, teaching and play space. Monitors are either already in place or are awaiting delivery for almost 95% of those spaces and all 32 local authorities have confirmed they will move to a 1:1 ratio before the summer holidays.

"Only a very small percentage of problematic spaces have to date been identified by local authorities as being problematic and remedial action has been, or is being, undertaken by councils.”

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