Category: Health

  • When you feel sick but are embarrassed to say so

    When you feel sick but are embarrassed to say so

    When Annick Bissainthe was diagnosed with irritable bowel syndrome (IBS) in 2018 it destroyed her relationship with food and that affected her relationship with people. 

    She said it restricted social interactions and prevented her from doing activities she used to do before her diagnosis. “Like two days before, I would agree that, yes, I’m going to meet you at a certain point,” Bissainthe said. “But something happens one hour before that [gets me] sick and I can’t go anymore.”

    IBS is a common condition afflicting 5-10% of the world’s population but its symptoms are things few people want to talk about: abdominal pain, cramping, diarrhea, constipation, bloating and excessive gas. 

    Preventing these symptoms often requires adjustments to a diet. It is easy to explain to someone why you can’t eat certain foods if you are allergic to those foods. But many people find it embarrassing to explain that they can’t eat those foods because of an irritable bowel.  

    Dairy, added sugars and spices are among Bissainthe’s top triggers for IBS symptoms, but they comprised a large part of her diet prior to being diagnosed. 

    “Everyone else in your culture eats it,” said Bissainthe. “Food is not just about eating, but there’s also a sociocultural aspect … it’s difficult especially being in an environment where you’re not understood.” 

    Symptoms of IBS go untreated.

    IBS is particularly prevalent among young adults but often undiagnosed. Living with IBS as a young person can be especially difficult. “I was in my late 20s, so I was like, ‘I’m a healthy young adult but not able to eat [certain foods]’,” Bissainthe said. “I felt like my body was letting me down.”

    Dr. Miranda van Tilburg, professor of Health Systems Science at Methodist University in the U.S. state of North Carolina, said that IBS has no known physical cause, so it is often poorly managed, treatment efficacies vary widely and patients’ concerns are frequently dismissed. 

    “There are no tests that we can do, biomedical markers, no radiography, nothing we can do to look at your body and say, ‘You have IBS,’” van Tilburg said.

    Dr. Irma Kuliavienė, a gastroenterologist at the Lithuanian University of Health Sciences, said that while the symptoms are real and have biological underpinnings, unlike a tumor, they can’t be “seen” such through endoscopy or colonoscopy scans.

    Jeffrey Roberts, an IBS patient advocate, said that he often wondered whether he was the cause of his symptoms and if it would restrict what he could do in life. He said the diagnosis of IBS is often dismissed as “just IBS” or brushed off as “all in the head.”  

    In the media, when bowel problems are raised, it is often to produce laughs, he said. 

    No laughing matter

    Treating IBS as a joke can be detrimental to IBS patients’ mental health and quality of care. Van Tilburg said IBS can be the primary source of stress in someone’s life but telling people to reduce stress when they have these symptoms is counterproductive. 

    The reasons why IBS occurs are unclear, although several possible contributing factors have been proposed. They include the interaction between the gut and the brain, known as the gut-brain axis, and the gut microbiome — the ecosystem of microorganisms in your gut.

    Because many potential biological mechanisms could be at play, it is difficult to identify a common therapy that will work for everyone, Kuliavienė said.  

    Dr. Shefaly Shorey, associate professor at the National University of Singapore, said that talking about gastrointestinal symptoms such as flatulence, diarrhea and constipation is considered taboo, especially in many Asian cultures. Shorey was diagnosed with IBS in 2017 and said this avoidance of open conversations about bowel problems can hinder needed care. 

    “These are not glamorous topics to talk about,” Shorey said. Lack of support and acceptance, especially from family members, can lead IBS patients to avoid opening up about their symptoms. 

    Finding the right treatment

    In some countries, dieticians and access to lab tests are not widely available and that can also affect whether someone can get properly diagnosed. Van Tilburg said that a key first step to helping people who have IBS is for doctors and nurses to accept symptoms as genuine. “We need to do a better job of educating physicians on how to talk to these patients,” she said. 

    This is important because IBS is a chronic condition that many patients will deal with for life, and while there are different therapies that can help reduce or eliminate symptoms, there is no one-size-fits-all treatment.

    Extensive trial-and-error is often needed to find what approaches will work best for each individual, a process that requires close collaboration between the patient and practitioner. Bissainthe still lives with IBS but having tried so many different treatment options over the years, is better aware of what management strategies work for her.

    Kuliavienė said that to find the right treatment there needs to be a trusting relationship between doctor and patient.

    “When we talk with our patients, when we hear our patients, we can see which pathway is better and choose specific treatments for specific patients,” she said. 

     

    Questions to consider:

    1. What is irritable bowel syndrome?

    2. Why are people embarrassed to talk about IBS?

    3. What things are you embassed to talk about with a doctor? 

     

    Source link

  • Call an ambulance! But be ready to pay.

    Call an ambulance! But be ready to pay.

    Quick-commerce service Blinkit — best known in India for delivering groceries in 10 minutes — rolled out an ambulance service last winter promising the same speedy service and setting the nation off on a new debate about privatized medicine.

    Five ambulances equipped with lifesaving medical equipment, emergency medicines and a three-person team, including a paramedic, are now operating in Gurgaon, a relatively wealthy city north of Delhi, at 2,000 rupees or about US $23 per trip. That’s affordable for less than a third of the population.

    Touted as India’s first app-based private emergency healthcare service, this has set off a debate about its implications for a sprawling public health system that is notoriously overstretched, with only one ambulance per five million people.

    A few weeks after the service launched, one of its ambulance teams was able to stabilize a trauma patient on the way to the emergency department. This led neurosurgeon Deepak Agarwal at All India Institute of Medical Sciences, a premier medical college and hospital to laud the new service on social media. He called it a “healthcare revolution” that offers care he had only read about happening in developed countries.

    It was a stark contrast, though, with the experience of Roopa Rawat Singhvi, a regional nursing lead in emergency and trauma care, who encountered a road accident victim near the hospital on 3 March.

    “I continued to call 108 and 102 (India’s version of 911) to reach ambulance services,” she said. “However, the calls were not going through.”

    After call finally went through, it took half an hour for the first responders to arrive and they were police, not an ambulance, she said.

    Healthcare for those who can pay

    This contrast — one patient whisked away with ventilatory support and trained staff, another left waiting while vital minutes passed — captures the growing debate around Blinkit’s entry into emergency healthcare.

    This contrast shows the need to explore India’s first app-based private ambulance initiative as more than just a tech innovation story, but as a symptom of a deeper tension between privatization and public neglect.

    As India’s public health infrastructure is eroding, private players are stepping into the vacated spaces under the guise of innovation. The question is: Will this be a temporary fix or a long-term threat to equitable emergency care?

    It wasn’t meant to be this way. In 2007, P.V. Ramesh was the principal health secretary of the Indian state of Andhra Pradesh and worked on the first National Health Mission project to establish emergency ambulance services.

    He said that the public sector ambulance services that evolved into the current nationwide emergency service started as a partnership in Andhra Pradesh between the government and a not-for-profit entity, Byrraju Foundation.

    There was a clear understanding, he said, that it would be operated strictly as a public service without a profit motive.

    “It combined the ambulances equipped with essential emergency care infrastructure, trained human resources and a call center provided by the Byrraju Foundation with the funding, hospital network and effective oversight from the public sector that served all citizens of Andhra Pradesh in case of medical or surgical emergencies,” Ramesh said.

    A dire need for ambulances

    That not-for-profit plan quickly collapsed.

    “Ambulance drivers started taking money from the private hospitals to take patients there and the private sector companies that oversaw the operations also began to cut corners,” Ramesh said. “Even doctors became complicit in the slow rotting of the system. The system deteriorated when the political and bureaucratic masters stopped monitoring the system after awarding the contracts to their favorites.”

    Pre-hospital care is far from ideal in both the public and private sectors in India, says Gayatri, an emergency medicine physician in Mumbai. Gayatri, who asked that her last name not be used, has worked in both public and private hospitals.

    “I used to work in villages in Chhattisgarh and Bihar,” she said. “In some areas, we used to call the government ambulance, but they would often refuse to come, either because it was a conflict-ridden area or because the road was in poor condition. If we put pressure and keep calling, the ambulance would come, but then the driver would ask for 3,000 to 5,000 rupees from the patient to transfer them.”

    Gayatri said that because many of her patients feel scared and disempowered, they agree to pay. “Sometimes we have to fight with the ambulance drivers and tell them not to ask for money,” she said.

    Stalling for time when saving lives

    Gayatri vividly remembers a night when she was transferring a patient in a vehicle and the patient had a cardiac arrest. She called for an ambulance, but it arrived without essential medications or even an oxygen cylinder. They had to borrow an oxygen cylinder from a referral center in a nearby village, losing time.

    “In emergencies, every minute counts,” she said. “And not having access to even an oxygen mask or cylinder in the ambulance was shocking and distressing for me.”

    But even private sector hospitals where she has worked used to send doctors trained in traditional medicine who are not qualified to administer emergency care in place of paramedics to attend home emergencies or to transport patients from emergency sites to the hospital.

    India currently has an almost non-existent emergency response system.

    According to Indian government data, there are a total of 28,250 ambulances across its states and Union Territories such as Jammu and Kashmir. This includes ambulances with advanced medical services and paramedics, vehicles that only transfer patients in non-emergency conditions, even bicycles.

    Meeting international standards

    While international standards recommend one ambulance for every 50,000 population, with one basic life support ambulance or BLS and one advanced cardiac life support ambulance or ACLS per 100,000 population, India has one ACLS ambulance for every five million people — the number in the United States is one per 25,000 population — and one BLS ambulance for every 100,000 people.

    Meanwhile, quality is a more persistent issue than quantity. According to a 2020 study by the All India Institute of Medical Science in Delhi and the National Institution for Transforming India, 90% of ambulances lacked essential medical equipment and 95% were operated by untrained professionals.

    “The corruption and deterioration of the service, coupled with a lack of infrastructure to provide adequate emergency referral systems, has created a vacuum that has invited private players to reframe this as a business opportunity,” Ramesh said.

    That’s why, he said, it makes sense for Blinkit to fill that hole. They recognized that the current system doesn’t meet the demand for reliable ambulance service in case of medical and surgical emergencies and realized they could develop a service to cater to those with the means to pay for it.

    Singhvi believes there are lessons to be learned from Blinkit’s efficiency. “They’ve hired trained paramedics, optimized logistics and used technology effectively,” Singhvi said. “Public systems could adapt these strategies to improve accessibility and response times.”

    Profits and regulations

    Ramesh said that with the current public infrastructure in shambles, he only hopes that the private ambulance companies run this service ethically and that there isn’t a monopoly that will allow them to charge unreasonable rates.

    But Gayatri does not offer them the benefit of the doubt. “Blinkit is a private company and private companies operate on the principle of making a profit,” she said. “It is unreasonable to expect that they will function in a way that keeps the welfare of the people in mind.”

    Gayatri believes that the gap is intentional. It is because of lobbying by the private sector that has made the public sector reluctant to invest in strengthening its health systems. Good regulatory oversight from the government, could prevent private companies from charging too much, but Ramesh is not optimistic it will happen.

    “Even if robust regulations are formulated and a law is enacted, does the government have the capacity to enforce it?” he said. “Regulations have not been successful in the health sector.”

    Instead, Ramesh said that the emergence of private ambulance services should be seen as a wake-up call to the government to strengthen public sector ambulance services.

    Ramesh acknowledges that Blinkit fills a need. But ultimately, while Blinkit’s initiative may cater to a small, affluent population segment, it underscores the urgent need to address the systemic inadequacies plaguing public healthcare.

    “If they provide equitable, high-quality service at a fair price, without bias toward certain hospitals, they could complement existing healthcare services,” he said. “But private models inherently exclude the poor. In a country where universal health care isn’t prioritized, do people have an alternative?”

    Questions to consider:

    1. What are the concerns some people have over private ambulance services?

    2. How can a government ensure that an ambulance service won’t gouge people in need?

    3. Do you know how to call for an ambulance and do you know how long it might take to reach you if you needed one?

     

    Source link

  • How Labour’s 10-year health plan for England joins up with higher education and research

    How Labour’s 10-year health plan for England joins up with higher education and research

    The government wants to reinvent the NHS (in England) through three radical shifts – hospital to community, analogue to digital, and sickness to prevention.

    Whether like the chief executive of the NHS you believe Labour’s 10-year health plan for England is about creating “energy and enthusiasm”, whether like the secretary of state you believe this is about building a NHS which is about “the future and a fairer Britain,” or whether across its 168 pages you find the government’s default to techno-optimism, AI will solve everything, one more dataset will fix public services, approach to governance to be somewhere between naive and unduly optimistic, it is clear that the NHS is expected to change and do so quickly.

    This is a plan that is as much about the reorganisation of the economy as it is about health. It is about how health services can get people into work, it is a guide to economic growth through innovation in life sciences, it is a lament for the skills needed and the skills not yet thought about for the future of the NHS.

    Elsewhere on the site, Jim Dickinson looks at the (lack of) implications for students as group with health needs – here we look at the implications for education, universities, and the wider knowledge economy.

    Workforce modelling

    One of the premises of the plan is that the 2023 Conservative long-term workforce plan was a mistake. The NHS clearly cannot go on as it currently is, and to facilitate this transformation a “very different kind of workforce strategy” is needed:

    Until 2023, [the NHS] had never published a long-term workforce plan. The one it did publish did little more than extrapolate from past trends into the future: concluding there was no alternative than continuation of our current care model, supported by an inexorable growth in headcount, mostly working in acute settings.

    A new workforce place is being put together, to appear “later this year” and taking a “decidedly different approach”:

    Instead of asking ‘how many staff do we need to maintain our current care model over the next 10 years?’, it will ask ‘given our reform plan, what workforce do we need, what should they do, where should they be deployed and what skills should they have?’

    The bottom line is that, therefore, “there will be fewer staff in the NHS in 2035 than projected by the 2023 workforce plan” – but these staff will have better conditions, better training, and “more exciting roles”.

    So one immediate question for universities in England is what this reduced staffing target means for recruitment onto medical, nursing and allied health degrees. Places have been expanding, and under previous plans were set to expand at growing rates in the coming years, including a doubling of medical school places by 2035. There were questions about how optimistic some of the objectives were – the National Audit Office last year criticised NHS England for not having assessed the feasibility of expanding places, in light of issues like attrition rates and the need to invest in clinical placement infrastructure.

    We won’t get a clear answer of what Labour is proposing until the new workforce plan emerges – especially as there is an accompanying aspiration in today’s plan to reduce the NHS’ dependence on international recruitment. But there are some clear directions of travel. Creating more apprenticeships gets a mention – though of course not at level 7 – but the key theme is a tight link between growing medical student numbers and widening participation:

    Expansion of medical school places will be targeted at medical schools with a proven track record of widening participation… The admissions process to medical school will be improved with better information, signposting and support for applicants, and more systematic use of contextual admissions.

    This is accompanied by endorsement of the Sutton Trust’s recent research into access disparities. And in one of those “holding universities to account” measures that everyone is so keen on, part of reinforcing this link will be done via work with the Department for Education to “publish data on the relevant background of university entrants, starting with medicine.” If you are thinking that we already did that – yes we did. The UK-wide HESA widening participation performance indicator was last published in 2022 – each regulator now has their own version (for example this from the Office for Students) which doesn’t quite do the same thing.

    Education and students

    Of course, creating more pathways into working in the NHS is one mechanism to grow its workforce. The other is to unblock current pathways that prevent people from getting into and getting on with their chosen careers in health.

    For example, there is a (somewhat tepid) commitment on student support: the plan commits to “explore options” on improving the financial support on offer to medical students from the lowest socioeconomic backgrounds.

    For nursing students, the offer is slimmer still – a focus on the “financial obstacles to learning”, including faster reimbursement of placement expenses, and tackling the time lag between completing a course and being able to start work. This latter measure will involve working with higher education institutions to revise the current approach to course completion confirmation, and is billed for September 2026. The Royal College of Nursing has suggested that these “modest” changes go nowhere near far enough.

    Nursing and midwifery attrition also comes under scrutiny – the government spots that reducing the rate of non-continuation by a percentage point would result in the equivalent of 300 more nurses and midwives joining the NHS each year. But rather than looking deeper at why this is a growing issue, the buck is handed over to education providers to “urgently address attrition rates.”

    Elsewhere the interventions into education provision are more substantial. There’s an already ongoing review of medical training for NHS staff, due to report imminently. On top of this, the plan sets out how the next three years will see an “overhaul” of education and training curricula, to “future-proof” the workforce. There’s lots of talk about faster changes to course content as and when needed, to reflect changes in how the NHS will operate. This comes with a warning:

    Where existing providers are unable to move at the right pace, we may look to different institutions to ensure that the education market is responsive to employer needs.

    Clinical placement tariffs for undergraduate and postgraduate medicine will be reformed – the plan suggests the tariff system currently “provides limited ability to target funding at training where it is most needed to modernise delivery,” and wants to do more in community settings and make better use of simulation. There will also be expansion of clinical educator capacity, though this will be “targeted” (which is often code for limited).

    And course lengths could fall – the plan promises to “work with higher education institutions and the professional regulators as they review course length in light of technological developments and a transition to lifelong rather than static training.” While this does not explicitly suggest shorter medical and nursing programmes – and a consequent growth in provision aimed at professionals – the preference is pretty obvious.

    On that last point every member of NHS staff will get their own “personalised career coaching and development plan” which will come alongside the development of “advanced practice models” for nurses (and all the other professional roles in the NHS: radiographers, pharmacists, and the like).

    Data and (wider) employment

    The plan stretches much wider than simply making commitments on training though and, as the plan makes clear, if the answer isn’t always going to be more money there has to be more efficiency.

    There’s a fascinating set of commitments linking health and work – one of those things that feel clunky and obvious until you note that “getting the long-term sick back into work” has just been a soundbite with punitive vibes until now.

    Of course, everything has a slightly cringeworthy name – so NHS Accelerators will support local NHS services to have an “impact on people’s work status”, something that may grow into specific and measurable outcomes linking to economic inactivity and unemployment and link in other local government partners. And health support in the traditional sense will link with wider holistic support (as set out in the Pathways to Work green paper) for people with disabilities.

    There’s also a set of commitments on understanding and supporting the mental health needs of young people – although the focus is on schools and colleges, there is an expectation that universities will play a part in a forthcoming National Youth Strategy (due from the Department of Culture, Media, and Sport “this summer”) which will cover support for “mental health, wellbeing, and the ability to develop positive social connections.”

    All these joined up services will need joined up data, so happy news, too, for those looking for wrap-around support in transitions between educational phases – there will be a single unique identifier for young people: the NHS number. And for fans of learner analytics, a similar approach (with a sprinkling of genomics) will “tell [the NHS] the likelihood of a person developing a condition before it occurs, support early detection of disease, and enable personalised prevention and treatment”.

    For some time, universities and other trusted partners have benefited from access to deidentified NHS healthcare administrative data via ADRUK – which has been used for everything from developing new medicine to understanding health policy. This will be joined by a new commercially-focused Health Data Research Service (HDRS) backed by the Wellcome Trust. This is not a new announcement, but the slant here is that it will support the private sector – and as such there will be efforts to “make sure the NHS receives a fair deal for providing access”, which could include a mix of access charges and equity stakes in new developments.

    Research, research, research

    In effect, the government’s proposals set out how improving the conditions, configurations, and coordination of the NHS workforce, and the information provided to them and their partners, can improve healthcare. The next challenge then is targeting the right kinds of information in the right places, and this depends on the quality of research the NHS can access, make use of, and produce.

    The health of the nation does not begin and end at the hospital door. As The King’s Fund points out, “we can’t duck the reality that we are an international outlier with stagnating life expectancy and with millions living many years of life in poor health.” The point of this plan is not only about making health services better but about narrowing health inequalities and using life sciences research to grow the economy.

    The plan talks about making up for a “lost decade” of life sciences research. In doing so, it cites an IPPR report (the author is now DHSC’s lead strategy advisor) which demonstrates that the global research spend on life sciences in the UK has reduced and that this has had an impact on life sciences GVA. Following this line of thought suggests that if the UK had maintained levels of investment the economy would have got bigger, people’s lives would have been better and because of the link between poverty and ill health, the NHS would be under less pressure.

    The issue with this citation is that the figures used are from 2011–16 and some of the remedies, like association to Horizon Europe, are things the UK has done. Though the plan makes clear that “the era of the NHS’ answer always being ‘more money, never reform’ is over,” it is in fact the case that the government has ploughed record levels of public money into R&D without fundamental reform to the research ecosystem. The premise that economic growth can be spurred by research and leads to better health outcomes is correct – but it isn’t necessary to reference research carried out in 2019 to make the case.

    This isn’t merely an annoyance – it speaks to a wider challenge within the plan which oscillates widely between the optimism that “all hospitals will be fully AI-enabled” within the next ten years (80 per cent of hospitals were still using pagers in 2023 despite their ban in 2019), and the obviously sensible commitment to establish Health Innovation Zones which will bring health partners within a devolved framework to experiment in service innovation.

    The fundamental challenge facing innovation within health is the diffusion of priorities. There are both a lot of things the NHS and life science researchers might focus their time on, and a lot of layers of bureaucracies that inhibit research. The plan attempts to organise research priorities around five “big bets” (read missions but not quite missions). These include the use of health data, the use of AI (again), personalised health, wearables, and the use of robots. One of the mechanisms for aligning resources will be:

    a new bidding process for new Global Institutes. Supported by NIHR funding, these institutes will be expected to marshal the assets of a place – industry, universities, the NHS – to drive genuine global leadership on research and translation.

    It’s very industrial strategy – the government is setting out big ideas with some incentives, and hoping the public and private sector follows.

    There are some more structural changes to research aside from the political rhetoric. Significantly, there is a proposal to change the funding approaches of the Medical Research Council and National Institute for Health and Care Research to pivot funding toward “prevention, detection and treatment of longterm conditions”. The hope is this approach will drive private investment. Again, like the industrial strategy, the rationale is that the state can be an enabling force for growing the economy.

    Ten years’ time

    The ten year plan, if it is to mean anything, has to be focused on delivering a different kind of health service. The fundamental shift is about moving toward personalised community orientated care. The concern is that the plan is light on delivery, which would tally with reports that a ninth chapter on delivery is missing all together.

    The NHS is stuck in a forever cycle of reform, failing to reform, entering crises, and then being bailed out from crises. The mechanisms to break the cycle includes changes to the workforce, new skills provision, using data differently, and reorientating life sciences research toward prevention and economic growth.

    The higher education sector, research institutes, and companies working in research are not only central to the new vision of a NHS but with the amount of investment placed on their capacity to bring change they are no less than the midwives of it. The government’s biggest bet is that it can grow the economy, improve people’s lives, and in doing so reduce pressure on public services. Its biggest risk is that it believes it can do this without fundamental reform to higher education or research as well.

    Source link

  • Defunding level 7 apprenticeships in health and care may backfire on lower levels

    Defunding level 7 apprenticeships in health and care may backfire on lower levels

    Well, it finally happened. Level 7 apprenticeship funding will disappear for all but a very limited number of younger people from January 2026.

    The shift in focus from level 7 to funding more training for those aged 21 and under seems laudable – and of course we all want opportunities for young people – but will it solve or create more problems for the health and social care workforce?

    The introduction of foundation apprenticeships, aimed at bringing 16- to 21-year-olds into the workforce, includes health and social care. Offering employer incentives should be a good thing, right?

    Care is not merely a job

    Of course we need to widen opportunities for careers in health and social care, one of the guaranteed growth industries for the foreseeable future regardless of the current funding challenges. But the association of foundation apprenticeships with those not in education, employment or training (NEETs) gives the wrong impression of the importance of high-quality care for the most vulnerable sectors of our society.

    Delivering personal care, being an effective advocate, or dealing with challenging behaviours in high pressured environments requires a level of skill, professionalism and confidence that should not be incentivised as simply a route out of unemployment.

    Employers and education providers invest significant time and energy in crafting a workforce that can deliver values-based care, regardless of the care setting. Care is not merely a job: it’s a vocation that needs to be held in high esteem, otherwise we risk demeaning those that need our care and protection.

    There are already a successful suite of apprenticeships leading to careers in health and social care, which the NHS in particular makes good use of. Social care providers (generally smaller employers) report challenges in funding or managing apprenticeships, but there are excellent examples of where this is working well.

    So, do we need something at foundation level? How does that align with T level or level 2 apprenticeship experiences? If these pathways already exist and numbers are disappointing, why bring another product onto the market? And are we sending the correct message to the wider public about the value of careers in health and social care?

    Career moves

    The removal of funding for level 7 apprenticeships serves as a threat to the existing career development framework – and it may yet backfire on foundation or level 2 apprenticeships. The opportunity to develop practitioners into enhanced or advanced roles in the NHS is not only critical to the delivery of health services in the future, but it also offers a career development and skills escalator mechanism.

    By removing this natural progression, the NHS will see role stagnation – which threatens workforce retention. We know that the opportunity to develop new skills or move into advanced roles is a significant motivator for employees.

    If senior practitioners are not able to move up, out or across into new roles, how will those entering at lower levels advance? Where are the career prospects that the NHS has spent years developing and honing? Although we are still awaiting the outcome of the consultation around the 10-year plan – due for publication this week with revisions to the long-term workforce plan to follow – I feel confident in predicting that we will need new roles or skill sets to successfully deliver care.

    So, if no development is happening through level 7 apprenticeships, where is the money going to come from? The NHS has been suggesting that there will be alternative funding streams for some level 7 qualifications, but this is unlikely to offer employers the flexibility or choice they had through the levy.

    Could level 6 be next?

    Degree apprenticeships at level 6 have also come in for some criticism about the demographics of those securing apprenticeship opportunities and how this has impacted opportunities for younger learners – an extrapolation of the arguments that were made against level 7 courses.

    Recent changes to the apprenticeship funding rules, requirements of off the job training and the anticipated changes to end-point assessment could lead to pre-registration apprenticeships in nursing and allied health being deemed no longer in line with the policy intent because of the regulatory requirements associated with them.

    The workforce plan of 2023 outlined the need for significant growth of the health and social care workforce, an ambition that probably is still true although how and when this will happen may change. Research conducted by the University of Derby and University Alliance demonstrated some of the significant successes associated with apprenticeship schemes in the NHS, but also highlighted some of the challenges. Even with changes to apprenticeship policy, these challenges will not disappear.

    Our research also highlighted challenges associated with the bureaucracy of apprenticeships, the need for stronger relationships between employers and providers, flexibility in how the levy is used to build capacity and how awareness of the apprenticeship “brand” needs to be promoted.

    A core feature of workforce development

    The security of our future health and social care workforce lies in careers being built from the ground up, regardless of whether career development is funded by individuals themselves or via apprenticeships. However, the transformative nature of apprenticeships, the associated social mobility, the organisational benefits and the drive to deliver high quality care in multiple settings means that we should not be quick to walk further away from the apprenticeship model.

    Offering apprenticeships at higher (and all) academic levels is critical to delivering high quality care and encouraging people to remain engaged in the sector.

    So, as Skills England start to roll out change, it is crucial that both the NHS and higher education remain close to policymakers, supporting and challenging decisions being made. While there are challenges, these can be overcome or worked through. The solutions arrived at may not always be easy, but they have to be evidence-based and fully focused on the need to deliver a health and social care workforce of which the UK can be proud.

    Source link

  • Latest from Belong – students’ health is not OK, and that’s not OK

    Latest from Belong – students’ health is not OK, and that’s not OK

    It’s hard to learn if you’re ill – good health is one of the classic prerequisites to learning.

    But one of the most frustrating things about the debate around student health in the UK is that there isn’t one.

    Anecdotally, poor access to preventative healthcare and health services tends to be justified either by NHS pressure from an ageing population or by expectations that universities should do more with less.

    Both arguments have merit, but they leave the crucial link between health and academic success stuck in that Spiderman meme, while the public and the press blames students for “boozing it up” or “inventing ADHD.”

    Mental health is well, almost over-researched – but health concerns for students go far beyond the usual talking points. Gonorrhoea diagnoses are at record levels, with the UK Health Security Agency identifying students as a key factor, drugs are the subject of many a survey, disordered eating among students is largely ignored, and sleep deprivation seems to be an issue. Some surveys say dental issues are increasingly common – as one expert notes, “dental health is mental health.”

    The question is whether any of these issues are unique to students – and to the extent to which they are, what sorts of policy interventions might address them.

    In the latest wave of Belong, our polling partnership with Cibyl (which our subscriber SUs can take part in for free), we examined everything from general health perceptions and healthcare access to specific areas like sleep quality, alcohol consumption, sexual health confidence, and experiences with the NHS.

    The results come from our early 2025 wave, with responses from 1,055 students across 88 providers. The data has been weighted for gender and qualification type (undergraduate, postgraduate taught, and postgraduate research) to ensure representativeness. There’s also analysis of various free-text questions to illustrate what’s going underneath the headline results.

    Yeah, I’m OK

    First of all, we asked students a standard question used in national surveys asking them to rate their own health. Only 20 per cent of students rate their health as “very good” compared to 48 per cent of the general population.

    Combined figures show that while 61 per cent of students report “good” or “very good” health (compared to 82 per cent in the general population), a full 32 per cent describe their health as merely “fair” – nearly two and a half times the rate in the general population.

    Qualitative comments illuminate what lies beneath. Many students clearly differentiate between their physical and mental wellbeing:

    My physical health is generally good, whereas I have faced some struggles in mental health (which can also at times impact my physical health).

    Physical is usually good but sometimes a little bit hungry after trying to save some food for other days. Mentally I am ok but I don’t fill very fulfilled.

    My physical health is immaculate however my mental health is the worst it’s ever been.

    Several respondents directly connected their health status to the pressures of university life:

    Could be better, I’m finding learning incredibly stressful as part of a full-time job.

    Almost died from an overdose of caffeine trying to work on a essay and had two breakdowns.

    Feel very tired due to uni, aware my health could be better, but do not have the time.

    For others, university has provided structure and support:

    Being at uni has helped me focus more on my self care and mental health to improve

    My health is generally good because I prioritise self-care, balance my studies, part-time work, and rest, and use available support when needed.

    Many respondents described their health as variable and requiring ongoing management:

    I am physically keeping fit, mental health I am working on, some days are better than others.

    My everyday health is a constant battle that I have to take a multitude of medications. I have good days and bad days and am lucky if I get a decent amount of sleep.

    Everyone gets their bad days and good.

    A significant number of students also reported living with chronic physical health conditions or disabilities:

    I’m disabled. I always feel bad.

    I am a full time wheelchair user with ME and fibromyalgia, so I am in a lot of pain and fatigue.

    I had a diagnosis of a rare cancer called Leiomyosarcoma in 2023. The cancer has gone but it’s left me with a whole range of health problems.

    Overall, the narrative accounts reveal complexity – where mental and physical wellbeing are often experienced differently, academic pressures can both harm and support health, daily fluctuations in health status are common, and chronic conditions create persistent challenges that require constant navigation of university life.

    Correlations or causations?

    We wanted to know if there are relationships between health and key elements of student experience. The data shows strong correlations between student health perceptions and their sense of belonging – among students reporting “very good” or “good” health, 85 per cent feel part of a community, compared to just 68 per cent among those reporting “bad” or “very bad” health:

    This pattern extends to whether students feel free to speak – 93 per cent of those with better health feel free to express themselves, compared to only 77 per cent of those reporting poorer health conditions:

    On teaching quality, 91 per cent of students with “very good” or “good” health report positive teaching quality, while 84 per cent of students with “fair,” “bad,” or “very bad” health still rate teaching quality positively:

    Correlation is not causation – though it’s technically possible that poor teaching or poor belonging is making students ill, to the extent that the free text offers clues, it suggests that the causation is the other way around – poor health appears to be robbing students of the ability to take advantage of the academic and social opportunities on offer.

    Are you registered?

    The good news in our polling is that most students (93 per cent) are registered with a GP. The problem is that only 65 per cent are registered near their place of study. A quarter (25 per cent) remain registered elsewhere in the UK, while five per cent maintain registration in another country:

    The qualitative comments reveal several distinct reasons for not registering locally. Many students commute to university and maintain their home GP registration:

    Because I don’t live at uni. I commute. So it would make sense to have my GP in my home town

    As I do not live on campus, it is easier for me to stay registered with my GP, who is closer to home.

    Even students who do live at university often cite proximity to home as a reason not to change registration:

    It’s only an hour to my home town so easier just to stick with them.

    Don’t feel I live far enough away from home to register with another GP.

    Continuity of care emerges as another significant concern:

    If I sign up for a local GP here, I would be de-registered from my home GP. Since I prefer to stay with my home GP for continuity of care and I only need healthcare support when I’m at home, I haven’t registered with a GP at uni.

    Because I am waiting for talking therapies which I can only get if I am registered with a GP in Somerset so registering in Plymouth will take me off of the waiting list.

    I have been on a waiting list for migraine treatments in my home town and don’t want to start again and wait even longer.

    Home GP knows about my disabilities and there back history.

    And some students express concerns about quality of care:

    They are useless.

    I’ve heard some horror stories about the GP here, and when my friend was too sick to eat or sleep, they wouldn’t even talk to her.

    Dental registration shows a more concerning pattern, with a third of students (33 per cent) reporting they are not registered with a dentist at all. Only 17 per cent are registered near their place of study, while 31 per cent maintain registration elsewhere in the UK and 12 per cent in another country:

    Despite the low registration rate, 56 per cent report having had a dental check-up in the past 12 months – almost identical to rates found in the general population, although that’s hardly a corks-popping moment for the country.

    Students cite NHS availability and cost as major barriers:

    There is no NHS dentist available in the county!

    There are no dentist mine is private.

    NHS is underfunded so it’s impossible to access these services. Private dentists are unaffordable.

    It is literally cheaper for me to travel to my country for a dentist appointment where there is healthcare than doing it here.

    Many students also note that dental appointments can be scheduled during visits home:

    Dental care is something that is tended to like every 6 months or so. So it makes sense to just keep the appointments whenever I am back home.

    Only visit once every 6 months so can plan to go home when the appointment is approaching.

    As with GP services, commuting students typically maintain their home dentist:

    I commute rather than live on campus, so it was more convenient to stay with my dentist closer to where I live.

    Loyalty to existing dentists also emerged as a significant factor:

    I’m with an NHS dentist at home and I don’t want to lose my NHS dentist by moving to a different one as it’s difficult to find NHS dentists.

    I go home enough to see my home dentist who has known me for 20 years.

    Can’t get no

    In early April, the long-running British Social Attitudes survey told us that public satisfaction with the NHS had hit a new low – just 21 per cent said they were satisfied with the NHS in 2024, with waiting times and staff shortages the biggest concerns.

    So we wanted to know what students think. In our polling nearly half (49 per cent) reported being either “very dissatisfied” (12 per cent) or “quite dissatisfied” (37 per cent) with the NHS. In contrast, only 31 per cent expressed satisfaction, with a mere three per cent indicating they are “very satisfied”:

    Many respondents expressed frustration with the difficulty of getting appointments and lengthy waiting times:

    12 hours wait time at A&E is scandalous, people die waiting for ambulances, good luck getting an appointment.

    It takes too long to get anything sorted.

    I have waited long periods to have health checks and it has taken months to get in to see anyone.

    Can’t seem to get a same day appointment.

    A significant number attributed NHS problems to systemic underfunding:

    It is underfunded, there is too much stress on all the services so they can’t take care of patients properly.

    It’s massively underfunded and unsupported by the government. The Tories ripped it to shreds.

    As an international student I pay £776 for this shit shower, joke of a country really is.

    It isn’t the fault of the nurses, doctors hospital staff etc. It’s that the NHS is criminally underfunded.

    Many highlighted specific concerns about mental health services:

    You have to be attempting to kill yourself for the NHS to help you with mental health problems.

    I’m diagnosed with anxiety and it’s been the worst mistake of my life I wish I just kept it between me and my therapist they don’t listen to a word I say.

    The NHS cannot take the strain of the sheer number of mentally ill young people.

    Mental health services and waiting times just to have initial appointments are terrible.

    Respondents also expressed frustration with a lack of communication between different parts of the system:

    Nobody talks to each other and waiting lists are long.

    Lack of communication between hospitals, staff members within the same hospital.

    Less continuity of staff – like you’re on a conveyor belt passed along looking at the surface issue – not the deeper.

    Long waiting times and lack of communication between various departments. Over complicated administration processes.

    And some had specific concerns about the quality of care they received:

    When I went to an emergency dentist in the UK, they left something in my tooth that rotted and I had to have the tooth removed.

    I’ve been to 4 different hospitals about my knee which keeps dislocating and popping. They don’t care to be honest.

    A male consultant kept refusing to answer my questions before a medical procedure and complained when I refused to let him touch me.

    I feel like I treat myself rather than being treated.

    Drugs, alcohol and food

    Plenty of press stories surround the idea that Gen Z is more likely to be clean living and teetotal than previous generations. Our polling suggests that 26 per cent of students never consume alcohol – a slightly higher abstention rate than the general adult population, where according to the latest NHS data 19 per cent report not drinking in the past year.

    For those who do drink, consumption patterns are distributed across different frequencies:

    This pattern suggests lower regular drinking among students compared to the general adult population, where 48 per cent report drinking at least once a week. When students do drink, most report moderate consumption (the below graph only includes those who indicated they drink):

    It’s worth noting that 7 per cent of respondents chose not to answer the question about quantity consumed, which may indicate some hesitancy to report higher levels of consumption.

    We also asked about drugs – specifically asking students about illegal drugs or prescription drug misuse within the past month. The results show that a small minority of students (seven per cent) reported using illegal drugs or misusing prescription medications in the past month, a rate much lower than is often perceived.

    Back in 2023 we also carried out polling on disordered eating amongst students, having spotted some pilot polling that the ONS did on the issue the previous year. Little has changed.

    In the ONS work, our 2023 poll and this wave, we used the SCOFF questionnaire – a validated screening tool for detecting potential eating disorders – to assess students’ relationships with food and body image. The results show concerning patterns:

    • Nine per cent reported making themselves sick because they felt uncomfortably full
    • 26 per cent worried they had lost control over how much they eat
    • Eight per cent reported significant weight loss in a three-month period
    • 19 per cent believed themselves to be fat when others said they were thin
    • 19 per cent reported that food dominates their life

    When these responses are analysed according to SCOFF scoring criteria:

    • 49 per cent showed no sign of possible issues (compared to 50 per cent in the ONS national sample)
    • 25 per cent demonstrated possible issues with food or body image (compared to 23 per cent in ONS)
    • 24 per cent showed possible eating disorder patterns (compared to 27 per cent in ONS)

    The findings suggest that the UK student population closely mirrors national trends in disordered eating and problematic relationships with food and body image. The particularly high percentage of students who worry about losing control over eating (26 per cent) and who perceive themselves as fat when others say they’re thin (19 per cent) – and the relationship we found between those issues and mental health in 2023 – suggest significant work to yet be done, that could have very positive impacts.

    No snooze, you lose

    Sleep and rest is a huge part of health. Our results show a mixed picture over quality and quantity. While 47 per cent of students report “very good” (10 per cent) or “fairly good” (37 per cent) sleep quality, nearly a quarter (24 per cent) describe their sleep as “fairly poor” (15 per cent) or “very poor” (nine per cent). More than a quarter (28 per cent) fall into the middle category of “neither good nor poor.”

    When it comes to sleep duration, half of students (50 per cent) report getting six to seven hours of sleep per night on average, with an additional 26 per cent getting eight to nine hours. However, a concerning 21 per cent are sleeping fewer than six hours per night, with 20 per cent getting just four to five hours and one per cent less than four hours.

    The findings show a potential improvement compared to the polling we carried out a year ago, which found students were getting just 5.4 hours of sleep per night on average. Our current data suggests a higher proportion of students are now achieving six-plus hours of sleep – but it’s still not nearly enough.

    The 2024 exercise saw strong relationships between sleep duration and both life satisfaction and anxiety levels. Students getting 8-8.9 hours of sleep reported significantly higher life satisfaction scores (6.9 versus the average of 6.3) and lower anxiety scores (4.7 versus the average of 5.0) compared to those sleeping less.

    Students in that survey clearly recognised the importance of sleep:

    I need more sleep!

    Could probably do with more sleep, just trying to get 8 hours a week would be nice.

    But the qualitative data highlighted several factors affecting student sleep patterns:

    • Academic pressures: “Currently, the workload is too big.”
    • Employment demands: “Being in my overdraft monthly, long hours at work cuts into my sleep time.”
    • Irregular timetables: “What would help? A more consistent timetable.”

    Housing a problem

    Governments love their public policy silos – but one of the things SUs wanted us to look at was the relationship between housing and health. In this data, nearly half of respondents (49 per cent) reported that housing does affect their health – with 27 per cent noting a positive impact and 22 per cent experiencing negative effects:

    Many students reported health concerns related to poor physical conditions in their accommodation:

    Student houses have mold and have usually been untouched from when they were bought 12 years prior. My house has plenty of mold which no doubt hasn’t helped things when I have been unwell.

    I live in a very mouldy flat that I have to spray at least once a fortnight to tackle the mould. It is damp and mouldy, but the landlord just tells me to open a window.

    My window doesn’t open and was reported to reception before I even arrived in September I have gone back to report it to them multiple times and they still haven’t done anything about it. I also do not have an extractor fan which works in my bathroom this means I have no airflow in my room.

    Housing affordability emerged as a significant stressor affecting mental health:

    Every year when my rent is rised it impacts my mental and physical health hugely as it causes me a lot of stress and forces me to cut things that make me feel better.

    It’s Cornwall so the housing situation is abysmal… Landlords and estate agents take advantage of this to a disgusting degree and overcharge students to the point of spending all or the vast majority of your student loan just on rent.

    After rent I have no money. Landlords know how much student loans we get and scalp accordingly.

    The social environment created by housemates significantly influences mental wellbeing, with both positive and negative experiences reported:

    My flatmates are incredibly unclean and disrespectful.

    My housemates are rude and disrespect and leave a mess everywhere and they smoke weed despite me asking them to stop loads. It makes me not want to be at home.

    Although on the positive side:

    My housemates are lovely people to talk to and I get along with them really well.

    I love my housemates, we cook and eat dinner together every day and it’s nice to just hang out.

    Insecurity about housing arrangements creates significant stress:

    I rent privately, so the expensive rent combined with low-quality housing and anxiety around the permanence of my home significantly affect my anxiety.

    I recently had my housing group fall apart and will need to give my ESA up to a friend of my partner in Essex due to inability to find student housing that will allow me to keep her.

    Landlord left us with no heating or hot water for 2 months.

    And some students reported significant benefits from supportive housing environments:

    It has been beneficial moving out of a toxic home environment. I have become very close with a few of my flatmates here.

    I recently got my own place after being in a house where I was abused. It’s more difficult financially but at least I don’t have someone else hurting me on purpose.

    I have found moving to a house away from campus with people I am close with has had a positive effect due to the home/uni balance I now have.

    It’s another classic silo issue. The failure of any of the four governments to cobble up a student housing policy is a housing issue – but it’s also an educational issue and a health issue. And because it’s a student issue, it ends up being an issue that is not handled or planned as an issue by anyone. And so it just gets worse every year.

    Not so free periods

    We were also asked to look at menstruation and sexual health. On the former, the results suggest that most respondents find menstrual products reasonably accessible – save for an important minority:

    When asked whether menstruation impacts their daily life, respondents were fairly evenly split:

    The relatively even division suggests that menstruation-related challenges continue to affect a significant proportion of the student population, potentially influencing their academic performance, social engagement, and overall university experience.

    Then on sexual confidence and health, the results show generally high levels of self-reported confidence:

    The standout is that approximately 18 per cent lack confidence in accessing NHS sexual health services – the highest area of uncertainty among those surveyed.

    The findings present an interesting contrast to a 2021 HEPI survey on sex and sexual health among students. That research found significant variations in consent understanding and confidence levels, particularly when examining school background and gender.

    In that work, privately educated males were a key issue:

    • Only 37 per cent felt “very confident” in understanding what constitutes sexual consent (compared to 59 per cent of students overall)
    • Only 34 per cent were “very confident” in how to communicate sexual consent clearly (versus 47 per cent overall)
    • Only 41 per cent were “very confident” in how not to pressure others for sex (versus 61 per cent overall)

    Our polling in this wave doesn’t have a large enough sample to offer similar demographic breakdowns, but the overall high confidence levels suggest either an improvement in students’ understanding since 2021 or – importantly – potential overconfidence in self-assessment.

    For better or worse

    Finally, we wanted to know whether students’ health had changed since coming to university. While 39 per cent reported their health has improved (with three per cent saying “much better” and 36 per cent “better”), 27 per cent indicated their health had worsened (23 per cent “worse” and four per cent “much worse”) – and a significant proportion (34 per cent) chose not to respond to this question.

    Many students reported deteriorating mental health since beginning their studies:

    Mental health has declined and physical health/pain got worse as well.

    Academic pressure has made me feel depressed.

    My mental health is no better and I have panic attacks at least two times a week.

    Anxiety levels are higher, I feel socially overwhelmed after a day at uni.

    Financial pressures emerge as a significant factor negatively impacting both physical and mental wellbeing:

    I can’t afford a lot of things. I struggle to buy food period products, and other healthcare. I’m inclined to work when I’m sick because I need to cover tuition and rent.

    I can’t afford basic nutrition.

    Many students reported having less time or opportunity for physical activity:

    Too tired to workout/run most days.

    I feel I have less time to exercise. I spend more time on a computer which affects my hands and back.

    I was much more physically active before starting university.

    Changes in eating habits were commonly mentioned as negatively affecting health:

    My diet is a lot worse, and I tend to be generally less healthy.

    I put on a lot of weight due to staying in my room all day and not having enough money to afford a good diet.

    As I am now living alone, so my eating issues have become worse as I am the one to control what I eat – so I will eat nothing for a month, and then gain all the weight back by giving up and binging.

    It’s not all bad news. For those in the “improved” camp, increased physical activity (“I’ve been going to the gym since first year and have really enjoyed doing so”), better nutrition habits (“I have more control and time over my diet”), improved mental wellbeing (“Well at collage I was suicidal but at uni I don’t really have that inkling anymore”), greater autonomy over health choices (“Being more independent and in control of my life has done wonders for my physical and mental health”), and beneficial routines (“The routine has enabled me to keep in touch with my health a lot better”) were all key themes.

    The positive experiences suggest that for a significant proportion of students, university can provide both the freedom and structure to develop healthier lifestyles and improved wellbeing.

    If it was up to me

    When, at the end of the survey, we asked students what they would change about health services if it was up to them, they offered a wealth of practical suggestions.

    Mental health services emerged as a top priority, with clear calls for “more therapy sessions,” “expanded mental health services,” and “shorter waiting times or support whilst on waiting lists.” Many emphasised the need for greater coordination: “Less pressure to do so well academically. Student union need to put more pressure on the uni to allocate funds towards mental health services.”

    Financial barriers to health featured prominently in student concerns. Suggestions included “lowering the cost of the university gym,” “free prescriptions till you finish uni,” and broader recommendations to “improve student finance so that students can afford to eat healthily.”

    Improving access to NHS services was another key theme, with students recommending “a GP on campus perhaps or someone you can talk to before having to go to the GP” and “easier GP registration, shorter wait times for appointments.” Some highlighted specific needs for marginalised groups: “Fast tracking marginalised students who are already forced through forms and waiting list just to access their healthcare.”

    Sexual and reproductive health resources were frequently mentioned, with calls for “free condoms across campus,” “free period products,” and “more information about sexual health/like events centred around that, including sexual health for trans people and using inclusive language.”

    Many also stressed the need for better information and outreach, suggesting “having a known place to access in a casual manner,” “health advice given in more accessible areas,” and “making clear where and how to access it with a focus on helping international students navigate a new system.”

    And several comments addressed broader cultural and systemic issues: “Stop encouraging mid-week drinking, university alcoholism culture is insane”, “More conversations about loneliness, it’s weirdly normalised at uni” and “Address systemic bias in medicine, especially impacting women.”

    An agenda for change

    There are bits of good news – but the big picture that emerges from our findings is stark and troubling. 20 per cent of students reporting “very good” health compared to 48 per cent in the general population is a disparity that would prompt immediate intervention in any other population group. But that problematic place in the policy Venn that students are in – both largely young and belonging to DfE, not DHSC – leaves them ignored. This student offers a damning indictment of a system where basic physiological needs compete with academic demands:

    I literally went to university at the wrong time with how much it currently costs. It’s impossible to concentrate on my studies without the constant fear of how am I going to eat tonight.

    Another speaks of “black mould and damp” while their landlord’s sage advice is to “open a window.” Is this really the backdrop against which we expect student success to happen?

    The data reveals a healthcare system fundamentally misaligned with student life realities. Only 65 per cent are registered with a GP where they study, just 17 per cent with a local dentist. And why should they bother? With 49 per cent expressing dissatisfaction with NHS services – “12 hours wait time at A&E is scandalous, people die waiting for ambulances, good luck getting an appointment” – the friction in accessing care hardly seems worth the effort. That we ask international students to pay for it is even more scandalous.

    The answers lie partly in our addiction to departmental silos and short-term thinking. No Westminster department champions students as a distinct population with specific health needs deserving of targeted interventions. Universities focus on student retention while the NHS prioritises acute care – and students fall through the gap between.

    The South African model of mandatory health modules covering mental, physical and sexual wellbeing offers an interesting approach – yet here we continue treating student health as an afterthought rather than a core educational function, something else that used to be developed in the gap between lectures that’s now filled with the demands of long commutes and punishing part-time work.

    What might a solution look like? Perhaps it starts with recognising that today’s “horizontal generation” won’t respond to top-down health messaging. Their peer networks and digital platforms represent not just challenges but opportunities for intervention. Digital solutions that personalise support, peer-to-peer health models, and practical education around cooking and nutrition align with how today’s students actually engage with information. But there’s another critical factor – our lack of comprehensive national data on student health.

    The current patchwork of institution-specific surveys and occasional national sampling is simply inadequate. How can we design effective interventions without a robust, longitudinal understanding of student health patterns? A dedicated national student health and wellbeing survey – tracking mental health, food insecurity, nutrition, sleep patterns, and their impact on academic outcomes – isn’t a luxury, it’s a fundamental prerequisite for evidence-based policy. Surely the NSS could take a year off every few years?

    Then when it comes to delivery, the answer won’t be found in Whitehall but in our regions and cities. Manchester’s integrated approach to student mental health – where university health services, local NHS trusts, and city council public health teams collaborate on shared priorities – demonstrates what’s possible when student health is approached as a citywide asset rather than an institutional burden. It should both be broadened beyond mental health, and replicated.

    And whatever is done really needs to be underpinned by rights – encompassing dual GP registration, affordable healthcare, timely disability diagnosis, health-supporting university policies, and integrated NHS partnerships.

    The alternative is to continue watching talented students struggle unnecessarily, their potential diminished by preventable health challenges. A student eating so poorly they “can’t afford basic nutrition” or sleeping in accommodation where “mould grew on my campus room’s walls before I even came in” isn’t just experiencing personal discomfort, they’re living the consequences of policy failure – and paying for it, in more ways than one.

    You can download the full deck of our findings from this Belong tranche on student health here.

    Source link

  • $100m Coalition election promise to fund 200 regional medical students matches Labor – Campus Review

    $100m Coalition election promise to fund 200 regional medical students matches Labor – Campus Review

    Regional and rural Australia’s doctor shortage is being targeted as an election issue by the Coalition, which is promising to fund an extra 200 students to train as general practitioners to work in the bush.

    Please login below to view content or subscribe now.

    Membership Login

    Source link

  • Why some viruses are so difficult to stamp out

    Why some viruses are so difficult to stamp out

    The United States is fighting an unexpectedly big measles outbreak, with hundreds of cases in the state of Texas alone. Health experts expect it will last for a year or longer, because the virus has a long incubation period — people can be infected for days before they begin to show symptoms. That, in turn, means it can spread silently.

    Another virus that’s spreading silently right now is polio. Tests of wastewater around the world have turned up alarming levels of the virus, notorious for paralyzing children, in Afghanistan and Pakistan, according to the World Health Organization (WHO), but also in Europe, in Spain, Poland, Germany, the United Kingdom and Finland.

    These two viruses should not still be around. They only infect human beings, and mass vaccination campaigns have been ongoing for decades to try to wipe them out. And the medical profession keeps coming so close to success. 

    And where do these viruses come from that keep returning despite our attempts to wipe them out? The answer is from us — from other people.

    Smallpox is the only human disease to have been completely eradicated. That was done with a dedicated global vaccination effort in 1972. Because the smallpox virus doesn’t infect any other animal, there wasn’t another place for it to survive and come back to reinfect people. 

    The same should be true for measles and polio, but war, disruption, poverty and a mistrust of vaccines make it difficult.

    Where viruses hide

    So even as vaccine campaigns come close to succeeding, the viruses can still hide out in unvaccinated and undervaccinated people. Travel and human contact do the rest to keep both measles and polio circulating. When an infected traveler hits a community of unvaccinated people — say a neighborhood of ultra-Orthodox Jews in London or a rural West Texas county full of vaccine skeptics — a contagious virus such as measles or polio can take off. 

    With both measles and polio, it takes immunization rates of more than 90% to protect a population. When rates drop below that, a community becomes vulnerable to outbreaks. A virus can take hold and spread among people, picking up steam.

    That’s happened in Pakistan and Afghanistan with polio, where efforts to reach remote populations fall short because of geography, conflict and mistrust. And in Gaza, where continuous Israeli attacks have destroyed virtually all healthcare facilities, United Nations agencies have struggled to vaccinate Palestinian children against polio outbreaks. 

    Polio is also complicated because of the different vaccine types. One of the vaccines is given orally, and it’s made using a live, but weakened, form of the virus. This gives good immunity but in rare cases the virus can mutate in someone’s body and return to infectious strength — becoming what’s called vaccine-derived virus. 

    A follow-up vaccination with a second type of vaccine made using a fully killed virus will protect against this, but when vaccine campaigns can’t be completed, vaccine-derived viruses can emerge.

    How viruses spread

    In Europe, no cases of polio have been seen, but wastewater evidence suggests the virus is surviving in people’s bodies, and could burst out to cause sickness if it gets to someone unvaccinated. Polio spreads via the fecal-oral route — in contaminated water, via poorly washed hands, on surfaces and also via sneezes and coughs.

    Fully vaccinated communities are safe but in 2022, an unvaccinated man in New York State became paralyzed after he caught polio. Investigation showed a vaccine-derived strain had been spreading quietly in the state.

    Measles is the most infectious disease known and that makes it particularly hard to eradicate. In a podcast interview I did for for One World, One Health, Dr. Peter Hotez, a pediatrician and vaccine scientist at the Baylor College of Medicine, explained just how infectious it is. 

    “If someone has measles, and especially before they get the virus and stop feeling very sick, they’re releasing the virus into the atmosphere,” Hotez said. 

    Even if they leave the room, that virus will linger in the atmosphere for a couple of hours.

    “So you can walk into an empty room that has the measles virus from someone who was there a couple of hours before and become infected,” he said, noting that one measles patient will infect up to 18 other people.

    A virus reemerges.

    Nine out of 10 unvaccinated people who are exposed to the measles virus will become infected. What is disappointing to public health experts in the latest U.S. outbreak is that so many people have become infected when measles was eliminated in the United States in 2000 and in all of the Americas in 2016.

    But pockets of people who are not vaccinated against measles can act like tinder. The spark is usually a traveler who goes to a country where measles is still common because vaccination rates are low — usually due to poverty. 

    In a November 2024 report the WHO said that measles is still common in many places, particularly in parts of Africa, the Middle East and Asia.

    “The overwhelming majority of measles deaths occur in countries with low per capita incomes or weak health infrastructures that struggle to reach all children with immunization,” the report said. Measles kills more than 100,000 people a year, mostly children. But before the vaccine was introduced in the early 1960s, it killed 2.6 million a year.

    The COVID-19 pandemic badly hurt all childhood immunization efforts, WHO and other global health authorities say. Routine childhood vaccines have not caught back up to where they were before the pandemic, leaving children and adults susceptible to vaccine-preventable diseases including measles and polio but also meningitis, hepatitis, tetanus, cervical cancer and rotavirus — a disease that causes diarrhea and vomiting in babies and young children. 

    The retreat of the United States from global health efforts — the dismantling of the U.S. Agency for International Development, its plan to cut $1 billion in funding to Gavi, the Vaccine Alliance, and its withdrawal from the World Health Organization — will further weaken global vaccination, experts say.

    And that means many more children will likely die who might otherwise live healthy lives. 

     

    Three questions to consider:

    1. How can vaccines help prevent the spread of diseases?

    2. What role should personal choice play in being vaccinated against deadly diseases?

    3. How can global cooperation help in fighting the spread of disease?

     

    Source link

  • Too much of what’s healthy can be harmful

    Too much of what’s healthy can be harmful

    Some TikTok videos about health and fitness are hard to resist. People describe how they lost weight by eating only raw fruits and vegetables for a month or by substituting protein powder in place of flour or sugar. How many people take these recommendations to heart? What happens if they do?

    Jason Wood was one of them. “I would sprinkle [protein powder] on top of a peanut butter sandwich or a yogurt just to make what I was eating seem healthier,” he said.

    But Wood’s practice of adding protein powder to make his foods healthier wasn’t healthy. Eventually, Wood was diagnosed with orthorexia, an obsession with nutrition. Orthorexia is an eating disorder that differs significantly from better-known eating disorders like bulimia — bingeing and vomiting the food afterwards — and anorexia — not eating at all.

    Wood now works with the National Association of Anorexia Nervosa and Associated Disorders and speaks to audiences about eating disorders. 

    Studies in Australia, Turkey and the United States have found that the viewership of TikTok lifestyle influencers has led to an increase in orthorexia symptoms, which are not well understood by popular culture and are not explicitly defined in psychiatric textbooks. 

    Avoiding what’s bad isn’t always good.

    Rachel Hogg, psychologist and researcher at Charles Sturt University School of Psychology in Australia, defines orthorexia as “the avoidance of foods that are unhealthy or impure.” 

    The term was first coined in 1996 by California doctor Steven Bratman after he decided to eat only clean, nutritious foods. Eventually his research led him to narrow his food options so much that he cut out entire food groups which caused him physical suffering.

    Wood recalls being freezing cold in the middle of summer with his whole body hurting and frequent dizzy spells. Because it’s an outgrowth of healthy eating, the condition is difficult to identify, says Hogg, who calls it “the wolf in sheep’s clothing.”

    Experts feel it is time people paid attention to the risk of developing orthorexia when exposed to high amounts of TikTok content. 

    Todd Minor Sr. lost his youngest son Matthew in 2019 to the TikTok “Blackout Challenge”; people who took the “challenge” would have themselves choked till they blacked out. In a January 2025 edition of Tech Policy Press, Minor called for social media warning labels as a public health tool. “These labels have a proven track record of raising awareness about the risks of dangerous products, especially among young people,” he wrote. 

    People don’t know what’s bad for them.

    Warning labels inform the consumer of the potential risk of product use and advise limiting dangerous exposure to vulnerable groups of people to avoid premature death or disability. According to orthorexia experts, all of these needs exist when it comes to TikTok. 

    Hadassah Johanna Hazan, a licensed clinical social worker in Jerusalem, knows firsthand how the public is painfully unaware of the dangers of orthorexia from talking to her patients. She describes how over the last 10 years ideal beauty has increasingly been defined as a fit and toned physique for both men and women. 

    This has led people to normalize eating patterns that Hazan describes as “very limiting at best and very harmful and unhealthy at worst.” She said constant and regular avoidance of food groups such as carbs or regularly substituting protein powders for ingredients such as sugar become addictions that her patients do not know how to stop. 

    Even those who teach healthy eating can fall into the orthorexia trap. Research published in the June 2021 supplement of American Society of Nutrition by a group of researchers in the U.S. state of Washington indicated that knowledge of orthorexia was low both in the general public sample group and in the sample group of nutrition students.  

    In fairness to TikTok, the social media giant has established an eating disorder safety page but the term orthorexia is never mentioned and there is no mention of content on TikTok being linked to eating disorders. 

    A balanced diet is best.

    Another group of people who seem ignorant of the risk is the group of TikTok health and fitness influencers who are the ones putting out #WIEIAD (What I Eat In A Day) video diaries and other similar content. 

    Elaina Efird, registered dietician nutritionist and TikTok body positivity influencer, said that influencers don’t realize how much they are entrenched in the problem. What motivates these influencers, she said, is that they either truly believe what they are advertising is healthy or they are so distressed by the alternative of being in a larger body that they overlook the harm in what they promote.

    As a TikTok influencer, Efird creates a space where all body sizes are valued and she wants viewership of her positive message to grow. But as a provider of healthcare to eating disorder patients, she also recognizes her moral responsibility.

    “I tell my clients that if they’re struggling, don’t be on TikTok,” she said. This insight comes from an understanding that certain groups of people are at a higher risk of being triggered by TikTok videos than others. 

    Hogg shares this understanding and even used it when co-designing a research study with fellow researcher Madison R. Blackburn that was published in the peer-reviewed journal PLOS One in August 2024. 

    Each participant was screened to make sure they did not have past or present eating disorders before being asked to watch up to eight minutes of TikTok content, which is the equivalent of just over 50 videos. 

    Algorithms don’t know what’s best for us.

    Hogg said that the sad truth is that an eating disorder patient in remission might search for a body positive video but then suggestions pop up on the TikTok homepage, which is called #ForYou, that might tout orthorexia.  She called the algorithm of TikTok a “blunt instrument.”

    Another vulnerable population with strong connections to TikTok are teens and pre-teens. According to a Statistica 2022 survey, 68% of pre-teens were using social media applications and 47% of respondents ages 11–12 were using TikTok in particular.  As Hogg put it, TikTok is powered by “young people creating content for young people.” 

    The disturbing reality known by psychiatrists is that pre-teens are at the highest risk of developing eating disorders because symptoms manifest typically during adolescence. 

    But what scares the public most about any disease is its lethality. According to an article published in February 2021 by the American Society of Nutrition, some 10,200 people die each year in the United States from eating disorders. 

    Even when death is avoided, an obsession with nutrition can lead to nutritional deficiencies, compromised bone mass, extreme weight loss and malnourishment, including brain starvation, even if that seems counterintuitive. And none of that even touches on the effects on mental or emotional wellbeing. 

    Now that Wood is in remission he wants the label “healthy” to be redefined to indicate support of mental, emotional, social and spiritual health and not just support of physical health. 

    Individuals, he said, should stick to positive reasons for engaging with social media such as community building and avoid using it to make harmful comparisons. 


    Questions to consider:

    1.  How do psychologists define orthorexia?
    2. How does orthorexia differ from anorexia or bulimia?
    3. Has social media influenced what you eat? 

     



    Source link

  • Resilience is a matter of national health

    Resilience is a matter of national health

    With ongoing shortages of some 40,000 nurses and a 26 per cent drop in applicants to nursing degree courses in the last two years the staffing crisis in the NHS is set to get more acute.

    There is the backdrop of strikes, the legacy of Covid, low pay, the costs of studying along with the cost of living crisis.

    It is, perhaps, little wonder that around 12 per cent of nursing students in England fail to complete their degrees – twice the average undergraduate drop out rate. As health students tell us, “there are times when the NHS is not a nice place to be.”

    The constant cycle of coursework and clinical placements is “a treadmill, hard graft.” Students talk about feeling isolated, particularly during placements.

    The pressure to succeed and the fear of judgment from peers and professionals over not being able to “tough it out” can get in the way of students accessing support. The emotional toll of the work, coupled with the expectation to maintain a brave face, leads to compassion fatigue, burnout and a sense of depersonalisation.

    “It’s not,” students tell us, “what I thought it would be.”

    The resilience narrative

    Of course, the notion that healthcare is inherently tough and that only the most resilient can survive is not new. In fact, it’s something of a badge of honour.

    As one student told us, “there is this echo chamber. Students all telling each other about how tough it is, about the pressure, the volume of work, how it is non-stop and overwhelming.”

    But tying students’ worth to their ability to withstand adversity, that it is up to them to make up for something lacking in themselves instead of focusing on their capacity to thrive and grow, can be disempowering and debilitating.

    It’s time to change this corrosive resilience narrative, to bury the notion that it is the student who is somehow coming up short, who needs fixing. Resilience is not about survival and just getting through. It’s about coming back from set backs and thriving. It is about learning and growing. And it’s about something that is fostered within a supportive community rather than an ordeal endured alone by every student.

    So resilience becomes about putting in place support, about gathering what you need to be a success instead of simply finding a lifeline in a crisis.

    It is community that becomes a building block of resilience: the pro-active building of strong networks among students that enable and encourage them to support each other; building a wider support network of academic staff, supervisors in placements, of family and friends. It is here you find fresh perspective, the space to come back from setbacks.

    A midwifery student describes the: “WhatsApp group to keep in touch, check in and support each other. We’ve got a real sense of community;” a nursing student talks about how “it turned out that other students were just as terrified and felt like they were starting from scratch with every new placement.

    Sharing our feelings and experiences really helped normalise them;” and the medical student who suddenly “realised that everyone else was struggling. I wasn’t the only one who didn’t have confidence in themself and their abilities.”

    And by challenging negative interpretations of themselves, the “I can’t do it”, “I don’t belong”, “I’m the only one who’s struggling,” students begin to see new choices. Resilience becomes about developing the sense of agency and the confidence to respond differently, to challenge, to get the support you need to navigate towards your own definition of success.

    What matters

    So, to be resilient also means making the space to reflect on what truly matters to you when the norm, as a health student, is to focus only on the patients.

    Our medical student talks about how:

    …I spend a lot of time focused on looking after others and have seen myself as a low priority. This lack of self care used to result in things building up to breaking point. I needed a place to reflect, away from all the academic pressures. A time to focus on myself.

    It can take courage to do different, to do what is right for you rather then what people expect you to do. It takes courage not to join in with the prevailing culture when it doesn’t work for you. So resilience is also about bravery.

    The midwifery student again:

    I’m stopping negative experiences being the be all and end all of my experience.

    Disruptors and modellers

    What we’re talking about here is a cultural shift, about redefining the resilience narrative so it is about enabling students to discover their strengths and navigate their challenges with confidence.

    The role of staff is critical – as disruptors of the prevailing narrative in healthcare; in modelling behaviour; and re-inventing their everyday interactions with the practitioners of tomorrow.

    By using coaching tools and techniques, those of whose job it is to support students can:

    • Create a supportive environment that mitigates against self-stigma and provides students with permission and opportunities to be proactive in disclosing needs and unconditional reassurance that they feel they will be heard and valued;
    • Work in relationship with the whole student, supporting students to reflect on who they are and where they are going, and to make courageous choices;
    • Foster a sense of community to create a more supportive and effective learning environment

    We know there are places where this work has already getting results.

    A Clinical Skills Tutor describes how this approach:

    …has made me rethink my relationship with students, opened me up to working with students in a way I’d not thought about. I’ve seen how empowering it can be. I’m much more effective at making sure they get the support they need.

    Empowering students to redefine “resilience” on their own terms makes it a platform for learning and growth, rather than a burden to bear. There are more likely to succeed in their studies and will be better prepared for the challenges in their professional lives.

    As our student nurse puts it:

    “Grit turns your thinking on its head. I’ve been happier, calmer, better able to cope. I ask for help and support when I need it. I don’t bottle things up to breaking point. Things just don’t get to crisis point any more.

    Source link

  • What’s all the flap about bird flu?

    What’s all the flap about bird flu?

    Avian influenza has scared doctors and scientists for a generation. But its arrival in the United States might finally give the H5N1 bird flu virus the combination of factors it needs to cause a global pandemic.

    Those factors include a new carrier; dairy cattle; a regulatory system that protects farmers at the expense of human health; and a government bent on taking down an already weak public health infrastructure.

    The H5N1 avian influenza virus making headlines around the world — and driving up the price of eggs — in the United States is no youngster. It’s been around since at least 1996, when it was first spotted in a flock of geese in Guangdong in southern China.

    Since then it has spread around the entire world, tearing through flocks of poultry in Asia, Europe and the Americas and wiping out birds and mammals on every continent, including Antarctica. H5N1 bird flu only rarely infects people but as of the end of January 2025, the World Health Organization reported 964 human cases globally and 466 deaths, although many milder cases are likely to have been missed.

    Vets and virus experts have had their eyes on H5N1, in particular, for decades. It didn’t look like a serious threat when it killed geese in 1996. But the next year the virus caused an outbreak in people just over the border from Guangdong in Hong Kong.

    It infected 18 people and killed six of them before it was stopped. That got people’s attention. A 30% fatality rate is exceptionally high for a virus — something approaching the mortality of smallpox.

    Mutations and swap meets

    The virus gets its name from two prominent structures: the hemagglutinin, or H designation, and the neuraminidase, or N. All influenza A viruses get an HxNx name. The current circulating viruses causing human flu misery right now are H1N1 and H3N2, for example, as well as influenza B, which doesn’t get any fancy name.

    But influenza viruses are exceptionally mutation-prone, and even the extra designation doesn’t tell the whole story about the changes the virus has undergone. Every time a flu virus replicates itself, it can make a mistake and change a little. This is called antigenic shift. As if this wasn’t enough, flu viruses can also meet up inside an animal and swap large chunks of genetic material.

    The result? The H5N1 viruses now circulating are very different from those that were seen back in 1996 and 1997, even though they have the same name.

    This is what’s been going on over the past 30 years. H5N1 has been cooking along merrily in birds around the world. So, after the 1997 outbreak, not much was seen of H5N1 until 2003, when it caused widespread outbreaks in poultry in China. Researchers discovered it could infect wild waterfowl without making them sick, but it made chickens very sick, very fast. And those sick chickens could infect people.

    The best way to control its spread among poultry was to cull entire flocks, but if people doing the culling didn’t take the right precautions, they could get infected, and the virus caused serious, often fatal infections. Doctors began to worry that the virus would infect pigs. Pigs are often farmed alongside chickens and ducks, and they’re a traditional “mixing vessel” for flu viruses. If a pig catches an avian flu virus, it can evolve inside the animal to adapt more easily to mammals such as humans. Pigs have been the source of more than one influenza pandemic.

    Pandemic planning

    In the early 2000s, scientists and public health officials took H5N1 so seriously that they held pandemic exercises based on the premise that H5N1 would cause a full-blown pandemic. (Journalists were included in some of these exercises, and I took part in a few.)

    But it didn’t cause a pandemic. Vaccines were developed and stockpiled. Pandemic plans were eventually discarded, ironically just ahead of the Covid pandemic.

    However, flu viruses are best known for their confounding behavior, and H5N1 has always been full of surprises. It has evolved as it has spread, sometimes popping up and sometimes disappearing, but never causing the feared human pandemic. It has not spread widely among pigs although it has occasionally infected people around the world, as well as pet cats, zoo animals, wild seals, polar bears, many different species of birds and, most lately, dairy cattle.

    It’s this development that might finally be a turning point for H5N1.

    For a virus to start a human pandemic, it must acquire the ability to infect people easily; it must then pass easily from person to person; and it must cause significant illness.

    Competing interests

    So far, this hasn’t happened with H5N1. It has infected 68 people in the United States, mostly poultry or dairy workers. Mostly, it causes an eye infection called conjunctivitis, although it killed one Louisiana man. But it is spreading in a never-before-seen way — on milking equipment and in the raw milk of the infected cattle.

    “The more it spreads within mammals, that gives it more chances to mutate,” said Nita Madhav, a former U.S. Centers for Disease Control and Prevention researcher who is now senior director of epidemiology and modeling at Ginkgo Biosecurity. I interviewed her for a podcast for One World One Health Trust. “As it mutates, as it changes, there is a greater chance it can infect humans. If it gains the ability to spread efficiently from person to person, then it would be hard to stop,” Madhav said.

    And while some states are working to detect and control its spread, the federal government is not doing as much as public health experts say it should. Two agencies are involved: the U.S. Department of Agriculture (USDA) and the Centers for Disease Control (CDC).

    Dr. John Swartzberg, a health sciences clinical professor emeritus at the University of California, Berkeley said in an interview with the UC Berkeley School of Public Health that the USDA is charged with two responsibilities that only sometimes work in concert.

    “One of the responsibilities they have is to assure a healthy agricultural industry for the United States,” Swartzberg said. “The second responsibility is to assure safety of the human beings who consume agricultural products in the United States.”

    More information, not less, is needed.

    Dairy farmers feared they’d lose money if their farms were identified as sources of infection. And it’s a lot more expensive to cull cattle than it is to cull chickens.

    “And I think what we’ve seen with this bird flu problem is that the USDA is tilted in favor of protecting the industry, as opposed to protecting the health of humans,” Swartzberg said. “CDC is also involved, but the CDC has no authority to go into states and tell them what to do. It has to be done state by state.”

    On top of that, U.S. President Donald Trump has ordered the CDC to take down websites reporting on avian flu and other issues. He is withdrawing U.S. membership from WHO, crippling the ability to coordinate with other countries on controlling outbreaks of disease.

    He notably tried to suppress reporting about Covid during his previous presidency and promoted unproven and disproven treatments.

    His newly confirmed Health and Human Services Secretary, who will oversee CDC and other agencies charged with human health, Robert F. Kennedy, Jr, is a vaccine denier, proponent of raw milk and has no public health qualifications.

    The stubbornness of people in the United States doesn’t help. When public health officials warned against drinking raw milk last year, raw milk sales actually went up.

    “Food safety experts like me are just simply left shaking their heads,” Donald Schaffner, a Rutgers University food science professor, told PBS News.

    The big fear? That in flu season, someone will catch both seasonal flu and H5N1, giving the viruses a chance to make friends in the body, swap genetic material and make a deadly new virus that can infect people easily.

     

    Three questions to consider:

    1. How can politics affect public health risk?
    2. How does public understanding and trust affect the risk of disease?
    3. Countries often blame one another for the spread of disease, but should they?

     

    Source link