Some weeks, I think more about local journalism. This has been one of those weeks, as I’ve been thinking quite hard with my comms colleagues at work about whether and how to include public health messages in statements relating to a minor local news story. It’s sometimes a trickier call than you’d think.

When I saw James O’Malley’s most recent Substack post was about saving local news, the topic was already on my mind. He suggests that local news might be sustainably delivered through ‘paywalled newsletters’, initially supported by the BBC’s Local Democracy Reporting Service (LDRS) funds, which currently pay for local newspaper journalists.

In an instant, this would mean that many more pockets of the country once again have quality reporting in a quality publication, covering the nuts and bolts of their local democracy. And with a LDRS subsidy, it would mitigate the chicken-and-egg problem that newsletters have, of needing to sign up enough people to be viable while still paying the wages of the writers.

Over time, some newsletters might even become profitable or sustainable – like the Mill. Others may need to be subsidised for slightly longer.

But ultimately, it would stimulate an ecosystem of viable local newsletters, with the reach and distribution to serve communities with real, meaningful news – with all of the civic positive-externalities that implies: Better democracy, better accountability, and better media.

As I read this, I immediately thought this was both a brilliant and terrible idea, and I haven’t entirely managed to reconcile my thoughts on it since.

The downside is, of course, the paywall. I’m not sure that content whose accessibility is limited to a few paid subscribers really does deliver better democracy or accountability. At the very least, it’s harder to counter misinformation and disinformation that is not out in the open in the first place. I’m also not confident that it’s ethically sound to use LRDS public money to fund journalism that’s only—or at least preferentially—available to those willing to pay a subscription fee.

And yet, if a product like that existed locally, I wouldn’t hesitate to sign up, so I’m not that ethically opposed to it. Heck, I even subscribe to the apps of some local newspapers so that I can view the less ridiculous content without a deluge of advertising. And surely a sustainable future for local journalism, even if it is a little less open, is better than no local journalism at all?

It’s a quandary.

The image at the top of this post was generated by DALL·E 3.

James O’Malley opens his latest Substack post:

Twitter’s most underrated function is that it is a tool for social mobility.

After graduating into the financial crisis, I moved to London and I didn’t know anyone. My parents are not super wealthy, I went to a normal comprehensive school in the Midlands – and then to a post-1992 university. So when it came to getting a job and building a professional network, I was essentially starting from scratch.

But the one asset I did have was that I was a Twitter early adopter. Through the platform I discovered an entire professional world that would historically have been closed off to me, and as I followed journalists, politicos and other high-flyers, I was able to glimpse into their world, learn the industry gossip, identify the behind-the-scenes power-players and master the terms of art. Scrolling my timeline was like having a permanent spot at the water-cooler of London’s political and media elite.

I’ve never previously considered Twitter from the perspective of social mobility, but now that James has pointed it out, it seems obvious. Indeed, when I was active on Twitter in the early stages of my career, it helped me to make professional connections in a similar way. Public health in England is a small professional world, and as a result, it is disproportionately London-centric. Twitter helped me to make professional connections even from afar.

Yet, looking back, many of the people I made professional connections to were the—for want of a better phrase—‘extremely online’ colleagues, who were often not as influential, switched-on or expert as they thought they were.

Last week, we heard complaints at the COVID inquiry about politicians’ inability to distinguish between absolute and relative risk. Not many years ago, I did my best to explain the same to an uncomprehending prominent professional by direct message on Twitter. They may have been rarely off the telly and hugely popular on Twitter, but the conversation revealed their grasp of the basics to be a little loose. Another told me that a study they shared was significant because of a wide confidence interval, which they believed to demonstrate a very high level of confidence: an almost perfect inversion of the true meaning.

I came to learn that the people with deep knowledge and real, lasting influence tended not to be active members of the Twitterati. In my field, at least, when ‘extremely online’ people reach positions of real-world seniority, it can become somewhat fraught. Public health is a naturally complex, subtle and political field which perhaps doesn’t reward talent for brief, blunt, off-the-cuff responses. There are exceptions, of course, and I’m not inured to the irony of writing all of this in a blog post.

In politics and journalism, public engagement is the job, so naturally, excellent practitioners will often do well on social media. In these fields, Twitter is a perfect tool for social mobility, precisely as James describes. In medicine, I’m not so sure.

The image at the top of this post was generated by DALL·E 3.

James O’Malley recently wrote about status in a way that reminded me of Will Storr’s brilliant book The Status Game.¹ It made me reflect on some disparate thoughts I’ve been having recently about the role of ‘status’ in the medical profession, and especially within public health.

A little while ago, I talked with a colleague who had moved to a new role. Their former role had been equivalent to mine: actively managing local outbreaks and situations involving risks to a geographically defined population. The formal ‘status’ of the new position was no different—the pay was the same and so forth—but the day-to-day was different. The role was part of a national team broadly concerned with developing guidelines rather than having direct input into managing ongoing situations.

I knew that, like me, this person enjoyed the messily complex, ethically challenging, adrenaline-pumping world of managing ‘live’ situations, so this seemed a slightly surprising career move for them. Luckily, I knew them well enough to ask what had possessed them to take on such a different role.

My colleague told me—not quite in these terms—that they felt that the new role had a higher ‘status’: that, in their opinion, developing policy and guidance was a more ‘senior’ responsibility than managing incidents.

I know I sound desperately naive in saying this, but that floored me. I’ve been involved in developing more than my fair share of national guidance and have always seen it as a bolt-on to my ‘core’ job. I felt able to contribute to the development of this sort of thing because of my ongoing practice and experience; it wasn’t a ‘higher status’ bit of my job than, for example, chairing multiagency outbreak control teams.

I suppose I saw writing guidance as a little comparable to teaching. It is an important and worthwhile activity, but pivoting to doing it full-time seems like a career ‘jump’ into a different field, not a ‘status upgrade’ deal.

The idea that some colleagues saw this differently was quite a revelation. I think this is perhaps unique to the public health speciality: I struggle to think of anyone I know in clinical practice who has seen the leap to a job in guideline development rather than clinical practice as a ‘status increase’ in quite this way.

Status can be a funny thing: for it to hold any meaning, there has to be a socially agreed ‘ranking’ of sorts. James talks about the boost he feels when a journalist he respects engages with his work, but part of that ‘respect’ no doubt comes from a social consensus that the journalist is ‘high status’. We might be friends, but I don’t think he’d feel quite the same status boost from me blogging about his post. At the same time, as James points out, different groups have different consensuses: I strongly suspect James wouldn’t be as excited to see a complimentary post on his work from Suella Braverman as from Barack Obama, but they’re similarly statuesque figures to their particular crowds.

Even in a small field like mine, people can see status in different places. I suspect that within individuals, people recognise different things as holding status at different times in their lives and careers. At this point in my career, I would actively decline a ‘promotion’ to a management position, for example, because I value my clinical work too highly. Perhaps later in my career, I’ll value the broader influence that management positions can have.

I guess my reflection is that our own conceptions of status are even slipperier than I’d considered. I think James and Will are right to suggest that status is underestimated as a driver of behaviour, but applying that insight to understand individuals’ behaviour is more complicated than it might initially seem.

1. He also said that Succession is better than The West Wing, and without even having seen a single episode of Succession, I’m pretty sure I disagree. ↩

The image at the top of this post was generated by DALL·E 3.

A lot is often written about the need to adapt our national infrastructure, and particularly that of cities, to manage climate change. Most of what I read is about adapting cities to produce less carbon. For example, by promoting active travel over carbon-fuelled vehicles or by using heat pumps in place of carbon-fuelled central heating.

A lot of this is framed very poorly. Coverage regularly implies a choice, most frequently citing ’economic damage’ as a key barrier to implementing ecologically sound practice. It shouldn’t need saying that making our planet uninhabitable is the ultimate act of economic damage.

As my old friend James O’Malley frequently reminds us, adaptations actually have to be built to make a difference. If every option is blocked because it’s not quite eco-friendly enough, then we’re doomed to end humanity.

One aspect that seems under-discussed is how we need to adapt the built environment to cope with the climate change that is already baked-in through the damage we’ve already done. I was pleased to see an article in Le Monde yesterday about exactly this issue, looking at how Paris needs to adapt.

I think the two issues ought to be considered hand-in-hand: the super-insulated houses required to make heat-pumps work must also support passive cooling, or they will be uninhabitable in the medium term. Building better infrastructure for active travel is a must, but doing it with asphalt is a bad idea. Nice big windows to reduce reliance on powered lighting are unhelpful if they also trap heat.

I worry, though, that this complaint just puts me in the same category as those who oppose developments for not being quite ecologically friendly enough. I don’t think it’s the same complaint: building infrastructure in a way that guarantees a short lifespan can’t be good for the planet… but is it better than nothing?

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.

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.

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.

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.

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.

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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.

It seems almost a little wrong to select something a friend wrote for my recommended weekend read… but this is my blog, and I make the rules. So this week, I’ve selected James O’Malley’s thoughtful blog post about the hegemony of social media and the potential danger the emerging situation poses to the concept of free speech. He poses more questions than he answers, but in so-doing he made me consider restrictions on free speech from a somewhat different point of view.