Yesterday, while Wendy was busy presenting at an international conference, I crossed the border from California to Tijuana to go exploring.

From San Diego, this was very straightforward. The Blue Line on the San Diego Trolley took me directly to San Ysidro, the district on the US side of the US-Mexico border. The Trolley stop is maybe 200 metres from the border crossing point, and there are helpful signs to put the way. There are also lots of slightly threatening signs from the US Government about covert monitoring.

There are, in fact, two pedestrian border crossings: one near the Trolley station, and one a short walk away by the Border Outlet Shopping Centre. I took the former (better sign-posted) option, walking up what felt a lot like a back alley behind a coach station to the border crossing point.

On entering through the slightly threatening no-return gates, I entered a border crossing, reminiscent of a typical airport border point. There was a very long queue for people with Mexican passports, but nobody in the queue for people who, like me, had foreign passports. This phased me a bit: I knew from my prior research that I needed to fill in an immigration card, but could see neither a card nor anywhere to fill it in. In the end, I just approached one of the border agents’ desks, where a friendly officer told me not to worry, it was quiet, and I may as well fill it out at her desk, which I did while she checked my passport.

We made small talk about this being my first time in Mexico (she was amazed), her previous experiences of visiting London and the sights of San Diego I’d seen so far. Before long, she’d stamped my paperwork and sent me on my way. After this point, customs x-ray searched any large luggage, but as I had none I was straight back outside and in a new country.

From here, it’s typically a 20-minute walk to the touristy area around Avenida Revolución, but I went a bit wrong, crossing over a highway on the footpath of a road bridge rather than the more direct pedestrian bridge, so it took me about half an hour. This walk is not through a particularly attractive area. I was pestered frequently by disabled and often elderly beggars, street sellers, and taxis pulling up alongside me to offer me lifts. Looking down on the vehicular border crossing, I could see stall upon stall with sellers plying their trade to people waiting in the long, seemingly stationary queue for the US border.

I walked through expanses of largely deserted civic architecture with broken fountains and such surrounded by closed up shop units. It was a bit eerie. I’m not sure whether this is attributable to me visiting on a Sunday or to the significant downturn in the Mexican economy in the decades since Tijuana was a real draw for tourists.

Here and there along the way, there were small stores and restaurants whose seemingly desperate owners practically begged me to come in and look at their wares, often offering free alcohol as an enticement. I’m afraid I declined.

My own idiocy in taking the wrong bridge notwithstanding, it was actually quite easy to navigate to Avenida Revolución thanks to the visible-from-everywhere Tijuana arch, which stands right in the centre. Rather disappointingly, the sign in the middle seems to have changed from the famous ‘Bienvenidos a Tijuana’ on a Mexican flag background to something “modern” sponsored by Samsung.

The area around Avenida Revolución was lively in every sense, with performers drawing large crowds, street vendors enthusiastically shouting about their products, and bars and restaurants making keen efforts to attract the passing traffic. The famed decorations around Santiago Argüello lent a party atmosphere to the whole area.

And yet, I found it hard to forget the scenes of deprivation and desperation I’d walked through to get to this point, not least as I knew I was going to have to walk back the same way before too long. This left me feeling a little melancholic. Nevertheless, I had a good wander around, aimlessly soaking in the atmosphere rather than rushing into any of the frequently advertised tourist attractions.

I got far less lost on the way back thanks to very frequent signage to the US border. I crossed back over at the other of the two border crossings I mentioned.

There could hardly have been a more marked difference between the manner of the crossing in the two directions. As soon as one stepped through the gates to the US border crossing complex, frequent stern signs forbade the use of mobile phones and cameras. Crossing back into the USA involved a walk through a labyrinthine concrete corridor ending with an almost whimsical spiral concrete ramp to even reach the border crossing point. I had to queue for a little over an hour to meet the US border agent, who questioned my intentions in crossing the border in some detail. He also seemed a little confused by the fact that my passport was for both the United Kingdom and Northern Ireland, which hardly inspired confidence, but he did eventually let me through.

The fact that the US-Mexico border is the first controlled land border I’ve ever crossed probably says more about the remarkably peaceful times in which I’ve lived that it does about me personally. At the time I crossed the Denmark-Sweden border it was technically manned, but this just involved someone passing through my train cursorily glancing at passports. Some pundits currently predict something similar will be in existence between Northern Ireland and the Republic by the time this is published: I think that’s nonsense, but that’s perhaps a post for another time.

At the moment, I’m part-way through Rutger Bregman’s Utopia for Realists. In this book, which argues for a borderless world, the US-Mexico border is cited specifically as one which inflicts economic harm on people on both sides. I found the apparent difference in living standards quite shocking: it seems mildly crazy that people living in two developed countries and so physically close to one another can have such different life experiences and prospects.

There has been much written over the last few months about the level of poverty in California, despite its reputation as a liberal state. Wendy and I have both been quite surprised to see the seemingly high number of homeless people in San Diego. Crossing the border, I felt as though there was a far greater degree of profound poverty in Tijuana, but perhaps California’s poverty is just better hidden than Tijuana’s. Appearances can, after all, be deceiving.

I’m glad I took the time to visit Tijuana while I’m over here in California. The experience wasn’t at all what I had expected: rather than a tacky pastiche Mexico “mini theme park” which I had thought would exist on the other side, the reality has left me more pensive and reflective than I would have expected. And that’s no bad thing.

Fairly obviously, all of the photos in this post are my own.

Earlier today, I had the pleasure of visiting Bai Yun, a 26-year-old Giant Panda, at San Diego Zoo. I’ve never seen a panda in the flesh before, though didn’t need to come as far as San Diego to do so: Yáng Guāng and Tián Tián at Edinburgh Zoo are a good 5,200 miles closer to home.

The visit was a relatively hurried one: even on a Wednesday afternoon, there was quite the queue to see the panda enclosure and the zoo staff members were keen to keep people moving. (As an aside: I suspect the employees would also object to me describing them here as “zoo staff members”, as they kept correcting visitors with a note of mild irritation that this wasn’t “part of the zoo” but rather a “dedicated panda research facility”.) Nevertheless, it was certainly a memorable experience. I was particularly struck by how cute the pandas were in real life: just as cute as in the cutest pictures.

As a general rule, I’m not much of an “animal person”. However, I make an exception for panda bears. Wendy asked me this afternoon what it was about pandas that overcame my general disinterest in animals, and I think it comes down to three things.

Firstly, pandas are ridiculous creatures. They have the gastrointestinal tract of a carnivore, yet insist on a diet of pure bamboo, which they can’t properly digest. This means that they need to eat some 20kgs per day to survive, taking up around 14 of their 20 waking hours per day, and resulting in a need to defaecate about every half hour. If ever there were a creature that should be extinct, the panda is it.

Secondly, panda diplomacy is fascinating. For thousands of years, China has been using gifts (and latterly loans) of pandas to further its political aims. No other country has managed to replicate this with such success with any other animal—and it’s not that easy to think of many diplomatic practices with quite such a long and lustrous history. The zoo staff members regularly reminded vistors that the bears and any offspring were owned by China and that the results of their panda research were regularly reported back to the Chinese. Panda diplomacy even turns up as a C-plot in The West Wing.

Thirdly, and most importantly, pandas are really really cute. I mean, just look at that picture. There’s a lot written in the scientific literature about why pandas are so cute: most sources seem to suggest that it is because their faces appear proportionally similar to those of babies. I don’t know whether that’s accurate or not, but I certainly like them!

The picture at the top was, fairly obviously, taken by me earlier today.

As I type, I’m 34,000 feet above Greenland on my way to San Diego aboard a British Airways Boeing 777-200. Wendy is snoozing next to me, fully reclined with eye mask in situ.

Apart from the miracle of travelling at 550mph across the globe in a pressurised metal tube, things aren’t going so well. The in-flight entertainment system broke after the first hour of the flight—perhaps I’ll never know what happens in the second half of The Greatest Showman—and for the last three hours we’ve had too much turbulence for me to be able to comfortably read. The combination of free alcohol, no entertainment and people strapped to seats is leading to a somewhat tense atmosphere with complaints being fired at the harried crew from all angles. Worse, they’ve now completely run out of gin on board.

We’re on a last-minute replacement plane whose interior has seen better days, and the resulting re-allocation of seats means that Wendy and I are sat immediately next to the toilet. I realise someone has to sit here, but I paid to select our seats so that it wouldn’t be me. Like most people, my sense of egalitarianism seems to have evaporated as soon as I felt that I’d got the raw end of the deal.

And yet, there’s rather lovely about being in splendid isolation from the rest of the world. Fortunately, this plane doesn’t have wifi. So with nothing to watch, an inability to read, and a sleeping wife, I’m just sitting here and thinking. How often does anyone get the chance to do that?

I have a natural inclination towards spending time with my own thoughts. As I walk to work in the morning, I typically listen to music or a podcast, but my journey home is usually spent just thinking things over. I think it helps to keep me sane. Rarely, though, do I get the chance for a more prolonged period of thought.

I realise the irony that I’m now writing this thought down, laptop balanced on knee, with lots of turbulence-induced typos being corrected as best I can. If you’re wondering: I’m saving this in the Evernote app on my Chromebook to post later.

And that’s really all there is to say. I’m going to put my laptop away again now and return to quiet contemplation. Over and out.

The photo at the top was taken by me earlier today.

Tonight, it’s the grand final of the 2018 Eurovision Song Contest. As long-time readers will know, I really enjoy watching Eurovision – I even live blogged the UK selection programme once. There are a few reasons I really enjoy it.

Firstly, of course, the music. If I had to choose a favourite radio station, it would undoubtedly be Monocle 24. There’s quite an overlap in the Venn diagram of international music Monocle 24 would play and the sort of music that does well at Eurovision. In fact, most years, they’ve already had quite a bit of air-play of the big-hitting songs by the time the contest comes around.

Secondly, there is something so joyful about seeing so many different countries and cultures come together for a single peaceful purpose. In that regard, Eurovison is a little like the Olympics – only moreso, because the countries are peacefully scoring one another. More of this in the world would be a good thing.

Thirdly, there are bits of it which are undeniably batshit crazy. I’m not that entertained by the stuff which is out-and-out mad, but the unexpected crossovers been madness and talent which occur from time to time are quite something: take this year’s entry from Israel, which is crazy, brilliant and catchy all at the same time.

It’s this third point which makes me feel a little glum about the UK’s entries, which are typically standard, uninspiring pop fare (look at this year’s entry from SuRie). We seem to have an astounding capacity for moaning about the poor scores the UK entry receives even when the middle-of-the-road pop numbers rarely perform well even in the UK chart, despite the considerable Eurovision following. It would be really nice to have a UK entry that was quirky, whether that’s through outright craziness or just having great execution of something which is very ‘on trend’: look at this year’s entry from Sweden.

But I think the BBC lacks the boldness and creativity to find or inspire that sort of song. Whenever the BBC tries to do ‘zany’ in its programming, it tends to come off as ‘crazy by committee’ and spectacularly flops. This is even more so the case since the budget cuts at BBC Three, which was their outlet for experimental material. The best they seem able to come up with these days is crap like Don’t Scare the Hare or 101 Ways to Leave a Gameshow, which is a shame given the BBC’s lustrous history of the surreal.

The UK public vote rarely tallies with the most popular songs across Europe, even in an approximate way, so a publicly voted selection show (which the BBC has returned to using in the past couple of years) doesn’t seem like a logical way to go. Similarly, the UK jury seems permanently out of touch with the views of the rest of Europe, so professional selection doesn’t seem ideal either. I think the BBC needs to divest itself from song selection, and outsource it to people who have a chance of selecting something half decent.

The question is… who can provide that? I’d put it in the hands of the curators of the Monocle 24 playlist. They know a good song when they hear is – and have a definition of “good song” that at least approximates that of viewers across Europe.

Of course, I suspect such a system could never work in practice: I’m sure Monocle wouldn’t want to sully their upmarket brand, and the BBC wouldn’t want to lose control. But I think it’s an interesting idea!

The logo at the top is the official one for this year’s contest, taken from the press pack.

In this morning’s Monocle Minute, there was a fascinating bit about a public health measure in Pakistan which had completely passed me by:

Pakistan’s Punjab province has taken an intriguing step to discourage its citizens from chugging too many cans, demanding that brands such as Red Bull and Monster remove the word “energy” from their packaging and replace it with “stimulant”. The move comes from the scientific advisory panel of the Punjab Food Authority (PFA), who ruled that the word was misleading. The PFA decided that the drinks do not provide people with nutritional energy per se, rather that the caffeine, taurine and guarana merely stimulate drinkers.

I think there is much to be done around the regulation of food packaging, as it often seems pretty misleading. But most of what I’d thought about previously was around claims about the “healthiness” of foods and claims about calorific content. In fact, I’ve had previous publications ranting about both the food industry and the public health response on the latter point, but don’t have any clear answers of my own to offer. I’d never really thought about the connotations of “energy” drinks as a name, so I think the story above is a really interesting development and I’ll be intrigued to see whether it spreads more widely.

Sometimes, even those of us in public health miss public health developments in our own country. I only recently because aware of the fact that liquid laundry detergent capsules are now packaged in opaque containers not because of changing consumer preferences but because of very sensible European legislation, designed to reduce their attractiveness to children.

That’s a public health legislative win by anyone’s yardstick… and while most had realised the packaging had changed, no-one in my office was even aware that the legislation existed. It’s amazing how much public health measures can pass by even those of us working in the field – we perhaps don’t do enough to celebrate public health achievements that aren’t badged like that.

A year or so ago, my friend James O’Malley wrote a great article revealing that Fuller’s pubs had gone sugar-free on soft drinks – years before the Soft Drink Levy came into force. This was a voluntary public health measure by a private business. Wouldn’t it have been great if, say, Public Health England or the Faculty of Public Health had seized on this as an example of responsible action and praised the chain – rather than simply ignoring it? Just a thought.

The photo at the top is a cropped version of this photo posted to Flickr by Mike Mozart. I’ve edited and re-used it above under its Creative Commons licence.

In most of medicine, and in Health Protection in particular, one occasionally comes across people who have made questionable decisions which have had severe consequences. When people decline routine vaccinations or fail to use a condom for specious reasons, it can be both depressing and frustrating to be picking up the pieces.

It’s easy to rationalise that health is not at the top of everyone’s personal agenda and that sources of misinformation are common and commonly believed. At these times, it feels like the most productive outcome is to channel the frustration into improving the information on offer and trying to reach the people who have missed it.

A friend once told me to think of ‘health’, a topic which most of my life is dedicated to, in terms of ‘transport’, a topic with which I’m intimately engaged as a ‘user’ but in which I’m completely non-expert:

I might get frustrated that people don’t take obvious preventative health measures, but when was the last time I checked my tyre pressure, an obvious ‘preventative measure’ in the ‘transport’ world? (I’ve done it once in the nine years I’ve owned my car.)

I might get annoyed that people don’t have any idea of the true cost of their healthcare, but what’s the true cost of the public transport I take to work each day? (I’ve no idea.)

I might think that’s it’s patently obvious that homeopathic remedies contain no active ingredients and are a total waste of money, but what’s the evidence of benefit for the ‘premium’ grades of petrol? (I often buy them, even though there’s probably no benefit.)

And then, just occasionally, I come across something that seems so appalling unappealing that I’m baffled that anyone, medical knowledge or not, could possibly want to engage with it, let alone risk harm by doing so:

One type of apitherapy is live bee acupuncture, which involves applying the stinging bee directly to the relevant sites according to the specific disease.

Live bee acupuncture. Wowzers trousers. This paper by Vazquez-Revuelta and Madrigal-Burgaleta in the Journal of Investigational Allergology and Clinical Immunology, from which the above quote is taken, reports a terribly sad case of a 55-year-old woman who died from live bee acupuncture.

The paper reports that she’d been attending four-weekly for two years for the procedure, with the aim of treating

muscular contractures and stress.

As one might expect,

the risks of undergoing apitherapy may exceed the presumed benefits, leading us to conclude that this practice is both unsafe and unadvisable.

There is little about this paper which isn’t at least mildly astonishing. But then I wonder… I don’t know what the transport equivalent of intentional bee stings might be, but perhaps I engage in that too.

The alarmingly cute picture of a bee at the top of this post was posted on Flickr by Ozzy Delaney. I’m reusing it here under its Creative Commons licence.

Like the first two books in the series, it felt like a privilege to be read Ali Smith’s Spring, which are sure to become a classic, at the moment in time in which they’re set. Smith captures the voice of an age. I’ve found the writing in this series dizzyingly brilliant—the language and the fascinating ways in which Smith manipulates it are somehow more important than the plot. The raw anger in this volume in particular was something else. This was astounding.

There are lots of different editions of Italo Clavino’s Difficult Loves: mine had the classic collection of “Difficult Loves” short stories written in the 1950s, followed by the slightly longer stories “Smog” and “A Plunge Into Real Estate”. The overarching themes were love (in its broadest sense) and loneliness. I don’t usually get on with short stories, but this collection was an exception. The everyday tales which beautifully captured universal emotions; the dry humour; the hint of craziness that made me look at the world slightly differently; all allowed Calvino’s prose to take flight. It’s been years since I last read any Calvino, but I won’t let it be so long next time!

Let’s Explore Diabetes With Owls was a collection of amusing autobiographical short stories or ramblings about travel, writing, and life in general. As you probably know, Sedaris is an American living in rural England and he draws a lot on differences in US and British culture in this volume. This is the first time I’ve read any of his work, and it made me laugh out loud a few times, which books rarely do – and it was pleasantly cosy and inconsequential. I’ll certainly read more of Sedaris’s collections. 

I found Sarah Moss’s Ghost Wall utterly gripping, and finished it in a day. It was a book about a group of undergraduates, guided by an amateur historian (and his wife and child) plus a university professor, going on a camping trip in Northumberland and trying to recreate Iron Age life. There were some beautiful descriptions of the expansive scenery of Northumberland, which meant all the more to me for being local, and some very carefully observed descriptions of the lack of recognition of domestic abuse among victims. This left me with a lot of food for thought.

Thanks for the Feedback by Douglas Stone and Sheila Heen was a book about how to receive feedback effectively. I found the book baggy and over-long, with rather too many repetitive examples. That said, there was more useful stuff in here than I expected. It shifted my understanding of feedback conversations from being one-way (i.e. passively receiving feedback) to being two-way (i.e. working together to understand the intention behind the feedback and reach a mutual understanding on the next steps). This is an obvious point, but I confess that it’s not one that’s occurred to me in those terms before—perhaps fed by a lifetime of written feedback and evaluative assessment where there’s no opportunity to engage in further discussion.

Heartburn was a short and funny autobiographical novel about the breakdown of Nora Ephron’s marriage to Carl Bernstein. It used a series of relatively frothy vignettes (interspersed with the occasional recipe) to reveal rather deep reflections on life, pain and betrayal. I think I perhaps prefer Ephron’s shorter essays than this longer book, but I found the book so cleverly put together that I might come to think differently about that as I reflect further.

Women and Power was a book based on two speeches by Mary Beard about the way in which women have been systematically denied a public voice. The first took a historical, longitudinal and structural approach to that question, while the second focused more on contemporary examples. I found Beard’s historical account interesting and compelling, but I wish it had gone further. In particular, I would have liked to better understand Beard’s views on how things can change, and what the future may hold – but perhaps that’s not the point of a history book.