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"Wisdom is not the product of schooling, but of the lifelong attempt to acquire it"

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“The State of Medicine” Margaret McCartney

This one’s for you if…you are worried or interested in the future of the NHS

It is easy to think, with the constant barrage of bad news stories in the press, that the NHS is on its knees. That it is not fit for purpose. That it won’t survive the crippling co morbidities of a population that is ageing, increasingly obese has more complex needs than ever before. Add a dash of neoliberalism, that the effects of smoking and obesity are the responsibility of individuals not society as a whole and you might begin to think it’s time for a new system. A few years ago, I now admit with shame, I probably would have agreed.

The whole purpose of this blog is to celebrate the power of reading. The power of learning, engaging, debating and changing your mind. Politicians out there- it really is possible to change your mind based on expanding your knowledge- you should try it some time.

Books such as this, so excellently written by McCartney, make you realise the value of the NHS. Make you realise that a huge proportion of its workload comes from a lack of responsibility by other areas of society. The alcohol industry. The smoking industry. Austerity’s effects on social care. Lack of follow up by private healthcare organisations. Worst of all? Lack of evidence in policy making. McCartney talks us through a list longer than a long person’s arms of policies put in place for political gains which end in money down the drain and no improvement for patients.

One particularly nonsensical part of the way the NHS is currently run is as follows. Targets are set. If a hospital doesn’t meet them, they are fined. (Regardless of the possibility that missing the targets could be due to insufficient funds/staff). Staff also have to write reports on the missed targets. So the hospital/trust which is doing badly is left with an increased workload and reduced funds. From which point they are supposed to improve their rate of hitting the targets?!

I like to end on a high. So how can we ‘save’ the NHS? Let’s realise that problems like obesity occur because we live in a highly obesogenic society- communities lack safe and accessible places to exercise, the nature of our society encourages us to sit on our backsides for an unprecedented proportion of the day, and shops offer us food that is ridiculously calorific, with unbelievable levels of sugar, and put the ‘bad stuff’ on promotion. Let’s encourage politicians to use evidence when debating and implementing healthcare policy. Let’s try the insurmountable task of holding them to account when they don’t. Doctors work day in day out using evidence to provide high quality care for their patients. And I don’t think it’s unreasonable to expect the same from those in government.

Warning: the following content may be infuriating.

Aneurin Bevan 1946 House of Commons “Medical treatment should be made available to rich and poor alike in accordance with medical need and no other criteria. Worry about money in a time of sickness is a serious hindrance to recovery, apart from its unnecessary cruelty. The essence of a satisfactory health service is that the rich and poor are treated alike. Poverty is not a disability and wealth is not an advantage.”

Mid staffs crisis and understaffing- trust was told to save £10million and a CQC report “found a shortfall of 120 whole time equivalent nursing posts”. “The nurse [working in mid staffs at the time] described how managing other nurses placed her under pressure to lie in the records, having been told that if they didn’t meet the targets, heads would roll and A&E would be closed, with everyone losing their jobs” p32

“Social inequalities aren’t caused by laziness, or by people choosing to have a poorer quality of health. Instead, they arise from circumstances partially or completely out of poeple’s control, which have small, cumulative effects on their life chances, possibilities, directions and, ultimately, quality of life and time of death. Caring for relatives, going to an overstretched school, having a lack of good childcare, living in an area of greater pollution- all these add together and translate into inequalities becoming deadly.” p55

Money matters.
“In the US, a regular non means tested income to disadvantaged Native Americans was associated with benefits to children that was still detectable a quarter of a century later.” p56
“if everyone drank responsibly the alcohol industry would lose 40% of its sales and some estimates are higher. In formulating its alcohol strategy, the Government must be more sceptical about the industry’s claims that it is in favour of responsible drinking.” p62
“In 2013, I read a report by PwC purporting to show that technology in the NHS could save money. I found out that the report itself had cost £75,000, yet it was fatally flawed..making entirely non evidence based statements suggesting that large quantities of patients could be safely managed at home rather than in hospital.” p142
“Recurrent reforms from the 1990s onwards have been predicated on the belief that money is the best motivator for change. This had resulted in too much medicine- treatment by rote rather than because it matters to you, the individual patient. The seams of vocation and ethics are pulled at by the incentives which request compliance, not the interrogation of suitability for the individual.” p199

Kenneth Arrow, Professor of economics, “I live in Silicon Valley, where there are loads of startups- at least half of them fail. That’s normal; it’s part of a competitive system. It’s a problem if it happens in a medicsl system, because it interrupts care, and it’s deleterious to an ongoing relationship; it’s bad for people who were getting that service. But the fact that they fail is the way the market system works. Next time around, they’ll guess their costs better. But if you are right in the middle of medical care and the supplier goes broke, you have adjustment costs. It’s not the same if I’m buying fruit and they go out of business- well, I can go to a nearby store…I’m so surprised that a country that has contained its costs and achieved good healthcare should be worried.” p88

Paraphrasing US journalist H.L.Mencken “For every complex problem- such as how best to organise medical staffing at weekends in the NHS- there is an answer that is simple, clear and wrong. This needs unbiased minds and clear statistical understanding not an election manifesto promise to be driven through no matter the cost.” p93

NHS always picks up the tab. Circle tendered for a 10 year contract to run a hospital and pulled out after 3 citing that demand for A&E had risen. “the NHS can never transfer the operational risk of running a hospital, leaving the taxpayer exposed should the franchise fail…Additionally, the National Audit Comittee pointed out that under the terms of the contract, Circle would be responsible for only some of its debt- the taxpayer would be ‘left exposed’ to pick up the rest. Not only that, the chief exec was given a generous redundancy package and left to work in another NHS role.” p149

“We need our NHS to be run on evidence, moral value and humanity. We need to ask for the right evidence, out evidence before policy, make no policy without cognisance of the evidence and always consider the harms.” p210

“We also need the option of rejecting short term political policy making in favour of making mature cross party decisions drawing on evidence and expertise, freeing the NHS from the legacy of damage through the short-term need for political parties to claim successes for themselves or blame failure on others.” p231

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“A Woman’s Work” Harriet Harman

This one’s for you if… you’re interested in the views of the longest serving female MP on women’s rights and life in politics as a woman.

Women’s rights is a challenging problem to solve. Before reading this book the question I kept coming back to was what do we mean by equal rights? Women and men are inescapably different. Only women can carry and give birth to children. So what do we want our utopian world to look like? Can equality realistically mean that having children has NO negative affect on your career? And is that fair? Having children will inevitably involve time off work, so for me I felt that “equality” was the opportunity to progress in your career at the same rate as men, using number of days worked as the measurement.

Obviously we are currently a long way off any utopian view of women’s rights, whatever that may look like. Until we can get away from the female/male stereotypes that were shown by the BBC programme “No More Boys and Girls” to be so deeply ingrained by primary school age, women will always be expected to do more at home, be more responsible for childcare and be less likely to have the higher earning job and therefore more likely to give it up when children come along.

However, Harriet Harman thoroughly educated me on policies, their potentially positive effect on the economy, and addressing the imbalance where having children does so much more to halt the progress of mothers’ career’s compared to fathers’. Ideas such as compulsorily sharing of parental leave so that the “hit” on female work is less skewed. Making childcare provision more affordable so that women’s jobs do more than just breaking even. The point is that should a woman wish to work, society should be able to provide the training and childcare support required to enable that to happen. Many of these ideas rely heavily on state supply of these services, which is a debate for another day on how much we should and can expect of the state in terms of what support it can provide us with.

I recognise the progress that needs to be made on women’s rights and don’t for a second think that we should rest up on pushing for that progress. But as an optimist, I also like to reflect on how much progress we have made. Harriet Harman reminds us of the restrictions on women as she grew up and when she entered politics. It really is incredible to see how much progress has been made, and how much she has contributed to this.

In addition to the history of the women’s movement, this book is a fascinating account of life in politics as a woman. There are multiple examples of how unaccessible parliament was for women when Harriet Harman was first elected in 1982, demonstrating how male dominated systems must change in order for them to be accessible to women. The long boozy lunches and the late night votes didn’t exactly lend themselves to the ability to balance your responsibilities at home with your children. Harman also demonstrates how stereotypically female personality traits do not help in your progression towards seniority in politics. On multiple occasions she discusses how she put the party before her own interests and in so doing put up with treatment than many of her males colleagues would not. Inevitably every team needs a balance of skills and characteristics to achieve its potential. At some point in the future, I am sure we will have as many caring and sensitive men as women, and as many ballsy, ambitious women as men. In the meantime, balancing these characteristics remains another argument for increasing female representation in senior roles in all industries.

If you were recruiting for the people who were to run the country you might put qualities such as good communication, strong leadership and an ability to manage people in the advertisement. Naively or not, I was appalled at several of the examples of what goes on behind the closed doors of Parliament, demonstrating immaturity, betrayal, and petty power plays (see below).

To finish on a positive note, I have nothing but huge admiration and respect for what Harriet Harman has achieved so far in her time in politics and for the circumstances in which she has managed that. A fantastic role model for young women and men alike.

 

There was a time when “You can’t expect the same pay as a man, you can’t expect to be treated equally at work, you can’t expect men to play their part at home, you can’t object if your husband beats you, you can’t expect to be valued if you’re not young and pretty, you can’t expect to be taken seriously intellectually if you are…we were not going to put up with it.” p24

“A lone woman would be refused service at a hotel bar on the assumption that, if she was on her own, she could be there only in order to pick up a man- so she must be a prostitute.” p29

“The Parliament I entered in 1982, 97 per cent of whose members were men, was reported on by a press lobby of whom 95 per cent were men. They were not in the least interested in the women’s agenda.” p80

“men still outnumber women in the lobby by three to one. It’s wrong that the largely male world of Parliament is still reported to the men and women of this country through predominantly male eyes.” p84

Clare Short criticised Alan Clark for being drunk in the House but “it was she was reprimanded, for breaking the rule that it’s unparliamentary for an MP to allege that another is drunk.” p116

UNBELIEVABLE account from when Harman was on the front bench. She promised her children she would take them to the cinema on half term. She was phoned by whips and after missing several calls told them “I was not available”. It was assumed she was having an affair. “Firstly while children will never forget a broken promise, there’s always someone who can stand in for you at work. And secondly, that while it would, in the eyes of my colleagues, have been beyond the pale for me to be absent because of my children, falling down in my duties because of an affair was not only understood by my male colleagues but thoroughly approved of.” p121

Combining economic policy with women’s rights. “If mothers with young children could get the childcare and training they needed, they would be able to get back to work. Instead of claiming benefits, they would be paying taxes and in a position to se up businesses which would help the economy to grow. With mothers working, there’d be fewer children in poverty.” p149

“while I was sitting on the platform waiting to speak, Gordon had gone through it and typed in alterations. Gordon’s authority was such that there was no way special advisors, even two of them, could hold out against him.” p184 Why the need to go behind her back about her speech to the conference? Why not have open discussions and or say as leader I disagree and feel it would be better for the party for you to say x not y?

“Having previously had two members of staff in my constituency office and two political advisers, I hadn’t a clue how to lead a department of 93,000 people…With the change in my relationships with my colleagues and the complete absence of any ‘headspace’ in which to think about things uninterrupted, I lost my bearings.” p196

In the case of a women given 2 black eyes, 2 broken ribs and a punctured lung by an abusive husband, who was a Dr. “it was a travesty to minimise the violence this woman had suffered because her husband was outwardly jovial and well liked at work. The fact that he was a role model to younger professional colleagues made his behaviour worse, not better. And however welcome his appearances as Father Christmas, they were irrelevant and shouldn’t be a reason to to keep him from serving a custodial sentence.” p243 This reminds me of the recent and extraordinary case of the Stanford swimmer whose sporting prowess- which is in no way relevant to whether or not he committed a serious crime- was considered during his sentencing.

When she won the Deputy Leadership election she turned to John Prescott and said “I’ll need all you advice and support. I hope you’ll help me? ‘No’, he replied. “I won’t”. He had never liked or approved of me, but I was taken aback that he would put personal antagonism above the interests of helping his successor do a good job.” p271

“Prime Minister’s Questions is not just about your government’s policies, it’s about your performance as well. PMQs is like taking an exam, in public, where the syllabus is the whole world.” p284

“While we reshape our future, we must be careful not to misrepresent our past. We fought to get into government so that we could work on the problems caused by the Tories. Labour tackled pensioner and child poverty, modernised the health service and schools…Denigrating our past denies those achievements, strengthens the position of our opposition and pushed further into the future the day when Labour gets into office again.” p329

When she is on school visits “Most of the young women and men have been brought up in households where the mother takes the main responsibility for children, so, while the girls aspire to go further than previous generations of women have been able to in their work and therefore share domestic responsibilities, the boys see a model of home life with them as the main breadwinner and head of the household.” p367

“Deep Sea and Foreign Going” Rose George

This one’s for you if… you’ve ever bought a product that was shipped.

Have you ever wondered where your clothes come from? Or your fruit and veg? Or how far the various parts of your household appliances have travelled?   Or HOW they have travelled? Chances are you could guess that quite a lot of it is shipped. But have you ever stopped to imagine the life of the people who work on those ships? The months on end away from family, friends, civilisation, terra ferma? Have you ever thought about the loneliness and the isolation they must experience? Or the terror they feel every day that they pass through waters with high risk of attack from pirates? All this and more is covered in George’s interesting account of spending months at sea. I was amazed to read  about how poorly crew members are treated. But possibly the most surprising thing of all was that “shipping is so cheap that it makes more financial sense for Scottish cod to be sent 10,000 miles to China to be filleted and then sent back to Scottish ships and restaurants, than to pay Scottish filleters.” Unbelievable!

“Imagine you have a problem on a ship while you are on that ship. Who do you complain to, when you are employed by a Manila manning agency on a ship owned by an American, flagged by Panama, and managed by a Cypriot, in international waters?” p10

“If the engine is set to 80rpm (revolutions per minute)- the average speed of a resting human heart- the shaking is inevitable. Cruise ships modify their structures to prevent this happening and disturbing passengers. Working seafarers must live with it.” p38

“A sweater can now travel 3000 miles for 2.5 cents; it costs a cent to send a can of beer. In hard economic times, when there is more supply than demand, shipping a container can cost nothing.” p42

“Only 13 per cent of containers in Europe are physically inspected. Worldwide, the rate is thought to be between 2 and 10 per cent.” p43
One seafarer (Alan) died when ship sank and his brother (Martin) tried to find out what happened to him. “Legally, Alan worked on a small part of Panaman, floating in no-man’s sea. If Panama didn’t want to release the results of its investigation, there was nothing Martin could do about it, and nowhere he could go to protest.” p83
“There is no shortage of weapons for sale in Somalia’s markets, along with infinite supplies of khat…which produces effects similar to amphetamine. It is cheap, and it is an efficient lubricant for violence.” p151
“When you work in an invisible industry, you get tired of the effort required to pull it into the light.” p153
Consultant who is paid to do hostage negotiations with pirates. “Frequently the team members can be sleeping under the boardroom table for a month. They are rotated out every 30 days: that is considered the maximum time before mental and physical exhaustion begin. Chirac and his crewmates, humans confined in a small space, dependent on other humans confined in a small space.” p161
On another ship taken by pirates who started to torture the crew. “They knew enough to research Chirag’s name on the internet, to bring him a printout of a letter his sister had written to the Indian government begging them to do something to release her brother. But the Indian government would do nothing when the sip flew the flag of the Marshall Islands. They can only pressure the owners. German owners, Marshall Islands flag.”
Merchant seamen were also treated poorly during the War. “But by 1939 merchant seamen still had no standard uniform, no badge, no identifying features. When about 95 merchant ships were sunk during the first few months of the Second World War, their surviving sailors were required to pay their bus fare home, even if they were travelling there from a torpedoed ship; uniformed men were not.” p238
“American merchant mariners weren’t given veterans’ status until 1988, although at least 5000 of them had died supplying and fuelling the war effort. Now, they are at least entitled to use veterans’ hospitals and be buried in a national cemetry, although not to financial compensation for their service. Britons who sailed the Arctic convoys, in weather so cold that tears would freeze, were finally awarded medals in 2013” p253

“The Better Angels of our Nature” Steven Pinker

This one’s for you if you don’t believe that violence has decreased, or if you wonder why it has.

Above all else, this is a book of optimism. A book that shows the staggering progress that humankind can make, in one generation, in a decade, in a century and over hundreds of years. The news headlines of today make us feel that we live in terribly dangerous times, and with only our lifetime’s experience to judge against, we do. But reading this deep exploration of the history of violence teaches you to appreciate the relative peace we enjoy, and the relative abundance of human rights that exist today. That is not to say there is no need to progress further. In fact it reminds me of one of my favourite quotes: “Be proud of your progress but never satisfied.”

The fact that we can wonder through life so ignorant of our luck, so oblivious to the progress that has been made, leaves you questioning the way we report and receive the news. Since the dawn of Facebook, Twitter, FaceTime and other means of modern communication, there has been a thirst for instant updates. So how are we to discover and appreciate news of the past, or of research examining stretches of time we can barely imagine? And then there are a whole lot of biases of the news that we DO get- the tendency to emphasises deaths due to terrorism over other causes, with serious consequences for government and military action. And whether or not you agree Paul Slovic’s research into psychological biases confirmed Stalin’s observation that “one death is a tragedy but a million deaths is a statistic. People cannot wrap their minds around large (or even small) numbers of people in peril, but will readily mobilize to save the life of a single person with a name and a face.” (p685) All of this emphasises the appreciation that science is “a paradigm for how we ought to gain knowledge- not the particular methods or institutions of science but it’s value system, namely to seek to explain the world, to evaluate candidate explanations objectively, and to be cognizant of the tentativeness and uncertainty of our understanding at any time.” p218

Steven Pinker takes you on a journey through human history, describing life and its accompanying violence from biblical times to the present day. It is truly a fascinating journey. Then begins his quest to analyse why violence has decreased? Without rereading 840 pages, and without dismissing the complexity of the answer, three important factors appear to be governance, education and trade. It is incredible to think that as early as 1795 Kant mentioned democracy and openness to global trade in his essay Perpetual Peace. The invention of the printing press coincided with a period of reduced violence, and Pinker discusses at length how reading about other cultures and countries increases sympathy and understanding. Interestingly research by Hakemulder found that novels increase sympathy more than reading non fiction P712.

The quote at the top of this blog encapsulates my love of learning. Pinker’s book teaches you a lot about a lot, covering topics as wide ranging as psychology, the philosophy of Hobbes, Locke, Descartes and Kant to name a few, ethics, criminology, neuroscience, psychology, evolutionary biology. Plus he uses some incredible words that I had never come across before- tendenciously, eschatological, synechdote, ecumenical to name a few.

I don’t have space to tell you everything that interested me about this book but here are a couple of bullet points I thought were worth mentioning:
The Flynn effect- intelligence scores substantially increase with time. The difference between successive generations is incredible.
Violence does not increase following economic downturn- criminologist David Kennedy.
Fearon and Laitin 1945-1999 found that income inequality did not correlate with increased civil wars.
Baumeister and colleagues found that self control is like a muscle- after practising self control for weeks, students did better on a test of their self control, but had reduced smoking, drinking and junk food consumption without thinking about it.

Progress
“we enjoy the peace find today because people in past generations were appalled by the violence in their time and worked to reduce it, and so we should work to reduce the violence that remains in our time.” xxv

Time of the Old Testament “The possibility that a woman had a legitimate interest in not being raped or acquired as sexual property did not seem to register in anyone’s mind…Human life held no value in comparison with unthinking obedience to custom and authority.” p14

Hobbes in Leviathan 1651, on the reasons for violence: “So that in the nature of man, we find three principal causes of quarrel. First, competition; secondly, diffidence; thirdly, glory. The first maketh man invade for gain; the second, for safety; and the third, for reputation.” p39 Interesting accidental gender bias which links to evolutionary biology- men act to maximise offspring, thus fighting over limited resource of mates while women invests in each child to maximise survival.

America “The North is an extension of Europe and continued the court and commerce-driven Civilizing Process that had been gathering momentum since the Middle Ages. The South and West preserved the culture of honor that sprang up in the anarchic parts of the growing country, balanced by their own civilizing forces of churches, families and temperance.” p127

“This common knowledge, as economists and logicians call it, gave rise to a horizontal web of solidarity that cut across the vertical ties to parents and authorities that had formerly isolated young people from one another and forced them to kowtow to their elders.” p130

James Madison “If men were angels, no government would be necessary. If angels were to govern men, neither external not internal controls on government would be necessary.” p193

“The point is not that killing ten civilians is O.K, but rather that in any previous war, even a few years ago, this kind of civilian death would barely have caused a ripple of attention.” p321

Violent practices pass “from unexceptionable to controversial to immoral to unthinkable to not-thought-about during the Humanitarian Revolution.” p351

In light of bankers in the modern day “Merchants and other middlemen, who skim off a profit as they pass goods along without causing new stuff to come into being, are seen as parasites, despite the value they create by enabling transactions between producers and consumers who are unacquainted or separated by distance. Moneylenders, who loan out a sum and then demand additional money in return, are held in even greater contempt, despite the service they render by providing people with money at times in their lives when it can be put to the best use.” p397

Blackwell and Sugiyama “found that when a terrorist blows himself up, the financial payoff can buy enough brides for his brothers to make his sacrifice reproductively worthwhile.” p430 based on analysis in Gaza/West Bank of families ability to pay for brides, number of children in an average family, number of women available.

Cosmopolitanism playing part in humanitarian revolution. Contrast “The Ottoman heirs to classical Islamic civilisation resisted the adoption of mechanical clocks, standardised weights and measures, experimental science, modern philosophy, translations of poetry and fiction, the financial instruments of capitalism, and perhaps most importantly, the printing press.” p440

“Insofar as violence is immoral, the Rights Revolutions show that a moral way of life often requires a decisive rejection of instinct, culture, religion, and standard practice. In their place is an ethics that is inspired by empathy and reason and stated in the language of rights.” p572/3

“Testosterone rises in adolescence and young adulthood, and declines in middle age. It also declines when men get married, have children, and spend time with their children.” p625 It follows that “to the extent that violence is a problem of young, unmarried, lawless men competing for dominance…then violence really is a problem of there being too much testosterone in the world.” p626

Why democracy/governance works to reduce violence “the government’s monopoly on force prevents the loser doing anything about it, and gives him less reason to WANT to do something about it, because he is not conceding weakness to his adversary and has less incentive to carry on the fight to restore his honor.” p649

“The psychology of forgiveness, recall, works best when perpetrator and victim are already bound by kinship, friendship, alliance, or mutual dependence.” p657

How little some things change!! George Orwell 1946 Politics and the English Language “In our time, political speech and writing are largely the defense of the indefensible…This political language has to consist largely of euphemism, question-begging and sheer cloudy vagueness.” p683 speaking of atomic bomb, British rule in India, Russian purges.

“Children’s IQ at the age of ten predicted their endorsement of antiracist, socially liberal, and pro-working women attitudes at the age of thirty, holding constant their education, their social class, and their parents’ social class.” p801 Along with a study which found “Education and intellectual abilities in the past indeed predicted democracy and rule of law (together with prosperity) in the recent present, holding all else constant”, wealth did not have the same effect p804.

“Though gentle commerce does not eliminate the disaster of being defeated in an attack, it eliminates the adversary’s incentive to attack (since he benefits from peaceful exchange too) and so takes that way off the table.” p825

“Cut” Hibo Wardere

This one’s for you if you’re ready to learn about FGM.

Samantha Power, United States Ambassador to the United Nations, recently spoke of getting close to issues that you care about. A tentative step towards getting close to an issue is to learn about it, to understand it. Reading this book is one such step. You might then feel inspired to take action, to change things for the better. It is important to realise that this issue IS CLOSE. It happens in Britain. Today. Tomorrow. But together, if we all get close, we can change the path that the future will take.

Hibo Wardere’s book is an eye-opening, often heartbreaking and sometimes gut wrenching true story about how her life has been affected by FGM. Female Genital Mutilation. Female Genital Mutilation. You have to say these individual words to yourself a few times before it even begins to hit home what countless girls all over the world are going through each day. This happens mostly to children under 10 years of age, including babies who grow up not realising what has been done to them. Hibo’s work has been to educate first her community and then the wider world about this practice, bringing attention to the fact that it is child abuse, with an aim to abolish it altogether.

I personally had not realised the extent of the long lasting effects that women suffer as a result of FGM from the endless infections, to the incredible difficulties to enjoy an intimate relationship with their partner, to their struggle to give birth to children without severe complications (see below).

While this book makes you aware of the cruel and barbaric actions that humans can take against one another, it is also an inspiring story of the way that one woman has made our world a better place. I have utmost admiration and respect for this remarkable woman. She grew up as a curious child, who felt angry and betrayed by her mother when she was put through the torture of FGM. She persistently asked her mum about it every day for 10 years. She flew to an unfamiliar country and gradually found the courage to speak about her experiences, first to her husband, her family, her colleagues and eventually to strangers.

I cannot escape the irony that I read this book while I slowly work through the 800 plus pages of “The Better Angels of our Nature” (watch this space for a blog) which describes medieval torture practices not unlike FGM.

“It was of some comfort [a hug from her husband after reading a book about FGM],but it did little to take away the pain. Not only of what I lived with day to day- the discomfort, the recurrent infections, the pain of making love with my husband, the horror of childbirth- but there was something else now, too. The flashbacks that had haunted me my whole life suddenly came thicker and faster to my mind” p12. And on a similar note: “There was also a 70 per cent increase in the number of women with Type 3 experiencing postpartum haemorrhages. Babies born to mothers with Type 3 FGM also had an 86 per cent higher chance of requiring resuscitation.” p238

“That word again-brave. The implication that I’d had some choice, that my mind might have been able to control itself, that I could have reacted differently to their butchering of me, that I might not have screamed as I was hacked at- if only I’d been brave enough.” p35

On reaching puberty “What did this mean ‘to be a woman’ and why did it always seem to involve pain?” p52

Hibo lived her childhood and adolescent life wondering why a newly married couple went away and often on return, the wife looked thinner, more unhappy, a shadow of her former self. She made her friend promise to tell her when she came back (it was not normal for anyone to speak of this). “you have to sleep with your husband…He has a thing, and that thing becomes bigger, like a rolling pin, and that has to go through your tiny hole. That’s what they call sex.” p59

“Just by arriving in this country, I had saved future babies from mutilation and I cried because there was no other feeling of freedom like it. I knew from that moment on I would decide everything and be in charge of my life in this new land, with these pink people who call themselves white.” p67

When Hibo went to a doctor to be opened, the Somalian translator refused to translate her wishes because she was so against the idea. “I couldn’t believe the words that were tumbling from her mouth. We were thousands of miles from Somalia, in another culture. This couldn’t be happening! This white woman wanted to help me and the translator wouldn’t tell her how.” p76

Her shock after arriving in London and realising that a man was able to cook, make tea, and fend for himself. “Who is making this tea for him?” p82

After realising that there were girls at a school in her community in the UK who were being taken to Somalia to be cut. “I mentally scanned through memories I’d deliberately buried and I hated myself for not being strong enough to speak out, to report those mothers to the police. Just like so many, I had turned my face away from abuse. I hadn’t asked the questions because I was too scared of the answers.” p133

The views of a man, on how FGM can break up couples and families: “This to me is the double abuse that women suffer. A man can dump his wife for not sexually satisfying him because sex is very painful for her because of the cut or because, in some cultures, a woman might be opened and closed, and opened and closed after different milestones like after giving birth. So she denies him, and he in turn divorces her or dumps her at home and goes out and has sex with uncut women. That is not uncommon, and yet again she suffers through no fault of her own.” p186

“Between September 2014 and January 2015, more than 2,600 new cases of FGM were identified [in Britain]” p190

A detective for Metropolitan Police’s Project Azure to investigate FGM in London, speaking of the limitations and challenges in prosecution. “It’s like all child abuse- children will tell you they’re being sexually abused because they want it to stop, not because they want their parents prosecuted. Your mum is still your mum.” p196

“Research suggests that migrating communities tend to hold on to their traditions as a way of maintaining their identity- people can find it hard to integrate or adapt, especially if they don’t speak the langauge, and sometimes cling on to the old ways as a form of protection against the new culture in which they now find themselves.” p209

“The Spirit Level” Richard Wilkinson and Kate Pickett

This one’s for you if you’d like to read more about the possible correlation between social problems and income inequality.

The Spirit Level is easy to summarise- the authors make two points: 1. That greater income inequality is closely correlated to a higher prevalence of a vast number of social problems and 2. That this correlation can be explained by the stress and anxiety induced by awareness of lower social status. They use a data set of 23 countries to create scatter plots comparing the prevalence of social problems against the level of income inequality in these countries.

After reading the book, I became aware of criticism of their methodology, which lead me to read a report written by policy exchange, a think tank which according to wikipedia is centre-right of the political spectrum. The authors do respond to that criticism in most recent publications of their book and in an article for the Guardian. The criticism questions the need to exclude countries with populations less than 3 million, and suggests that income distribution data is in fact available for countries which the authors say is not. As this paragraph makes clear, sociology is an inexact science, with facts obscured by personal opinions, and fundamental differences between, and allegiances to, the political left and right muddying the waters even further.

Putting the criticisms to one side, I have, as is the pattern on this blog, picked out quotations which I think are particularly interesting. Two of my highlights from the book are the many thought provoking experiments that are discussed and the fascinating chapter comparing international differences in prison systems and attitudes towards prisoners.

The authors suggest that a study published in the BMJ supports their idea that high levels of inequality are associated with poor health across the population. By following the link you will learn that “If the inequality-mortality relation is truly causal then the population attributable fraction suggests that upwards of 1.5 million deaths (9.6% of adult mortality) could be averted in 30 OECD countries by levelling the Gini coefficient below the threshold value of 0.3” alongside the admission that studies included are heterogeneous and that a “consensus remains elusive”. Hopefully with further work in this area, a consensus might be reached in the future!

“We knew of a young man who was unemployed and had spent a month’s income on a new mobile phone because he said girls ignored people who hadn’t got the right stuff. As Adam Smith emphasized, it is important to be able to present oneself creditably in society without the shame and stigma of apparent poverty.” p25

“Familiar faces have been replaced by a constant flux of strangers. As a result, who we are, identity itself, is endlessly open to question.” p42

“Empathy is only felt for those we view as equals, ‘the same feeling for one another does not exist between the different classes.'” p52 Quotation from De Tocqueville.

Describing an experiment in North Carolina with macaque monkeys. Once a dominance hierarchy had been established, and the monkeys were given access to self dispensed cocaine, the subordinate animals took more cocaine. The researchers also found that dopamine levels rose in those who became dominant while there was no change in brain biochemistry in the subordinate animals. Wilkinson and Pickett suggest “In effect, the subordinate monkeys were medicating themselves against the impact of their low social status.” p72

Talking about policies aimed to prevent obesity focusing on individuals “these approaches overlook the reasons why people continue to live a sedentary lifestyle and eat an unhealthy diet, how these behaviours give comfort or status, why there is a social gradient in obesity, how depression and stress in pregnancy play a role.” p101/2

An experiment was carried out in India involving around 300 high caste and 300 low caste boys who were asked to carry out maze solving tasks before and after an announcement of their name, village, father’s and grandfather’s names and caste. Before it, the low caste boys did slightly better than the high caste boys. “After this public announcement of caste, the boys did more mazes, and this time there was a large caste gap in how they did- the performance of the low caste boys dropped significantly.” p113

David Downes (who?) discussing how experts came together to influence the prison system in the Netherlands, “the offender must be treated as a thinking and feeling fellow human being, capable of responding to insights offered in the course of a dialogue…with therapeutic agents.” p151

The above comments about prisons in the Netherlands is in stark contrast to the tent city jail in Phoenix, Arizona where “prisoners live under canvas, despite temperatures that can rise to 130 degrees F, and are fed on meals costing less than 10p per head.” p152

“When people react to a provocation from someone with higher status by redirecting their aggression on to someone of lower status, psychologists label it displaced aggression.” One example given is people from poor backgrounds criticising immigrants. p166

How can equality be achieved? The authors compare Sweden and Japan, two of the countries they found to be most equal. “Sweden does it through redistributive taxes and benefits and a large welfare state. As a proportion of national income, public social expenditure in Japan is, in contrast to Sweden, among the lowest of the major developed countries.” p183

Several high status macaque monkeys were placed together, and as a result, some adopted lower social status. “Animals which move down in these conditions have been found to have a rapid build-up of atherosclerosis in their arteries.” p194

“One suggestion now is that people should use an electronic card to cover payments for fuel, power and air travel. Those using less than their ration would be able to sell their unused allocation back to a carbon bank, from where it could be bought by richer people wanting to use more than their allocation of fuel and power.” p222. A similar idea was put forward by David Miliband and a trial was started in Manchester in 2007.

“the consumption of the rich reduces everyone else’s satisfaction with what they have, by showing it up as inferior” p227

Experiment asking participants whether they would rather have a higher income but be less well off than others in society or vice versa. “Fifty percent of the participants thought they would trade as much as half their real incomes if they could live in a society in which they would be better off than others.” p229

“Economists sometimes suggest that the market is like a democratic voting system: our expenditure is, in effect, our vote” p295. As the authors point out this is hardly democratic given that wealthier people get many times more votes than those who are less well off.

 

“In Order to Live” Yeonmi Park

This one’s for you if you’re interested in what life is really like in modern day North Korea.

Shocking. The word I would use to describe this book. Shocking on a whole new scale. In many ways, this book reminded me of reading about Mao’s reign over China in Wild Swans. But the author of this book was born in 1993, the same year as me. To think that the experiences she describes are happening to people now, is truly horrific. The poverty in North Korea, the human trafficking in China once they cross the border, the journey to South Korea via Mongolia, and the enormous culture shock of arriving in South Korea, all accompanied by a perennial fear that is difficult to imagine. The saddest thing of all is when you try to think of a way out of the terrible situation that faces North Koreans. The fear of nuclear war will surely cripple any meaningful action by western governments. And the chances of change from within are equally crippled by the culture of citizens monitoring each other and living in fear of the authorities.

“We all belonged to inminbam, or neighbourhood “people’s units”, and we were ordered to inform on anyone who said the wrong thing. We lived in fear, and almost everyone- my mother included- had a personal experience that demonstrated the dangers of talking.” p16

“In most countries, a mother encourages her children to ask about everything, but not in North Korea…”even when you think you’re alone, the birds and mice can hear you whisper.” She didn’t mean to scare me, but I felt a deep darkness and horror inside me.” p19

“Everything about you is recorded and stored in local administrative offices and in big national organizations, and the information is used to determine where you can live, where you can go to school, and where you can work.” p26 This explains how the actions of the inminbam contribute to your position in society, or “songbun” status.

“Instead of scary fairy tales, we had stories set in a filthy and disgusting place called South Korea, where homeless children went barefoot and begged in the streets.” p46 Government propaganda extended not just to children’s stories but to their schoolwork as well- using derogative terms to describe Americans in maths problems.

“Just about every morning we woke up to the sound of the national anthem blaring on the government supplied radio. Every household in North Korea had to have one, and you could never turn it off. It was tuned to only one station, and that’s how the government could control you even when you were in your own home.” p66 This meant that people woke up and ate lunch at times set by the state.

After having an operation, “Because we had no money to bribe them, the nurses ignored me. My mother had to do everything from keeping my incision clean to giving me whatever food she could find.” p112

“The Chinese government doesn’t want a flood of immigrants, nor does it want to upset the leadership in Pyongyang. Not only is North Korea a trading partner, but it’s a nuclear power perched right on its border, and an important buffer between China and the American presence in the South.” p131 Therefore North Koreans were at huge risk of being sent back to North Korea by the Chinese authorities.

“The material things were worthless. I had lost my family. I wasn’t loved, I wasn’t free, and I wasn’t safe. I was alive, but everything that made life worth living was gone.” p142 In China, Yeonmi agreed to live with the person who had trafficked her and her mother in return for him buying her mother back so that they could be reunited.

“If the Chinese government would end its heartless policy of sending refugees back to North Korea, then the brokers would lose all of their power to exploit and enslave these women. But of course if North Korea wasn’t such a hell on Earth, there wouldn’t be a need for the women to flee in the first place.” p154/5

Reflecting on her time in China: “For nearly two years, I’d felt like all five of my senses were numbed. I could not feel, smell, see, hear, or taste the world around me. If I had allowed myself to experience these things in all their intensity, I might have lost my mind…So I survived, but I never felt joy, never felt safe. Now, as I listened to my mother sing the old songs, the numbness melted away.” p186

While crossing from China into Mongolia “I also started hating the dictator Kim Jong Il that night. I hadn’t thought much about it before, but now I blamed him for our suffering. I finally allowed myself to think bad thoughts about him because even if he could read my mind, I was probably going to die out here anyway…even in the face of death, betraying the Dear Leader was probably the hardest thing I had ever done.” p196

On reaching South Korea “I felt the shame of the survivor who lives while so many friend and family members have died or are are trapped in a living hell.” p206

Park’s interrogation agent in South Korea, interviewing her about her past, scoffs at the idea of her attending university but admits that everyone deserves second chance. “A second chance is what criminals get. I knew I wasn’t a criminal; I did what I had to do to survive and save my family.” p211 This also reminded me of the rhetoric that some people are using when discussing the current European refugee crisis.

“if everything I had been taught was a lie, how could I know these people weren’t lying, too? It was impossible to trust anyone in authority.” p215 Just one of the long lasting effects of having lived under such a dictatorship.

When asked during her 3 months at a resettlement center what her hobbies were, Park thought “I had no idea what a “hobby” was. When it was explained to me that it was something I did that made me happy, I couldn’t conceive of such a thing . My only goal was supposed to be making the regime happy.” p216

 

“The Rise of Islamic State” Patrick Cockburn

This one’s for you if you think there must be more to the conflicts in the Middle East than you can ever learn from any Western news article.

“The Rise of Islamic State” is a short book, but the author writes so concisely that I wanted to write down almost every sentence, hence why there are so many quotations in this blog. I wanted this book to transform me into someone who has a sound understanding of all of the factors that have contributed to the current situation in the Middle East, able to enter into a debate with anyone who wants to discuss it. Alas, unsurprisingly, it remains incredibly complex, but I do feel that I have a better grasp of the contributory factors. According to this particular book (disclaimer this is obviously a gross oversimplification) they were 1) Religious/ethnic divisions between Sunni, Shia and Kurds 2) A shift of Sunni Islam towards Wahhabism 3) Disunity amongst ISIS’s opposition 4) Complex relationships between different groups of allies  (see below) 5) The self interest of each party involved 6) Corrupt governments, Iraq being the example discussed most in this book 7) A weak Iraqi army, largely as a result of 6). Sadly, you are left feeling that the countries of the Western world act simply to impress their own voters. Voters who know about events of the Middle East through media outlets that often overemphasise the role of the west, which has, in Iraq, Afghanistan, Libya and now Syria “exacerbated existing differences and pushed hostile parties towards civil war.” Cockburn discusses at length the steep challenges that reporters on the ground face in trying to report events accurately.

Joe Biden (US Vice President) on the US’s idea to recruit “moderates” to fight ISIS “there was no moderate middle because the moderate middle are made up of shopkeepers, not soldiers.” xx

“The first moves from Washington [after 9/11] made it clear that the anti-terror war would be waged without any confrontation with Saudi Arabia or Pakistan, two close US allies, despite the fact that without their involvement of these two countries 9/11 was unlikely to have happened.” p4 To back up this argument the author goes on to say 15/19 of the hijackers were from Saudi Arabia, Bin Laden was a member of the Saudi elite, money from Saudi Arabia has been funding jihadis/al-Qaeda, while Pakistan is deemed to have supported the Afghan Taliban.

“In other words, three and a half months after the fall of Mosul and six weeks after the start of US air strikes, the Iraqi army was still unable to withstand an ISIS assault or carry out an elementary military operation.” p25

“As the bombing of Syria began in September [2014] the US would boast of having assembled a coalition of forty states, but this loose allegiance was not only unwieldy but had so many different agendas as to paralyse united action.” p37

ISIS, similarly to al-Qaeda, takes tax or protection money from businesses “people would not eat at any restaurant that wasn’t up to date with its tax payments to ISIS lest the place be bombed while they were dining.” p49

Iraqi  corruption. One former minister “The Iraqi government is an institutionalised kleptocracy.” Activist Ghassan al- Attiyah said “Maybe a judge sets you free but you must pay for the paperwork…Even if you are free you may be captured by some officer who paid $10,000 to $50,000 for his job and needs to get the money back.” P67

“Syrians have to choose between a violent dictatorship…or an opposition that shoots children in the face for minor blasphemy” p81

“By insisting that Assad should go as a precondition of peace, while knowing this is not going to happen, his enemies are in practice ensuring that the war will go on.” p93

“A reason for waterboarding al-Qaeda suspects was to extract confessions implicating Iraq rather than Saudi Arabia in the [9/11] attacks.” p100

“The “Wahhabisation” of mainstream Sunni Islam is one of the most dangerous developments of our era.” p108

“Journalists never fully admit to themselves or others the degree to which they rely on secondary and self in tested sources.” p122

“A government or an army can try to maintain secrecy by banning reporters but they will pay the price as the vacuum of news is filled with information supplied by their enemies.” p123

A correspondent reporting on Syria from Bierut after 2011 says it is “like reporting the last American presidential election from Canada depending on members of the Tea Party faction of the Republican Party for information.” p133 The inevitable bias that results leads to a lot of surprises and unexpected developments.

On the Iraqi army “Soldiers were sent to the front with only four chips of ammunition for thei AK-47s; they went hungry because their commanders had embezzled the money to be spent on food” p136

After 2003 in Iraq and 2011 in Libya “There was absurd talk of “nation-building” to be carried out or assisted by foreign powers, which clearly had their own interests in mind” p142

One Iraqi told the author: “I never imagined that ten years after the fall of Saddam you would still be able to get a man killed in Baghdad by paying $100.” p147

“Part of the strength of the fundamentalist movement is a sense that there is something inevitable and divinely inspiring about its victories.” p153 This may also mean that ISIS will fight harder and longer in a battle, aware that “any failure damages its claim to divine support” p159

Shia militias do not distinguish between ISIS and the rest of the Sunni population so “The result is that Sunnis in Iraq have no alternative but to stick with ISIS or flee, if they want to survive.” p155

According to an Iraqi observer, Sunni Arab monarchies “like the fact that ISIS creates more problems for the Shia than it does for them.”  p156

“ISIS has many enemies, so numerous indeed that they should be able to overwhelm it in the long term, but their disunity and differing agendas mean that Islamic State is fast becoming an established geographic and political fact on the map.” p161

 

“The Rise of the Robots” Martin Ford

This one’s for you if you want to learn about how increasing automation might change the world as we know it, and what we should do about it.

Being given a book is always interesting- what do your nearest and dearest think you will enjoy/think you’d like or need to learn about? It would seem that, in giving me this book, my brother wanted to give me a serious lesson in economics!! “The Rise of the Robots” can be quite heavy at times if you do not have a background in economics, but I found that the possibility of the predictions in this book coming true made all the theories and statistics seem relevant enough to be interesting! Ford describes a vicious cycle of increasing automation, loss of jobs, lack of wages leading to a lack of consumption and therefore economic growth which will ultimately cause a lack of investment and contraction of the economy, causing businesses to look for further cost reductions, and increasing automation. Overall, the book is incredibly thought provoking, particularly in its discussion of rising inequality, the reasons for it and possible solutions to it.

But surely this topic can be viewed in a different way. Increasing automation, on whatever scale it eventually happens, has the potential to bring about drastic change. And change is one of those funny things that we always fear, but is the root to all good things. Think about the things that make you happy- surely they were all originally brought about by change- new relationships/adventures/a new job/hobby/friend. By reading this book, you’re taking a step towards embracing change and engaging in solutions to problems that are likely to arise (or may have already started to!). So if politicians could think ahead of their 5 year government term, it might all turn out to be rosy. Pigs can fly right?

“it has become clear that the productivity increases that went into worker’s pockets back in the 1950s are now being retained almost entirely by business owners and investors.” xii

On the increased output that machines may achieve, without human assistance “The result would be massive unemployment, soaring inequality, and, ultimately, falling demand for good and services as consumers increasingly lacked the purchasing power necessary to continue driving economic growth.” p30

On the high levels on inequality in the US and the UK “In other words, one of the most fundamental ideas woven into Western capitalism- the belief that anyone can get ahead through hard work and perseverance- really has very little basis in statistical reality.” p47

“Economists who have studied financialization have found a strong correlation between the growth of the financial sector and inequality as well as the decline in labor’s share of national income.” p57

“rather than simply failing to enact policies that might have slowed the forces driving the country toward higher levels of inequality, America very often has made choices that have effectively put a wind at the back of those forces.” p60

Economies need for the mass market: “The presence of that solid middle is one of the primary factors that differentiates an advanced nation from an impoverished on- and its erosion is becoming increasingly evident in the UK and across Europe, but especially in the United States.” p80

Technology firms have a staggeringly small workforce for the profits they make. “WhatsApp had a workforce of fifty-five- giving it a valuation of a staggering $345 million per employee.” p169

“Markets are driven not just by aggregate dollars but also by unit demand. A single very wealthy person may buy a very nice car, or perhaps even a dozen such cars. But he or she is not going to buy thousands of cars.” This also applies to any other consumer good, showing that increasing inequality, and sequestration of money amongst a smaller percentage of the world’s population, will cause economic growth to stagnate. So not only is it immoral, its also economically bad news. p194

“While it’s certainly possible that two scientists may look at the same data and interpret it differently, in the field of economics the opinions all too often break cleanly along predefined political lines. Knowing the ideological predisposition of a particular economist is often a better predictor of what that individual is likely to say than anything contained in the data under examination.” p199

Automation may reduce the cost of manufacturing, and entertainment but “The most important things- food, housing, energy, healthcare, transportation, insurance- are much less likely to see rapid, near- term cost reductions.” p211 So does this mean that those industries are going to be less affected by automation (if so then surely the jobs in these industries will remain?)

“It is not at all clear how the poorest countries in Asia and Africa will manage to dramatically improve their prospects in a world that no longer needs untold millions of low-wage factory workers.” p222

Moving onto possible solutions, the author discusses two options- a guaranteed income for everyone, and changes to taxation.

In the 1970s, Hayek said the following, which may become increasingly relevant if the automation revolution unfolds “The assurance of a minimum income for everyone, or a sort of floor below which nobody need fall even when he is unable to provide for himself, appears not only to be a wholly legitimate protection against a risk common to all, but a necessary part  of the Great Society in which the individual no longer has specific claims on the members of the particular small group into which he was born.” p256. This reminds me of a passage from Sophie’s World about John Rawls, who believed that laws should be made on the basis that you could drop dead and come back not knowing your position in society (otherwise referred to as the veil of ignorance).

“we ought to transition to a form of taxation that asks more from those businesses that rely heavily on technology and employ relatively few workers [i.e whatsapp!]. We eventually will have to move away from the idea that workers support retirees and pay for social programs, and instead adopt the premise that our economies in their entireties support these things.” In other words moving tax “away from labor and toward capital.” p276/7

 

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