Why a Health Program That Works in America Failed in Britain
theatlantic.com
theatlantic.com
One reason the U.K. results were so lackluster might be that the Lancet study compared home-visiting to “usual care,” or the health care new moms would receive anyway. But since the U.K. has universal health care and the U.S. does not, it could be that there was less of a difference between the two British groups than the two American ones.
most of the American studies on NFP were conducted by the program’s own developer
Not ideal?
This is a great example of the use of understatement if there ever was one. I'd say such a conflict of interest would put the credibility of the entire study at risk.
>The study also focused on young moms, using their youth as a proxy for low income, so its subjects might have been less disadvantaged than their American counterparts to begin with.
The article does mention that similar programs did show good results in the Netherlands and Germany (if at a smaller scale than in the US). I don't think the article really answer the question it raises. It seems odd that you would keep smoking or drink just because you have universal healthcare. It that was the case it would indicate that we care more about our finances that our health (which might be true).
It is just hinted at in The Atlantic's article, but the original Lancet article confirms that they wanted to reduce second pregnancies.
Why was that?
There's a bunch of public health stuff where England needs to do better. (Mothers smoking through pregnancy, mothers drinking too much through pregnancy, mother taking drugs through pregnancy, mothers eating too much through pregnancy, children not breast fed, children weaned too soon, children weaned with wrong food, children given added-sugar drinks, children and mothers at risk of violence, children and mothers at risk of accidental harm, etc etc. (It's a long list! And there's plenty more)
This are partially helped by the universal access new mothers have to health visitors, and access to things like Sure Start Centres (I'm not sure if those centres are still available though), but there's still a lot to be done.
Smoking during pregnancy has been on the decline for years, and 2014 was the lowest it's been.
http://www.hscic.gov.uk/article/4788/Prevalence-of-mothers-s...
> Today's report shows the prevalence of women who classed themselves as smokers whilst pregnant fell to 12.0 per cent (75,910 out of 632,960 maternities)3 from 12.7 per cent (83,490 out of 658,110 maternities) in the previous year4, and this continues the steady decline from 2006-07 when this was 15.1 per cent.5
Lowest on record, but still 12% is pretty high. I suspect the reason, as you say, is the taboo. A pregnant woman who smokes faces a lot of judgement, so she's probably going to smoke at home.
It goes on but not so much in public though.
http://www.ons.gov.uk/ons/rel/ghs/opinions-and-lifestyle-sur...
http://www.hscic.gov.uk/catalogue/PUB14184/alc-eng-2014-rep....
(I'm on mobile at the moment so I'm having trouble finding rates for dependant drinkers who don't cut down while pregnant. That first link suggest 2% of pregnant women don't cut down or even drink more, but that doesn't tell me how much they used to drink - someone drinking one glass once a month moving to one glass once a fortnight has doubled their consumption but probably isn't doing any harm)
Sure Start:
But 12 years after the first Sure Start centres opened, one leading academic who was part of the government's official evaluation of the scheme says there is still no clear evidence it has helped children
Asked what evidence there was that Sure Start was helping children, Sir Michael replies: "We don't know - that is still lacking." One major problem, he says, was that ministers ignored calls for a properly controlled evaluation of the programme - in which children would have been randomly assigned to a Sure Start or a non-Sure Start group. He accuses Labour of deliberately ignoring the possibility the programme might not work
Every country can always do better in health care: perfection is not achievable. But most studies I've seen suggest that the UK gets health outcomes that are good, albeit not the best, but it does so for much less money than many systems. When you normalise for costs, the NHS is actually pretty darn good.
I agree with your comments about the NHS, for most stuff it's great and very cheap. (Sad that I need to say that, but there are people who want to dismantle it).
This government is, with one hand, pushing millions deeper into poverty and a significant portion of that into homelessness. With the other, battering the national health service into a for-profit machine in time for when these desperate souls will need it most.
It's just a shame that many in our nation believe these people to be 'scroungers' and 'not worth helping'. It's far more shameful that these same people don't clock how the news outlets feeding them this crap change their tune like a faulty jukebox.
Above sounds challenging. That is not my intent. I've done physics at post-doc level. I've taught for 25+ years. I've been involved in community development in my spare time for 40 years. The fields differ in surprising ways. Empiricism has an oddly limited remit.
Stupid people do stupid things and the more you try to support them, the more they do it.
People need to learn discipline.
You support people to stop smoking / drinking because being a judgemental cunt and yelling "JUST STOP SMOKING" at them doesn't work, and we know it doesn't work.
Your approach literally kills babies.
If you can't make an actual argument, and all you can do is whine, you are just showing that you don't have a rational argument.
> Stupid people do stupid things and the more you try to support them, the more they do it.
You're a hypocrite.
"Stupid" is an observation, a correct observation, and it is not targeted at a HN user, and it is not supposed to motivate an argument by itself.
In contrast, the comment that insults me does not put forth correct observations; rather, it puts forth an "argument" that is motivated by being insulting (i.e., is not even a valid argument).
Please double check before you call someone on HN a hypocrite. Unfortunately it's a very serious allegation and it's not OK to make that allegation casually and be wrong about it. Technically, you owe me an apology, though I'm not holding my breath.
Unfortunately, unless I missed something, you were not personally attacked. Your comment was critiqued, and accurately so. If you do not want people to describe your comments as nasty and judgemental, it helps to make sure they aren't.
So I will suggest that rather than defending your right to making sweeping judgements, you try to up your game. And, for now, walk away from this one and let it go. Sometimes, not digging your grave deeper is as good as it gets.
/wisdom from the school of hard knocks
> You're a hypocrite. (-rogered)
I responded to that comment twice. First, defending myself as not having made hypocritical comments. Then, somewhat "regretting" that, I made a second comment pointing out that I regretted flaming but that I had been attacked and was merely defending myself.
So at the point of making that second comment, where I said I was attacked, I was actually referring to the immediate parent, the one I quote above, not the original comments by DanBC.
At least, I think that's right.
Anyway, I appreciate the advice, and I did indeed walk away (actually, I did it before your comment---I made a comment stating as much).
I comment less and less on HN.
edit: This conversation has been disconnected by the mods from the original thread, otherwise I wouldn't be willing to clutter up the thread with this mess. Also, that I'm still getting downvoted on a thread that is disconnected perhaps supports my slight suspicion that I get auto-downvoted by a bot whenever I post.
---
edit: here is my response to the below comment which I found, only after writing it, I could not post, due to being rate limited.
I'm pretty surprised by your comment here.
I wasn't crabbing at you or trying to argue.
You said I hadn't been attacked, which was mistaken (an entire comment only consistent of "You are a hypocrite,") and I poited out your mistake.
I told you I appreciated your advice.
I pointed out that this kind of meta-conversation is only acceptable to me because it has been disconnected from the main thread, and by that I was trying to demonstrate that I am trying to behave ethically. In other words, I'm trying to say "I don't want to keep flaiming the issue, but I think it's OK to have this out-of-band conversaiton."
So what is your problem?
> "I don't agree but I am not going to argue it" instead of deleting your comment is still arguing it.
I don't agree with this. The comment I was responding to said:
> Your "rational argument" amounted to "people are stupid, fuck 'em."
And that is a malignant distortion of what I said.
I think it's fine for me to state that, while I'm not going to offer a rebuttal, I don't agree that it is accurate.
tl;dr your aggression here is unwarranted. You come in supposedly offering "wisdom" and trying to help and you just become aggressive when I take you up on that and actually try to talk to you. Giving you the benefit of the doubt, I guess the sentiment of what I was saying to you didn't come across.
I have a great deal of sympathy for your frustrations, but the way you are handling this is only going to make things worse.
I don't care to have an argument with you, so this will be my last comment.
Take care.
I wasn't crabbing at you or trying to argue.
You said I hadn't been attacked, which was mistaken (an entire comment only consistent of "You are a hypocrite,") and I poited out your mistake.
I told you I appreciated your advice.
I pointed out that this kind of meta-conversation is only acceptable to me because it has been disconnected from the main thread, and by that I was trying to demonstrate that I am trying to behave ethically. In other words, I'm trying to say "I don't want to keep flaiming the issue, but I think it's OK to have this out-of-band conversaiton."
So what is your problem?
> "I don't agree but I am not going to argue it" instead of deleting your comment is still arguing it.
I don't agree with this. The comment I was responding to said:
> Your "rational argument" amounted to "people are stupid, fuck 'em."
And that is a malignant distortion of what I said.
I think it's fine for me to state that, while I'm not going to offer a rebuttal, I don't agree that it is accurate.
tl;dr your aggression here is unwarranted. You come in supposedly offering "wisdom" and trying to help and you just become aggressive when I take you up on that and actually try to talk to you. Giving you the benefit of the doubt, I guess the sentiment of what I was saying to you didn't come across.
So are you saying that the credibility of 99% of science is at risk?
Note that peer review doesn't get out of this because it really is "peer" review, i.e., an old boys' network.
Hackernews is supposed to be about free thought and open source and in reality, anyone with an opinion against the narrative is silenced.
Im not even close to a troll and i have had many of my comments silenced over the past week.
True science is striving for the truth, even if it makes that same person wrong.
without truth, we will have no progress. I suppose this means that myself and hackernews just dont have a good 'culture fit'. Im more about getting to the truth, expressing free thought, and having intelligent discussions. Not having to walk on egg-shells and fear the down vote and account ban for saying something that goes against the personal beliefs of the mods.
the community rules are also heavily skewed toward one group, because like many other inclusive groups, its an attempt to socially engineer the thoughts and beliefs of the community. Dictatorships and evil people have been using these techniques for centuries.
If i wanted this, i would work for a big corporation again.
Im done. Its only been a week, but im not coming back.
That's exactly my point. You're saying that the many, many studies that support the idea of climate change are meaningless, because science is a lie. But you still want me to trust your studies that say climate change is a myth. If your premise is true, then we can't trust anything, ever, not even the stuff you like.