Tomorrow is not promised, but we can do a lot more to make it fairer when it comes

My legs are both longer and older than my wife’s J’s. Hers are also considerably prettier. Having longer legs is not usually a problem. I don’t mind fetching things down from the top shelf or holding an umbrella to shelter her when it’s raining, or even moving her car with my legs scrunched up so as not to disturb her seat position. However, other times the leg length difference is a pain and, to be frank, simply unfair. We can, for example both walk the same number of miles, yet she will accumulate an extra 30% more steps on her Fitbit. It’s not like I’m especially competitive or anything, but when steps get counted, gaining extra steps just because you have shorter legs than your companion simply isn’t fair.

It’s not just the difference in leg length that can lead to discord in our house. Putting on or losing the odd kg or two can give rise to cries of ‘that’s not fair’. During our recent kitchen makeover, something that lasted three long weeks, we did, out of necessity, often frequent, the local takeaways. The inevitable result was we both gained some extra kgs. With Christmas just around the corner, we were keen to try and shed the extra weight ahead of the holiday break. We knew we were likely to continue to eat more of the wrong things and probably not exercise as much. So we decided upon a quick ‘let’s be careful what we eat’ approach to our diets. I lost those extra few kg relatively easily and quickly, J not so easily.

But, as he hastily ducks his head to avoid the rolling pin thrown his way, it’s not her fault. It really isn’t. Research undertaken by Newcastle and Glasgow universities has confirmed that men do lose weight much easier than women. The research (The Direct Trial) was aimed at exploring whether a low-calorie diet might help those with type 2 diabetes. The aim was to see if a low-calorie diet could help them lose just 15 kg and do so relatively quickly and easily. The original study, published in 2017 showed very promising results, with 50% of the participants going into remission from type 2 diabetes.

However, the participants were followed up over the next three years. The result of this longer study revealed an unexpected additional outcome. Whilst both the men and women followed the same diet, there was a marked difference in weight loss between the sexes. On average men lost 11% of their body weight. The women, by comparison, lost just 8.4%. It just isn’t fair. Of course, there are many reasons why men appear to lose more weight more easily than women. Men’s general build is different to women. They need to consume more calories a day simply to maintain their weight than women do. Typically, a man in their 50s will need 2,500 calories a day to maintain weight while women will need about 2,000 calories. Usually to lose weight, people normally try and reduce their calorie intake by 500 calories a week. In the longer study, where the men and women were following the same diet, eating the same portions of food, it was obvious (after the event maybe) that the men would automatically lose weight. Which they did, and the women said that simply wasn’t fair!

There are others who perhaps think life is unfair at the moment. In London and the South East for example, I think that pubs and scotch egg producers who have enjoyed such a huge increase in sales of this ‘substantial meal’ recently, will think the new Covid19 restrictions are just unfair. They are not of course, they are lifesaving. If you like scotch eggs, (as I do), you can always make your own (as I do) and pour yourself a glass of something cold (as I do) and sit in your own home and enjoy both.

Last week also saw Michael Marmot publish his new report about creating a fairer society. It’s a challenging report. If you have not had a chance to read it, you can take a look at it here. I have long admired Marmot for absolutely capturing both the scientific and sociological evidence but at the same time presenting this in a way that reflects today’s health inequalities zeitgeist. Greta Thunberg has done something similar around climate change. The title of this latest report, ‘Build Back Fairer: the COVID-19 Marmot Review’, is a very clever riposte to the now familiar pandemic mantra ‘Build Back Better’.

The ‘Build Back Better’ campaign reflects a more economic view of the world, one that perhaps reflects the innovation and creativity that dealing with the pandemic has engendered. There is no doubt that there have been many clever new ways of thinking and working that have been very positive. I hope these remain as we move through the pandemic and beyond. Not to do so would be unfair on all those who have worked so hard and at pace, to develop solutions to the many unprecedented challenges of Covid19, including the global community who have developed the various vaccines.  

This report reinforces the critical messages in Marmot’s Fair Society, Healthy Lives (The Marmot Review), published in 2010. I think its fair to say that many of the social determinants of health identified in his review have largely been ignored by governments since then (and don’t get me started by Cameron’s big Brexit referendum mistake). The pandemic has absolutely exposed the level of deprivation and health inequalities in the UK which Marmot wrote about back in 2010. And like Greta Thunberg with raising awareness over climate change, it took a football player Marcus Rashford to get the UK government to see that there really was something unacceptable in 2020 in having our children going to bed at night hungry.

Is it just me who thinks there is something wrong that, when as a nation we are presented with a major challenge to the world we know and the health of our nation, the government can suddenly find the money to keep people safe and protect the economy, but yet has been reluctant to invest the same amount of money proactively to reduce health inequalities. Against this context, the recent UK policy of austerity feels unfair. Hopefully, as we move towards a repositioned normal, the government of the day will recognise the science (including social sciences) and commit to ensuring a fairer, more equal society. Everybody’s health and wellbeing is important. That’s what building back fairer really means.

This is my last blog posting before Christmas 2020. For many, Christmas this year will be very different. Some may think that is simply unfair, but whilst I will miss our family celebrations, I intend to stay safe and J and I will celebrate on our own, with our goats, hens, Billy the parrot, Muffin our cat and the ever enthusiastic Dylan the dog, who incidentally has even shorter legs than J. And I hope everyone is able to enjoy a very peaceful Christmas. 

Ps. In the interest of fairness I have agreed to have bone-shortening surgery for my legs in the New Year (but maybe just not this New Year).