Category: Health

  • The danger of overdoing over-the-counter medicine

    The danger of overdoing over-the-counter medicine

    In 2023, David Mitchener, 89, was admitted to a hospital in Surrey, England where he died. His death was attributed, in part, to high levels of Vitamin D, which he had been taking for nine months before his death.

    It turns out that using herbal remedies and nutritional supplements could put your health at risk.

    In a 2020 study at a Canadian naturopathic clinic, 42% of participants said they did not discuss their use of natural health products, including herbal remedies and vitamins, with their doctor. It turns out there are risks associated with not disclosing that you’re taking herbal remedies and supplements.

    Some people are aware of the risks and are careful when using these products, but some people aren’t, said Frances Atcheson, a community pharmacist based in Northern Ireland. “There is a danger with people thinking that they’re always safe to take, just because they’re natural.”

    Lezley-Anne Hanna, chair of pharmacy education at Queen’s University Belfast, said that the products could interfere with a patient getting a correct diagnosis. “If you didn’t disclose that you were on an herbal medicine, well, that could actually be causing your symptoms in the first place,” Hanna said.

    Drug interactions

    A major risk, Atcheson said, is that the natural medicines will interact negatively with with conventional medicine. Increased bleeding risk, for example, is associated with using herbal remedies such as ginkgo biloba, cranberry juice and ginger at the same time as blood-thinning medication, such as warfarin and aspirin.

    In 2014, the Medicines and Healthcare products Regulatory Agency (MHRA), which regulates medicines in the United Kingdom, warned about the interaction between hormonal contraceptives and St. John’s wort, a herbal supplement that is used to alleviate mild depression and anxiety.

    Such interaction has been blamed for unplanned pregnancies. St. John’s wort can also cause serotonin syndrome when used with other antidepressants. This can show up as high blood pressure, shivering and mania.

    Ayurvedic medicine, which originated in India, uses many herbal remedies. The products can also include metals. However, in December 2025, the U.S. Food and Drug Administration issued a warning about the possibility of heavy metal poisoning, such as lead and mercury, when using Ayurvedic products.

    This could lead to infertility, kidney and brain damage and convulsions.Taking herbal remedies and supplements when there aren’t specific symptoms or illnesses has risks too.

    Side effects of natural remedies

    While taking Vitamin D supplements is recommended for everyone in the United Kingdom by the Department of Health and Social Care, too much Vitamin D can lead to bone pain, loss of appetite and abdominal pain in otherwise healthy patients.

    Liver injury caused by herbal remedies and supplements has been reported in Australia, the United States and Spain, in some cases so serious that it led to the need of a liver transplant.

    Seema Haribhai, a 37-year-old woman from North London, became concerned about the potential side effects of conventional medication and turned to herbal remedies to treat psoriatic arthritis — a type of arthritis that causes pain and swelling in joints. A coroner’s report attributed her death to liver failure that might have been aggravated by herbal remedies recommended by an Ayurvedic medicine practitioner. “All medicines can cause harm, even those that are herbal based,” the report said.

    Eva Delaney, 24, of Belfast takes the herbal supplement ginkgo biloba to improve brain function and Kalms tablets, which contain the herb valerian root, to reduce stress. She says she found out about the supplements in the pharmacy where she worked and consulted a pharmacist at her work before buying the products. “It probably should be the thing where you should always go to your pharmacist first,” she said.

    Hanna said that pharmacists should be able to discuss these products in the context of patient safety. “Pharmacists are the expert in the safe and effective use of medicine,” she said.

    Discussing herbal medicine with doctors

    What form the herbal remedies and supplements take, Delaney said, play a role in whether people tell a healthcare professional they’re taking them. “I think if it’s a tablet, you’d be more inclined to tell someone, ‘Oh, I’m taking this’,” Delaney said. “But if it was anything else, like a syrup … I think it would be harder to consider that as a medicine.”

    In a 2021 study, more than 90% of pregnant women in Ethiopia using herbal remedies throughout their pregnancies did not discuss this with their health-care professionals. The most common reason they gave was that the healthcare professional did not ask.

    Atcheson said that she wouldn’t normally ask about herbal remedies specifically. But she will ask patients: “Are you on any other prescribed medication or do you take anything over the counter? And sometimes they will volunteer information if they’re taking herbal remedies or supplements.”

    Hanna said that healthcare professionals need to ask specific questions in order to learn about patients’ use of herbal remedies and supplements. “If you want to know if somebody’s on a herbal medicine,” she said, “you need to ask.”

    It is also important for healthcare professionals to know their own limitations, and to know how to find the information they lack. “It’s about accepting that you may not know that particular product or you may not know that name,” Hanna said. “But where can you go and find out reliable information? Where could you advise the person to go?”

    Finding reliable resources

    Atcheson said that she uses the online Cochrane Library as a resource when presented with a patient question she can’t answer. The Cochrane Library provides evidence-based information on herbal remedies and supplements and their effectiveness in different medical conditions. Unfortunately, she said, there aren’t many other readily available resources. “Apart from the Cochrane Library, I’m just going onto Google Scholar looking for reviews,” she said.

    Atcheson recalls telling a patient not to take collagen supplements because the patient had chronic kidney disease. “There’s something about collagen where it can actually interfere with the kidneys when you take it orally,” she said.

    Many young people find misinformation on the internet, she said. “I’ve heard about people buying supplements and herbal remedies for weight loss,” Atcheson said. “It’s especially risky when you’re buying things on the internet. Then there’s no point of contact at all.”

    In the UK, people can look for a  Traditional Herbal Registration symbol on product packaging when deciding whether to buy a herbal remedy. This symbol means the product has met the safety and quality standards set by the MHRA.

    Hanna said that discussing over-the-counter products with a health-care professional can help patients feel empowered about their own health and provide them with unbiased information.

    “It really would be a missed opportunity to not use a healthcare professional,” she said, “and to help you whenever you’re thinking about a herbal medicine.”

    Questions to consider:

    1. Why don’t many people discuss herbal medicines with their medical doctors?

    2. What are some things you need to consider before taking vitamins or herbal remedies?

    3. If you or someone you know takes vitamins, how did you or they decide to do that?

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  • Tanzanian parents struggle with misconceptions of autism

    Tanzanian parents struggle with misconceptions of autism

    The nurse hands the newborn child to his mother, Jamila, who smiles down at him, mesmerized by the tiny being who is about to bring hope and joy to the family. Juma, the proud father, laughs with delight at getting a son, a symbol of pride.

     It feels like the beginning of a perfect future. The whole neighbourhood is celebrating.

    “Say ‘mama’.”

    “Come, walk to me.”

    “Can you count one to three?”

    But all the relatives begin to worry when, four years later, the child still can’t talk or walk and he behaves differently from the other children around him.

    The neighbours begin to whisper, quietly spreading false rumours about the family.

    “Evil spirits must have attacked them.”

    “They are being punished for their sins.”

    Unable to face the embarrassment, Juma refuses to take responsibility and eventually leaves. Jamila is then left alone to carry the weight of raising her child in silence, shame and confusion.

    This is the reality for many families in Tanzania who have a child with autism.

    Neema Massawe, the mother of a six-year old with both autism and cerebral palsy, shared her experience. “My child is a lovely six-year old, born with a condition described by doctors as cerebral palsy and autism,” Massawe said. “She has difficulties with movements and speech, and can only be helped.”

    Ignorance is the problem.

    As of 2023, less than 1% of the population of Tanzania is diagnosed with autism, but that’s more than 600,000 people. Still, public awareness of the condition remains alarmingly low, particularly in rural areas where access to diagnosis and support services is even more limited.

    For many children with autism in Tanzania, their struggle goes beyond their developmental challenges and is compounded by misunderstanding, stigma and limited support. Families often face judgment from their communities and cultural beliefs sometimes attribute the child’s condition to curses, punishment or supernatural causes.

    In an article published in 2019, Jane and Isaac Jisangu, parents of an autistic child, told how their community once believed their child was bewitched and accused them of being bad parents.

    Jane Jisangu told the interviewer: “The problem exists, but most people don’t know about it. Some will tell you to go to ‘experts’ or go see your elders. They might help you.”

    Her words reflect how, with limited awareness and scarce resources, families often turn to traditional healers or spiritual explanations rather than seeking professional medical help. The account was reported by China Global Television Network in 2019, highlighting how limited local research and reporting on autism in Tanzania often pushes families’ experiences to international platforms.

    No child deserves inhumanity. 

    Tumaini Kweka, the mother of a 14-year-old autistic boy said that because of autism, her son is often loud and restless.

    “Many people called him a ‘troublesome boy’,” she said. “One day, the maid decided to burn him with an iron machine to teach him a lesson. This really affected his siblings and I as well.”

    This is just one of many examples of how autistic children are treated daily. Sexual harassment, physical abuse and emotional mistreatment are heartbreakingly common. Many are scolded for behaviours they cannot control and are isolated simply for acting differently. Because of such treatment, countless autistic children are denied the chance to attend school, their educational journeys cut short before they even begin.

    Although the Tanzanian government has introduced policies such as the Law of the Child Act, 2009, to protect the rights of children with disabilities and ensure equal access to education and healthcare, the implementation remains weak.

    Limited resources, a shortage of trained professionals and widespread public ignorance continue to hinder meaningful progress.

    Deborah Mapunda, the grandmother of an autistic child, recalled how even visits to the hospital, which were meant for support and care, were met with cold stares and criticisms. “People gave us a lot of judgment and tend to look at us critically,” she said.

    Each stare and criticism left her feeling isolated, frustrated and painfully aware that society often rejects the family rather than understanding the child’s needs.

    “Maybe if everyone understood the situation, they would be nicer,” Mapunda added.

    Parents and caregivers carry quiet burdens.

    Just as autistic children struggle, their parents and caregivers carry a heavy emotional, social and financial burden that often goes unseen. Back in 2012, researchers at Muhimbili Hospital in Dar es Salaam found that many caregivers experience deep stress and even conflicted feelings about raising a child with a developmental condition.

    They spoke about how difficult it was to manage behaviours that are normal within autism but misunderstood by the wider community. Behaviours such as aggression, loud vocalizations, hyperactivity or restless movement often create tension with neighbours and extended family members, who quickly become irritated or uncomfortable.

    Over time, this constant friction makes some caregivers feel as if their child can not “fit in” within the community, a belief that grows into fear, shame and a persistent worry about the child’s future.

    Autism does not affect the child alone; it touches every family member. According to the Family Systems Theory, family members are deeply emotionally connected, so the challenges of one person influence the entire household.

    According to a 2017 study led by University of Kent researcher Ciara Padden, many parents of autistic children are forced to quit their jobs or reduce their working hours due to high caregiving demands, including communication challenges and severe sleep difficulties.

    This places a heavy strain on the parents, making it difficult for them to maintain financial stability and take care of the rest of the family and any other remaining children.

    What the future holds 

    Will children ever outgrow autism? The answer is no. But this does not mean that their lives cannot be full, meaningful and successful. Awareness of autism is slowly increasing in Tanzania, yet ignorance remains widespread, especially in rural areas.

    “I highly believe that educating people is the first step for improving the lives of these children,” said Shangwe Mgaya, mother of an autistic child and an advocate for autism awareness.

    Connect Autism Tanzania, an organization that collaborates with about a dozen centres in northern Tanzania, has made a significant contribution to empowering and training teachers on how to support autistic learners effectively. Four workshops are conducted annually in rural areas and simple tools have been developed for primary caregivers, teachers and the general public to raise awareness and promote education.

    Many non-governmental organizations have also turned International Autism Day, celebrated on 2 April, into a powerful moment for understanding and support. Events like the annual Run4Autism marathon help raise both visibility and funds for autism centers across the nation. Additionally, a gala dinner scheduled for 31 January 2026, aims to bring communities, experts and families together to discuss the challenges autistic children face and inspire stronger national action.

    These efforts have brought a sense of hope to parents and caregivers of autistic children. As awareness slowly increases, more families are beginning to believe that their children might one day receive proper support in schools and be valued as members of the community who can make meaningful contributions.

    For example, a mother on Facebook shared a video of her autistic son swimming and wrote how proud she was that he had mastered swimming in a short period.

    Even though autism can not ‘go away,’ the future can change dramatically depending on how society responds. For now, parents in Tanzania are holding onto the hope that the next generation of caregivers, teachers and neighbours will be more informed, compassionate and better prepared.

    Questions to consider:

    1. In what ways do children with autism struggle beyond their developmental challenges?

    2. Why do you think so many people are ignorant about autism?

    3. In what ways might people have the wrong ideas about you?

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  • Should schools provide more than an education?

    Should schools provide more than an education?

    Ashley teaches Spanish at a public high school in the U.S. state of New Jersey that has a large percentage of students from low-income backgrounds. She has gone food shopping for families and has babysat for weeks while a parent had surgery. She has attended countless graduations, birthday parties and baby showers. She has spent thousands of dollars of her own money on students.

    Because school teachers can face negative repercussions for speaking out, I agreed not to use her last name or the last names of any of the other teachers in this article.

    Ashley is one of many teachers across the United States who perform duties beyond their job description, training and pay. They see it as a result of parents who must work multiple jobs due to greater financial hardship.

    “Anything can happen in this economy,” Ashley said. “A family can be one pay check away from being unhoused.”

    In the U.S. state of Colorado, Shannen teaches at a charter school — a taxpayer-funded, public school that operates under its own “charter,” giving it a degree of independence within local school systems. In November 2025, she voted to approve two propositions to boost Colorado’s universal free school meals program and food stamps program, known as SNAP, which subsidizes nutritious food for low-income families. In 2023, about 35% of SNAP recipients were children.

    “I think it’s a good thing to have in schools,” Shannen said. “We see a lot of kids with food insecurity, but who don’t want to say that, so it’s nice that it’s just available [for everyone]. We provide breakfast, snack and lunch.”

    Should schools feed everyone?

    According to a 2025 report from UNESCO, decades of international evidence support the benefits of universal school meals, including behavioral and academic improvement for students of all income levels, and less stigma compared to income-based eligibility.

    Yet Shannen and other teachers wonder if initiatives like this are sustainable — or just blurring the lines between school and home, and parenting and teaching.

    “I wish it weren’t so dependent on schools because then what happens on the weekends and in the summers?” Shannen said. “I don’t know if it should necessarily be the school’s role, but it ends up being the school because it’s the easiest. Teachers and administrators are asked to take on far more than just educating.”

    Ashley said that school is where many of her students get their needs met, and much of that support comes from teachers. “If I don’t supply medicines, they’re not getting them,” she said.  She also buys bandages, rubbing alcohol, tissues, hand sanitizer, paper plates, napkins, utensils and wipes. “If I’m not replacing them, it’s not getting done,” she said. Ashley’s students can also wash their clothes using the school’s laundry machines.

    Students attending school without the resources they need is not unique to the United States. According to a 2024 report by the National Foundation for Educational Research in the United Kingdom, economically disadvantaged students there continue to arrive at school hungry and without necessary supplies and clothes like winter jackets. Nearly 20% of teachers in the UK are also reporting spending their own money to meet the welfare needs of their students.

    Equity versus equality

    Shannen said that it is important to understand the difference between equity and equality as a teacher. “If one of my kids said they didn’t have shoes, I would … make sure they got their shoes,” Shannen said. “For certain students [in need], I think schools should provide as much as possible to make sure they have the same opportunities. Sometimes equity is making sure certain kids are getting more so that in the long run it’s more equal.”

    Giving all this extra support can take a toll. Jill, a public high school teacher in New Jersey, takes on multiple roles but gets no additional support. That has affected her well-being and ability to do her job.

    “I have to be a social worker, psychologist, counselor, nurse, provider, all of it,” Jill said. “I came home crying the other day because a student has a severe drug problem at home, and also came out to me because he couldn’t come out to his parents. As this is happening, I have a whole class of 30 other kids who need my attention.”

    Jill said she could benefit from working with an aide in the classroom. Reporting by the National Education Association showed that today’s students have increasingly complex needs that would benefit from smaller class sizes.

    Ashley agrees that more professionals are needed at school. “We have six guidance counselors, a substance use counselor and a trauma counselor,” Ashley said. “We have a team of educational experts, social workers, psychologists and nurses. We probably have 25 different healthcare professionals. And that’s still not enough.”

    Who should pay for the essential needs of students?

    All of the teachers I interviewed also say their pay needs to reflect their workload. Salary is not keeping up with inflation and the economic challenges those in the United States are facing. Without the help of her partner’s income, Jill would not be able to afford the $3,000 monthly rent on their apartment. She has a master’s degree and her salary is $68,000 after 10 years of teaching.

    Carson is a former teacher at a private high school in Sacramento, California. He believes unions can advocate for burnt-out teachers.

    “Teachers’ unions usually help with salary, but they should help with managing expectations, like grading,” Carson said. “It wasn’t the teaching that burnt me out. It was … all the other stuff.”

    Education International is a global education union that believes the rights of teachers and students are intertwined — the right to dignity at work and the right to receive a quality education.

    Organizations in the United States that are members of Education International are the National Education Association and the American Federation of Teachers.

    “Teaching is a calling,” Carson said. “And that’s why I think teachers’ unions are important,” Carson added. “Teachers are naturally going to give and give. They need somebody looking out for them.”

    Questions to consider:

    1. Why are many schools becoming places that provide food and social services in addition to education?

    2. Why do some teachers feel compelled to pay for things like food and clothing for their students?

    3. In what ways are schools good places for the distribution of food and other public assistance to needy people?

     

     

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  • What’s not part of university requirements? Eating.

    What’s not part of university requirements? Eating.

    University systems have long been promoted as the most reliable path to upward mobility and economic security.

    Yet for a growing number of students, that promise is part of a troubling paradox: the act of seeking a degree requires a harrowing trade-off between paying for schooling and securing the eating. The result is a lack of physical and economic access to enough safe and nutritious food for a healthy and active life. It is a pervasive crisis of food insecurity,

    Today, nearly nine in 10 United States campuses operate food pantries or “basic need hubs,” serving thousands of students each semester.

    What began as a grassroots response to hunger is now becoming institutionalized — a subtle but significant shift in how universities define student success and well-being. According to a survey conducted by the Hope Center for Student Basic Needs, a national research center at Temple University focused on transforming higher education to improve student success and well-being, 59% of students of students at 91 institutions across 16 states experience at least one form of basic needs insecurity, while 41% of students experienced food insecurity.

    Many campus pantries have transformed into one-stop centers that connect students with food assistance programs, financial aid, child-care resources and mental-health support.

    Finding the funds for food

    The Lancer Care Center, which began as the Lancer Pantry in 2015 at the Pasedena City College, has now been integrated into a centralized, holistic support center. Today, it provides coordinated assistance and functions as a single hub for various types of basic needs, ranging from housing, food, emergency funding, peer mentoring and financial assistance.

    Yet, even as they expand, most remain under-funded and overstretched: 60% of campus food pantries lack adequate refrigeration and many rely on short-term grants and student volunteers to operate.

    A survey conducted in 2023 by Swipe Out Hunger, a national non-profit organization dedicated to eliminating student hunger, reported that food pantries face three key challenges: funding, inventory and staffing. More than one in five among the 355 college food pantries surveyed reported that securing stable funding, maintaining streams of funding and obtaining grants remain the most significant challenges.

    Beyond calories, these spaces also provide something harder to quantify: trust.

    “If you have somebody that trusts a systemic function of your campus, like a food pantry, it is likely that they will also trust other systems that are in place,” said Laura Egan of the Clery Center, an organization that focuses on campus safety and student rights. “If and when they or someone they know needs to make a report of a crime or needs to access a resource because they are a survivor of a crime, they will be more likely to look to and trust their campus, who has already established a system of providing them regular support in a non-judgmental [way].”

    When hunger is hidden

    For Egan, said accessibility matters just as much as supply.

    “What we really appreciate seeing with food pantries on college campuses is the community support that it provides, the ready access that provides a student, with no questions asked about why you might need to access that resource,” she said.

    Despite their growing presence, hunger on campus often remains hidden, masked by stigma and assumptions about who is considered food insecure. New York University Izzy Morgan is the administrative coordinator at the College Student Pantry  New York City and says that many students don’t even realize that they are food insecure.

    “I come from a family with money and, you know, I have all these privileges,” Morgan said. “I’m on a pretty big scholarship at school, and even if all of that is true, you could still be insecure.”

    The College Student Pantry, operated by New York City’s Trinity’s Services and Food for the Homeless, serves college and graduate students across the city.

    Affording healthy food

    For Morgan, that self-realization came upon discovering that the pantry provided access to fresh vegetables that would otherwise be unaffordable.

     “Part of why I got this job was because my boss, who is actually my pastor, came up to me and said, ‘Izzy, I think you’re food insecure’,” Morgan said.

    Daniela Bermudez, a volunteer and Outreach and Social Media coordinator at the pantry, said that For many students, hunger is normalized as part of the college experience. “A lot of college students have this (assumption) that they’re supposed to struggle,” Bermudez said. “It’s almost normal to not have a well-balanced meal daily.”

    Understanding food insecurity often comes gradually. “It’s kind of hard to almost wrap your head (around the meaning of food insecurity),” Bermudez said. “I’m noticing that (when) I’m not eating the right food groups and I don’t necessarily have the continuous ability to access these foods, that is a sign of food insecurity.”

    Universities often measure success through graduation rates and employment outcomes, but for a growing number of students, success must depend on something far more basic: the ability to eat regularly, without shame or uncertainty. As higher education continues to market itself as a pathway out of poverty, the persistence of campus hunger raises an urgent question: Can institutions truly promise opportunity while leaving students to choose between a meal and a degree?

    Questions to consider:

    1. Why do many university students struggle to pay for food?

    2. What are universities doing to make sure students can eat?

    3. Do you think food should be a basic right for everyone? Why?

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  • What happens when people lose access to birth control?

    What happens when people lose access to birth control?

    Abandonment of U.S. financial support for contraception around the world has disrupted the ecosystem that fostered birth control, family planning and sexual and reproductive health for decades.

    Back in February, the United Nations Population Fund announced that the United States had canceled some $377 million in funding for maternal health programs around the world, which includes contraception programs.

    Contraception reduces mortality and can improve the lives of women and families. The United Nations estimates that the number of women using a modern contraception method doubled from 1990 to 2021, which coincided with a 34% reduction in maternal mortality over the same period.

    Now, tens of millions of people could lose access to modern contraceptives in the next year, according to the Guttmacher Institute, a family planning research and lobby group. This, it reported, could result in more than 17 million unintended pregnancies and 34,000 preventable pregnancy-related deaths.

    Sexual and reproductive health and rights programs improve women’s choices and protection including violence and rape prevention and treatment.

    Who will fill the gap?

    European donor governments have pledged to increase contributions to UNFPA and other global health funds to partially fill the gap. The Netherlands, Sweden and Denmark, for example, have pledged emergency funds to UNFPA Supplies, the world’s largest provider of contraceptives to low-income countries.

    The EU has also redirected part of its humanitarian budget to cover contraceptive procurement in sub-Saharan Africa. Canada announced an additional CAD $100 million over three years for sexual and reproductive health programs, explicitly citing the U.S. withdrawal.

    Despite its own aid budget pressures, the UK has committed to maintaining its £200 million annual contribution to family planning programs, with a focus on East Africa.

    The Bill and Melinda Gates Foundation expanded its Family Planning 2030 commitments, pledging tens of millions in stopgap funding to keep supply chains moving. The World Bank Global Financing Facility offers bridge loans and grants to governments facing sudden gaps in reproductive health budgets and calls for governments to co-finance. However these initiatives will not immediately replace the scale of previous U.S. government investments.

    The loss of U.S. support has left many women with no access to family planning, especially in rural and conflict-affected areas. Clinics are reporting a surge in unintended pregnancies and unsafe abortions.

    Health clinics closing

    In Zambia, Cooper Rose Zambia, a local NGO reported laying off 60% of its staff after receiving a stop-work order from USAID. Clinics have been rationing contraceptives with some methods already out of stock.

    In Kenya, clinics in Nairobi and rural counties are turning women away, with some supplies stuck in warehouses and at risk of expiring. In Tanzania, medical stores confirmed they were completely out of stock of certain contraceptive implants by July 2025.

    Mali will be denied 1.2 million oral contraceptives and 95,800 implants, nearly a quarter of its annual need. In Burkina Faso, another country under terrorist insurgency internally, many displaced women have no access to modern contraceptives.

    The consequences of the stock depletions will be particularly catastrophic in fragile and conflict settings such as refugee camps.

    Struggling to adapt to the reality has led organizations to cut programs and redirect their remaining resources. Many are trying desperately to raise new funds. But there are some voices that cheer the cuts, describing them as a wake up call.

    A wake up call for Africa?

    Rama Yade, director of the Africa Center of the Atlantic Council, a non-partisan organization that studies and facilitates U.S. international relations, argues that the aid cuts could be a wake-up call for African nations to reduce dependency and pursue economic sovereignty.

    For pan-African voices who have long criticized foreign aid as a tool of neocolonialism, the U.S. government cuts are a chance to build local capacity, strengthen intra-African trade and reduce reliance on Western donors. Trump’s dismantling of USAID offers a new beginning for Africa.

    In an essay in the publication New Humanitarian, Themrit Khan, an independent researcher in the aid sectors wrote that recipient nations have been made to believe they are unable to function without external support.

    Khan proposes several actions to mitigate the foreign funding cuts: relying more on local donors; developing trade and bilateral relations instead of depending on international cooperation programs through the United Nations and other international organizations; re-evaluating military spending and reducing debt.

    Colette Hilaire Ouedraogo, a senior midwife and sexual and reproductive health practitioner, told me that up to 60% of activities were from external funding partners. She recalled the alerts sent by the health department to increase funding from national sources as early as 2022.

    She predicts that the cuts affecting the availability and access to contraceptives and the overall quality of services will slow down progress towards universal health coverage targets and the UN Sustainable Development Goals. There is a risk of reduced attendance at reproductive health and family planning centers. Consequently, unwanted pregnancies and unsafe abortions could increase leading an higher maternal mortality.

    Questions to consider:

    1. How can contraceptives result in lower deaths for women?

    2. Why do some people argue that the cut off of funds from the United States might ultimately benefit nations in Africa?

    3. Why are contraceptives controversial?

     

     

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  • Sleep Hygiene for Teens: Proven Ways for Teens to Get Better Sleep

    Sleep Hygiene for Teens: Proven Ways for Teens to Get Better Sleep

    It’s 11:00 pm. You’re still scrolling through your phone, telling yourself, “Just five more minutes.”

    Then all of a sudden, it’s midnight, and your brain is somehow more awake than it was an hour ago.

    Sound familiar?

    Late nights make mornings miserable. When you wake up tired, focusing in class or during activities becomes impossible.

    But getting enough rest isn’t always as simple as going to bed earlier. Distractions can easily keep you up. And even if you do make it to bed on time, you might toss and turn instead of drifting off to sleep right away.

    Sleep hygiene for teens is all about building healthy habits that make it easier to fall asleep, stay asleep, and wake up refreshed.

    These practical tips will help you give your mind and body the rest they need.

    (Don’t forget to download your free quick action guide below.)

    Why do teens stay up late?

    Teens stay up too late for several reasons, and most of them stem from habits and lifestyle choices.

    After a long day of school, extracurriculars, and homework, nighttime can feel like your only chance to relax. That’s when activities like scrolling through social media, gaming, or chatting with friends can push past bedtime.

    Many of these activities also involve screen time, which makes things worse. According to the Sleep Foundation, using screens at night can delay the release of melatonin. This is the hormone that helps you fall asleep. As a result, you may find yourself staying awake much later than planned.

    Additionally, biology plays a role. During puberty, hormonal changes naturally push the body’s internal clock later, often by an hour or two. That’s why you might not feel sleepy until significantly later.

    With all these factors at play, the relationship between teens and sleep can be complicated. But understanding why this happens is the first step to better rest.

    Why do teens need more sleep?

    Why do teens need more sleep?

    Teens need about 8 to 10 hours of sleep each night.

    During this stage of life, you are undergoing rapid physical and mental growth. So, sleep isn’t just “rest time” for your body; it’s when your brain and body do some of their most important work.

    Here’s why sleep is so important for teens:

    • Better focus and learning: Sleep supports brain development. It also strengthens memory and helps your brain process what you learned during the day. This means you can absorb new information and feel more confident in your learning.
    • Stronger mood regulation: Without enough sleep, it’s easy to feel cranky or anxious. A good night’s rest helps you manage stress, control emotions, and handle challenges more calmly.
    • Improved performance: Sleep can enhance your performance in sports, music, and other activities. Proper rest sharpens your reaction time, creativity, learning, and overall performance.
    • Healthy growth and development: Your body needs sleep for important functions. Sleep helps to support growth, repair muscles, and keep you energized for the next day.
    • Stronger immune system and long-term health: Sleep gives your body the time it needs to recharge and fight off illnesses. It also supports a healthy heart, balanced metabolism, and overall well-being.

    Sleep deprivation in teens is more common than you might think.

    When you consistently get less than 8 hours of sleep, the effects build up over time. You might notice yourself feeling more irritable, struggling to concentrate, or getting sick often.

    The good news? Once you start prioritizing sleep, your body can recover, and you’ll typically begin feeling better within a few days.

    Why do teenagers sleep so much on weekends?

    Why do teenagers sleep so much on weekends?

    If you find yourself sleeping until noon on Saturdays, you’re probably dealing with what’s known as “sleep debt.”

    When you don’t get enough rest during the week, your body tries to catch up on weekends.

    While recovery sleep can help you feel better temporarily, it’s not a long-term solution. The goal is to get consistent, quality sleep every night so you don’t need to crash on weekends.

    In short, getting enough sleep isn’t just about avoiding morning grogginess. It’s essential for supporting your body’s rapid growth during the teenage years and protecting your health in the long run.

    Sleep hygiene habits for teens that actually work

    Sleep hygiene means building habits and creating an environment that helps you get high-quality sleep every night.

    You don’t have to completely overhaul your life to improve your sleep hygiene. Even a few small changes to your routine can make a huge difference in how quickly you fall asleep and how rested you feel the next morning.

    Let’s explore some practical sleep hygiene tips for teens.

    Set a consistent bedtime and wake-up time

    Your body works best on a routine. Going to bed and waking up at the same time every day, even on weekends, helps to keep your internal clock on track.

    Start by setting a realistic bedtime and sticking to it as consistently as you can. Try not to shift your sleep schedule by more than an hour, even if it’s tempting to stay up late on weekends.

    When you keep a steady routine, your body begins to recognize when it’s time to wind down. You’ll naturally start feeling sleepy around bedtime. This makes it easier to fall asleep and wake up feeling refreshed the next morning.

    Create a pre-sleep routine

    A calming bedtime routine signals to your brain that it’s time to get ready to sleep.

    Pick one or two self-care activities that help you feel calm. Examples include reading a book, listening to soft music, taking a warm bath, or doing some light stretching.

    Avoid anything too stimulating before bed. Activities like doing homework, watching an intense show, or playing a fast-paced game might make you stressed or excited.

    Once you’ve found what works for you, commit to doing it for about 30 to 60 minutes before bedtime. Over time, this routine will train your body and mind to shift into “sleep mode” easily.

    Limit screen time at least 30 minutes before bed

    Limit screen time at least 30 minutes before bed

    Phones, tablets, and laptops give off blue light, which can interfere with the production of melatonin. As a result, your brain may find it harder to wind down at night.

    To avoid this, try putting away your devices at least 30 to 60 minutes before bed. Use that time to do something relaxing that doesn’t involve screens, such as reading, journaling, or listening to calming music.

    If that feels challenging, start small. Try going screen-free just 10 minutes before bed and gradually increase the time every one or two weeks.

    Keep your room cool and dark

    Your sleep environment matters more than you might think.

    If your bedroom is too bright, your body may still think it’s daytime, which can lower melatonin levels and make it harder to fall asleep. Your body also needs to cool down to get good quality rest.

    Here are a few ways to create a sleep-friendly environment:

    • Use blackout curtains or a sleep mask to block out light.
    • Keep your room cool with an air conditioner or fan.
    • Use earplugs or a white noise machine.
    • Turn off your devices or mute notifications before bed.

    Avoid caffeine in the late afternoon and evening

    Energy drinks, coffee, and some sodas contain caffeine. Caffeine stays in your system for hours, keeping you awake long after the time you intend to go to bed.

    Try switching to caffeine-free drinks in the late afternoon and evening. Avoid caffeine for at least 6 to 8 hours before going to bed.

    In general, teens should also limit their daily caffeine intake to under 100 mg, which is approximately equivalent to one cup of coffee.

    Don’t nap too late in the day

    Naps can boost energy and focus, but long or late naps can make it harder to fall asleep at night.

    If you really need to nap, keep it short. Set an alarm to wake you up after 20 to 30 minutes. Make it a point to nap earlier in the afternoon rather than close to bedtime. That way, you’ll still feel refreshed during the day without disrupting your nighttime sleep.

    Tips to promote better sleep quality

    In addition to improving your sleep hygiene, other lifestyle habits can help you fall asleep faster and enjoy deeper sleep.

    Use your bed only for sleep

    Reserve your bed strictly for sleeping. Avoid using it for other activities, such as studying, scrolling through your phone, or watching shows.

    When your brain associates your bed only with sleep, it becomes easier to relax and drift off when you get into bed.

    If you enjoy reading, journaling, or listening to music, try doing those activities in another cozy spot, like a sofa or chair. Only move to your bed when you’re ready to sleep.

    Exercise during the day

    Exercise during the day

    Regular physical activity can significantly improve the quality of your sleep. Exercise helps reduce stress and promotes deeper, more restorative sleep.

    Teens should get about 60 minutes of exercise daily. But if that feels overwhelming, start small. Try 30 minutes of activity on most days and gradually build up from there.

    Just remember to avoid intense workouts close to bedtime, as they can leave you feeling energized rather than sleepy.

    Manage stress before bed

    Maybe you’re lying in bed replaying an awkward conversation from lunch, or you can’t stop thinking about tomorrow’s biology test. When your mind races like this, falling asleep becomes nearly impossible.

    Here are some ways to manage stress and clear your mind before bedtime:

    • Create a to-do list to organize your thoughts and reduce mental clutter.
    • Do deep breathing exercises.
    • Write in a journal to release your worries or reflect on your day.
    • Practice gratitude by reflecting on a few positive things that happened.
    • Listen to calming music or nature sounds.

    Consider using a sleep tracker

    If you’re curious about your sleep patterns, using a sleep tracker can provide valuable insights.

    Many phone apps and smartwatches can track how long and how deeply you sleep, helping you understand your sleep patterns better. They can also show how certain habits, such as exercise, caffeine intake, or screen time, impact your sleep.

    With this information, you can make small but effective adjustments to improve your overall sleep quality.

    Conclusion

    Building better sleep habits is just the beginning. When you learn how to take charge of your routines, you don’t just sleep better. You also think more clearly, handle stress with confidence, and feel more in control of your life.

    Through my 1:1 coaching program, I’ve helped teens transform not just their sleep, but their entire approach to school, stress, and life. If you’re ready to build habits that actually stick and create lasting change, I’d love to help!

    (And if you haven’t already downloaded your free quick action guide, you can get it below.)

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  • 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? 

     

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  • 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?

     

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  • 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.

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  • 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.

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