The great benefits of chocolate

It is always good to come across those moments in which the value of research is re-affirmed again. A team of researchers at the University of Cambridge, led by Dr Oscar H. Franco, has found that eating reasonable amounts of chocolate is good for the heart and the brain, and protects against diabetes and high blood pressure.

Some of us always knew that…

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The higher education health effect

You knew that going to university is good for your intellectual health, but what you may not have known is that it is also good for your blood pressure. Researchers at Brown University in Rhode Island have discovered that the more stages of education you go through, the lower your blood pressure will be as you go through life; those with postgraduate degrees fare particularly well.

But if you really want to improve your health and your chances of longevity, you should also – as another study at the Duke University Medical Center in North Carolina has shown – go through life with an optimistic attitude. Doing so visibly reduces heart disease and strokes. So your formula for a long and healthy life is to go through higher education up to a PhD, and then use your qualifications to effect and stay optimistic. Just don’t read or listen to the news.

Obama has another go at health

Public health and the availability of healthcare in an affordable and efficient way are top priorities for people in most countries. Governments respond to that by ensuring that they, too, are seen to prioritise healthcare. And yet it is a political graveyard, whatever country you may want to consider. The only politician that I can remember in my lifetime, in any country of which I have knowledge, making some political capital out of the health brief was Charles Haughey, when he was Minister for Health in Ireland in the late 1970s. He somehow managed to side-step the hot issues and dodge the usual bullets, and was admired and lauded; and for what? He offered every member of the population a toothbrush. Smart move.

Every other politician who has tried health has regretted it. Brian Cowen and Mary Harney in Ireland; Frank Dobson and many others in the UK; Hillary Clinton and, now, Barack Obama in the US. The problem is that everyone wants to be protected and cared for, but without big bills when disease or ill health strikes. And nobody knows how to square that circle. The only way to do it securely is through insurance that has been properly assessed on an actuarial basis, but unless there is some ‘risk equalisation’ (meaning that the cost of insurance is not related to the likelihood of illness) it becomes prohibitive; and if there is risk equalisation it becomes unprofitable for insurers. There is no way of winning in this game.

And yet, as civilised countries, we must find a way of addressing this, as we cannot go back to making people live insecurely in fear of the consequences for them and their families of serious illness. So we must continue to try, and more politicians will have to be offered up on this altar.

Let us hope that Barack Obama – whom the world needs to be successful for all sorts of reasons – is not one of these. After a lot of political jousting over the past year on the back of proposals made by his Democratic Party, he has now come forward with his own proposals for health reform. In the United States this is vital not least because of the large numbers who are currently outside any system of healthcare. If I read his plan correctly, he is hoping to achieve progress through compulsory insurance for all in a setting of a regulated industry with capped premiums (so presumably some risk equalisation). Whether this can work remains to be seen. But much more important right now than whether the figures might add up is whether it can work politically. There would be damaging consequences if this plan fails. So I am not thinking too much about whether this is a viable way of managing healthcare, I am just hoping it is accepted and is implemented, so that Americans can get proper cover and so that Obama’s political capital rises again. These are tricky times, and what happens to US healthcare may affect us all in unexpected ways.

A very public illness

Some days ago I wrote a post in which I asked some questions about what is, and what is not, appropriate in terms of media coverage of a person’s private life. The trigger for that post was the news item that had been carried a couple of days earlier by the Irish television station TV3 about Irish Finance Minister Brian Lenihan’s health, revealing that he had cancer. The comments responding to my post were lively, and a majority of those commenting took the view that TV3 had been justified, while some (myself included) wondered whether the timing had been necessary or right.

Of course since then the Minister has made a public statement on his health, confirming that he has pancreatic cancer and explaining the treatment that will now follow, beginning with chemotherapy. He also confirmed that it is his intention to continue in his role as Minister for Finance, though he would review that if he felt that he could not give the job his proper attention.

I should perhaps say that I have known Brian Lenihan for some considerable time. He and I were students together in TCD in the 1970s, and we have been friends for some time. He was one of the brightest law students of his generation, but he was also always extraordinarily generous in his attitude to others, and in subsequent years he became a very gifted academic and, then, politician. I hope I am not misusing this platform when I say that I am sure that everyone reading this will join me in wishing him a speedy recovery to full health.

But I also have to say that I applaud his decision to continue as Minister. In saying this I am not making a political comment, nor am I here saying anything about the merits of his politics or that of the government. Rather I am saying that as someone who is recognised as a highly talented politician, he is right to want to continue to apply his talents to the very difficult economic circumstances in which we find ourselves. But more than that, I am applauding his decision to be a role model for those who also face this kind of challenge to their health. Medical experts say that maintaining a professional focus during treatment for cancer enhances the patient’s chances of recovery.

Those who have expressed doubts about his continuing as Minister have, understandably, suggested that the country’s economic health cannot be a secondary consideration at this time, and of course that is right. But that does not mean that we must assume that Brian Lenihan as a cancer patient is less able to address the tasks that come with his office, or at any rate that he is less able to address them than anyone who might be appointed in his place.

I think that sending the signal that once you have cancer you cannot be trusted with anything important would be a devastating one to all those who face this still terrible illness. And so I believe that the Minister’s choice is correct. I also believe that he has shown great openness and courage, and I hope that he gets the support and encouragement that he needs.

Future health

When the Taoiseach (Irish Prime Minister), Brian Cowen, was Minister for Health he memorably called this particular cabinet brief ‘Angola’, because of all the unexploded political landmines he felt it contained. In fact, very few politicians have found the stewardship of the country’s health system to have furthered their careers, with the possible exception of Charles Haughey, who was able to remain focused on policy initiatives and service improvements while there. Most politicians in charge of health appear to be quickly overwhelmed by the combination of intractable problems and vocal vested interests. And just in case anyone thought that this was a peculiarly Irish phenomenon, the same is pretty much true in the UK, and as we know even Barack Obama is struggling (though perhaps with some success now) to make health reform work for his administration in the United States.

But difficult though health policy and its implementation may be, it is right at the top of everyone’s list of priorities. Right now the global health system is having to deal with H1N1 influenza, as well as the various other diseases and pandemics rampaging through parts of the world. We also know that ageing-related health issues will need to be addressed for demographic as well as social reasons. We know that the relationship between health, diet and lifestyles needs to be explored further. In short, health is everyone’s burning concern. And in that setting, we have not really worked out yet how best to structure the healthcare systems in our countries, and how to pay for them; the demand-led system of universal benefits, when applied to healthcare, has not just become unaffordable but actually unmanageable – but we struggle to work out how we could do it better.

One aspect of all this that will need a lot of attention is health research. This is important for two reasons: first, we should be addressing in high value research the key issues that are having an impact on people’s health; and secondly, we should harness the economic benefits of healthcare research as a magnet for high value investment by companies in this field, including some of the biggest blue chip companies in the world. Although these are two different reasons, they actually point us in the same direction: that we should focus on certain programmes of research where as a country we have or can reach critical mass, and we should present these areas as ones that should attract international industrial investment in Ireland. Some of these areas are already clear, such as cancer research (where the National Cancer Institute has brought together the key players from the North and South, with US partners); others show potential, such as Diabetes; and others again support health research and treatment, such as medical diagnostics (with DCU’s Biomdedical Diagnostics Institute playing a particularly important role).

All this is likely to be helped by the new strategic plan of the Health Research Board, which has prioritised research in certain key areas and has also highlighted the importance of translational research, meaning research with a programme for its use in improving or solving health-related issues.

It is important for us to think of health as an opportunity as well as a problem. Ireland has some real excellence in health research across all the universities and other institutions (such as the Royal College of Surgeons in Ireland), and therefore can both make a contribution to addressing global health issues and gain an economic benefit from doing so. It is, as they say, a no-brainer.