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James is wrong about giving 16- and 17-year-olds the vote



by sjhoward

This is the 2,301st post. It was published at 17:38 on Sunday, 3rd May 2015.

As a bit of an experiment, you can access an audio version of this post here.

The images in this post are all from Flickr, and are used under their Creative Commons licence. In order of appearance, they were uploaded by Eric Hossinger, AdamKR, The Fixed Factor, and James West.

This post was filed under:
» Politics
»

My friend James O’Malley argues on his blog that 16- and 17-year-olds should be given the vote as it will help to tackle the seemingly undue attention given to old people by political parties:

By increasing the potential pool of voters at the bottom, it affects the potential electoral mathematics that the parties have to do to maximise their votes. If there are more young people who can vote, it tips the scales back towards the young. Pensioners might be reliable voters, but if there were an extra 1.6 million (ish) young people on the electoral register might be a greater motive for refocusing policies and priorities.

I’m undecided on whether 16- and 17-year olds should be allowed to vote―I see good arguments on both sides―but I think that James’s specific argument is wrong for reasons mathematic and democratic.

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First, the maths. For the purposes of these back-of-the-envelope calculations, I’m using ONS projections for England (as that’s what I have at hand), defining the “youth” vote as 29-and-under,1 and defining the “grey” vote as sixty-and-over.

Currently, the “youth” vote accounts for roughly 20% of eligible voters, versus roughly 29% for the “grey vote”. Giving the vote to 16- and 17-year olds would move these percentages to about 22% and 29%: that is to say, it wouldn’t make much difference. And the difference is lessened further by the fact that most people agree that the “youth” vote is less likely to turn out than the “grey” vote.

But, of course, the real imbalance in the “youth” versus “grey” votes isn’t in 2015. The population is ageing: the scale of the imbalance today is nothing to what the scale of the imbalance will be in the future.

If we fast-forward a couple of decades to the 2035 election, ONS projections suggest that the “youth” vote (as currently defined) would make up roughly 18% of the electorate, versus 37% of the electorate being “grey” voters. Giving 16- and 17- year-olds the vote rebalances this a titchy bit (to 20% and 36% respectively), but this difference is really so little as to be meaningless―the imbalance remains far greater than it is today.

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My second problem with James’s argument is democratic. He reckons that the makeup of the electorate needs to be changed to better ‘balance’ it in age terms, because generational disputes cause problems in our country. As an example:

The old, who own property want the value of their homes to continue to increase, whilst it would be better for the young people who Ed Miliband calls “generation rent” if property prices were to fall, so that buying a house can become even a remote possibility.

But, surely, to suggest that’s a problem is profoundly undemocratic! We have decided that the best way to run our nation is by the majority electing representatives who they think will best serve their interests. The majority of the population is ageing. We shouldn’t go around thinking of ways to “fix” the result to better reflect youth interests because the youth is in the minority.

If we stick with our current form of representational democracy, then, for the foreseeable future, our politics will continue to be determined by the “grey” vote as it is the “grey” vote which makes up the largest part of the electorate. The different electoral turnouts between the generations certainly exacerbate the problem, but they are not the source of it.

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Having said all of that, there is a problem here. Actually, it probably is unreasonable for the electorate to become so imbalanced: not generationally imbalanced, but gratuitously imbalanced between net financial contributors to the state and net financial users of state services. It’s hard to see how a state can function when politicians essentially only have to appeal to those who use the state’s services (especially the elderly), and have to appeal less to those who (by and large) pay for it (largely the working aged). It becomes perfectly logical for politicians to whack up tax rates or borrow with little regard for the future.

Of course, this probably won’t actually happen. It’s more likely that the “grey” vote will be effectively capped at a certain size as people work longer, as neither the state nor individuals can afford to pay for pensions which increasingly approach or exceed the length of an individual’s working life. And, of course, outrageous levels of tax and spend would provide a good incentive to improve low turnout in the younger section of the electorate, which would provide a degree of rebalance in and of itself.

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On the other hand… things could get worse more quickly. We’re seeing national and international narrative opinion increasingly extending the length of childhood. We’ve already seen in the UK a major shift in legislation pushing the end of childhood (in terms of, for example, school leaving and consumption of cigarettes) from 16 to 18. There is increasing scientific evidence that key elements of development, particularly emotional development, continue until the early 20s. UNESCO considers our period of “youth” to continue until 25. The African Youth Charter considers it to continue until 35. In this context, it’s not inconceivable that a future government might choose to increase the voting age, not decrease it.

To summarise: give 16- and 17-year-olds the vote if you want. But do it for good reasons, not because you want to “fix” the outcome of elections in a way that will matter little and matter for a short time. And go and read James’s post, too.


  1. Woe is me, having just exited my own definition of “young”. 


This post was filed under: Politics,

As a bit of an experiment, you can access an audio version of this post here.

The images in this post are all from Flickr, and are used under their Creative Commons licence. In order of appearance, they were uploaded by Eric Hossinger, AdamKR, The Fixed Factor, and James West.

Tackling the threat of antimicrobial resistance: from policy to sustainable action



by sjhoward

This is the 2,300th post. It was published at 13:00 on Monday, 27th April 2015.

This post was filed under:
» Health
» Writing Elsewhere

Today, Philosophical Transactions of the Royal Society B has published a paper I co-wrote with the Chief Medical Officer and some public health colleagues on antimicrobial resistance policy. The abstract says:

Antibiotics underpin all of modern medicine, from routine major surgery through to caesarean sections and modern cancer therapies. These drugs have revolutionized how we practice medicine, but we are in a constant evolutionary battle to evade microbial resistance and this has become a major global public health problem. We have overused and misused these essential medicines both in the human and animal health sectors and this threatens the effectiveness of antimicrobials for future generations. We can only address the threat of anti-microbial resistance (AMR) through international collaboration across human and animal health sectors integrating social, economic and behavioural factors.Our global organizations are rising to the challenge with the recent World Health Assembly resolution on AMR and development of the Global Action plan but we must act now to avoid a return to a pre-antibiotic era.

The paragraph which has received most attention – perhaps surprisingly in a paper which predicts that more people will be dying of AMR than cancer and diabetes combined within decades – is one on food prices:

Public support for action to tackle AMR is crucial, as many measures to mitigate the effects of resistance will incur substantial financial and societal costs, which will ultimately be borne by the public, both through taxation and,probably, through higher purchase costs of products whose manufacturing methods are altered. For example, a pricing paradox exists in farming whereby antibiotics, an increasingly scarce natural resource, cost less than implementation of more rigorous hygiene practices. Reversal of this paradox may lead to higher food prices. While these costs are undoubtedly lesser than the long-term cost of unmitigated antibiotic resistance, they are also more immediate and, superficially at least, discretionary.

Anyway, it’s all quite interesting stuff (though I guess I’m a bit biased). Read it here.


This post was filed under: Health, Writing Elsewhere

Happy birthday, John Snow: you’ve never been so relevant



by sjhoward

This is the 2,299th post. It was published at 13:10 on Sunday, 15th March 2015.

The picture at the top of this post is of a bloke called Chris and the replica Broad Street pump in Soho. It was posted on Flickr by Matt Biddulph, and is used under its Creative Commons licence.

The other two pictures are my own.

This post was filed under:
» Health
»

Today marks the 202nd birthday of John Snow, the anaesthetist whose work on cholera changed the course of modern medical history, kicked off the modern era of public health, and—in 2003—saw him voted the greatest doctor of all time in a UK poll.

Snow is best known for his work on the 1854 cholera outbreak in Soho, London. He used what we would now call epidemiological techniques to map the outbreak and figure out that cases were centred around the Broad Street water pump. It turned out that the pump was dug mere inches from a cesspit which was leaking into the water supply, causing illness in those who drank from it.

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The relevance of Snow’s work to modern public health cannot be overstated. Having spent much of his bicentennial year writing speeches with the Chief Medical Officer, I’ve found myriad parallels to draw between modern public health and the 1854 outbreak, and today seems as good a day as any to share some of them.

In the recent past, public health has been criticised for being too remote and too disconnected from the communities it serves, leading to a considerable gap between what public health teams provide and what people actually need. There are a number of ways of tackling this, but perhaps one of the most important developments in the last few decades has been the cultivation of truly integrated multidisciplinary public health teams. These bring together people with a wide variety of backgrounds and skills to work on some incredibly knotty problems.

And so it was with the 1854 cholera outbreak.

Snow couldn’t have worked on the outbreak alone, as he had no community connections. Without his partnership with Reverend Henry Whitehead, the curate of St Luke’s Church in Soho, Snow would never have been able to find details of the cholera cases he needed to draw up his impressive maps and tackle the outbreak. Only by working with someone with different skills and a different background was Snow really able to connect with his community.

Following the Health and Social Care Act of 2012, much of the responsibility for public health services passed to Local Authorities. You don’t have to spend too much time around public health teams to hear occasional grumbles about this—while people recognise the potential for influencing the wider determinants of health by working in Local Authorities, there are often frustrations about having to convince non-specialists of the utility and evidence base of certain courses of public health action.

And so it was with the 1854 cholera outbreak.

People often believe that Snow himself removed the handle from the infamous Broad Street pump to prevent the spread of the cholera outbreak. He didn’t; probably because that would have been considered vandalism, and possibly because—as an anaesthetist—plumbing skills weren’t his forte.1 Instead, he talked his Local Authority into removing the pump handle. He initially found it difficult to get the message across, and his beautiful maps actually stem from his attempts to persuade the Local Authority to take action rather than from his investigation itself. Ultimately, the Local Authority either bought his argument or tired of him banging his drum, and removed the handle, saving the day.

In modern public health, people often complain that national government interferes in the ability of local teams to act, either through interfering with the supply of funds, or through giving seemingly endless direction on things that should be considered or done at the local level.

And so it was with the 1854 cholera outbreak.

It’s an oft-forgotten footnote to the outbreak story that, having heard of what had happened in Soho, the national government ordered that the Broad Street pump handle be re-attached. There were too reasons for this: electorally, the closure of the Broad Street pump was a bad thing, for it was one of the most popular pumps in London, renowned for the clarity and taste of its water; scientifically, it was thought that the idea of faeco-oral transmission of disease was simply too disgusting to be true.

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Yet when the pump handle was reattached, the outbreak didn’t restart. This was probably because the cesspit next to the pump well had been emptied—but it should also remind us that no matter how crazy they may seem, not all ideas from national government are completely mad.

Effectiveness in modern public health can often involve challenging and overturning the status quo, sometimes in the face of considerable opposition from those with entrenched views.

And so it was with the 1854 cholera outbreak.

At the time of the outbreak, disease was thought to be transmitted by miasma—bad air. Today, it’s easy to underestimate the degree to which this faintly ridiculous theory was accepted: a glance through contemporary medical journals will reveal paper after paper on the design of hospitals and homes to promote the best flow of miasma. Indeed, one of the reasons so many Victorian hospitals had their morgues in the basement was so that miasma from the dead wouldn’t waft across other patients.

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Snow—an anaesthetist, let us not forget—overturned the apple-cart of contemporary medicine by suggesting that disease could be water-borne. Virtually nobody believed him, and after 1854, he spent much of the following four years prior to his death trying to compile data to demonstrate his findings. His was a revolution that didn’t come easily. The Lancet, in an editorial on Snow’s theory in 1855, said

In riding his hobby very hard, he has fallen down through a gully-hole and has never since been able to get out again … Has he any facts to show in proof? No!

Yet, of course, germ theory proved Snow right—and The Lancet finally got round to publishing a correction on Snow’s 200th birthday.

When working in public health in the North of England, it can often feel like breakthroughs made here are not fully appreciated, respected and integrated into practice until they’ve been endorsed by others—and particularly those in London.

And so it was with the 1854 cholera outbreak.

Snow was born in York trained at Newcastle Medical School. The first cholera outbreak he helped to tackle was in Newcastle in 1831, and though he was just 18 at the time, many believe that this is when he first developed the idea that cholera may be transmitted through water. Yet it wasn’t until his London-based work 23 years later that anyone took a blind bit of notice!


  1. Or maybe, like so many modern anaesthetists, he talked endlessly about the Hagen–Poiseuille law and considered himself something of a plumbing expert. 


This post was filed under: Health,

The picture at the top of this post is of a bloke called Chris and the replica Broad Street pump in Soho. It was posted on Flickr by Matt Biddulph, and is used under its Creative Commons licence.

The other two pictures are my own.

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